Writing Wrongs
Vinay Guduguntla B.S., B.B.A.1, 2, Tessa Adzemovic B.A., M.S.1,2,
Vineet Chopra M.D, M. Sc.2,3
All: University of Michigan, Ann Arbor
1. University of Michigan Medical School
2. Institute for Healthcare Policy and Innovation
3. Division of Hospital Medicine, Department of Internal Medicine
Address Correspondence to: Vineet Chopra M.D., M. Sc.
University of Michigan Health System 1500 E Medical Center Drive
3875 Taubman Center – SPC 5352 Ann Arbor, MI 48109-5330 Phone: 734-936-5582
Format: Article
Word Count: 1438
Tables: 1
Abstract
In academic medicine, letters of recommendation are a way of life – one that will never
go away. While they are “free”, they do not come easy. They often require careful thought and
preparation on both the writer and the requestor’s behalf. However, the payoff can be immense,
as existing literature has well characterized the importance of LORs and the critical role they
play in applicant selection. While much has been written about the content of recommendation
letters, little attention has been given to those who write them. This gap is important, as often,
letter writers approach the task as a rote chore or tedious undertaking, rather than as an
opportunity to elevate a mentee. Moreover, we know that many trainees are ill-equipped or
poorly informed on how to best manage the roadblocks in communication, planning, and
follow-up that accompany this endeavor. As a result, a lackluster letter is often produced and there can
be direct harm to the application or professional relationship. These “wrongs” must be righted to
ensure a strong recommendation. In this essay, we characterize five prototypes of problematic
letter writers, using tongue-in-cheek names to describe stereotypical behaviors. Our aim is to not
only help writers self-diagnose, but also encourage requestors to identify patterns before a single
“Nothing else can quite substitute for a few well-chosen, well-timed, sincere words of praise. They're absolutely free and worth a fortune.”
--- Sam Walton
In academic medicine, letters of recommendation (LORs) are a way of life. While they
are “free”, they do not come easy. The journey is difficult; numerous emails, phone calls to
administrators, and “chance” run-ins with prospective writers often represent the warm up for the
big “ask.” However, the payoff can be immense, as existing literature has well characterized the
importance of LORs and the critical role they play in applicant selection.1 A strong letter not
only highlights an individual’s skillset, but serves as a personalized, summative endorsement of a
trainee’s ability. In fact, well written LORs are predictive of performance in medical school.2
Given their importance, it is imperative that requestors and letter writers are, to put it
colloquially, “on the same page”.
While much has been written about the content of LORs, little attention has been given to
those who write them.3 This gap is important as often letter writers approach the task as a rote
chore or tedious undertaking, rather than as an opportunity to elevate a mentee. Moreover, we
know that many trainees are ill-equipped or poorly informed on how to best manage the
roadblocks in communication, planning, and follow-up that accompany this endeavor. Too often,
then, the product is a lackluster letter that can hurt an application or professional relationship.
Though small mistakes over the years are natural when undertaking the responsibility of
writing LORs, writing wrongs are sets of behaviors that might impair trainee advancement.
These “wrongs” must be set right in order to ensure a strong letter and successful career
tongue-in-cheek names to describe stereotypical behaviors. We aim to help writers self-diagnose
what ails them, while empowering requestors to identify patterns that may be problematic.
Letter Writing Wrongs
The Phantom
The Phantom is a high-profile faculty member who is highly ambitious and consequently,
very busy. They travel frequently, have packed calendars and are difficult to reach. After a
prolonged wait for a face-to-face meeting, they quickly agree to write letters of recommendation.
However, they are prone to doling out “the silent treatment,” which (in US vernacular), is the act
of “completely ignoring someone by resorting to silence.” Despite a prolonged chase by the
requestor, marked by a number of increasingly urgent emails, the Phantom becomes
unresponsive to all forms of communication. They are eventually lost to follow-up, leaving the
trainee high and dry.
The Yes-Man or Woman
The Yes-person is overcommitted. They lack the ability to say no to trainees, eventually
leading to a daunting stack of letter requests. At their core is a conflict-avoidant personality and a
strong desire to be liked by all. These letter writers over promise, resulting in “high-output
failure” and diminished quality. Even if they are able to fulfill all the commitments, the end
result is often a letter that fails to convey the trainee’s unique strengths and skills. Eventually, the
recommendations become monotonous, and readers, seeing the pattern, begin to devalue
endorsements from the writer. Moreover, even if the writer is able to fulfill all of their
The Sloth
The Sloth is, simply put, slow. Known to take a prolonged period of time to finish tasks
(including LORs), these writers have fair communication skills, but always seem to have a
reason for delays. After a few exchanges, applicants become fearful of pestering their letter
writers - leading to an eerie silence as deadlines approach. Due to the increasing wait times,
trainees often postpone submission of their applications or scramble to find additional letter
writers. The process often yields a loss of trust, fracturing the relationship between writer and
requestor. Overall, these writers can get the job done, but at a frustratingly slow pace.
The Cookie-Cutter
The Cookie-Cutter takes the all too familiar approach to writing: copy and paste. Here,
standardized forms and templates are used to compose LORs. The result is often a generic, vague
product riddled with typos. Errors such as switched pronouns, incorrect names, and remainders
of templated phrasing abound. Such writers are also the most prone to using stereotyped
adjectives for men and women.4 Often, men are described by their ability, while women are
described by their effort,5 propagating unconscious gender bias in reference writing. Some
programs may begin to doubt the authenticity of the applicant’s entire portfolio as many such
letters have been recognized as plagiarized or otherwise questionable.6 If you have seen one
cookie cutter letter, you have seen them all.
The Delegator
The Delegator is a senior faculty member with limited bandwidth, who pawns off the task
to “touch up” or “embellish” these prior to submission. While this is billed as giving requestors
the freedom to highlight relevant personal details of their applications, applicants often get lost in
the minutiae and unknowingly leave out the proper verbiage for a convincing recommendation.
As a result, the end product feels one-dimensional. Moreover, there are a number of trainees who
feel disenfranchised by this approach, as it is contrary to the spirit of letter writing.
Writing Rights
The aforementioned characterizations are common letter-writer behaviors that trainees encounter
(Table 1). The root causes of writing wrongs are communication failure, poor time management,
and a perceived obligation to fulfill letter requests. How best to manage these barriers? Like a
game of chess, we propose a three-step approach:
1.
The Opening
The ideal letter is composed from a blank page and tells a personalized, compelling story about
the requestor. Trainees often state that they would like a “strong” letter of recommendation, one
that conveys an unequivocal, outstanding endorsement. To do so, faculty should adopt strict
criteria for endorsements. Simply put, faculty should accept requests only from trainees with
whom a meaningful connection has been established. Equally important, trainees should consider
the rapport they have with faculty members, and only approach those with whom there is mutual
respect and a vision for success exists. This will ensure that the writer prioritizes supporting the
requestor and their letter.
2.
Once a request for a letter has been made, a clear line of communication regarding next steps
should be defined in-person. The goal of a face-to-face meeting is to have an open and honest
conversation with your requestor regarding letter content, strengths and highlights. This
opportunity provides a venue to re-establish connections, lay a foundation for a persuasive LOR,
and to review specifics of the letter.
For example, trainees may suggest a writer speak with various members of the patient care team,
such as interns, residents, nurses, and even the patient’s themselves to better understand their
clinical abilities. In addition, writers can use more readily available data points such as teaching
evaluations or publications to highlight strengths. Specific positive phrases should also be
discussed to help convey a strong belief in a trainee’s future success.3 Writers may even go one
step further and propose a hybrid letter that is co-written with another colleague, or a chief
resident, if the fit is right. These types of joint efforts are extremely valuable as they are unique,
demonstrate substantial effort in writing the letter, and a high degree of support for the applicant.
3.
The Close
The final step is often the most difficult. To close successfully, requestors should check in
regularly with their writer and ensure that all necessary information has been provided, with the
necessary materials, instructions, and deadlines on file. It is crucial that requestors not lose sight
of the whole picture; a LOR is a core piece of the application, and success often rests on its
shoulders. To this end, requestors should always be prepared for the worst-case scenario and
have a Plan B, including “backup” letters. In addition, after submission is complete, trainees
should inform writers of the outcome of the application, ideally with a hand-written thank you
Conclusion
Letters of recommendation are a “write” of passage for all medical professionals. Often
roles reverse, and those who were once requesting letters become writers themselves.
Accordingly, recognition of writing wrongs at an early stage will not only result in a more
efficient recommendation process, but also lay the foundation for requestors to become effective
writers themselves. Our current recommendation process leaves much room for improvement.
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