Standardized letter of recommendation for pediatric fellowship selection

Objectives/hypothesis: To develop a pediatric otolaryngology fellowship selection standardized letter of recommendation (SLOR).

Study design: SLOR and narrative letter of recommendation (NLOR) comparison study.

Methods: An SLOR was created to investigate qualities desired in fellows using five content-based categories: writer background, comparison of the applicant to contemporaries and predecessors, applicant's qualifications for pediatric otolaryngology, a global assessment of the applicant, and a summary statement about the applicant. In phase I, the SLORs were completed, including writing time, by the applicant's pediatric otolaryngology chief. In phase II, letters were ranked on Likert-type scales for the content-based categories, reviewer's overall ranking, and ease of review by six otolaryngologists. Reviewers recorded time needed to review each letter.

Results: Nineteen SLORs (73%) were collected. Mean writing time was 8.84 ± 3.87 minutes. Interrater reliability was higher on the SLORs in the content-based sections and the overall ranking. Ranking times were lower on the SLORs. Mean and median rankings were higher on the SLORs for writer background, comparison of the applicant to contemporaries and predecessors, applicant's qualifications for pediatric otolaryngology, and ease of review; mean global assessment of the applicant, summary statement about the applicant, and overall rankings were lower on the SLORs.

Conclusions: To our knowledge, this is the first inquiry using an SLOR developed for otolaryngology. SLORs are an alternative to NLORs for fellowship selection that offers improved reliability and efficiency. Further investigation using SLORs in otolaryngology residency selection is merited.