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Background <p>The utility of Letters of Recommendation (LORs) in The Match has been questioned in recent years. Although programs across specialties have generally favored LORs, their use and value remains unclear.</p> Objective <p>The aim of this study was to review all existing literature pertaining to LORs to better understand their strengths and limitations. We hypothesized despite overall support for LORs, the evidence may argue against their current use.</p> Methods <p>This study was a scoping review conducted between October 17th, 2024, through January 25th, 2025, using a single database PubMed search term “Letter of Recommendation Residency”. Articles were screened for relevancy, followed by full text review, including only primary research articles and non-applicant perspectives. Open ChatAI, a third-party AI platform, and Covidence, a third-party review platform was used to extract studies based on outcomes and characteristics.</p> Results <p>Our final review included 108 research articles. Among selected articles, three primary aims were appreciated including program opinions, content analysis, and predictive value. A majority of studies supported LORs (68.1%) despite a high prevalence of observed bias (82.4%) and low predictive value (56.5%).</p> Conclusions <p>LORs remain a key part of the application materials among concerns in the literature for their limited predictive value and bias concerns (race, gender, title). This highlights the need for a novel tool geared toward objectivity and aptitude to improve the quality of The Match for both programs and applicants.</p>

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Nothing to Write Home About? A Scoping Review of Letters of Recommendation in the Match

  • 期刊论文

  • 发表日期：

    2026年2月28日

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  • Paul Beinhoff,
  • Chad Carlson

摘要

Background

The utility of Letters of Recommendation (LORs) in The Match has been questioned in recent years. Although programs across specialties have generally favored LORs, their use and value remains unclear.

Objective

The aim of this study was to review all existing literature pertaining to LORs to better understand their strengths and limitations. We hypothesized despite overall support for LORs, the evidence may argue against their current use.

Methods

This study was a scoping review conducted between October 17th, 2024, through January 25th, 2025, using a single database PubMed search term “Letter of Recommendation Residency”. Articles were screened for relevancy, followed by full text review, including only primary research articles and non-applicant perspectives. Open ChatAI, a third-party AI platform, and Covidence, a third-party review platform was used to extract studies based on outcomes and characteristics.

Results

Our final review included 108 research articles. Among selected articles, three primary aims were appreciated including program opinions, content analysis, and predictive value. A majority of studies supported LORs (68.1%) despite a high prevalence of observed bias (82.4%) and low predictive value (56.5%).

Conclusions

LORs remain a key part of the application materials among concerns in the literature for their limited predictive value and bias concerns (race, gender, title). This highlights the need for a novel tool geared toward objectivity and aptitude to improve the quality of The Match for both programs and applicants.