Unveiling Humility in Emergency Medicine Chief Residents: A Thematic Exploration of Standard Letters of Evaluation.

INTRODUCTION: Although humility is a key leadership trait linked to collaboration and trust, current residency application processes lack methods to identify it. By examining whether themes of humility appear in the Standardized Letters of Evaluation (SLOE) of medical students who later became emergency medicine (EM) chief residents, we sought to determine the presence of humility-related traits in SLOEs and explore their potential to inform the identification of applicants with leadership potential during residency selection. METHODS: Two independent reviewers examined 104 SLOEs (52 chief, 52 non-chief) from 2015-2021, representing 43 students (21 who later assumed chief resident positions and 22 who did not) between 2018-2024 at a single academic EM residency program. A third reviewer resolved all coding disagreements. Reviewers deductively analyzed all written comments, targeting elements associated with humility as conceptualized by Tangney (2000) and Gruppen (2015). A SLOE was categorized as containing elements of humility if at least one clearly defined construct (such as openness to feedback, recognition of limitations, or concern for others) was identified. Sections of the data displaying the most convergence of humility elements underwent open coding, revealing emerging themes. RESULTS: Nineteen of 21 (90.5%) chief residents had letters encompassing elements of humility compared to only 10 of 22 (45.5%) non-chief residents (P < .01). Openness was the most prominent element noted, followed by the need to make changes in performance, concern for others, and confidence. Further analysis of comments that highlighted humility uncovered several other themes including commitment and advocacy, eagerness to learn and improve, and maturity and responsibility. CONCLUSION: This study highlights specific humility-related traits noted in the Standard Letters of Evaluation of fourth-year medical students who later became chief residents in emergency medicine, offering preliminary insights into how qualitative evaluation tools may capture characteristics associated with future leadership roles.