Klimpl et al. make a strong argument in regards to the impact of obtaining quality letters of recommendation (LORs) from the sub-internship or acting internship rotation as an important outcome to consider when designing this rotation.1 It has been shown that LORs that convey a greater depth of interaction with the applicant, the applicant’s abilities, and specific applicant traits of the applicant are valued by Program Directors.2 Inclusions of direct observation of applicants in LORs are seen as useful indicators of strong students.3
When designing the Direct Care Hospitalist Service (DCHS) rotation, we aimed to maximize our faculty’s continuity on our day and night services during the month to allow for more direct student observation. In our initial faculty survey during our pilot year, all were satisfied (4/12) or very satisfied (8/12) with the ability to know the sub-intern well enough to write a LOR.
We agree that direct outcome data in terms of LOR quality, residency interview offers, and the residency match are important outcome measurements to evaluate the impact of the rotation. However, as sub-internship is not required prior to residency applications, the true impact of this capstone rotation is in the transition to residency and subsequent performance. If an LOR or evaluation from a sub-internship is obtained prior to residency applications, this information can and should be better conveyed given the increase in direct observation and continuity present within the DCHS rotation.
Author Contribution:
All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline.
Declarations:
Conflict of Interest:
The authors declare that they do not have a conflict of interest.
Footnotes
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References
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