By C.P. Kaiser

Prospective radiology residents rely heavily on the dean's letter to gain entree into an institution. But these letters are typically cloying documents, and selection committees must learn to sift through the syrup to find the substance, according to one committee chair.

"Some schools make every student sound like the next Louis Pasteur," said Dr. Levon N. Nazarian, chair of the radiology residency selection committee at Thomas Jefferson University in Philadelphia.

Institutions want to place students into good residency programs. Consequently, the dean's letter will almost never say a student is bad. In fact, if a student is bad, he or she will be called good or very good, Nazarian said. After good and very good come excellent, which means good; outstanding, which means excellent; and exceptional, which means outstanding. Sometimes superior is thrown in, which falls either above or below excellent, depending on the school.

Comments must also be dissected, Nazarian said. A student whose "histories and physicals showed marked improvement," for example, basically does terrible histories and physicals. An applicant who "has an opportunity to become an excellent student" is a very good student, which is bad, because very good in deanspeak is bad.

More detective work is needed to decode the end of the letter where the dean recommends the student as a (good, excellent, outstanding, exceptional) person for postgraduate training. Some schools explain the code such that excellent means top 50% and outstanding top 10%. Other schools leave selection committees guessing. Some institutions cleave the markers, pegging students as excellent to outstanding candidates.

"I don't know what to make of those in-between comments," Nazarian said.

Dr. Diana Baker, fourth-year resident at the University of California, San Francisco, represents one of the new breed of radiologists reaping the benefit of advanced technologies and training techniques.