Eric Grosch, Letter to Dr. Morgenstern on LOR - Semmelweis ...

...One of our wisest and most experienced faculty members, <strong>Dr</strong>. Douglas Lindsey, offers <strong>to</strong> write
letters for every medical student. He writes them honestly. He then shows the student the letter. It
is up <strong>to</strong> the student <strong>to</strong> decide wether it is sent. This is an excellent policy of a great teacher.
Unfortunately, it is probably unique. (320)
A few students have been asked <strong>to</strong> sign statements that they have not seen their reference letters.
This is ridiculous and unenforceable. Don't sign...it is common practice for students <strong>to</strong> be asked <strong>to</strong>
sign a waiver of their right <strong>to</strong> request <strong>to</strong> see referee letters. If you are forced in<strong>to</strong> this type of
situation, you may have <strong>to</strong> sign it and hope for good letters. If possible you do want <strong>to</strong> see those
letters before they go out. (321)[53]
The practice of “confidentiality,” under compulsion and under false color of “honesty,” in the
rater, may thus spawn duplicity and dishonesty in the ratee.
On the subject of so-called honesty, one naturally wonders whether the “honesty” will be
even-handed or biased. A few obvious questions spring <strong>to</strong> mind:
Will the rater be as “honest” about how he himself prioritized the needs of trainees lower than his
own personal needs and therefore devoted insufficient time <strong>to</strong> the those in need of guidance <strong>to</strong>
foster their improvement as he claims <strong>to</strong> be about the shortcomings of those trainees, whom the
rater thus abandoned? Will he be honest about his own failures <strong>to</strong> implement and incorporate core
content of his specialty (e.g., emergency-medicine) in training and rating his trainees? Will he be
honest about his own failure <strong>to</strong> provide daily feedback <strong>to</strong> trainees <strong>to</strong> keep them informed of what
specific performances they needed <strong>to</strong> demonstrate the following day <strong>to</strong> show improvement? Will
the rater be honest about his own failure <strong>to</strong> document daily or weekly improvement or otherwise
and reasons therefor in his rating-comments? Will the rater be honest about his own failure <strong>to</strong>
define behavioral educational objectives,[92] <strong>to</strong>ward which the trainees might strive? Will the
rater be honest about how he exchanged gossip with other faculty about various trainees and
thereby formed a collective, united, homogenized opinion of trainees, insteade of expressing his
own opinion, based on his personal observations? Will the rater be honest about casting the
evaluation in terms only of the trainee's failures, not in terms of systematic failures of the
institution?
Tonesk provides a twisted view of objectivity vs. subjectivity and authority-relationships in
medical education.[93]
In the realm of edi<strong>to</strong>rial peer-review, Walsh et al found referees more considerate and courteous
<strong>to</strong>ward authors if their names attached <strong>to</strong> their reports[94]. What's wrong, therefore, with
accountability in LORs?
Flacks wrote:
. . . maintaining the confidentiality of the contents of evaluations and letters of reference would
[not] improve the quality of such assessments. On the contrary, . . . I've become convinced . . .
that the reverse is true. New state laws and university regulations have opened the process . . --