Girzadas D V, Harwood R C, Dearie J, Garrett S
Department of Emergency Medicine, Christ Hospital and Medical Center, Oak Lawn, IL 60453, USA.
Acad Emerg Med. 1998 Nov;5(11):1101-4. doi: 10.1111/j.1553-2712.1998.tb02670.x.
To compare the Council of Emergency Medicine Residency Directors' (CORD's) standardized letters of recommendation (SLORs) with traditional narrative letters of recommendation (NLORs) with regard to interrater reliability, consistency, and time of interpretation.
In part I of the study, four members of the residency selection committee each evaluated the same 20 SLORs and 20 NLORs from which all identifying characteristics had been deleted. Using Likert-type scales of the global assessment, each letter was assigned a numeric value from 1 to 7. The interrater reliability was calculated for both types of letters using the Kendall coefficient of concordance. Average time to interpretation of the letters was also determined. In part II, using the same numeric values as in part I, 207 single-author SLOR/NLOR pairs were evaluated to determine whether the global assessment of the SLOR was consistent with that of its partner NLOR. Interpretation of the NLOR was performed blinded to the SLOR. Statistical analysis was calculated using Spearman correlation coefficients.
In part I of the study, the interrater reliability of the SLOR was 0.97, as compared with 0.78 for the NLOR. The average time to interpret the global assessment of the SLOR was 16 seconds, vs 90 seconds for the NLOR. In part II of the study, of the 207 SLOR/NLOR pairs, 112 (54%) were assigned the same numeric value, 80 (39%) differed by one, 13 (6%) differed by two, and two (1%) differed by three, for an overall correlation of 0.58.
Compared with NLORs, the CORD SLOR offers better interrater reliability with less interpretation time. Single-author SLOR/NLOR pairs submitted for a single applicant do not correlate well. Residency selection committees must decide whether the added work of interpreting NLORs is beneficial.
比较急诊医学住院医师培训主任委员会（CORD）的标准化推荐信（SLOR）与传统的叙述性推荐信（NLOR）在评分者间信度、一致性及解读时间方面的差异。
在研究的第一部分，住院医师选拔委员会的四名成员分别对20封已删除所有识别特征的SLOR和20封NLOR进行评估。使用李克特式量表进行整体评估，每封信被赋予1至7的数值。使用肯德尔和谐系数计算两种类型推荐信的评分者间信度。同时确定解读信件的平均时间。在第二部分，使用与第一部分相同的数值，对207对单作者SLOR/NLOR进行评估，以确定SLOR的整体评估与其对应的NLOR是否一致。对NLOR的解读在不知道SLOR的情况下进行。使用斯皮尔曼相关系数进行统计分析。
在研究的第一部分，SLOR的评分者间信度为0.97，而NLOR为0.78。解读SLOR整体评估的平均时间为16秒，而NLOR为90秒。在研究的第二部分，207对SLOR/NLOR中，112对（54%）被赋予相同数值，80对（39%）相差一个数值，13对（6%）相差两个数值，2对（1%）相差三个数值，总体相关性为0.58。
与NLOR相比，CORD的SLOR具有更好的评分者间信度且解读时间更短。为单一申请人提交的单作者SLOR/NLOR对相关性不佳。住院医师选拔委员会必须决定解读NLOR所增加的工作量是否有益。
