Letters of recommendation for the predoctoral internship in medical schools and other settings: Do they enhance decision making in the selection process?

Since the 1970s, letters of recommendation to medical and other internship settings have surfaced as important variables in the internship selection process. However, several studies have challenged their value in the selection process, specifically by pointing out that these letters have an overly positive bias and fail to address applicant weaknesses. Our study, using the Linguistic Inquiry and Word Count text analysis method, developed a quantitative profile for a sample of letters of recommendation, determined whether letters differentiated among applicants with regard to positive/negative attributions, evaluated letters for positive and negative bias, and investigated potential gender bias of writers toward applicants. Results indicated that writers apply positive and negative attributions homogeneously across applicants, thus, rendering applicant differentiation on this basis impossible. Also, results demonstrated that letters of male and female writers were not biased toward male or female applicants. These findings, in combination with previous studies, question the utility of letters of recommendation as presently structured. Possible modifications are discussed.