The Utility of the Plastic Surgery Standardized Letter of Recommendation Form in Predicting Residency Match Outcomes

BACKGROUND: Letters of recommendation play an important role in resident selection. While plastic surgery's Standardized Letter of Recommendation (SLOR) form most commonly serves as an adjunct to narrative letters, the SLOR provides objective data in the review process and could eventually replace narrative letters. The utility of the SLOR in predicting Match outcomes has not been studied.METHODS: Applicant data from 225 first-time residency applicants in 2020-21 were collected. Logistic regression modeling was used to predict Match outcomes. This model was validated using 100 randomly selected applicants from 2019-20.RESULTS: Rank placement (SLOR Question 6) was the most important factor when predicting Match outcomes (p<0.0001). All other SLOR questions were not predictive and subject to notable score inflation. No SLOR score differences were noted based on race; female applicants were rated higher in two of ten domains (p<0.05).CONCLUSIONS: One question on the plastic surgery SLOR was highly predictive of an applicant matching. However, the remaining SLOR questions had little utility and were subject to gross score inflation. Further work should be done to optimize the utility of the SLOR in differentiating applicants. This has important implications in ensuring the selection of professional, competent residents according to the aims of the Accreditation Council of Graduate Medical Education.

Automated summary

This study investigated the predictive ability of the standardized letter of recommendation (SLOR) in plastic surgery residency match outcomes. It found that one question in the SLOR was highly predictive, while the remaining questions had little utility and were subject to score inflation. Further optimization of the SLOR's effectiveness is necessary to ensure the selection of professional, competent residents.