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AAIM Seeks to Assess Impact of Guidelines

Beginning in summer 2017, the Alliance began efforts to assess the use and impact of residency program director guidelines for writing letters of recommendation for fellowship applicants. Residency program directors took part in an assessment prior to the release of the guidelines, and a post-assessment in 2017.

A post-assessment open only to fellowship program directors is located below. The AAIM Resident to Fellow Interface Committee leads research efforts and will seek to publish results in spring 2018.


 Encourage your fellowship program director to complete survey

Guidelines for a Standardized Fellowship Letter of Recommendation

 AAIM has endorsed new standards for the program director letter of recommendation (LOR) for fellowship applicants. Published in the May 2017 issue of The American Journal of Medicine, these guidelines seek to improve reliability and efficiency through standardization, while continuing to allow advocacy and discussion of applicant characteristics. Supported by APDIM Council, ASP Council, and the AAIM Resident to Fellow Interface Committee, they reflect efforts to overcome challenges of the current LOR involving variation in terminology, length, interpretation, and meaningful comparison. 

AAIM appreciates the contributions of the following members from the Standardized LOR Workgroup: Nancy Day Adams, MD, Richard L. Alweis, MD, Karen M. Chacko, MD, Frances A. Collichio, MD, Bhavin Dalal, MD, Solomon Liao, MD, Caroline Milne, MD, Elaine Muchmore, MD, Teresa K. Roth, Melanie Sulistio, MD, and Gopal Yadavalli, MD.

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I. Paragraph describing your program

  • Location of program, number of trainees, and number of hospitals used for rotations 
  • Unique features of the program 
  • Types of required inpatient and outpatient rotations, including number of critical care rotations and number of elective months 
  • Percentage of residents that pursue fellowship training

II. Resident's achievement in all six core competencies

• Patient Care
Resident’s cognitive input into management decisions and effectiveness of interaction in and with consultation teams, as demonstrated by:

Whether applicant has engaged in/become independent in/mastered clinical management. Provide a representative example/faculty comment, if possible

• Medical Knowledge
As assessed by supervisors, rather than IM-ITE scores, including:

Whether applicant is achieving/has achieved/or excels in medical knowledge in all or specific aspects of internal medicine, with particular note made of the chosen subspecialty

The In-training Examination is protected data limited to learner assessment and program evaluation and items unrelated to residency that are accessible in other documents, such as USMLE scores, should not be included.

• Interpersonal and Communication Skills

Effectiveness of communication with team members and patients, timeliness of written documentation, and quality of teaching junior residents and students, supported by:

Whether applicant is achieving/has achieved/or excels in communication with team members, patients and their families providing a representative example, if possible. b. Examples to demonstrate whether applicant is learning/has achieved independence/has mastered the ability to communicate clearly in progress notes, histories and discharge summaries c. Examples of assessments of their teaching activities

• Systems-Based Practice 

Team leadership skills, interdisciplinary team interactions, and management of transitions of care, is achieving/has achieved/or excels in to include one or more of the following:

a. Success of applicant in building team relationships

b. Examples of recognition of system errors and identification of need for system improvements

c. Identification of forces that impact the cost of health care and mitigation strategies

d. Examples of efficient transitioning of patients across health care delivery systems

• Practice-Based Learning and Improvement

Willingness to accept and act upon feedback from physicians and other team members, such as:

a. Analysis of individual performance data and demonstration of self-improvements

b. Demonstration that applicant is learning/is independent in/has mastery in the skill of assessing data at point of care, including examples

• Professionalism

Peer and staff interactions, completion of required tasks within expected time-frame, including:

a. Usually/always completes chart documentation in timely manner

b. Shows up for meetings and conferences on time

c. Promptly responds to calls from teammates and patients

III. Describe scholarly contributions during and prior to residency training, highlighting

i. Involvement of resident in formulation of questions regarding quality improvement, patient safety, education or clinical research

ii. Types of scholarly activities (such as oral abstract presentations, peer-reviewed publications)

IV. Details that provide deeper insight and clarity about personal characteristics of the resident, such as level of engagement in assigned activities and degree of initiative, should be included

V. If applicable describe skills the resident has sought to master that are beyond the residency requirements, such as exemplary teaching

VI. If applicable, describe any performance-related extensions in training, curtailment of clinical privileges, or formal probation

VII. Provide an overall assessment of the resident’s suitability as a candidate for fellowship training in the subspecialty of choice

Please contact academicaffairs@im.org or (703) 341-4540 with questions or comments.