Selection of Neurological Surgery Applicants and the Value of Standardized Letters of Evaluation: A Survey of United States Program Directors

Background The letter of recommendation (LOR) represents a nonstandardized way to evaluate residency candidates. The goal of this project was to assess the current components of the Electronic Residency Application Service application and to determine and develop support for a standardized letter of evaluation (SLOE) in the resident selection process. Methods A 16-question survey was sent to US neurosurgery program directors. In addition to demographic information, respondents were asked to rank 7 aspects of the current application (1–7), evaluate the inclusion of specific standardized questions about applicants (yes or no), note their agreement with statements about LORs (on a 5-point Likert scale), and provide any additional comments. Results Fifty-three of 113 program directors (47%) completed the survey. The interview (average rank, 2.0 ± 1.4), United States Medical Licensing Exam step 1 score (2.86 ± 1.4), and LOR (2.96 ± 1.5) were ranked as the most important aspects of the application. Agreement was high for items regarding the utility of the current LOR (51%–78% agreement). Almost two-thirds (65%) of program directors agreed that implementing a standardized LOR would improve the resident selection process. Inclusion of questions regarding applicants' work ethic, teamwork, communication, professionalism, and initiative were strongly supported (>80% in favor), whereas including a question on theoretical rank position was mixed (54%). Conclusions Most neurosurgical program directors agree that increasing the objectivity of the application would be beneficial, including the addition of standardized questions. However, there is only moderate interest in implementing an SLOE.