Improving the Standardized Letter of Recommendation in the Plastic Surgery Resident Selection Process

OBJECTIVE: The American Council of Academic Plastic Surgeons (ACAPS) Plastic Surgery Recommendation Form is a standardized letter of recommendation (SLOR) used in the plastic surgery resident selection process since 2012. This study aims to evaluate this form and use a multistep survey to optimize this SLOR. DESIGN: A 16 question survey was sent via Survey Monkey to 510 ACAPS faculty. The results of this survey were followed up with a live-response survey at the ACAPS Spring Retreat. Consensus was used to modify and create a more optimal SLOR. SETTING: This study was performed by the Division of Plastic and Reconstructive Surgery at the University of California, San Diego. PARTICIPANTS: Survey respondents represented over five hundred plastic surgery faculty from a variety of subspecialties and academic programs nation-wide. RESULTS: The response rate to the online survey was 36%. On a scale of 1 (not useful) to 5 (very useful), letter readers and letter writers found the SLOR 3.88 and 3.90 respectively. Most respondents believed that the SLOR should be used as an adjunct to the narrative LOR. Fortytwo faculties participated as respondents to the live audience questions, although over a 100 faculty were present for the discussion. Most participants agreed that independent program applicants should have a separate SLOR form, with at least 1 filled out by the Program Director of the residents' primary board. The majority (61%) of respondents supported the addition of 1-line characteristics to each applicant quality, and the change to a percentile format for assessment. CONCLUSIONS: Letters of recommendation are vital to the resident selection process, and thus it is incumbent upon fields of medicine to consciously work on improving how these letters are written. This study outlines a 2 step process by which a SLOR was evaluated and optimized for faculty in the field of plastic surgery. (C) 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.