Factors That Influence the Quality of Letters of Recommendations for Orthopaedic Trauma Fellowship Applicants: A Survey of Fellowship Directors

Background Letters of recommendation (LoR) have been identified as one of the most important factors for interview selection and ranking applicants in the orthopaedic trauma fellowship match. A primary aim for this study was to see what specific factors fellowship program directors (PD) use to characterize an applicant unqualified for fellowship training and how this affects an applicant’s LoR. Methods and Participants A survey was sent to all 66 orthopaedic trauma fellowship PDs. PDs were asked how they would respond to an applicant requesting a LoR who they deem unqualified for orthopaedic trauma fellowship training. PDs were then presented with a list of 10 factors that may deem an applicant unqualified for orthopaedic trauma fellowship, which they ranked in order of importance. A weighted score was calculated for each factor. PDs were also given the opportunity to provide additional factors in a free response. Results The five-question survey yielded 42 responses from PDs (42/66 PDs; 64%). When faced with a request for a LoR from an ‘unqualified’ applicant, 22 PDs suggested they would not write a LoR for the applicant (52%), 19 PDs indicated they would write an underwhelming LoR (45%) and a single PD stated they would write a supportive LoR (2%). The highest-rated factors when deeming an applicant unqualified were lack of professionalism and personal responsibility. Low Orthopaedic In-Training Examination scores, lack of published research in specialty/subspecialty, and low total number of publications were ranked as the least important factors. Conclusions Orthopaedic trauma fellowship PDs specifically identified lack of personal responsibility and professionalism as the most important factors when deeming an applicant ‘unqualified’ for fellowship training. Prior to requesting LoR, applicants should prioritize personal responsibility and make every effort to display professionalism when building relationships with orthopaedic trauma faculty.