National survey of writers of dean's letters for residency applications.

The purpose of the study reported here was to provide descriptive information about dean's letters, which are comprehensive summary letters sent near the end of students' undergraduate medical training by medical school deans to be part of the students' residency applications. Deans of student affairs at 124 U.S. medical schools were surveyed regarding composition of these letters at their institution. They were asked to describe themselves and the letters they write. Responses were received from 87 percent of these schools and provided data on types of information included in the letters, the decision to edit evaluations, student participation in the letter-writing process, use of final summary statements, cost and length of letters, and attitudes toward the development of national letter-writing guidelines. Major findings of the survey show that 97 percent of the writers allocated more space for clinical evaluations than basic science evaluations. Less than 50 percent of the writers included the student's class rank. Almost all included narrative evaluations of the student's performance during the clinical years. Negative information on students was addressed inconsistently by the writers. Eighty-five percent of the writers categorized their students in final summary statements, but many of these failed to provide descriptions of the categories used or explanatory data. The present authors make recommendations for writing more credible and useful letters.