Reading Between the Lines: Determinants of a High-Quality Letter of Recommendation in Cardiothoracic Surgery

Background: The letter of recommendation is an important component of a residency application and is useful for identifying stellar cardiothoracic surgery (CTS) candidates. We identify letter attributes and phrases that CTS program directors (PDs) find to be the most valuable in selecting candidates. Methods: An online survey was distributed to CTS PDs in the United States and Canada, querying the importance of various letter characteristics. Reponses were ranked on the basis of a weighted average. Results: Twenty-six (26.5%) CTS PDs completed the survey. Personal acquaintanceship with the writer was the most important characteristic (weighted average, 4.77). Interpersonal skills, teamwork, and professionalism were the most important applicant attributes (4.00, 3.88, 3.76). Inclusion of personal interactions or experiences with the applicant (4.65) and the phrases “I give my highest recommendation” (4.56) and “we plan to recruit this candidate” (4.52) were rated the highest. Conclusions: Describing personal interactions and experiences with the applicant, their work ethic, interpersonal skills, and teamwork is essential for a strong letter. Personal acquaintanceship with the letter writer has the greatest positive impact overall.