A call for structure

The academic faculty promotion and tenure process for medical school faculty is a critical and high-stakes endeavor, yet the traditional narrative letter of recommendation (LOR) format is often hindered by vague criteria, bias, and subjectivity. When examined through the Standards for Educational and Psychological Testing framework, the LOR format is vulnerable to limitations in validity, reliability, and fairness. The LOR format also shows vulnerability to methodological biases (eg, selection bias, content inconsistency), cognitive biases (eg, leniency bias, halo effect, confirmation bias), and structural inequities (eg, gender, racial/ethnic, and prestige biases). Additionally, the LOR writing process imposes considerable resource demands that divert faculty time from core academic missions. In this Scholarly Perspective, the authors propose a structured LOR format that integrates standardized structured assessments with guided prompt components focused on the candidate's key contributions across 3 dimensions: primary domain of impact, broadest scope of impact, and significance of contribution. This approach aligns with competency-based assessment principles that have transformed other areas of medical education, shifting evaluation from impressionistic judgments toward evidence of specific achievements against defined benchmarks. While acknowledging institution-specific needs and implementation challenges, this proposed structured LOR format offers a potentially more valid, reliable, and equitable approach that institutions can adapt to their specific values and promotion criteria.