What do you do when a below average resident asks you to write a LOR? Of course, programs want to help their residents and see that they go on to pursue good fellowships and jobs. However, what if you're writing a LOR for a resident that you know probably won't do well at that fellowship & may even give your institution a bad name? Why put yourself out there to later blacklist your institution and your credibility? It seems very uncommon for an attending to refuse to write LOR. Maybe we are just not ballsy enough.
LORs for Subpar Residents
- Thread starter LaBelleVN
- Start date
- Joined
- Jan 30, 2006
- Messages
- 2,801
- Reaction score
- 1,187
Why not tell the resident that you cannot write a "good" LOR? You'd want to be honest anyway, and your tone in the letter may reflect that they are not all that great anyway.
- Joined
- Apr 3, 2007
- Messages
- 1,822
- Reaction score
- 821
It would be awkward to refuse to write a letter.
However, is the resident a lazy bum? I would have no issues refusing to write a letter for someone who was lazy for 4 years, never did their work and did things during residency that impacted patient care. I have heard and seen of residents like this. Some residents are so lazy ie. "Can I go home at 4 pm"..."no I dont want to do this presentation"...instead of taking the approach of hey "I want to do this maybe I will learn something out of it"....but still 4 years down the road ask for a letter of rec...LMAO. Residents that never read...sit around gossiping and socializing for 4 years.
If the resident showed effort and is reliable, I would write the letter. I wouldnt want to write a letter for someone who you knew was going to cause trouble in fellowship. Just as long as they can do the job and are not doing the fellowship just "to do it", it's all good.
Last edited:
Exactly! That's what I did. However, the other attendings wrote wonderful LORs all the while bitching & moaning about how this particular resident is terrible on surgical pathology, doesn't know how to gross, lacks common sense & confidence, & diagnostically is equal to a beginner 2nd year resident at best. This resident was accepted to a pretty stellar & intense surg path fellowship. I'm already embarrassed for my program.
- Joined
- Jan 30, 2006
- Messages
- 2,801
- Reaction score
- 1,187
Well, hopefully they learn something at the intense surg path fellowship. Question- if they already secured the fellowship, why are they asking for a LOR? If it's for a job it will be more than a year old when it is reviewed.
This happened a few months ago so the LOR was for the fellowship application. The resident was offered the fellowship a few weeks ago & the attendings who wrote her the letter were a bit shocked she was accepted.
- Joined
- Aug 15, 2003
- Messages
- 3,124
- Reaction score
- 131
I like this idea. Simply say, "I'm sorry, but I don't feel I can write you a strong LOR." If they don't get it from that, they're a little obvlivious.
Ahahahahahahaha... Why are they shocked? They wrote stellar LORs. They candidate's CV probably looks innocuous enough, and it may even be padded with useless poster presentations or a paper.
Well, look on the bright side, now he/she is an S.E.P.
Sorry for being Schadenfreude, but I do hope it comes back to bite them in the behind. Big time.
- Joined
- Jan 30, 2006
- Messages
- 2,801
- Reaction score
- 1,187
They probably didn't take the applicant out to dinner/lunch for the douchebag weed-out test!
- Joined
- Jan 30, 2006
- Messages
- 2,801
- Reaction score
- 1,187
Whenever I needed a LOR, I never asked for one without the modifier "good"- i.e., "Can you write me a good LOR?"
That way you can sense exactly how it will go.
- Joined
- Oct 25, 2007
- Messages
- 1,369
- Reaction score
- 23
That sounds like a problem of poor feedback and cowardly attendings, unwilling and unable to do their part in the resident training process. It's one thing to be supportive and try to build up a person's confidence, and quite another to not fully let them in on the secret that they just aren't up to snuff and need to do something about it. It's utterly pointless to wait until they ask for a LoR in late 3rd or 4th year and deal with it by suggesting they try Dr. Easy who might be able to write a better one, and laughable to downright unethical that someone who wrote a LoR (and didn't tell the truth in it) should act surprised that the person got a position based on it despite, per their admission, not being ready.
Personally? It's that kind of foolishness that should be eliminating ACGME accreditation for a program. The responsibilities for resident training don't stop at simply having a bunch of specimens pass through the department. But alas, the system seems to punish programs who don't 'graduate' everyone, and instead indirectly encourages those programs to do exactly this sort of thing.
Personally? It's that kind of foolishness that should be eliminating ACGME accreditation for a program. The responsibilities for resident training don't stop at simply having a bunch of specimens pass through the department. But alas, the system seems to punish programs who don't 'graduate' everyone, and instead indirectly encourages those programs to do exactly this sort of thing.
- Joined
- Aug 3, 2007
- Messages
- 947
- Reaction score
- 627
Yeah, for some reason even when the few pathology residents aren't up to snuff, they still manage to get funneled through the system. There doesn't seem to be the turnover or pyramid schemes of giving residents the axe at the end of the first year like some primary care and surgery programs do. That being said, it would take a lot for a path resident to get canned at any program these days; and that goes for all programs across the nation.
And it does seem that if such a resident were to get bad LOR, in pathology for some reason the perception is that the program is just as much responsible for lack of teaching/preparation as the individual is. But that's where verbal recs/phone calls come in. All it takes is the slightest hesitation from someone giving a recommendation to hurt your chances. That's why as someone said, make sure whoever your references are, they're going to put you in the best of light.
And it does seem that if such a resident were to get bad LOR, in pathology for some reason the perception is that the program is just as much responsible for lack of teaching/preparation as the individual is. But that's where verbal recs/phone calls come in. All it takes is the slightest hesitation from someone giving a recommendation to hurt your chances. That's why as someone said, make sure whoever your references are, they're going to put you in the best of light.
Last edited:
- Joined
- Jan 23, 2007
- Messages
- 1,654
- Reaction score
- 37
Those type of programs don't exist in any field, not in surgery or primary care.
If you have ever been in a program that has truly poor teaching, you would know how difficuly it is (if not impossible) to teach yourself general surgical pathology.
- Joined
- Aug 3, 2007
- Messages
- 947
- Reaction score
- 627
There is more evidence of such programs existing than not existing. Talk to enough people and some will have at least heard of such places in various specialties. e.g. I rotated at a program where they accepted six first year surgery residents who did not apply as prelim and only four of those would go on to get categorical spots in their PGY-2 year. Also, a buddy of mine in family practice said his program was on a five year streak of not renewing at least one or more residents' contract at the end of their PGY-1 year...that's a good enough track record to qualify as a butcher shop i.e. more likely the problem is with the program than the residents. These programs are a rare breed, I'll give you that, but that doesn't mean they don't exist. At least not from what I heard as recently as a few years back. Although as I said, I think it's becoming rare and maybe the ACGME has put the clamp on such programs and came up with stricter rules before programs routinely dismiss someone. Hopefully, this is the case in order to make it a more fair playing field.
Last edited:
- Joined
- Aug 15, 2003
- Messages
- 3,124
- Reaction score
- 131
The responses I'm seeing here make me think we want to have our cake and eat it too. What I mean is, we have threads for programs that are "malignant" or that terminate residents. But here we're saying too many residents that can't perform adequately are being promoted and funneled through the system. So which is it? And if there really are residents who can't perform, what becomes of them? Similarly importantly, who shoulders the blame for the failure (resident or program)? This all relates to the original question in this thread. That is, if a weak resident asks you for an LoR, isn't is better for the system as a whole if you say, "No, I'm sorry, but I don't feel I can write you the strong letter you would want." If the resident just performed poorly for your rotation they'll be OK (unless you're the cytologist and they're applying for a cyto fellowship), but if they really are a weak resident who cannot perform at the level of their peers, then they shouldn't get a fellowship, right? Or a job, right? It would suck for said resident, but wouldn't that be better for the system as a whole? Less crappy pathologists doing sub-par diagnostic work means better pay for the quality pathologists. Should also mean less money spent on unwarranted diagnostic tests (every prostate core does NOT need a triple stain), and better patient care.
Ok, rant over.
Ok, rant over.
I'm sure you have both occurring, ie. malignant programs and sub-par residents/fellows. Excluding the outright malignant programs, and effort should be made to make sure that residents perform at a certain level before they're advanced and certainly before fellowship application time comes. I know of plenty stories of residents in other specialties having been held back for not performing at a certain minimum level. Some were held back as little as 3 months, while others were forced to repeat an entire year. Again, some of this may have been a combination of a program having too high expectation of the people they've hired, but some of it also fell on the individual residents who just weren't as sharp.
Then again, in other specialties, it's much easier to spot poor performers. They may come close to doing real harm to patients, for example, and thus need to be stopped/remediated asap. Whereas in pathology, it is much easier to coast through. After all, faculty shoulder all responsibility of signing out cases. In such a system, it's not difficult for some residents to fake a minimal amount of know-how. Grossing specimens may be an issue for some, but again, "mistakes" can probably be covered up, and once it comes time to review slides with faculty and sign the case out, what "mistakes" may have happened at the grossing may never come to light.
But in the case of the OP vignette, the resident in question has been obviously allowed to coast, despite plenty of people having noticed deficiencies, that could and should have been addressed earlier.
Bad karma all around.
Then again, in other specialties, it's much easier to spot poor performers. They may come close to doing real harm to patients, for example, and thus need to be stopped/remediated asap. Whereas in pathology, it is much easier to coast through. After all, faculty shoulder all responsibility of signing out cases. In such a system, it's not difficult for some residents to fake a minimal amount of know-how. Grossing specimens may be an issue for some, but again, "mistakes" can probably be covered up, and once it comes time to review slides with faculty and sign the case out, what "mistakes" may have happened at the grossing may never come to light.
But in the case of the OP vignette, the resident in question has been obviously allowed to coast, despite plenty of people having noticed deficiencies, that could and should have been addressed earlier.
Bad karma all around.
- Joined
- Aug 15, 2003
- Messages
- 3,124
- Reaction score
- 131
I think that's true only if programs allow it. By that I mean if residents truly are previewing cases, faculty should have some idea if they can diagnose appropriately. This stuff is all related, right? So when a poor resident comes and asks for an LoR, and you say no, if they have the audacity to ask why or whine to the PD, you have grounds to stand on. "No, I won't write Dr. Z an LoR when they often miss lymph node mets, positive margins, etc...".
- Joined
- Jan 23, 2007
- Messages
- 1,654
- Reaction score
- 37
The truth is, most of the time it is hard to tell if a resident is bad or not. I think that is why most attendings hesitate to refuse to give a a resident a reference/LOR. They are bad just because they make a mistake on your service? They only rotate on your service, what, once a year? How do you know it is a consistent pattern? Through gossip or hearsay? That is a bad reason to permanently ruin someone's reputation.
Likewise, it may be hard to tell they are good too. But most attendings assume that lack of any major mistakes means that the resident is good, so that usually isn't an issue.
Likewise, it may be hard to tell they are good too. But most attendings assume that lack of any major mistakes means that the resident is good, so that usually isn't an issue.
- Joined
- Jan 30, 2001
- Messages
- 312
- Reaction score
- 0
No attending wants to go on record in writing saying someone was a bad resident. It's easier just to write a very neutral letter and hope that the reader can read between the lines. For the truth about a resident, an evaluating person needs to call. I have seen many resident candidates' LORs from med school mentors/ preceptors and they are largely useless. No one ever says anything bad. The worst will sound slightly vague and non-specific. Phone calls, especially to people NOT listed a s a reference but working in the same institution with knowledge of the resident, are the most candid. But it is unlikely anyone would take the trouble to do this for a fellowship. For a job yes. This is why you don't want to burn bridges anywhere.
- Joined
- Mar 17, 2003
- Messages
- 2,962
- Reaction score
- 79
I was always under the assumption that superlatives were upgraded a couple levels and to translate you just downgraded them to know what the reviewer really thought.
i.e.
Phenomenonal = great
Outstanding = good
Great = average
Good = poor
Adequate = totall sucks.
i.e.
Phenomenonal = great
Outstanding = good
Great = average
Good = poor
Adequate = totall sucks.
- Joined
- Oct 25, 2007
- Messages
- 1,369
- Reaction score
- 23
Ideally these issues would be addressed at the PGY1-2 level, and wouldn't -need- to be shuffled ashamedly aside when someone asks for an LoR. Of -course- nobody wants to bash their own resident in an LoR. The problem is that some folks also don't want to let a resident know up front when they're not cutting it and have things they need to work on, which -creates- the whole uncomfortable moment when they do eventually ask for an LoR...as essentially every resident WILL do. The situation changes if a resident isn't much good but they've been kept in the loop about that fact for a while, and things have been done to address it.
That said, I totally agree that if you're looking to hire someone and really want to know something about them, you must call their references and at least their most recent places of training/employment -- keeping in mind that you may be talking to the poor communicating sour apple who gives you entirely the wrong impression. But if you talk to enough people I think you get a better idea than from two or three letters. Better if you also personally know someone from their training/previous employment, which is another reason faculty contacts are important. Better still if you also have extended interview time.
That said, I totally agree that if you're looking to hire someone and really want to know something about them, you must call their references and at least their most recent places of training/employment -- keeping in mind that you may be talking to the poor communicating sour apple who gives you entirely the wrong impression. But if you talk to enough people I think you get a better idea than from two or three letters. Better if you also personally know someone from their training/previous employment, which is another reason faculty contacts are important. Better still if you also have extended interview time.
Last edited:
- Joined
- Aug 30, 2011
- Messages
- 231
- Reaction score
- 5
If someone asks for LOR and you don't want to write one, ask the resident to write one for oneself 😉 Then, you can edit it and submit an appropriate one that you like.
I would also recommend to residents that they should not waive their right to see the letter... the resident should be aware of any strengths or weaknesses being ascribed to them in any letter, especially at this level of their career.
Finally, if you don't want to write one and you don't want to ask the resident to write one to be edited by yourself, then tell the resident that you don't feel comfortable writing a letter. Try getting deposed for a lawsuit, now that's really 'adequate' 😛
I would also recommend to residents that they should not waive their right to see the letter... the resident should be aware of any strengths or weaknesses being ascribed to them in any letter, especially at this level of their career.
Finally, if you don't want to write one and you don't want to ask the resident to write one to be edited by yourself, then tell the resident that you don't feel comfortable writing a letter. Try getting deposed for a lawsuit, now that's really 'adequate' 😛
