Hi Everyone:
Last spring I wrote 41 Program Director’s letters for fellowship, and this year, the number should be similar. As wonderful as you all are, it’s still painstaking to write these letters given the stakes.
PD letters are a cross between recommendations and performance summaries. Pure recommendations, written by your attendings and research mentors, are meant to endorse you. They are invariably positive, differing only in detail and degree of praise. They rarely contain criticism, because writers know—or should know—that if they can’t support you, they should advise you to seek a letter from someone else.
Program Director letters are more akin to the Medical Student Performance Evaluations (MSPEs) and standardized department letters you received for residency. My letters largely adhere to guidelines published in 2017, though mine are a bit longer than the recommended two pages since they include quotes from your evaluations and excerpts from YNHH “RAVES” and emails which regularly come my way. Each letter follows the same format, which serves two purposes: to help readers find information they need and to allow an objective comparison between candidates (see attached).
The letters open with a brief description of our residency, followed by competency assessments in the ACGME’s six milestone domains: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Systems-Based Practice, Practice-Based Learning and Improvement, and Professionalism.
Next, I describe your scholarship (research, QI, curriculum development), extracurricular activities (committees, leadership), special skills (statistics, programming, advanced degrees, distinctions), recognitions (awards), performance-related concerns (rare), and special comments (anything else).
Then, I describe your suitability as a fellowship candidate based on clinical performance, scholarship, and leadership. This section is not a ranking: most of you are talented clinicians, scholars, and leaders, which means most of you are designated as Exceptional, Outstanding to Exceptional, or Outstanding. In other words, most of you would thrive in any demanding fellowship.
I close with comments about your potential to contribute to academic medicine, how I’d feel if you stayed at Yale (some type of happy), and a statement about the strength of my recommendation. Finally, I describe your personal traits such as warmth, kindness, empathy, diligence, humility, and reliability. As a residency director, I know my fellowship colleagues seek trainees who are ambitious, hardworking, and emotionally intelligent.
It takes nearly a month to write these letters.* There’s no shortage of content available, so most of my time is spent wading through rivers of praise and accomplishments, panning for gold. Because you sign away your right to read these letters, you’ll never see my words, but if you’ve worked hard, taken good care of your patients, contributed to our community, and treated others with kindness, you can be sure I’ve written a letter that would make you proud.
Enjoy your cold, wet Memorial Day weekend, everyone. I’ll be curling up with hot coffee and a book.
Mark
*No, I do not and will not use A.I.
P.S. What I’m reading and listening to:
- The Best Hot Dogs By Kathleen Squires
- A Shark Attack Changed Her Life but That Hasn’t Stopped This CT Paralympian From Giving Back By Lori Riley
- 60 Percent of Grades at Harvard Were A’s. Enough is Enough. By Jason Furman and David Laibson
- A Cattle Ranch is Doing What the Ivy League Can’t By Michal Leibowitz
- The Warnings I Almost Didn’t Heed By Nami Mun
- Can Art Teach? By David S. Wallace
- As a Doctor, I Can Understand the Allure of ChatGPT By Helen Ouyang
- I Knew My Writing Students Were Using AI. Their Confessions Led to a Powerful Teaching Moment By Micah Nathan
- What A.I. Did to My College Class By Theo Baker
- Find The Best Connecticut Beach for You. Where to Swim, Park and Get In Free By Annie Xia and Luca Powell
- Mets Fans Are Struggling. Be Gentle. By Devin Gordon
- Jurassic Park By Michael Crichton
- Who Gets to Shape Healthcare? On Health & Veritas with Harlan Krumholz and Howie Forman
- On Violence By Hannah Arendt