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Match Application Blog

Letters of Recommendation
for ERAS and Residency Applicants

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ERAS and interview season is upon us. While there are many components to a strong and successful application, the four letters of recommendation (LORs) are one of the most important things that Program Directors consider when granting an interview and ranking applicants. This is magnified even more in smaller, niche specialties where program directors are likely to personally know many of the letter writers. While you cannot directly control what your letter writer will put in their LOR, we have highlighted some frequently asked questions below to make sure that are able to obtain the four strongest letters you possibly can.

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Should I waive my rights to see the letter of recommendation for residency?

You should almost always waive your rights to see your LOR.

Firstly, if you suspect that your letter writer will not be writing a positive letter of recommendation in support of your application, you should not be asking that individual to write a LOR for you.

Secondly, waiving your rights to see the LOR inspires more confidence in the Program Director that you trust your LOR writer’s assessment of your character/performance.

Finally, while you may waive your rights to see your LOR, often times letter writers will share the LOR with you before they send it out (especially if they are a long-time/close mentor).

When should I ask for a letter of recommendation?

You should begin to ask your letter writers as soon as you can. If you have been conducting research or have previously completed clinical experiences with someone who you would like to write a LOR, you should ask them early and give them the due date. While academicians and physicians understand the importance of LORs, they can take a significant amount of time (especially if they are writing multiple LORs). Ask early to give them time to plan. If you are on an acting internship or away rotation, you should ask your letter writers at the end of the rotation (not a week later or a month later), again to give them time.

How do I ask for a letter of recommendation?

The most direct way is to schedule a meeting with your letter writer and ask them if they can write a positive LOR for you. While you can also send an email, asking in person may be a better option. Your letter writer will then typically tell you what information they need from you to help them write the letter. This is often an updated copy of your CV, personal statement and any other information that you are particularly proud of. If you are particularly close with your letter writer, they may even ask you to “draft” a letter of recommendation to send to them to edit. At the end of the day the more information you can provide to your letter writer the better as it will make their job easier.

Did your mentor ask you to write a draft of your LOR but you’re unsure where to start?

Do you have an example of an email to request a letter of recommendation?

Dear Dr. Smith,

I hope this email finds you well.

I am writing to kindly request a letter of recommendation as I prepare to apply for residency in Internal Medicine. As you recall, I had the privilege of working with you for four weeks during my clinical rotation at the University of Maryland’s University Hospital this past spring. Our time together on both the inpatient floors and outpatient clinics was incredibly valuable and has reinforced my passion for pursuing a career in Internal Medicine.

During my rotation, I was truly inspired by your dedication to patient care and your extensive knowledge as an internist. Your guidance, mentorship, and constructive feedback have been instrumental in shaping my clinical skills and fostering my growth as a medical professional.

As I embark on this critical phase of my medical career, I believe that a letter of recommendation from you would significantly strengthen my residency application. Your insights into my clinical abilities and dedication to patient care would provide invaluable support to my candidacy.

I understand that writing a letter of recommendation demands time and effort, and I genuinely appreciate any assistance you can provide in this matter. Accordingly, I can provide you with my CV, personal statement, or any other supporting documents that may aid you in crafting the letter.

I would be grateful if you could submit the letter by [mention the application deadline], as this is the date that programs will begin downloading applications. If you need any additional information or have any questions, please feel free to reach out to me.

Best,

Your Name

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Do you have an example of a conversation to request a letter of recommendation?

Here is a sample conversation to broach the topic in person.

You: I wanted to set up this meeting to see if you would be able to support my residency application with a positive letter of recommendation. Given the amount of time we spent on my clinical rotation, I felt that you would be able to provide good insight into my strengths and skills.

Mentor: Of course, I imagined that you would be asking for one this cycle so it is no big deal.

You: Wonderful!

Mentor: Yes, as we discussed, I felt that you did an incredible job and I’m more than happy to help you in any way possible. If you can send me an updated copy of your CV, a draft of your personal statement and any other information you would like me to highlight, it will help me tremendously.

You: Certainly, I will get that information to you as soon as possible. I know you are very busy, but if you could upload the letter by (state due date), it would be greatly appreciated.

Mentor: No problem. Just send me a reminder email 2 weeks before the due date if I haven’t already uploaded it.

Should I send 3 or 4 letters of recommendation for residency?

Generally, most residency programs require at least three letters of recommendation. However, if you have a fourth LOR that adds a unique perspective or highlights different aspects of your skills and experiences, it may be beneficial to submit it as well. Still, it’s crucial to check each program’s specific requirements before sending your LORs. Finally, it is always better to choose quality over quantity. If you feel that your fourth LOR may be generic it may be advisable to not include it.

What is a strong letter of recommendation for residency?

A strong letter of recommendation for residency is one that is detailed, personalized, and comes from someone who knows you well. It should highlight your skills, experiences, and personal qualities that make you an excellent candidate for the residency program. The letter writer should provide specific examples of your clinical skills, ability to work in a team, leadership abilities, and dedication to patient care.

Can I use a letter of recommendation from an older experience?

Absolutely, but within reason. If you have a research experience from two years ago, it is perfectly acceptable to request a LOR from that mentor. That being said, I would not ask for letters from High School or Middle School teachers.

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Who Should I ask for a letter of recommendation?

In an ideal world, you should ask someone who knows you well and who is well known in their field. However, often times you cannot check both of these boxes. Most program directors will say that they prefer a strong letter of recommendation from an individual who knows the applicant well and can speak to their skills/strengths over a generic lukewarm letter from a well-known Department Chair who only briefly interacted with the applicant.

What about standardized LORs?

Some specialties now have standardized forms that they mandate letter writers submit with the LOR that is uploaded with your ERAS application. Simply tell your LOR writer that this form also needs to be uploaded and provide a copy to them via email for their convenience.

Looking for a comprehensive ERAS Application Template with examples of diverse experiences and publication types?

Can I use a letter of recommendation from another specialty?

Possibly. Again, in an ideal world, it would be great to have as many LORs come from physicians or scientists with direct connections or appointments in your specialty, but it is not imperative. If you are dual applying you can select which letters you would like to send. So, for example, if you have 7 letters (3 general surgery and 4 vascular surgery) and are dual applying to general surgery and integrated vascular surgery, you can select the general surgery letters for your general surgery application and the vascular surgery letters for your vascular surgery rotation.

What mix of clinical vs. research letters of recommendation should I use?

This depends on your background and experiences. Because you are applying to a medical residency you most certainly should not exclusively use research LORs. If you have a significant research background, I think a 50/50 split between research and clinical mentors is appropriate. Sometimes you will have mentors that you have worked with clinically and in a research setting. This is a great scenario because they can comment on your skills in both settings.

Curious about delving into research but unsure where to begin? Our Systematic Review Premium Bundle has got you covered! This all-inclusive package brings together all our research courses to provide you with a comprehensive learning experience.

Should I use a letter of recommendation from someone outside of the U.S.?

Because you are applying for a clinical position in the US, you should try to obtain as many LORs from mentors in the US as possible. If you are an IMG, LORs from US mentors and US clinical experiences will assuage fears in program directors regarding familiarity with the US healthcare system. That being said, if you are able to get a LOR from someone who is incredibly well-known worldwide (i.e. an internationally well-respected neurologist from London), that would be acceptable.

What do Program Directors look for in a LOR?

There is an art to writing an LOR and often times there is coded language in the LOR. Program directors read 100s of LORs each cycle and if your specialty is small enough, they may know many of the letter writers personally. Additionally, they may read several LORs from the same letter writer for different applicants.

Ultimately the Program Director wants to see that the letter writer is someone you have spent significant time with and their overall assessment of your performance and character. LORs with generic statements without actual descriptions of interactions with the applicant are not ideal.

Letters of recommendation typically end with a frank paragraph or sentence that says something along the lines of “This applicant ranks in the top XX% of medical students I have worked with.” If they say that you are the best student they have worked with or are in the top 1% or top 3, that is the hallmark of a strong letter vs. an average letter

How do I submit letters of recommendation through ERAS?

I have a full video that explains in detail how to submit LORs through ERAS. You can check it out HERE.

Draft Your Powerful Letter of Recommendation! Structural Changes, Language Revision & Content Guidance by a Physician Advisor

When should letters of recommendation be sent through ERAS? When is the deadline to submit LORs?

Letters of recommendation should ideally be submitted to ERAS a few days before programs start reviewing your application, which is generally at the end of September, as it takes a few days for the LORs to be uploaded to ERAS. However, ERAS allows LORs to be uploaded even after the application is submitted. While there is no official deadline, it’s crucial to have all your LORs as soon as residency programs start reviewing applications and inviting candidates for interviews.

Can I send my letters of recommendation after I apply to programs?

Yes, you can send your letters of recommendation after you apply to programs. While your ERAS application can be submitted without all your LORs, it’s important to have them uploaded as soon as possible. Once you upload all 4 letters for a program, you can’t change the assigned letter. Residency programs generally start reviewing applications in early to mid-October, and a completed application, including all LORs, makes a stronger impression. Remember, your application will be considered incomplete without the LORs and could potentially be overlooked during the initial review phase.

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Letter of Recommendation Sample and Commentary

Dear Program Director

I am writing this letter of recommendation in support of Shiv Roy, who is applying to this year’s match in Internal Medicine. Shiv has been an exceptional student under my mentorship during her US clinical rotations and research endeavors. I have had the privilege of working closely with Shiv during her time at my primary care outpatient clinic in San Diego, where she displayed remarkable dedication, medical knowledge, and a commitment to excellence.

This paragraph starts out by clearly stating that the writer is a strong supporter of the applicant. They mention the context in which they know the applicant and may mention how long they have worked with the applicant (if it has been a long-term mentorship).

From the outset, Shiv’s depth and breadth of medical knowledge impressed me. During her three-week clerkship at my clinic, she seamlessly integrated herself into the work environment. In a short period, Shiv was actively involved in patient care, performing tasks ranging from taking comprehensive histories and conducting physical examinations to formulating differential diagnoses and implementing treatment plans. I was particularly impressed by her note-taking skills on our electronic medical record system, Epic, which she mastered through her own initiative and meticulousness. Her colleagues and residents also recognized her hard work and exceptional patient care. Outside of this, both the office staff and residents commented on her positive attitude, can-do personality and pleasant nature. Indeed, Shiv’s presence in the office was felt so much that I have even had several patients ask for updates on “Dr. Shiv” since her rotation with us.

Next, the letter writer dives into their personal experiences with the applicant and provides specific examples of things they did well. They also mention her interactions with other trainees, staff and even patients.

Furthermore, Shiv’s enthusiasm extended beyond clinical rotations. Following her time at my clinic, she expressed a desire to engage in research activities within our department. I connected her with Dr. Jim Smith, a respected colleague studying social determinants of developing pulmonary fibrosis. Shiv worked remotely with Dr. Smith for six months, all while completing additional clinical rotations and studying for the three-step sequence of the USMLE. Her commitment to research and her ability to balance multiple responsibilities were truly remarkable.

While the applicant may also have a letter from her research mentor Dr. Smith, this letter writer highlights her research experience with him since he was the one to connect her with him. In this letter, the letter writer not only highlights his praise and recommendation for the applicant but consistently states that others feel the same way.

In addition to her exceptional scholastic achievements, Shiv’s personal qualities further distinguish her. She is an incredibly compassionate individual with strong family values. Shiv’s commitment to supporting her family in India is evident in her willingness to work a second job as a food delivery driver, alongside her full-time responsibilities in the lab. This resilience and empathy demonstrate her determination to overcome challenges and her unwavering dedication to helping others.

Finally, the letter writer comments on the applicant’s personal qualities and in this particular example highlights her resilience and dedication to her family.

Having mentored numerous medical students, residents, fellows, and junior faculty members throughout my career, I can confidently assert that Shiv Roy is a generational talent. Her potential for success is truly outstanding. I hold no reservations in providing my highest recommendation for Shiv as an applicant in this year’s internal medicine match. She is my top choice, and I firmly believe that she will bring great honor to your institution.

This is the final paragraph and is normally the most important. In this paragraph, the letter writer tells Program Directors where this applicant compares to other individuals they have mentored. They will use frank language here and may even say that they are going to rank this applicant to match at their program (if the letter writer is a Program Director).

Thank you for considering Shiv’s application. Should you require any additional information or have further inquiries, please do not hesitate to contact me. I am more than willing to provide any necessary assistance.

Best Regards,

Looking for detailed letters of recommendation templates?

As you can see, the letter above highlights all of the key components of a strong LOR. The letter writer clearly knows the applicant and has worked with her closely. They are able to articulate her strengths, clinical skills, interpersonal skills and dedication to patient care. Importantly, they provide specific examples. The more personalized the LOR the better. Had the letter writer failed to highlight these examples and simply stated that the applicant “possessed empathy and strong clinical and interpersonal skills” it would have significantly watered down this LOR. The final paragraph is also important, simply “recommending” an applicant is not enough, the letter writer should be able to say that the applicant is in the top XX percentile or the top X number of applicants I have worked with.

If you need help with your LOR, check out our letter of recommendation editing services HERE.

In summary, LORs are one of the most important components of your application. While you have little control with respect to what your letter writer actually puts in the LOR, you can set yourself up for success by following the guidelines highlighted in this blog post. As always, if there are any further questions or guidance needed, we offer advising sessions with members of our experienced team.

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