Table 4.

Recommendations for Specific Letters of Recommendation (LOR) Sections

LOR Section	Recommendations
General recommendations	Follow the 2017 AAIM guidelines. Frame communal descriptors as strengths rather than weaknesses. PDs and evaluators should undergo regular anti-bias training to raise awareness of use of biased language and its context. PD and evaluator training should include discussions of bias in a broader social context, including discussions of structural racism and sexism. Have LOR reviewed by a third party with anti-bias training. Develop guidelines for the creation of a new “section for growth.”
Core competencies section	Require a separate section to describe each competency, as opposed to a single section where all competencies are described together. Ensure that evaluative quotations or narrative descriptions communicate the clinical performance of applicants, including only the pertinent content (eg, descriptions of patient care should not enter the medical knowledge section). This is especially true for evaluative quotations. Use agentic and communal descriptors to create a fair appraisal of each applicant.
Scholarly activity section	Develop guidelines to allow better characterization of an applicant's career trajectory in terms of skills and demonstrated competencies. Consider using the current scholarship subsection within the ACGME Internal Medicine Subspecialty Milestones as a guide for describing applicants' scholarly activities. Use active verbs to describe applicants' activities.
Overall summary section	Develop guidelines to standardize the overall summary section, which include a method for synthesizing the core competencies, scholarly contributions, and personal characteristics/skills sections. Use agentic and communal descriptors to create a fair appraisal of each applicant.

Abbreviations: AAIM, Alliance for Academic Internal Medicine; PD, program director; ACGME, Accreditation Council for Graduate Medical Education.