American Council of Academic Plastic Surgeons
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Evaluating the ACAPS Standardized Letter of Recommendation for Application to Plastic Surgery Residency: Usefulness and Patterns
Philip D Tolley, MD; Daniel Cho, MS MD PhD; Jenny Yu, MD; Nikki Thrikutam, MD; Danielle Eble, MD; Johnathan Shih, MD; Vanessa Leonhard, DO; Jeffrey B Friedrich, MD MC FACS
University of Washington, Division of Plastic and Reconstructive Surgery, Seattle, WA, USA

Background: The American Council of Academic Plastic Surgeons (ACAPS) created a standardized letter of recommendation (SLOR) form in 2012 to provide additional objective data in residency applications. However, since its introduction there have been no published studies evaluating its efficacy. With decreasing amounts of differentiating criteria in the application for residency, potentially greater importance will be placed on the SLOR form for evaluating applicants. This study aims to analyze patterns and distributions of responses in the SLOR form.
Methods: All letters of recommendation submitted to our institution for application to residency from the four most recent application cycles (1591 total letters) were evaluated. All personal applicant information was deidentified. All aspects found on the SLOR form were recorded for each letter. Overall use of SLOR form, distribution of overall rank, differences in home versus away program letters, and scoring based on applicant gender were evaluated.
Results: Overall, 82.3% (1310/1591) of letters received included the ACAPS SLOR form. The distribution of overall rank was skewed with 25.7% (326/1269) of applicants being ranked 1 and 74.6% (947/1269) being ranked 1 or 2-5. Home program letters were more likely to rank applicants 1 overall compared to away programs (35.4% versus 13.0%; p<0.001), who were more likely to rank applicants in the 5-10 and 10-20 categories (28.6% versus 13.7%; p<0.001 and 7.7% versus 3.2%; p<0.001 respectively). While male applicants were more likely to be ranked 1 overall (27.8% versus 23.4%; p 0.08), female applicants were more likely to be ranked in the 2-5 category (51.9% versus 46.2%; p 0.05). However, when evaluating applicants ranked 1 or 2-5 there was no significant difference between males and females (74% versus 75.3%; p 0.61). Conclusions: Caution must be used when interpreting the overall ranking as the distribution is skewed with nearly 75% of applicants being ranked 1 or 2-5 and biases exists between home and away program letters. Encouragingly there is not an overt difference between males and females in overall ranking. Understanding the patterns in the SLOR form will be helpful in the use of this resource as it gains importance in the evaluation of applicants.

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