So welcome. My name is Jessica Cavanaugh. I'm assistant professor at the University of Kentucky. And today, we're going to be talking about how to look good on paper, to write support letters, personal statements. And there's going to be a little added slant on gender bias. And so for the group of us three faculty members, we have no disclosures, no financial considerations for writing letters. If anybody wants to pay me to write letters of rec, please do so, and I'll have disclosures for next time. The objectives for the lecture today are to understand the key elements of a personal statement for academic medicine in regards from residency applications to faculty promotion, to recognize some common mistakes found in writing written personal statements. We'd like you to cite some key components of a letter recommendation, learn three aspects that can make a letter recommendation improve from mediocre to a glowing review, and identify some examples of everyday language in letter writing that can illustrate gender bias. And then lastly, list five ways to avoid gender bias in reference writing. So our first speaker is Dr. Andrew Savoy, DO. He attended the University of Georgia for his undergrad, got a doctorate in osteopathic med at the Philadelphia College of Osteopathic Medicine in Suwannee, Georgia. Completed his PM&R residency at University of Kentucky, and after being with us on faculty there for a while, has now ventured out into private practice. So he'll be giving this first portion of the talk on personal statements. Good afternoon. So before I dive into it, let me just take a quick poll. Do we have students? Any students? OK. How about residents or fellows? Yeah. Any early practice, mid-practice, late practice? OK. All right. Nice to see everybody today. So I'll be going over the personal statement bit. The personal statement is the thing that we all dread. Most of us have not done a personal statement in a long time. The personal statement forces us to look at ourselves in ways that we don't really want to do. We have to put ourselves on the paper. It makes us feel vulnerable. But it is one of the best tools that you have to get somebody to understand what you're about as more than just numbers on a page. When we do residency interviews, or when I did residency interviews as a faculty member at UK, it's very easy to get caught up in just seeing all the numbers on the page. It's the personal statement that really tends to set people apart before you ever meet them. So spending an appropriate amount of time, diving into it, taking it seriously is going to pay dividends in the end. The personal statement differs based on what you want to do. You're not going to write a single blanket statement and apply it everywhere. If you're trying to get into a residency program, you need to talk about why you want to do that specific residency. What interests you about the work that you could be doing? With a fellowship, what is it about that particular niche of that specialty that gets you fired up and passionate? Why do you want to do that particular thing? Beyond that, we have more formalized letters or personal statements, things like the NIH Biosketch, which has a very specific format that they want you to adhere to. It's a way of saying, this is what I bring to the table and what I can do as a project leader or participant or member. And these are the reasons why that is the case. Lastly, academics. When you're applying for a tenureship or promotion, when you're trying to advance your position in academics, the personal statement is sort of a broader look and a cohesive package that you put together that serves as a way of explaining the CV, of explaining certain things in your past that maybe don't come across in the numbers. And the same thing with medical school or with residency, this is a way for you to sort of touch on the different things that don't show up other than gap year. What does that mean? So it acts as an introduction. What are you about? And what do we need to know in order to help understand why you want to do these particular things? It is meant to be personal. It's not supposed to be like reading out of an encyclopedia about your different list of things you've done and your accomplishments, which are very good to include, but with a personal touch and a way that makes sense for what you're trying to do. A lot of the successful ones include a description of an influential experience. I think most of us get that advice. Talk about something that made you want to go into PM&R. Talk about why you wanted to do the brain injury specialty. And it usually harkens back to a patient experience that you had or maybe a family member talk or you saw a physician who is your mentor do something in a certain way. And so you can relate that as your personal experience when you're writing a personal statement. It also describes what you're looking for. It's not just, this is all about me. It's also a way of saying, this is what I want to get from my education. This is what I want to get from my job or from this program that I'm applying to. It also can define your professional future goals and then what you want to do in that specialty. So in preparing for a personal statement, really just have a brainstorming session. What are some of the things that I maybe can talk about? What are some of the experiences that I've had that can help me explain why I'm trying to do what I wanted to do? This is a nice format from University of Washington, but really it comes down to just jotting things down and seeing how you can create a cohesive package within the requirements of the document you're trying to produce. For most personal statements, there's not a format. It's not a introduction, three body paragraphs, and a conclusion that we learn in grade school. You can really make it your own as long as there is a cohesive flow and it reads well on the paper. Some folks include antidotes. Some folks talk about personal beliefs and try and include sort of a mission statement. If it's pertinent to what you're trying to do, you can definitely do that. But make it about you and how it pertains to your efforts in the future. So why do you want to go into the specialty? What are some of the skills you possess? If you're going for an interventional fellowship, talk about the difficulty in managing some of the procedures that you've done and how you've overcome that. What are you looking for in the program? What are the certain things that you're deficient in and the program can help you to overcome or to flesh out your skill set? What are some of the life experiences that have helped you get to this point and helped shape you? These are things that will help illustrate the person on the paper. This is also a good time to explain the gaps that you've had. Seeing a gap year always raises a couple of questions. If you've had a gap year or if you've had a hardship, this would be the time to talk about it. It doesn't need to fully envelop your entire personal statement, but devoting a small portion of your statement to that topic can help assuage any fears that someone may have about bringing on a candidate or you can even use it to help bolster that if you took a year off to take care of your ill family member. That's an important thing to note so that the gap year is illustrated as a life-changing event in the way that it should be. So tips for writing clarity. You've got to read a lot of these. After a time, it starts to look just like letters on a page. So some of the more successful personal statements end up being somewhere between the three quarters to a one-page long length. You want to avoid jargon. You want to avoid abbreviations and should go without saying don't plagiarize. We have the full internet at our fingertips. Everything that goes into the personal statement should be of your creation. Get help. For me, this was the most difficult thing. My wife is a wonderful editor. She knows how to structure sentences and words in ways that are much better than I can do, but it makes me feel nervous to get her to look at my work because I'm basically exposed on the page, but without her help, my personal statements and my documents that I've used would not be nearly as good as if I had just done it on my own. The other thing is have somebody within the specialty itself take a look at your work. It doesn't have to be somebody that you have direct contact with, but a lot of academic institutions, too, will have resources available so that you can have somebody look at it, look at the form, look at the structure. Are there too many of the same word in this statement? And mistakes. Mistakes are the kiss of death. You don't want a misspelled word after this long of going through a personal statement because those things tend to stick out. You see that and you're focusing on it as an interviewer. Common things that people tend to do is rehash the CV. You know, we have your CV on the page. It's literally on the next page. We can just take a look at it. The lack of flow or if there's a weird structure to it, if it doesn't seem to go point A to point B to point C, if I have to sort of go back and forth and find what's going on, it makes it difficult to go through it. Too long. You know, a page is really the maximum that it needs to be. Once it starts heading onto that second page, you get a lot of fatigue. Most great personal statements can be condensed into a page. Try not to use cliches, quotations. And funny enough, things like exaggeration, arrogance do come across in personal statements in your writing. So this is another reason to have a family member, a colleague, a friend look at the writing and sort of get an idea. Does this come across in the way that I need it to or want it to for people reading it on the other end who have not met me? Focusing too much on things that are too far in the future or too far in the past. If you're applying to a residency position, the personal statement should be about why that residency is the right thing for you, not how it's gonna be used as a stepping stone for your eventual fellowship position. You know what I mean? Also, if you're in the fellowship phase or in the early career phase, harking back to some of the things you've done in grad school, medical school, residency is nice, but it shouldn't encompass the entire personal statement. You should have some forward-looking things to discuss within the statement. So we're not gonna read all these things, but I did highlight a couple of the sentences that stood out to me. So Mike on the left, frustrated aphasic stroke patient who refuses to speak. You know, if you've done a rotation on an inpatient ward, you know this patient already. You've had this experience. And so Mike included this as his personal, this is why he was interested in getting into PM&R. He had this patient who refused to speak and it left an impression on him. For Justin, a work ethic honed by summers, working construction sites and twilight shifts, sweating through UPS shipping quotas. You think that dude's gonna work hard? He's gonna work hard, and he did work hard. Brian, Brian included his world travels, which is great. I've worked to help others at home in America, the Dominican Republic, and in Morocco. You know, letting the reader understand that you've been exposed to and have been introduced to multiple different cultures is a great way of sort of showing your, I don't wanna say worldliness, but you know, it is a great experience to have to put into your personal statement. And then Pooja. Pooja started as an anesthesiology resident. So when you read through her file, she started in anesthesia. And so she ended up changing to PM&R and so she chose to use the personal statement as the vehicle to explain why that is. Well, it was clear to her that she enjoyed patient interaction and disease investigation, something that she wasn't getting from her anesthesiology residency program. Briefly touch on the NIH biosketch. I have not personally done one of these for myself, but it is a brief biographical sketch and it's to, it's for proposed personnel and contribute on a grant application. It's being used to show what you can do or provide for a project. And it has to conform to a specific format. This is a little, I think this is directly from the website. And again, the personal statement is tailored to the application. Why do you want to be on this particular project? What publications do you have to support the skillset that you are bringing, the knowledge that you are bringing? And it tells why you are well-suited to be on the project. You may cite up to four publications and they can include various number of things. Just adhere to the format if this is one of the things that you're gonna be doing. Just an example, this should be in the slide deck. And then promotion and tenure. Promotion and tenure is a very institutional specific thing. Every institution is gonna have a different format for the way they want your dossier to be produced, for your CV to be ordered. And this is the one case where the personal statement really is fleshing out your CV. So CVs can get extremely long. It can look often just as like bullet lists of various publications, presentations, and things, activities that you've done. So this is your time to delve into those activities and showcase why they were a big deal. You know, if you gave a national presentation, it's gonna show up probably as a single line within a 20-page document. This is the time to bring that to the front and showcase why it was such a big deal. Lastly, this is a nice little Venn diagram. You know, when you're looking for a new endeavor, you really wanna make sure you're touching upon the three things. And this is especially true for academics. Your institution is gonna have needs. Certain work has to be done. You yourself are gonna have your own passion, the things that make you excited to go to work, and then your own skillset. And between all three of those is really what you're trying to get to. You're trying to get that project or that position or job that gets you excited about work, that you're well-equipped for, and that the institution is gonna be happy to have you doing. Go Dawgs. Next is Dr. Kavanaugh. Dr. Kavanaugh grew up in southeastern Indiana and graduated from Xavier University in Cincinnati, Ohio with honors in biology. She received her MD from the University of Cincinnati in 2006 and completed her PM&R residency at University of Kentucky in 2010. She is board certified in PM&R and brain injury medicine. She is interested in neuro-rehab, specifically stroke and spasticity management. And when she's not working as a clinician, she's doing hot yoga and running her two young daughters all over town. Not this week. So the next portion of the talk is going to be on specifically letters of recommendation. So there are two different subsets of thought just based on kind of the survey he got of folks that are in the room. There are gonna be those in here that are gonna be asking for letters, and there's gonna be those of us writing letters. And so I'm trying to tackle all the different facets. For requesting a letter, it's important that you choose your letter writer carefully. So I was the program director for University of Kentucky for about four years. And again, reading lots and lots and lots of these letters, you got to see what was good and what was bad. And you got to see letter writers who actually knew the person, and then those that were just saying, oh yeah, this person's okay, and you could tell there was no true connection with them, and they were kind of just doing it out of niceness. So when you go about asking for a letter, make sure it's gonna be somebody that you have had a memorable connection with or some sort of experience, somebody that you think is gonna really make you shine, not somebody where you're not even sure if they remember who you are, because that can be reflective in the letter that is then received. You want to request it early, so the earlier the better, because it gives more time for us busy practitioners to try to get a letter written out on time and get it uploaded and whatnot. And provide pertinent materials to the folks that need it. So your CV and your personal statement are usually the big things that are helpful to me when I'm letter writing. And then be sure to thank your writer, because they always like to have those little niceties that makes it worthwhile, since this is not a paid part of the job, it's what we do because we are happy to be in academic medicine and help everyone get through the next cycle. So, moving on to writing a letter recommendation. The flip side of the coin, if you don't think you can write a good letter of rec, you want to tell the person, maybe you want to pick somebody else. So the first rule should be, if you don't think you should write it, then don't write it. And that's going to just save everybody some time. So, brief guide to letter writing. You want to identify the candidate and the position desired, describe your relationship with the candidate, link the time known. You can provide some specific evidence or details to support your recommendation. And then at the end, you just want to summarize, state what you've recommended. And then this is the time also when your letter writer can help highlight problem areas that you could have had in your CV. Say you failed a step, or say you had to take time off to remediate. Those, if the person writing the letter can help you, they can make that actually a glowing side instead of a negative. This is how resilient they were. Oh, the person was like working three jobs and their mom had an MS flare and this is why they did poorly, but they did the hard work on my rotation and I think they would still be a valuable candidate. So that's what I would say. Sometimes it's helpful to explain those problem areas to your letter writer. For writing the letter of rec, there have been some different things, thoughts of mind. You want to be short and clear. There used to be a consensus that the lengthier the letter, that means you really knew the person and so it's a better letter. Now with all the letters being uploaded into the internet, usually one letter's the best because nobody's wanting to click to that second page. So condensing it, make it concise. Discuss the skills that the person has. Be specific. Don't say, oh, they were a great person on the rotation and not have any key factors of why they were a great person on your rotation. Offer contact in to go at the end for clarification to close. And then for the letter writer also, make sure there aren't any typos and critically read it. I have had a handful of reading through other people's letters where basically they had a letter template and they were like, Dr. Smith was great. And then you're reading in the body, it's like, Dr. Jones, blah, blah, blah. So you know they're not even talking about the same person. They just copy pasted the same thing in. At the very least, if you're going to be shady, go through and find all and replace all the Dr. Joneses with Dr. Smith or vice versa. And the he's to she's and vice versa. And then the last thing I think is important, just to have that air of professional accountability is to place it on letterhead. So this I have drawn up just for folks who have not done this in a while or for those of you going through it. The students in the room will know about the letter recommendation portal. There's a website you now go to. You have all these key files or factors that have to be involved when you are uploading your PDF. It has to be a PDF. Can't be mailed or faxed or all the things they did back in the olden times. This is just showing that first website portal. And that's why it's important when you get the request and you'll get an email from AERIS that will have that exquisite letter ID that you need to put in there. If you do not put that letter in there exactly right, you're not going to pull up the right person. So I've had people where they've submitted the right letter for the wrong person and vice versa. And I've had to be, as program director, contact them to say, hey, did you mean to submit Dr. Jones's letter here when you probably meant the other person's? And then they fixed it and it was not a big deal. So this was a slide because letterheads, who has letterhead? Most academic professionals are going to have letterhead. They're going to have their university's letterhead. But what if you are a private practice independent contractor and you don't have any letterhead out there? You haven't had your own LLC or things to where you've had to need it? There are plenty of Word document letterhead templates that you can pull that are free. I maybe would not pick the cartoon bird letterhead for a specific business formality. But I think you could get away with a lot of different other options. They look professional. The other thing that I think had been a, I have actually heard people turn down being able to write a letter because they said, well, I can't scan it. I'm like, not in the office. How can I even scan this letter? Thanks to the ample opportunities allowed for COVID-19 and my new abilities to homeschool elementary school children, I can tell you how easy it is to scan and import files. So briefly, we are going to digress on a technical part of the letter recommendation talk. On your iPhone, you want to start a new note. And then it will reveal a little camera when you take your document and put the camera in front of the document. It's gonna make this yellow highlighted area. And then the photo taken will magically edit margins. Boom, you have a PDF. So then you can name it, file it away and have it forever. I use it as my cheat code to do letters at home when I have a printer at home, but then I want to sign the letter and send it back with a signature. So then I can scan it instead of having to have a scanner at home as well. To draft or not to draft. In basic science, it's a lot more common for PhD candidates and such to draft a letter, a recommendation for the person that they're asking. It's more common practice. And so people that might've been in grad school before this are aware of that practice. And so sometimes I've had a letter drafted and given to me like, hey, will you write me a letter of rec? I also have this draft example for you. What I think in the medical world, I don't think that that's done quite as often. I think in my whole realm of 10 years of practice after residency, I've only had one draft handed to me. But for me, that's a good thing because I tend to write in my own voice and I feel like drafted letters can tell they're not written in my voice and I would have to rewrite the whole thing anything. Anyway, so I don't think you're saving anybody any time by producing a draft. Additionally, confidential letters of recommendation are usually preferred because if they're confidential, they're somehow seen as they're gonna be more candid and more reliable and more truthful. And so if you hand a person a draft and you use that exact draft, it's almost not as authentic. Speaking of confidentiality and keeping things anonymous kind of, there is the Family Education Rights and Privacy Act called FERPA. And so it was created in 1974 to protect the privacy of student education records. And so these records also apply to your medical school files. And so letters of recommendation could be things that you could request in FERPA if you were to try to get a review of all your records. And so if schools don't turn over all their records, that's when they can lose funding. So as such, letters of recommendation, usually it's on that portal. When you guys are going to it, you say whether you waive your right to FERPA for that document or not. So it's seen that if you waive the right to FERPA, it's more anonymous, it's confidential, you're not gonna see it, that's seen as more candid. And so for letter writers, we need to add a statement saying, yes, we know that they waived their right. And how we find that out is through the same website where it says, you know, click box had happened, they had waived the right to FERPA. So this journal from the Journal of Graduate Medical School Education showed different elements that you should involve in each of the different segments. I include it here for folks to review after the fact, but the things that you would wanna include, again, how I got back to the title, the position the person is asking for, how you know the person, that should be in the introductory paragraph. In the body, that's when you wanna get into the nitty gritty of what this person's skillset is or details and specifics. And then at the end, you wanna provide a summary, just summing it all up and saying how you recommend them and how they'll be a great asset to the program or what have you. So speaking to the, they'll be a great asset or we really want them, it's kind of important that folks who are writing the letters know the cheat codes that program directors are looking at because your words might not be meaning what you think that they're meaning. You're like, I said they were a good candidate. I think they're a really good candidate. Well, good candidate to some folks means not really that great. Good means not awesome, so we do not want that person. So there have been studies to look at what program directors are looking at between the lines. So another article from the Journal of Medical Education, this looked at the percentage of program directors who are rating key features in a letter that they think are most important to them. And so they ranked them from highest to lowest and they looked at the percentages and broke it down. And the most important feature of a letter of recommendation proved to be depth of interaction with applicant. So if you can say, I knew student Dr. X and he spent a month with me and he did this detailed procedure with me and he took great care of patients' families, et cetera, et cetera, that depth is gonna look better than, oh, I rotated with that kid for like half a day in clinic. It's a different read. And so just like how I was saying, you wanna focus in on requesting a good letter writer, the letter writers need to know that we need to really talk about the applicant as well. Again, long letter, more than four paragraphs, not as important anymore or as it used to be. Also not as important participation in research as like 40% people notice or care. But again, it's these key factors, knowing the applicant, the applicant's abilities, those things are gonna hold more merit than the other things that might speak to success for some folks. The percentage of program directors rating, whether things, certain phrases are positive, neutral, or negative. So I give it my highest recommendation. That, slam dunk, you want that person. That really means something. If somebody's giving their highest recommendation, that's important. Again, I recommend solid performance, performed at expected level. Those are not as glowing as statements. They're perceived more negative. And so those are the things that you would wanna include as a letter writer. You would wanna say, I give my highest recommendation. I want that person to stay at our institution. That would be great. That's also another key thing. That means, oh, that person thinks that applicant's so good, we want him to stay too. There are some differences in letters of recommendation between letters of people writing for residency or fellowship positions. And so the two I just kinda highlighted with a star because I think they are the key differences that I've noticed in my own personal practice was that for residencies, we are, resident directors are gonna care more about being involved in the program, being involved in hospital activities, really showing involvement and being participatory in our field. That's gonna hold merit to us more than doing a lot of research. Now, flip side, fellowship programs are really gonna care about research and really enjoy and want to see that research element in their letter. So here's my example letter. We can guess if it's good or bad letter. I copied this from memory based on a letter I actually did receive on an applicant. And I was just like, are you kidding me? So no letterhead, that's number one off the bat. Who's the writer? Who's the application? What are they doing? It's to whom it may concern, I recommend student doctor for residency program, thanks. That was it, that was the letter. Then there was like the handwriting to the administrative assistant on the side, like, hey, please scan this in, Edith, or whatever the thing was. And that got scanned. That's somebody's official letter of recommendation. So there was really no content whatsoever. So I'm showing you a firsthand example of worst case scenario of letter of ever, and this has happened in real life. So this is not a one-off, it has happened. Now here you see a different kind of example. So you're seeing it on official letterhead, you see regarding this person, their ACC, the AAMC ID is up there, their heiress letter is on it. So you can see if it's matching the heiress letter versus the one that was scanned into. If there was that mismatch, you could go back and they could find out, well, this is the wrong person for the wrong place. I'm very pleased to write this letter of support. This is who they are. This is all the thing they were doing. So letterhead check, identification check, intro of the writer, we got that. Descriptors are in there. Strongly recommend, and that is in there at the end. So at the end in your closing statement is usually where you want to put in these strong statements saying, I really want them. Delighted to see him match our program. That was like the slam dunk, we would really want him to be there. And again, my little FERPA statement was in there. So you have an example of kind of worst case scenario, best case scenario. I will now say, since I bingos, it's because I can make fun of the bingos and nobody else can, so now you know. But I will go on to introduce Dr. Jamie Key. She attended the University of Tennessee for her undergraduate degree in psychology. She received her doctorate from University of Pikeville. That's how they say it, Pikeville in Kentucky. She focuses on brain injury medicine and graduate medical education. And has been acting as a residency program director in Kentucky here since 2020, as well as our brain injury fellowship director. So she's read plenty of letters. She's also the ambassador for diversity, equity, inclusivity to the UK College of Medicine. And so I will turn it over to Jamie. Thanks everybody for bearing with us. There were some people that walked in during the last lecture, so are we still predominantly students and residents, or we have more faculty? If you're faculty, raise your hand. Okay, just want to make sure I know who I'm talking to. Okay, so although Dr. Savoy represents the deeper South, you're going to hear it come out in my voice. So if you don't understand me, just wave at me and I'll slow down or try to be less Southern. All right, so we're going to talk about cover letters and letters of support. And then one topic that I'm pretty passionate about is gender bias training for writing your letters and representing the person well, okay? So cover letters, this is going to be less interesting to the residents and students in the room now, but you are looking at this for the rest of your life. When you decide to be a physician, you don't know that you need a degree in literacy, in social work, in all the things that would make you a more marketed person. So you have to be able to market yourself. Some people are better than others. And so find friends that are good at marketing and make sure they read your stuff as you go through. Anyway, cover letters. You ask, why should I do this? Why do I even need to add another document to the whatever application I'm putting in? This is your one chance to add a little personality in your flavor to your application. And so it's your time to bring to the table exactly what you want the person to be looking for as they read through the rest of your application. I use it as a tool to say, here I am, now go read more about me. You really want this to be a very marketable piece for you. And then it may be a formality to you, but it is your chance to specifically address things that you want them to read more about. So you're kind of just directing them through your application. For the breakdown, I'll do this quickly since there's a younger crowd. But for the first paragraph, you really want to say, hey, here I am, and this is what I'm interested in. I'm interested in your position for this. The second paragraph, you expound on that and talk about why you are interested and why you're that person for them. And then the third paragraph, make sure you thank them. You're really pleased and excited about being able to apply to whatever that is. And then you want to move on and give a discrete timeline of what you expect after that. Even if someone has said, you'll hear from us on this date after we've received and read through all the applications, put that in the back part of this because it shows attention to detail and the fact that you are very interested and you have invested in this application process. And so if they say you're gonna hear from us all by October 25th, say, I look forward to hearing from you in the next week or whatever. For cover letter things to do, you do want to be specific in who you're writing to. Do not use do not, don't use to whom it may concern probably ever, like be direct and intentional with who you're writing to. Make sure you know your audience. And that's for everything that we've talked about today and what's to come. Be upbeat and positive in your letter, even if you're the most grumbly, angry person in your personality. And I can be that way sometimes, just don't let that come out in your words. That's another reason why it's great for people to read your letters because they can tell you if it comes out at that tone or if you're complaining. And then close with your call to action that I just talked about. What to do not or what to don't. Don't sound desperate and don't beg for the position. I can't tell you how many personal statements and letters I've read over time that sound like the person's just begging to be there. And if you've gotten to that point where you're applying for residency, if you're applying for the job, then be proud of that. And you are the piece that they're looking for, right? No one should have to beg for any position at this point. Avoid sarcasm and humor. I love both a lot, but so it's really hard to keep out of formal letters, but you wanna do that as you're applying for something like this. And then don't throw anyone under the bus. If you had a bad experience or you're leaving one institution and trying to go to another, don't talk about how badly it was or what it was you were leaving because that's not important and they're not gonna wanna know that information. Okay, so letters of support. You know, we've touched on some of these over the last couple of lectures, but they're used everywhere and you should be very good at them, especially if you plan to stay in academic medicine. They're used in residency and fellowship applications for research proposals or grant submissions, faculty position hiring, or for your promotion and tenure, okay? So you're gonna need them forever, so you should be good at it. For research, this is a goal, your goal is probably to get some support for funding or to start a research project. Typically, the audience is the funding agency. Figure it out before you submit your letter. It's going to mean a lot that you're that detail-oriented, that you know who you're talking to, okay? Kind of slated template for that is to do an intro paragraph, just kind of introduce them to the study or what you're looking to look at. And then in the body, start talking about all of that. And you can see this here, it'll be in the slide deck too. And then at the back, tell them why it's so important to our field, why you wanna do it, who's gonna benefit from it, and why it's so important to fund. And then it may open a door to something completely different or better, right? For promotions and tenure, tenure's going away in a lot of places, but you're gonna always want to be promoted. Dr. Cavanaugh talked about thanking people that are letter writing for you. That's because they're keeping all of those thank you notes in a folder so that they can give it to the promotion committee later on. Anytime you get any kind of mail or thank yous or you've helped somebody along the way, that's gonna help them later. So start compiling those when you get them and then make sure you thank those that helped you on the way up as well. But the goal here is to answer specific instructions. So every institution has a set of instructions that they wanna see, a set of information they wanna see about the individual. Dr. Cavanaugh went up for promotion just recently. I was asked to write a letter for her. I was given a whole list of things that they wanted to hear about from me. And so that's nice because you get a little bit of a breakdown on what you're supposed to talk about, but you wanna make sure you do your job and do it well. Typically, you do wanna talk about the, I'm having a hard time not being in front of this. Keep coming out. But typically, you wanna talk about the three things listed there. And then again, make sure you address the audience as they should be addressed. So this is another template for that in particular. Usually, these are a lot longer. A person that's going up for promotion has done a lot, and you wanna make sure you're doing your due diligence of telling that story. And so you start by introducing yourself and how you know the candidate. You give a brief description of the candidate's focus. So what's their story? What are they good at? What have they been doing? And then you talk about the efforts in all of those three areas that were just listed. You wanna talk about their bigger achievements first. Spend more time on it. And then as you go through, make sure that you're organized in your process, but don't write four paragraphs about every single thing you want to talk about. And then make sure that you're comparing that person to people under the same stipulations and guidelines for promotion, right, because every institution is going to be a little bit different, and so you want to make sure that you're being fair across the board and looking at that individual for promotion. And then you want to close with the succinct assessment of the candidate and their potential to succeed. Okay, trying to get through that because I know a lot of you aren't here yet. So we'll move on to some more important and fun and interesting data that's hotter on the on the table right now. So this is PM&R as it looks, which is interesting because when I was a resident going through there was about 5,000 of us. Now there is almost 10,000, so it's really cool to see. But you'll see there that we are predominantly still male, and then you'll look down at this bottom part right here at how it's stratified based on the caliber of the teacher. So you'll see professor over on the left, then associate professor, assistant professor, instructor, and then other. Below that, they're categorized by men and women in each section. It's not surprising to see that assistant professors are about equal, right? That's a good thing. That means we are improving as a society and as a body of physicians to see a more equal number there. But as you move up, you see that the associate professors and the professors, you start to see the lean towards males, okay? So again, time is going by. Maybe we're getting better. You know, we need a few more years to see if there are more female professors that show up, right? We need to do a good job bringing them up. All right, so this is one of the more recent studies on gender bias and reference letters. You can read this too, but I'll just kind of bring out the important points. It looked at 16 studies. Over 12,000 letters of support were reviewed, and this included 7,000 applicants. One problem is they didn't know if applicants were repeated, right? Because they didn't know they were using multiple institutions to do this study. 32% were women. We're still seeing that in applications every year. It's still a predominantly male situation, but this is pretty consistent with what we're seeing now. Most of them found a significant difference with gendered adjectives between male and female, which we're going to talk about. And then we're going to talk about length and some of the other things that really, really bother me when I start looking at letters after knowing this information. Okay, so this study in particular talks about length of letter, gendered adjectives, which we're going to talk a lot about, doubt raisers, personal life mentions, and then is there room for standardized letters of support? Some programs or some specialties in medicine are already doing this. I'll see them from internal medicine the most, where it is very standardized and you get the same information every time, but we'll talk about that. So gendered adjectives, for those that don't know what they mean or what they are, these are kind of the two that this study put everything into context. So communal describes tendency to act for benefit of others, being friendly and selfish and expressive, and then agentic describes intellect, initiative, tendency to express leadership, such as assertiveness and confidence. Which one do you think represents females most of the time? I had a whole list that I'm gonna run through, but if we failed that one, you all aren't gonna participate for the second one, so we'll just keep going. For doubt raisers, if you've not seen these before, it's obviously negative language in a letter. Why anyone would go to the level that they do to write a letter for someone and then put that kind of language in is still beyond me, but it happens. Hedges, linguistic devices that employs vague and cautious language is a way to mitigate impacts of the negative thing that you really want to say. Radiologists do it all the time, right? And to an extent, we do it in medicine a lot if we're not sure. Potentially negative comments, unexplained comments, which we're going to go over, faint praise, and then irrelevancies. Another study that we're going to tie into all of this is this one here. I looked at another set of letters for a recommendation as medical faculty. This in particular talked about the letter length, and it was cohesive with the form of paper that we just talked about, and male applicant letters tend to be longer. That was the same across the board. One study in that other review article found that when males write the letter, they tend to have longer letters for females, but otherwise it was not held up in the rest of this. But anyway, letters of rec are supposed to include three facets. Commitment and relationship of the recommender with the applicant, and then some notation focus and record of the applicant and evaluation of their traits and accomplishments. Some of the shorter letters didn't accomplish all of that because it's hard to do in short verbiage, so this is an example of that. And we won't go through all the examples, but this one's easy because it's short. Dr. Koop, it gives me great pleasure in writing this recommendation letter for Dr. Sarah Gray. I've known Sarah as a resident and as a staff at wherever we are, and she is knowledgeable, pleasant, and easy to get along with. I have no hesitation in recommending her for the faculty position. I will be happy to answer any further questions in this regard. It's not negative. Seems like the guy liked her, but it's not really supportive either, so you can see where that might be an issue. This paper went on again into gender terms that you really want to stay away from. You know, I think we do a really good job of this now, and we're coming around, but we're still doing a bad job of it, too, if you look at it more closely. So, lady, mother, wife is mentioned a lot. Man, gentleman, father, typically. These are used more in female applicant letters, and then male applicant letters still are kind of cliche and grandiose, making them seem more manly and masculine in how they achieve their goals. Here's a couple of examples on all of the things we just went over. So, negative language is here at the top. It's a little bit difficult to read. So, feet, and then on the left is the female letter, and then on the right would be a male. So, it says, while Sarah has not done a lot of bench type research, and then the next one is, she is somewhat challenging personality. Again, why would you put that in a letter to somebody? Just decline to write the letter if you need to say that. And then on the other side of that, although his publications are not numerous, as you know, or while he's not the best student I had. Again, it's pretty obvious that you shouldn't be saying those things. Hedges. It appears that her health and personal life are stable. This is a big one for us, right? We're PM&R. We're supposed to be given equitable consideration to everybody. If someone throws that in, you're automatically just driven to think, is this person going to get ill while they're working with us? Are we going to have to struggle with, you know, them battling something while they're there? Shouldn't matter, right? We're supposed to accommodate everybody. It's why we came into this field to begin with. On the other side of that, he appears to be highly motivated colleague. That's great. Potentially negative. As an independent worker, she requires only a minimum amount of supervision. We'll move on down to a couple others that are just real obvious examples, but it kind of drives the point home. For the unexplained features, he says now that she has chosen to leave the laboratory and doesn't really explain why. And if you read the whole letter, which is in here, you'll see that they're not very happy about that. And then faint praise. She worked hard on the project she accepted. I really don't want to work for this guy, first of all, so I'm surprised he wrote her a letter. And then aside from that, in the faint praise category, I have every confidence that Bill will become better than average. That's a goal, right? That is goals right there. And then he is void of mood swings and temper tantrums. Can we say the same thing about you all? I don't know. And then irrelevancy. She is quite close to my wife. He is very active in church. It's one thing to say, you know, this is their values, this is how they carry themselves, but to throw out things that really doesn't mean much to the reader is another story. So here is an example of a lot of those being used in the letter. This is the one I was referring to. I probably wouldn't want to work for this hypothetical person, but you guys can read these in the slide deck. Another part of this study in particular talked about the standout adjectives and the fact that they noticed that males had a lot more of them than females, at least two to one for this paper. In this part, as they got through scrubbing all these letters, they started noticing a lot of his and hers and all the pronouns that we're really good at acknowledging now, right? But when they looked into this a little bit more deeply, they noticed, actually I should probably show you, so that the white column is female applicants and male column is the darker column, okay? But as they looked at this, they wanted to know what his next word was or what her next word was, and so they more often saw that females, they talked about her training, her teaching, her actual application that the person is reading, and then for males it was his research, his skills and ability, his career, and so what they determined from all of that was that females are still seen as an inferior body. They're still seen as the student and teacher, while the male is looked at as a researcher or someone that's very devoted to their career. So here's ways that you can improve your verbiage, and this will be in there as well. I always like to look at the enthusiasm and vigor category, because I did psych in college. I'm a brain injury person. I like the crazy adjectives, so I have to be careful with that, but enthusiasm and vigor has some fun ones, and ways that you can describe people, even when you want to be careful about describing their personalities, right? There are multiple tools online. If you're not sure you're doing a good job, you're not sure of the verbiage you're using, you can throw your note on and it'll scrub it for you, and it'll tell you what it's leaning towards, okay? Your goal is to get in there and then be like, I can't tell you who you're writing about or what you're writing about. So try to go the full length of the ringing endorsement. Avoid letters of minimal support. Don't use doubt raisers. Explain the things that you actually won't talk about in the letter, and then emphasize their accomplishments, and then stay away from the gender terms if you can. And just so we know who really is reigning the year until at least November 5th, I'm a big Tennessee fan, and if you know me, you know it's a flaw. So we will take questions now. So if there's any questions, we're available to take them at this time to the panel, or to not the panel, or I can just wax on eloquently for much longer. That, no, that's exactly the slippery slope of that one, because it's like, oh that person's staying, is what I will hear in residency rank meetings. And I'm like, no, that doesn't mean that at all. It just means they really are good. I used to worry about it too, but at the end of the day, they really like that person and would love to see them in their residency, so why wouldn't you? That's how you have to take it. But then you get used to hearing from multiple people consistently, and so when they don't say it, you're like, well maybe they like somebody else more. You know, you start comparing letters and seeing who they say it about, who they don't. So it is a slippery slope. I don't, that one makes me anxious. Yeah, yeah, it happens, and you look for it. When you know you're reading a program director's letter, you look for that verbiage. Another big one that we didn't have on the slides is, when you're writing your letter, you always want to build yourself up so you can build the person up. And so you say, you know, I've worked with students for this many years, I've been the program director here, I know what you're looking for, so let me tell you how this person's going to be that. And they'll say, this person is within the top 5% of the medical students I've ever had. And so that's another thing that we'll start looking for, if it's someone that I've seen write letters consistently. Yes? It's why it takes us weeks and weeks to screen. But I think though, like how I would do it, is you would have like, oh this is the best one I ever read ever, so we need to try to get them to interview with us. And then the weird ones who are trying to do some sort of obscure, abstract, poetic art, and you're like, what are they doing? I don't know if this is good or not good. I don't, I don't, yeah, I don't know how you set the middle part out, like how do you set yourself out from the pack? I know what you're saying. But to me, if it says, if there's something in it where I'm like, oh this person wants rehab, that's still good enough for me, like for when I was screening them. Like I want to know the rehab. I've seen a lot where it's like, ortho, ortho, ortho, ortho. I'm like, I don't think this guy really wants to do PM&R. So, yeah, so. Pay attention to details. Do not tell me you want to go to the University of Lexington in Louisville, Kentucky. That's a dead out for me, if you can't get that right. But you know, there are other things like that. I use them to get to know you more, because everything else gets very standardized, right? The supplemental application has royally screwed that, because now we have a lot more fluff to read that is more personalized to you all. And so I've found myself, this year's first year we've done it, for those that are in this cycle. I found myself going to that first now, because there's that little blurb that can kind of target you on where you need to go next. And I still do my entire cascade of review, but I go there now first, and then I review the other stuff that I need to look at, and then I go to the personal statement. But in looking at personal statements, they are just the cover letter, right? They're the cover letter for you and how to direct me into looking further into what the application is. Sometimes I can read that and just be like, this is not our person. They have a great story. They're a great applicant. It's just, they wouldn't be a good fit. It wouldn't be a good fit. And so you can move on. There is no way to rank them at all, but they are used as a supplemental fashion to make sure we're getting the full picture of the person. Because we go through. Every program director has a sequence, right? They'll find the people that are connected to Kentucky. Why would they want to be in Kentucky? The signaling helps. It also throws us off, because it makes me anxious, right? I don't know what you're thinking. I just know you've used these strategically, and now I've got to figure it out. You guys thought it was anxious. Thought it was anxious. For you all, it's worse for me. So, you know, all of that's there, but after we get around all of the reasons why we would find you, based on your geographical location, or why you would want to be at UK, then I want to find the cool people that are sitting out there that I want to meet. And there are always way more than we're gonna bring in, right? I cried match day last year, because not everybody that I loved even matched. I'm telling everybody that we did great, and they're like, are you sure? That's because you all are amazing, and it's hard to bring everybody in. And so there is not a great answer to that. We just have to strategically find the good, you know, find the good ones. And that's different, no matter who you talk to, or where you look. Anytime someone says they smoke brisket on their weekend, I put them in the yes pile. But I'm not doing it anymore, so haha. Speaking as the non-program director side, I'm really hoping to find the 90% pile. I don't really want to find the 5% in either way. They're out there, but really, as a regular interviewer, I want to be sure that you can form coherent thoughts, that you know why you want to do this particular thing, and that you can talk to me about it. So in reading personal statements, you know, it's just as important as the numbers, because if I can't sit down with you in the room and just have a conversation, the interview is probably not going to go that well. So the personal statement, for me, was like a build-up of, okay, what can I ask about? What are they interested in? Like, how can I get them to engage so I can see the passion behind wanting to do? I stand by the fact that the hobby section is still the most important. I agree. Period. I go there second. Yes? Really nice presentation. Does it matter if there's any substantial downside to potentially not waiving the right to see a letter, just in case there's one of those weird comments that an applicant could potentially address during the interview? Hmm. I mean, that is a good, like, I haven't had to think about it. Like, I don't even know how to... I don't know. I always write a letter, and I'm super proud of it. You know, I don't say yes to all of them, but if I did, then, first of all, you know it's going to be great, because I don't say yes unless I can write a good one. But I always want them to see them, like, look, look, look, it's a good job I did. But I think... You guys have seen letters that folks have agreed to write that have earned awards? Yeah. Yeah. And, you know, you can... I still think that the letter should be waived, right? Because then you have the possibility of speaking freely about that person and giving an accurate recommendation. But there are ways in the interview to bring up comments or, you know, situations from the letters without saying, Hey, this person brought this up, most of the time. Or at least try to pull out that characteristic that they talked about and kind of dig at it a little bit more. But, yeah. I'm asking more from an advertising point of view than interviews. Yeah, well, and that's what I'm trying to think of the implication, like... I don't know. Well, and I guess that, to me, I'm going to agree with Dr. Key here. There's not a letter that I've written where I would be like, oh, I didn't want that kid to read that, what I wrote. So I can see it from the argument of, oh, if they saw the letter that I wrote, it's no harm, no foul. Because I'm not going to change the way I write it based on them being able to see it or not. I'm not going to agree to write a letter saying, this guy, like, went and took a nap in his car when he was supposed to be on a rotation with me. I'm going to say, maybe you need to ask somebody else for a letter. Yeah, and there's not a lot of outliers, right? Like, you get the same tone in most of the application and most of the letters. So even if there were to be a negative kind of feel to a letter, it tends to cross over all of them. You get, and I'm not saying negative in a really bad way, but you just kind of see that that person struggled with a personality, probably. But, like, you catch that across the board. It's not really ever, for me, I don't know about you, but I've not really caught one that's been like, whoa. Why is that person writing a letter? Yeah. Yes? You know, I and my partner, we're write it myself, or how do you do that? OK, so I guess we can take it in segments. But I would say, for the people who say, once you write the letter for me, what I would want to know is, well, I don't know how you as the person would ask, what's the reason for? Because sometimes I can see the value in it if you read what the student wrote, and you could say, oh, this is what they think is important about them. And then I could change it and reword it. But if they just want you to do the work for them, again, it gets back to that whole, is that really the right person? But I can see a reason why it could be good would be more like, what does that person think they want to highlight in themselves? It's kind of like doing self-assessments. Like when you're a resident, and you have to meet with your mentor, and you're doing a self-assessment, it's like, this is what I think is important about me. And then let's see if the mentor agrees, that's what's important about me, too. And it kind of meshes up. Being the blunt, sarcastic person that I am, I would say I already did that when I wrote my personal statement. In reality, you should respond back and be like, I'll be happy to give you what I think should be featured or what I'm proud of. Let me give you some bullet points and maybe a little discussion. And you can formulate the letter. But at this point, everybody's got a little time to write letters and support those that are still coming up. And you shouldn't be writing your own letter. But you could give them that much, at least. In terms of the confidentiality for letters of the future, I know when I went up for, because I'm going up from assistant to associate, and I had to submit all this binder of data, I don't know if I can request to see it or not. But I think it's still that whole air of confidentiality, because all the letters are going to the chair of the department, and it's not really having me involved at all. Now, whether I'm allowed to, because there's not a true educational perspective, I don't think that. Being a part of the, just in residency alone, being part of the ERIS profile and all your application, it stays together forever. Whatever institution you go to, all of that goes together in your file. So it's there. You could get it, but you're not supposed to. So, yeah. You're seeing it. Thank you for that example. Yes. As a medical student, by your residency, would you recommend that we don't talk too much about gap years or medical school, and just try to focus on medical school only? Yeah, medical school only. I don't know. Unless you had a formative thing, like say, who was somebody that I had recently that was not? Yeah, if you spent a year practicing to be an astronaut, that's awesome. Keep that in there. But the supplemental lab helps that, right? Because you can go in and say, I had this experience, this life experience, and you can throw that in there if you didn't want to use your personal statement for it. You get so many sections for career stuff that you've done versus life stuff that you've done. But yeah, if it tells your story and formed who you are, then you want to include it. Yeah, that's the one caveat I would include. It should still include one of the reasons why you want to do what you're doing. Seeing the Earth from space made me have a greater appreciation for humanity. That's why I wanted to go into medicine. You tie it back in. He's not sarcastic either. I don't even know what I was going to say. Oh my gosh, I'm not going to. What was I going to say? I don't know. So if it includes your journey to medicine, it may be included, but really try to focus on that. Especially between there, yeah. And good for you for having a gap year. I wish I had thought about that back then. Back then, you just stayed the course. You went all the way through. It did take time off to build your character. I'm trying to even remember who. There was somebody who totally flipped gears, but I don't know. There's some really cool stories out there. I mean, Dr. Holland in our department, he was like a national level firefighter first. That's why he probably has the black lung. I joke. If Todd was here, he would love it and appreciate it. He would love it. Yes? One question I have is that as a letter reader, when I'm reading through a lot of these letters, I feel like I saw this person's top 5%, top 10%, top 1%. It's so many letters that it kind of became hard. Like, if every one of these people's top 5% Are they all really in the top 10%, yeah. So I kind of wonder, like, that was kind of some of the skepticism that I had at times. And I always go off the wrong end of the subject. You're talking about the person's whole family, et cetera. Is that how you tend to tackle that? I take everything with a grain of salt, anyway. I'm just wondering if you have the best applicants ever, if they're all top 5%, 10%, 1%. Yeah, I mean, there's a lot of them. Usually, I'll, again, go back to, is this a consistent letter writer? And are they saying it every time? Or is this one time that they've said it, and they don't usually say it? Yeah, because then it could be more meaningful. Like, if you're seeing the same, say it's from the same program director at the same place, and then you can go, oh, I trust that person's judgment to say this. Whereas, like, the aside, if it's like the random community doctor, it's like, well, really, how many med students are you having? This is like one of, yeah. But you take it all with a grain of salt, and you kind of put it into the rest. You start reading them, and you'll be like, it's great. You like the person. Let's figure out the rest. Otherwise, if it's somebody that mentions it but doesn't, usually, that's a bigger thing to me. Yes? Does it change the perception of applicants reading letters and or a person's statement before the rest of the application, or do you recommend reading those after they kind of complete the whole story? Repeat your question. How do we do, like, does, so I've just been a reviewer for a while. Do I get that whole little file, and it has the letters erect? What did you ask? I think, well, I think each individual reviewer is going to do it differently is what I'm trying to stop the question. You'll get your system. The first time you do it, you're like, this is a lot of stuff, right? You're just like, what is important to me? But as you review applications, you'll get how you want to do it. So, like, I've been reviewing applications for medical school, and I usually use the person's statement and the letters from the end, because it kind of ties it all up for me. Completes it. And I was like, that's how I was curious, because I've never done it the other way. It would change my perception. It's like a game to me. I like to figure out how I feel about the person and read the letters, see if I was right. That's what, by the time, so she's doing all the screening and getting the applicants together now, so how I look at it is I usually do personal statement first, because I assume she's already done all the due diligence. And so I just want to know the person. So I read personal statement, probably the hobbies, and then I do the letters of rec. And the important part to me in the letters of rec are more, who are they getting to write the letters? Because I kind of think it's cool when they get, like, oh, this is family med, and a PM&R, and a surgeon. And you're like, oh, they're getting, like, everybody. So they're doing good in all these different aspects. Yeah, who your letters are from are very important. Or if it's people I know. I'm like, oh, I know that person from OSU. Oh, I know that person from Cincinnati. They're all from another institution, not in Kentucky, mostly Texas. I'm going to be like, that person's going to Texas. I'm just kidding. But probably, right? You put all your eggs in that basket. I'm just kidding. Everybody has their different process. I would look at hobbies and then awards, and I would try and see how they could fit all the awards between the hobbies. And then I would read the personal statement and then I would read the letters of recommendation. That was my personal order. See, that's what I'm saying. Everybody does it different. Yeah, I knew the numbers were going to get looked at. Somebody over there needs to ask their question. Corner pocket. You guys, what are your thoughts on that? So how many letters do you submit for fellowship? I think it's three, PD plus yours. So I mean, I think the important part for fellowship is you definitely want to have somebody that's in that fellowship, because you need to have somebody speak to that. But I think you could get away with the other one being somebody who knows you strongly, as opposed to a second subspecialty person who knows you meh. But that's just my take. Yeah, most of the time when I've read fellowship, because I also read them for fellowship. For the Brain Energy Fellowship. I don't know how I have time for other things, but that's what I do. Most of the time when I see the fellowship ones, they'll have somebody in that particular domain of what you're wanting to do. But it's really nice to have somebody that's been following you over the four years of residency to say who you were as a person during those four years. Because it's a lot of time, and a lot of life happens in those four years. And so it's really good to hear from the PD of your program or whatever. The chair, it depends. Departments are different. Our chair happens to be very involved in our department and our program. But other chairs don't ever speak to the residents. They're just there for the faculty. And so I've seen it be more useful to hear from the PD that oversaw you, or maybe your mentor that you had over the four years that can speak to your character. Thank you guys very much. I just have one last question. Is she a plant? As a recipient of some really wonderful letters of recommendation, I was just wondering, Dr. B, what do you think is an acceptable thank you? Is it like an email, a letter, an acrophand letter, or like burden balls? It's too late for you. Just write a letter. Honestly, an email, a card. Some people still write old-fashioned cards. It's nice to get. I still get cards from med students all the time. And they go in my to-save box. So everybody, the standing academics, save all your things. If you're going in academics, start file now. One of the guys that taught us, Roland, about promotion down the line keeps a sunshine folder and all the thank yous. Even just the little blast emails saying, thanks for the talk today. It was amazing, or whatever. Keep it. You never know how far it's going to go if you need to be promoted later. But yeah, don't buy stuff. Most of the time, they're dieting anyway and can't eat them. But a card, an email, it all works. The gesture is very much appreciated if you thank your people. All right. Well, thank you guys for being good listeners and having great questions. Thanks. Thank you.

personal statements

letters of recommendation

cover letters

residency applications

writing tips

specific evidence

conciseness

positive language

gender bias

templates

evaluation process