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Residency Application
Letters of Recommendation
Letters of Recommendation (LORs) are an important part of your application. Along with clerkship & Sub I grades and the interview, your LOR’s are one of the most important factors programs use when selecting candidates for interviews and in ranking candidates.
Residency programs hope to learn several things from a LOR:
- They are interested in your fund of knowledge, clinical judgment, interpersonal skills and personal qualities.
- They also want to know type of student you are to determine your potential as a resident.
- Essentially, they want to uncover if will you be a good fit for their program
You can and should be asking for LORs early on, even before you have decided on a specialty or picked programs. However, the majority of LORs come from 4th year work.
It is very important throughout this process to keep in mind that programs and specialties may have different requirements. It is your responsibility to research requirements prior to applying.
Who to Ask
- The most important factor is to ask someone who knows you well and can describe your fund of knowledge, clinical judgment, interpersonal skills and personal qualities.
- Letters should be from faculty who have observed your clinical work.
- The exception is a letter from a faculty research advisor, especially if research is important to your program or specialty
- The majority of your letters should come from 4th year.
- As a 4th year student you are more experienced and mature, and your work is likely to be a better basis for a strong LOR.
- Your most important letter will likely come from your fourth year Sub-Internship in your specialty. It is very important to ask early in this rotation for a letter and to work closely with this attending.
- Other valuable LOR’s may come from other relevant specialties, i.e. Pediatrics for Family Medicine or vice versa
- NOTE: Programs have different requirements. For example, a surgical program may require one non-surgical LOR. Check specialty-specific requirements.
- However, it is recommended to request at least one letter of recommendation from your 3rd year. You may need it to round out or complete your application. Having an extra letter or two on file is suggested, espeically if:
- You performed well
- It is from a relevant specialty
- It is from later in the year
- You are offered a letter
- Scheduling and timing of specialty choice can prohibit you from getting enough 4th year LOR’s.
- Do not ask 1st or 2nd year faculty, no matter how well you did or how much they love you. Programs want to know about your clinical performance.
- “Famous” vs. “non-Famous” Faculty
- “Famous” faculty are those physicians who are well known, in their field or region, or who hold important positions, such as department chair.
- A LOR from a “famous” faculty member can be extremely helpful, but only if they know you well. If not, it will be obvious and the LOR will carry little weight.
- Senior vs. Junior Faculty
- Both are perfectly acceptable however, a letter from a senior faculty member who knows you well can carry more weight. However, having worked with your letter writer personally is the most important factor
- No residents! There are rare exceptions, i.e. some Ortho programs require a letter from a chief resident.
- Faculty from away rotations, especially in your specialty can be very helpful.
- This letter can illustrate how well you perform outside your home institution and is an unbiased evaluation and comparison to other students.
- A letter from a faculty member in the program or region a student is applying can be helpful.
- Remember, you do not have to send this letter to all programs. You can send it just to that away site or to the region of the country where you did the rotation.
- Other important issues and exceptions…
- Never family members!
When to Ask
- Give your letter writers adequate time, about 4-6 weeks, to write your LOR.
- Depending on your programs, you should aim to have your LOR’s submitted by mid-September for ERAS, and by September 1 for SF Match
- It is best to ask at the start of the rotation, especially for 4th years. You can let the attending know you will be requesting a LOR as early as the first day.
- You can also wait to get to know the faculty and let them get to know you before asking. If you decide to wait, ask faculty soon after the rotation ends. They will have your performance fresh in their mind and can write a stronger LOR.
- If needed, you can go back and ask a 3rd year attending, but the longer you wait after you have finished the rotation, the more difficult it will be for them to write the letter
- Always remind your letter writer at the end of the rotation.
- Until ERAS/SF opens, please ask your letter writer to write the letter now and hold it until you can provide them with the ERAS Letter Request Form.
How to Ask
- Ask directly and in person
- We recommend meeting with your letter writer, in person, to discuss your career goals, strengths and interests. It will help him/her compose a more personal LOR.
- Address generic versus specialty specific LOR’s
- Discuss career goals & strengths
- Some may offer you a LOR. Respond to this offer ASAP.
How Do I Ensure a Strong LOR?
- It is extremely important when requesting a LOR to ask your letter writer if they can write you a strong letter.
- Know yourself: Did you do well on this rotation? Did you perform your best for this attending?
- Read body language and be aware of any discomfort
- If faculty makes any excuse, look elsewhere for a LOR
What information should I provide to my letter writer?
For ERAS:
- Once you have an ERAS token, you will be able to add your Letter Writer's name (LoR Author) into your MyERAS Application. You will then be able to provide your letter writer with an ERAS "Letter Request Form".
- This form provides the LoR Author with instructions on how to upload your letter into the ERAS LoRPP as well as a unique identifier which each of your LoR Author's will need in order to upload your letter.
For SF Match (Ophthalmology applicants):
- The SF Match LOR Portal allows applicants to send online requests for letters of reference and authors to upload letters directly into applicants’ accounts.
For MODS (Military Match):
- Students must request letter writers send their LOR to Gabrielle Alaimo, to forward to the appropriate military contact for upload to MODS
- This method is required for cilivilian letter writers. However, military letter writers may choose to upload materials directly in to MODS from military network computer
Other Information to Know
- It is strongly recommended that you waive your right to see the LOR.
- This must be indicated on the ERAS Letter Request Form before sending it to your letter writer.
- We recommend you share your CV with letter writers(Link to CV site)
- Letter writers may also request other documents from you, such as:
- Personal Statement (Link to P.S. site)
- Copies of Evaluations
- Transcripts
- We also recommend you provide and discuss a list of experiences and qualities you would like highlighted
- Tell your letter writer if you would like the letter to be specialty specific (you will be an excellent Ob/Gyn) or general (you will make an excellent resident)
- This is very important if you are undecided, applying to more than one specialty or to prelims/transitional years.
- LOR’s should focus on your direct clinical interactions with the faculty member, not your whole medical school career or life story. So only give what is relevant.
- Follow up with email summarizing meeting. This also serves as a good reminder.
- Thank you note & follow up
How many letters will I need?
The number of LOR’s that you will need will vary by student and program. While most will only need three, you may need more depending on your specialty, if you are applying to more than one specialty or prelims/transitional years, etc. This information is program specific. It is extremely important to check with the programs directly.
- Most residency programs will ask for 3 to 4 LOR’s.
- A maximum of four (4) LOR’s can be sent to any given program via ERAS
- The exact number is program specific.
- If you send more than the requested number, the program may indiscriminately discard one LOR.
- So check with each individual program!
- Some specialties will request a chairman’s letter (in the specialty to which you are applying). The Chair letter counts as one of your LOR’s.
- The majority of your LOR’s should be from faculty within your chosen specialty (2 of 3)
- Request extra LOR’s...
- In case some faculty members end up not being able to write the letter
- For applying to different specialties or prelims
- For specific programs (i.e. where you did an away rotation)
- For specific regions of the country
- You will be able to assign different LOR to different programs, so you may have or need 5 or more letters on ERAS, even though you are only sending 3 to each program.
Chairman Letter
- A letter from the Chair of the department is required for some specialties. Most common are medicine and surgery. Check with your programs.
- Only request a Chair letter if it is required or if you have worked with the Chair.
MSPE
- Medical Student Performance Evaluation (MSPE) is also referred to as the "Dean's Letter". This is not considered a letter of recommendation.
Tracking your LOR’s? (How do I check to see if my LOR’s have been received?)
- When ERAS opens, you will be able to track your letters in MyERAS.
- Additional information about tracking will be covered in future ERAS communications and sessions.
Early Match (SF Match-Central Application Service-CAS)
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Letters of reference
Three (3) letters of reference are required for review by the programs. No more, no less. It is
recommended that residency applicants provide one letter from a core rotation.Letter writers have the option to provide a reference letter or complete the Ophthalmology Standardized Form instead. Applicants should inform letter writers of this option
NEW to CAS (2017-2018): Introduction of Standardized Letter of Recommendation Form
You now have the option of requesting letter writers to use a standardized letter of
recommendation form. This is a 3- page standard form which they fill out and submit in place of
a traditional written letter. Again, this may be used in place of a traditional letter of
recommendation, but NOT in addition to a traditional letter. - Letters of recommendation for your preliminary year position should be processed through ERAS.
- This may mean in some cases, that you request your letter writer to upload one letter into the ERAS LoR Portal to support your preliminary year application and one to be uploaded into the SF Match Letter Writer Poral to support your Ophthalmology application.
- This may mean in some cases, that you request your letter writer to upload one letter into the ERAS LoR Portal to support your preliminary year application and one to be uploaded into the SF Match Letter Writer Poral to support your Ophthalmology application.
How do I choose which ones to use?
- Based on performance in rotation
- Better Performance usually results in a stronger LOR
- Based on Specialty Choice
- At least 2 of 3-4 LOR’s should be from your specialty
- Student Underground…Beware!
- Other students are probably where you will get much of your information, but that is not always reliable!
- Most students waive their right to see their LOR so they may not be the most reliable source.
- Other students can certainly be helpful in identifying supportive faculty.