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Letters of Recommendation: The Subjective Part of Your Application

April 5, 2017
Kevin Yang

Learn how to receive the best letters of recommendation.

Learning who to write your letters of recommendation can make all the difference.

By now, everyone has had experience gathering letters of recommendation (LORs) for college or medical school applications. For residency, the process is similar and even easier, though there are some additional caveats to consider.  

Keep in mind that the majority of your application is purely objective—grades, board scores, extracurricular activities—but the letter of recommendation is where your personality and unique features can shine through an evaluation. Here is some general and more specific advice.

General tips to consider about letters of recommendation

(1) Most programs are looking for 3-4 LORs. It is therefore beneficial to check out the residency program’s website and note down their specific requirements.

(2) You should be looking to get a letter from an attending physician or senior researcher who knows you well and can attest to the quality of your work. Try to avoid getting letters from resident physicians or mid-level providers.

(3) You should waive the right to see your letter. That does not mean you are unable to read the letter if the writer provides it, but you cannot ask to see the letter before it is sent.

(4) Physicians are busy people! Make sure to give them ample time to meet with you and write the letter. Have a due date set that is well in advance of the actual due date, and request the letter shortly after you finish the rotation or research so your memory is fresh in their mind.

Who should write your letters of recommendation?
Now that you’ve got a specialty in mind, you’re probably wondering who you should choose to write your letters of recommendation. As you go through your clinical rotations, keep an eye out for attending physicians who have high opinion of your skills, and ask them if they would be willing to write you a strong letter of recommendation. Keep in mind, you can upload as many to ERAS as you want, but you should only assign 3-4 per program you are applying to. In general, you want to have a letter from the department chair or program director of your school in the specialty you are applying to. If you haven’t worked personally with them, that’s totally fine. Not everyone gets the opportunity to do so.

Next, you should try and obtain letters from away rotations that you’ve done in the specialty, especially if they are at a program you are interested in matching into. This is exceptionally important in Emergency Medicine (EM), where it is almost required for you to obtain at least two Standard Letters of Evaluation (SLOEs) from program directors.

If you have significant research contributions or are applying for a specialty that values research, it would be worthwhile to have your Principal Investigator (PI) to write one. It is also beneficial to have a letter from an outside specialty such as Internal Medicine to demonstrate you are a well-rounded and flexible candidate.

What constitutes good letters of recommendation?

Most LORs will be anywhere from lukewarm to slightly positive, while a negative letter signals major red flags. In order to stand out from the rest of the applicants, you want your writers to be enthusiastic about their task and actively advocate for your entry into residency. They should not only talk about the qualities that would make you an excellent resident and physician, but provide key examples to illustrate their point. 

For example, they should good well to avoid the usage of faint praise such as ‘as far as I am aware’, ‘above average’, and ‘clearly improved’. Thus, it is important to provide each of your letter writers a packet about yourself—your personal statement, your clinical evaluations, a short letter to refresh their memory about important events, and your contact information if they have any additional questions.

Remember, the majority of your application is set in stone by the time you apply, but through your letters of recommendation, you can provide program directors a glimpse of the real you beyond the statistics—your passions, your personality, your work ethic, and what strengths you can bring to their program as a resident.

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Kevin Yang Kevin Yang is a fourth-year osteopathic medical student with an interest in psychiatry. He has been working for Kaplan since 2012 in teaching/tutoring/mentoring for the SAT, ACT, MCAT, and USMLE. In his spare time, he enjoys reading science fiction and fantasy novels, and he also has interest in writing, computers, and video games.


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