Can someone give me some insight regarding SLORs?

[keeping-it-real]

This is mainly directed at some of the attendings and residents on this board, but others are welcome to chime in. Here's my question.

Why would an attending accept a request to write a letter and then only write a "good" (i.e. lower 1/3 ranking) letter? And if they were going to do so, why wouldn't they give any warning of doing so?

I guess I'm just trying to get some insight as to the purpose behind doing this and maybe get a brief explanation from individuals who are more familiar with this situation. Also, is this "good" recommendation basically akin to writing "if you can't find anybody better, this guy might do."?

Any help or advice is appreciated. Thanks.

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[keeping-it-real]

70 views and nobody to comment?

 

[EM_Rebuilder]

My opinon on this is that the individual is a piss poor professional.

Even if they really think you are a *terrible* applicant and have NO business being in EM or even being a doctor....they should either defer the request, or the proper/professional thing to do is to sit down with you and tell you why, and mentor to how you can change things/be better...

I am not saying that everyone should write everyone a stellar letter, but if the letter is going to be worst than average, then the above should be done.

There is NO excuse for accepting to write a LOR or SLOR and making it sound very average at the best without any warning to the person its being written for.

I think the other thing that can happen (more for LORs) is an old doc or someone disconnected from residency who really does not understand just how important and how much weight might be put on such a letter. I expect better out of the 'typical' SLOR writers...

Just my .02

 

[theCamel]

em_b thanks for all the replies in this forum, it's cool that you take the time to answer these q's on everyone's minds...

i'm wondering how programs are supposed to truly get a sense of people's capabilities if everyone submits above average letters. doesn't the fine line then become distinguishing who is more above average, unnecessarily blurring the lines of applicants' perceived skill levels?

this has always confused me. as has the idea of not waiving the right to see a letter.

 

[AmoryBlaine]

em_b thanks for all the replies in this forum, it's cool that you take the time to answer these q's on everyone's minds...

i'm wondering how programs are supposed to truly get a sense of people's capabilities if everyone submits above average letters. doesn't the fine line then become distinguishing who is more above average, unnecessarily blurring the lines of applicants' perceived skill levels?

this has always confused me. as has the idea of not waiving the right to see a letter.

I finished up a rotation at a solid program a few weeks back. The clerkship director made a point of telling me that the faculty member who was responsible for my letter had thought I had done really well. He went on to say that he had been a little bit worried because this person has shredded the last few students sent her way.

I'd have to defer to BKN/attendings ultimately but my impression is that people are not shy about writing a mediocre letter. I mean if you rotate at a place and get a SLOR signed by the PD they are saying, "we think this person can handle a residency in EM." Just because they don't give you A+++ triple honors doesn't mean they are screwing you.

Plus, it seems like alot of LOR writing is in not-so-secret attending to attending code. If you want to do EM, spend a month somewhere, get a High Pass and a letter that isn't sparkling I think the message between the lines is "competent, but nothing special."

 

[keeping-it-real]

I finished up a rotation at a solid program a few weeks back. The clerkship director made a point of telling me that the faculty member who was responsible for my letter had thought I had done really well. He went on to say that he had been a little bit worried because this person has shredded the last few students sent her way.

I'd have to defer to BKN/attendings ultimately but my impression is that people are not shy about writing a mediocre letter. I mean if you rotate at a place and get a SLOR signed by the PD they are saying, "we think this person can handle a residency in EM." Just because they don't give you A+++ triple honors doesn't mean they are screwing you.

Plus, it seems like alot of LOR writing is in not-so-secret attending to attending code. If you want to do EM, spend a month somewhere, get a High Pass and a letter that isn't sparkling I think the message between the lines is "competent, but nothing special."

What about when the attending gives you good feedback during your rotation, states you are doing a great job, and then when you ask for a letter states "Sure, I'd be happy to write you a letter."?

Is this some passive aggressive tactic that I'm not keen to? It seems that it is a waste of both my time and the attending's time to write a mediocre letter; and as well, it then keeps me from getting a potentially stronger letter from another faculty member. I can also understand that you need not get honors to get a good letter, but I think most people would agree that ranking a candidate as "lower 1/3" is not very complimentary.

And I would have to agree about the message between the lines. I guess that's modern day professional behavior.

 

[keeping-it-real]

em_b thanks for all the replies in this forum, it's cool that you take the time to answer these q's on everyone's minds...

i'm wondering how programs are supposed to truly get a sense of people's capabilities if everyone submits above average letters. doesn't the fine line then become distinguishing who is more above average, unnecessarily blurring the lines of applicants' perceived skill levels?

this has always confused me. as has the idea of not waiving the right to see a letter.

My response to the potential of everyone submitting above average letters is that just because one attending thinks you are great doesn't mean that the program you are applying to will think you are great. And I think the opposite holds true, also. I mean, isn't this why they interview in the first place?

 

[EM_Rebuilder]

em_b thanks for all the replies in this forum, it's cool that you take the time to answer these q's on everyone's minds...

i'm wondering how programs are supposed to truly get a sense of people's capabilities if everyone submits above average letters. doesn't the fine line then become distinguishing who is more above average, unnecessarily blurring the lines of applicants' perceived skill levels?

this has always confused me. as has the idea of not waiving the right to see a letter.

Thanks, but please keep it in perspective and I usually do add that I am a PGY1 so much of this is new to me as well... I love to share what I have learned and hope to continue throughout my career...and I try to be careful about what I type/say on here as the last thing I want to do is mislead anyone...

On the LOR, there are or can be different levels of 'ok'....and I think thats fine...not every person is 'stellar, taught me a few things, must match, must be in EM or die!'....many people will be 'hard woker, good knowledge, team player, will train well'..... what you dont want is 'lazy, did he really go to medical school?, lied about labs and seeing patients'....now the problem is that the last bit MAY be true about an occasional student (sadly), but I think its a professionals job to sit down the applicant and say LOOK, heres your problems and why I WONT write you a (crappy) letter.....the professional should not just grin that he got choosen to write the letter and now uses his power to completely kill the kids chance.


So the take home... average is ok, but even still the person writing it should say it will be average (and average is OK....but the writer should say heres why its average).... not everyone should have a stellar SLOR or the weight of it goes down the tubes..

And to address the other problem of someone saying good job then saying 1/3 lower rank... but also remember that 1/3 lower rank is better than will not rank. Hopefully someone who actually evaluates SLORs will chime in, but depending on their program, I dont think 1/3 lower rank would toss your app in the trash.


I hope that made sense.... L&D nights for the month... lots of internet time, but my brain hurts too....

 

[BKN]

This is mainly directed at some of the attendings and residents on this board, but others are welcome to chime in. Here's my question.

Why would an attending accept a request to write a letter and then only write a "good" (i.e. lower 1/3 ranking) letter? And if they were going to do so, why wouldn't they give any warning of doing so?

I guess I'm just trying to get some insight as to the purpose behind doing this and maybe get a brief explanation from individuals who are more familiar with this situation. Also, is this "good" recommendation basically akin to writing "if you can't find anybody better, this guy might do."?

Any help or advice is appreciated. Thanks.

OK. I'll break down and comment.

Good means good, nothing more or less. There is no secret code. The reason all four global assessment categories are praise is that nearly all of the candidates are praiseworthy. With a few immature or addicted exceptions, the worst we're going to get is someone in the top 5% of human intelligence and work habits.

So, while PDs and senior faculty vary on how well they stick with the prescribed distribution in the SLOR, (most inflate the distribution), they mean what they say. If one of the lower 1/3 matches with them, they may not be thrilled (since it may mean extra work). But they are rarely very unhappy.

For the record, the GA ratings are supposed to be distributed as:
outstanding (top 10%)
Excellent (11-33%)
Very good (middle 1/3)
Good (lower 1/3)

And for the rare (I mean once a decade) student who wants to do EM but is lazy, lies about labs or seeing patients, obviously they don't get a letter. Well, they do . . .but it's going to the dean.

 

[keeping-it-real]

OK. I'll break down and comment.

Good means good, nothing more or less. There is no secret code. The reason all four global assessment categories are praise is that nearly all of the candidates are praiseworthy. With a few immature or addicted exceptions, the worst we're going to get is someone in the top 5% of human intelligence and work habits.

So, while PDs and senior faculty vary on how well they stick with the prescribed distribution in the SLOR, (most inflate the distribution), they mean what they say. If one of the lower 1/3 matches with them, they may not be thrilled (since it may mean extra work). But they are rarely very are unhappy.

For the record, the GA ratings are supposed to be distributed as:
outstanding (top 10%)
Excellent (11-33%)
Very good (middle 1/3)
Good (lower 1/3)

And for the rare (I mean once a decade) student who wants to do EM but is lazy, lies about labs or seeing patients, obviously they don't get a letter. Well, they do . . .but it's going to the dean.

Thanks a bunch for the explanation.