What do residencies look for in a good Letter of Recommendation?

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zac16125

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Can anyone tell me what residencies are looking for in a letter of recommendation from an attending? What makes a LOR good? It seems like they would all be rather generic and say the same things. Are there any specific things an attending came say in your LOR that will make it stand out in a good way?

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The person writing the letter knows you. They know you in a professional sense and provide a thorough evaluation of you in various aspects of you knowledge base, ability to apply your knowledge, ability to think on your feet, ability to work with others including patients, peers, ancillary staff and attendings. Your ability to take and give criticism in an appropriate way. Your attitude, personality and motivation towards the chosen profession.

If I think of more I will let you know.
 
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A good character reference, an interest in the field, and traits that show the person will be a good psychiatrist such as being a hard worker, enthusiasm for the field, etc.

The letter should show that it's simply not something written by a person who'll write a good letter for everbody. E.g. the person may write of an experience where the applicant shined above others.

I had a LOR written by an attending who wrote something to the effect that I was doing better work than PGY1s and 2s. During my psych rotation, I wrote an extended H&P starting with the person's prenatal development all the way up to the day of his admission, over 20 pages long. The attending noted this and that I did this voluntarily and the residents wouldn't dare do this unless forced to do so.

Many of the LORs I've seen I stamped as useless. E.g. they were short, didn't say anything exceptional, and seemed to be the type of thing where this person wrote a good letter for everyone.

An unfair thing, if I noticed anything bad written in a letter, it really stood out. The reason for this is because most LORs are good because an applicant would only ask someone who they believe will write a good letter. Further, several writers will write a good letter because applicants sometimes get a hold of the letters unintentionally. E.g. sometimes during the interview, an interviewer will tell the applicant the contents of the letter. A LOR writer will not want to be caught in a libel lawsuit, and I've actually seen that happen on one occasion.

Also factor in that admissions boards often have to decide between candidates to the degree where factors they know are irrelevant are taken into account. E.g. if you have dozens to hundreds of applicants for one spot, you're going to have situations where several people are just as good for a spot. Admissions people start pointing to things like "I didn't like the way his opening sentence was phrased." In such circumstances, you bet that a bad LOR will scream out "toss this applicant out" given that several people will end up being chosen on factors the admissions board even beleives is irrelevant.

It's a shame because I've known people who have an unfair blemish on their record and it blew them out of the water, but I knew the blemish was unfair. The admissions people did not.
 
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Agree with the previous, and would add:

1. A letter needs to be really good. All of the letters we see are generally positive, so if your letter is one of those "generally positive" letters then it will get overlooked. A lukewarm letter, or a letter with red flags, is extremely prejudicial because either (a) it demonstrates poor judgment, because you really should know better than to obtain a letter from someone who is not going to write you a great letter; or (b) it suggests that you are actually a lukewarm applicant or applicant with red flags. It is also possible that (c) you are actually a shining star and that your attendings can't see through the superficial games and politics or that the poor marks you received were the result of some misunderstanding or unfair circumstance. The false positive sucks from the perspective of the applicant, but from our perspective we just have too many other competitive applicants to consider for it to be worth our time to investigate as a serious possibility.

2. We like writers to comment on intellectual curiosity, maturity, teachableness, psychological mindedness, etc. Ability to work well with others in a team setting is important, but that's pretty much a given because everyone comments on it.

3. Your letter will be memorable if the writer provides a specific example consistent with the praise. e.g., "We had a patient in the ICU with a mysterious constellation of symptoms, and her failure to improve stymied even our infectious disease consultation service. On Melissa's first day of the rotation, while she was getting to know this patient and the patient's family, she made some very astute observations and asked critical questions that enabled us to diagnose a comorbidity of critical importance much earlier than would have been tested for otherwise. Consistent with her first day's performance, time and time again during the rotation she demonstrated a unique ability to establish rapport with even the most difficult patients...", etc.

4. Your letter will be viewed as more credible if the writer (if s/he is unknown to the reader/admissions committee) provides some sort of metric by which we can judge the generally positive tone. e.g., "I have worked with many medical students who have gone on to become chief residents of surgery and medicine at Brigham and Women's Hospital, UCSF, and Duke, and Marian stands out even among this elite group", "Jack compares very favorably to Jenny Smith, who graduated from your program in 2006 and who I mentored as a medical student", etc.

2-4 above will also show that the writer knows you well.
 
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Hate to bump an oldie but this is in the stickies, so thought it was the best place to ask.

I will likely have only 2 psych rotations before the application cycle. On my first psych rotation now and while I like it, I'm not sure if I will obtain a good LOR or not. For one, the physicians do not always spend much time with us (so little substance for a letter) and secondly I have no idea if they write good letters or not. With only a few opportunities (i.e. limited options in terms of docs to ask) I'm not sure if obtaining this awesome LOR I so often hear is needed will be a possibility.

Any advice (besides the obvious of working my butt off and showing my interest for psych)?
 
The name of the person writing it- academics like academics. This matters and is definitely not a secret. Obviously the content should be unanimously positive (if not glowing), but the name matters. And for your non-psychiatrist recs, academic rank impresses people.
 
I have 100 application files in a box behind me. Each of them has 3 LORs. I have read over 5k LORs. This year there are three or four that I can say stand out in my mind as superior to the other 300. On the other end, there are five or six very thin unimpressive letters that stand out as weak.

I hate to burst everyone’s bubble, but all letters say nice things. Letters from chairs or training directors are better than those from junior faculty, but letters are seldom capable of making up for any shortcomings in an application. Mostly they are just check boxes as “OK he/she has them”. The exceptions are often when we personally know the writer and may even be able to pick up the phone and ask, “OK, I saw your letter, now what do you really think?”
 
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Letters from chairs or training directors are better than those from junior faculty, but letters are seldom capable of making up for any shortcomings in an application. Mostly they are just check boxes as “OK he/she has them”. The exceptions are often when we personally know the writer and may even be able to pick up the phone and ask, “OK, I saw your letter, now what do you really think?”
Agree with this.

I'd also add in that when your residency selection committee has been around along enough, they often don't have to pick up the phone. We know that the "she will make an excellent psychiatrist" from Dr. X at Yale is the highest of praise whereas "a truly outstanding psychiatrist" from Dr. Y at Columbia is lukewarm.
 
I appreciate the advice! Thank you.
 
I keep wondering if a letter of recommendation from a doctor abroad has any value. For example, an IMG manages to achieve 2-3 letters of recommendations by american physicians and then he's got a professor in his medical school, who was the chair of the psychiatry subject and rotation and with whom he was involved in research and other academical and professional activities. So, of course this professor can write a much stronger letter of recommendation than an american physician with whom the IMG spent a month during a clerkship. So, given that you've got a free space to upload another letter of recommendation, would it be worth having this one from the foreign physician or any letter of recommendation written by non-american doctors would be simply ignored?
 
To the extent that the faculty member appears to know the applicant well and reflects on direct observations of their aptitude and interest as a psychiatrist, it would be equivalent to a good US letter.
 
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