The intent of the standardized letter, as communicated through the websites of the Electronic Residency Application System (ERAS®) and CORD as well as in direct communication to our community, was for it to fully replace the traditional letter of recommendation. The electronic standardized letter of recommendation allows for a standard display of the credentials of the letter writer, the degree of involvement between the applicant and the letter writer, and an ability to select answers to questions that are mapped to the 6 ACGME core competencies. There is also an ability to provide any additional pertinent information in a generous comments box. In essence, the eSLOR was developed to perform the following functions:

  • Provide a global perspective on an applicant’s candidacy for training in a format that allows for easier and potentially more meaningful comparisons to peers.
  • Provide this information in a standardized layout for easier comparison and individual data queries.
  • Encourage the creation of a completely electronic interface. This will eventually yield a database of information that will undoubtedly improve the match process as a whole.

In the most recent application cycle, the nation’s orthopaedic surgery residency programs will have reviewed more than 80,000 applications from over 1,000 unique applicants, each with three to four letter writers lobbying for their acceptance. A thoughtfully completed eSLOR provides an invaluable perspective to every reviewer and allows for the writer to evaluate applicants with common language. Additionally, there is a generous section that allows for personalization of the letter if the writer so desires. In addition to standard categories of medical knowledge, communication skills, and professionalism, personalized comments should highlight unique aspects of the applicant. At the end of the form is a summative statement that is meant to only suggest to a reader where a potential applicant would be placed on a hypothetical rank list constructed by the writer in question.

Lastly, with a historic match rate of 75% among senior medical students applying into orthopaedic surgery from US medical schools, we are encouraging letter writers to be mindful of grade inflation and encouraging reviewers to be equally mindful of those writers that give an honest and accurate summative statement. It is unlikely that every candidate should be ranked for a guaranteed match. In fact, an applicant who is ranked in the middle 1/3 of applicants is still very likely to match!