Your Complete Residency Letter of Recommendation Guide

Why Are Residency Letters of Recommendation So Important?

Letters of Recommendation (LoRs) are a critical component of every residency candidate’s ERAS Application. In fact, Program Directors consistently rank specialty-specific LoRs as one of the most important factors for inviting candidates to interviews: in 2020, 84% of PD’s cited LoRs as an important interview invitation factor with an importance value of 4.3 out of 5.

Furthermore, specialty-specific LoRs are consistently among the Top 5 Most Important factors for ranking an applicant, according to NRMP Program Director Surveys year after year.

ERAS Letters of Recommendation serve several key functions in your residency application:

  • Demonstrate experiences specific to the specialty to which you are applying
  • Demonstrate good rapport with multiple physicians
  • Showcase work ethic, commitment to the specialty, and contributions to medicine
  • Exemplify personal characteristics, academic performance, and involvement
  • Reinforce and integrate aspects of your ERAS Application and Personal Statement

Your ERAS LoRs are 1-2 page letters written by those you have worked with in the field. You should apply with 2 or more specialty-specific LoRs out of the 3 or 4 total LoRs you submit with each application.

**DO NOT SUBMIT LoRs  recommending you for a different specialty than the one which you are applying to.** 

Instead, ask your LoR authors to write 2 versions of your LoR. For example, the first LoR could be recommending you for Internal Medicine (especially if they are an internist) while the second LoR is a general recommendation for any specialty. Asking your authors to make a few small tweaks to their LoR (usually just a few sentences each) is an excellent way to help tailor your application to your top specialty as well as any backups to which you may be applying.

Who Should Write Letters of Recommendation? (and who should not)

The author of your LoRs is very important. It helps establish credibility, relevance to the chosen specialty, and can even serve as a bridge for further confirmation/investigation by programs of interest.

Generally speaking, your LoR Authors should be:

  • Practicing in the specialty to which you are applying
  • A higher rank/status than yourself (attendings, advisors, managers, etc.)
  • Medical professionals – This can mean being a physician, researcher, public health advocate, etc.

The BEST Letters of Recommendation are from:

  • Specialty-specific clinical settings in the United States
  • High ranked authors who know you very well and have worked with you in an extended clinical setting (PDs, Department Heads/Chairs, Attendings)
  • Recent – Within 1 year (or 2 years maximum)

Letter of Recommendation Authors should NOT be:

  • Peers, family, or friends (use your best judgement)
  • Written by those who do not know you or who have had little interaction with you
  • Written with errors in spelling, grammar, and syntax

Basically, the strongest ERAS Letters of Recommendation will come from specialty-specific physicians in the USA who have worked with you extensively and can craft a very detailed, personable, precise, and persuasive reference toward your candidacy – which leads to our next important topic – how to actually get these Letters of Recommendation.

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Obtaining the Best Letters of Recommendation

Getting the strongest LoRs takes planning and early execution. It will take your authors time to discuss your LoR with you, draft and edit, and then upload  to ERAS (which can be a daunting and confusing task – especially for international authors who are unfamiliar with ERAS).

For those currently in medical school – your clinical rotations during MS3 are when you should START PLANNING for obtaining your LoRs. This means making yourself known to attendings, establishing personal relationships, and standing out in the best ways. Moreover, be sure to foster these relationships even after your rotations. A strong residency network is one of your best allies when it comes to success in The Match.

The Reality: How to Write Your Own ERAS Letters of Recommendation

The truth is that every year, thousands of residency applicants are asked to write their own residency Letters of Recommendation. Many physicians simply may not have the time, interest, or desire to write the LoR for you, but are happy to sign off at the bottom after you’ve written it for them.

So, how do you write your own Letters of Recommendation? Luckily, we’ve created an Authorship Guide for any letter writer to use.

If you’ve written one or more LoRs for yourself, we highly recommend having a professional review and edit this document. Since LoRs are so incredibly important for your application, you do not want to fall short. With Residency Experts, Residency Document Editing (including LoRs) is only $99 for comprehensive, in-depth editing and optimization.

The Reality: How to Write Your Own ERAS Letters of Recommendation

Residency Letter of Recommendation Checklist

Section Checklist Guidelines
Format of the Letter Letter Length – In order to achieve the correct length for the strongest Letter of Recommendation, we recommend the letter be a minimum of 3 paragraphs and 1-2 pages.

– If the letter is lacking in length, we suggest meeting with your Letter Writer and providing  more materials for them to use to create more content (such as your Personal Statement, CV, or ERAS Application).

– If the letter is too long, review the letter for anything you feel is not necessary for a strong Letter of Recommendation and suggest revisions to your Letter Writer. Alternatively, if allowed, have your LoR Editing done by an Expert!

Signature A Letter of Recommendation without a handwritten signature is not as authentic to residency programs. If your letter is currently lacking a signature, be sure to contact your Letter Writer and ask them to hand sign the letter before they submit it.
Letterhead Letters of Recommendation should have a professional letterhead that includes the institution name and logo, the date created, as well as the author’s name and title.
Date – Within a year = Strong, ideal

– Within 2 years = Caution, this letter is on the border of being too old

– Older than 2 years = Too old: Talk to Letter Writer about AT LEAST uploading the letter with a new date if you are not able to ask for a new letter.

Specialty-Specific Specialty-Specific The strongest Letters of Recommendation are specific to one specialty. If the letter is generic, consider initiating a conversation with your Letter Writer and asking them to mention your strengths and suitability for one specialty of your choice.
Origin of the Letter US Based While International Medical Graduates may need to use Letters of Recommendation from their country of origin, having US-based LoR’s is preferred by residency programs.
Experience Origin The origin of the experience is important – hands-on clinical settings in the specific specialty are ideal. All LoRs should be relevant to medicine in some capacity, whether that is through research, public health, or otherwise.
Strength of Letter Writer Relationship – Letters of Recommendation should include the length of time which the writer has known the applicant.

– The nature of the relationship should also be evident.

– Be sure to contact your Letter Writer and ask for them to provide any of the missing components. They can include a sentence such as, “I have had the pleasure of working as [Candidate’s Name] mentor/ professor/supervisor/etc. for [length of time].”

Quality of the Content Characteristics It is important for Letters of Recommendation to include specific examples of the applicant’s competency, characteristics, and behaviors. Examples could include ACGME Core Competencies, GPAs, or stats of any kind. If the letter is lacking specific details, we suggest meeting with your Letter Writer and providing more materials for them to use to create more content (such as your Personal Statement, CV, or ERAS Application. You can also suggest providing them with a summary of your time together).
Genuine Letters of Recommendation must demonstrate a genuine knowledge, care, and confidence in the applicant. However, the LoR should not be excessive, boastful, or hyperbolic.
Weaknesses Weaknesses can be mentioned in a Letter of Recommendation. However, they should end as evidence of your growth as a person or professional. If possible, address the weakness with your Letter Writer and ask them if they could include any steps you took to improve, confirmation that the behavior has been fixed, and/or something about how you’ve grown as a person.
Spelling and Grammar All LoRs should be written with excellent spelling, grammar, syntax, and prose. If your author has poor writing skills or is not a native speaker, it is highly advisable to have your LoR edited by a professional.

Thanking Your Letter of Recommendation Authors

Thanking your LoR writers is respectful, polite, and simply the right thing to do! Sending a genuine thank you letter or email is a wonderful way to continue building a strong rapport with your LoR author.

Remember, getting this LoR isn’t the end of the road with your writer. They may serve as an invaluable aspect of your medical network, helping you land the future opportunities you are dreaming of!

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