How Important Are Letters of Recommendation? A Survey of Oral and Maxillofacial Surgery Residency Program Directors.

ABSTRACT

PURPOSE: Letters of recommendation are currently part of the application process for residencies in oral and maxillofacial surgery. However, the value placed on the information contained in such letters by program directors is unclear. The purpose of this study was to determine what role letters of recommendation play in the decision-making process. MATERIALS AND METHODS: In this cross-sectional study, a questionnaire was sent to 122 current and former program directors asking them to rate the importance they gave to letters of recommendation compared with other application attributes through a visual analog scale that ranged from 0 ("not important") to 100 ("very important"). Respondents also specified the format in which they would prefer recommendations be sent and, if they preferred letters, to state why. Responses were summarized with descriptive statistics (counts and percentages). The average perceived importance of applicant attributes and components of recommendations was compared using random-effects models to adjust for multiple responses from the same respondent. Post hoc pairwise comparisons were performed using Tukey adjustment. RESULTS: Of the 122 questionnaires sent, 14 were not deliverable. Forty-one of the 108 remaining program directors answered, for a response rate of 38%. Only 10% of respondents indicated that they do not consider letters of recommendation. However, they rated class rank, comprehensive basic science score, and leadership qualities more important than letters of recommendation. They preferred letters of recommendation from a faculty member rather than from a dean or non-oral surgeon and favored letters over a standard recommendation form, which they believed provided information not found in supporting documents. CONCLUSIONS: Despite some deficiencies found with letters of recommendation, and the varying importance given to the information they contain, program directors still find that they provide some useful information.