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Letters to the Editor

Letters of Recommendation: Wave the Waiving Away!

Agrawal, Himanshu MBBS

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doi: 10.1097/ACM.0000000000003977
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To the Editor:

The letter of recommendation (LOR) is an important part of any residency application. An LOR usually aims to highlight the strengths of the student. But if the student is a poor test taker or a poor interviewer, an LOR may offer an invaluable chance for remediation, even, in some cases, for salvation. It is read with intense attention, and there is also much “reading between the lines.”

The community standard is for the student to waive the right to view the letter. I believe there are unintentional consequences to the way this waiving is currently practiced. I suggest we amend unnecessary, cryptic aspects of this practice.

It is my understanding that waiving the right means that the author of the LOR may or may not choose to share their letter with the student. However, I have often observed that waiving the right to view the LOR is mistaken to mean that the student is forbidden to view the LOR. This unwitting mistake propagates a culture of secrecy that adds unnecessary anxiety to the process of applying to residencies.

Unfortunately, not being able to view the LOR also forces the student to rely blindly on the author’s ability to write a strong letter—indeed, I have seen several instances wherein an author thought very highly of a student, yet that message simply did not come through in their letter. (Perhaps that author had not written many letters, or had not received enough mentoring in the specific art of letter-writing.)

In situations where one feels an author cannot write a strong LOR for a student, I believe there are 2 options. Either the author should tell the student clearly what they intend to write (which may spare both parties time and energy) or the author should simply decline to write the LOR. A student should not be stuck with a lukewarm or seemingly passive–aggressive letter simply because the author lacked the ability to communicate well. The author–student conversation may be an uncomfortable one; however, it is part of the author’s responsibility to the student.

Authors of letters also have a responsibility to the community they serve. With greater transparency in the LOR process, some students may have the opportunity to reevaluate their decisions and their goodness of fit for a certain residency. This might save the student great angst in the long run and may spare the community the consequences of an ill-fitting practitioner.

Last, if students can view their LORs, they may become better advocates for themselves and pick the letters they feel represent them best. At a minimum, their viewing their LORs would do away with thousands of conversations that start, “I was wondering if you could write me a very strong letter of recommendation, and I was really hoping you could include the following phrases so the program knows that you really do view me as a competitive candidate….”

Come, let us either change this culture together or wave the waiving away!

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