A Residency Letter of Recommendation, or an ERAS letter of recommendation, is a document attesting to an applicant’s competencies, character, and suitability for a medical residency program. It is typically written by a medical school faculty member or a medical professional who has worked with the applicant in a clinical setting.
Letters of recommendation are a crucial part of the ERAS residency application process. A well-crafted residency letter of recommendation can significantly influence the outcome of a residency application by setting an applicant apart from peers.
Why It’s Important
Understanding the significance of residency letters of recommendation is crucial for any applicant aiming to secure a position in their desired medical specialty.
Here’s why ERAS letters are so pivotal:
- It highlights your specialty-specific experiences. Residency programs seek candidates with relevant hands-on clinical experiences, and recommendation letters help underscore your direct involvement in the medical specialty you’re applying to. Program directors often regard specialty-specific letters of recommendation as pivotal, with 84% citing these letters as a significant factor in inviting candidates for interviews.
- It demonstrates your professional relationships with multiple physicians. Strong recommendations from various physicians indicate your ability to build and maintain professional relationships, reflecting your teamwork and collaboration skills.
- It showcases your dedication and work ethic. A well-written letter provides specific examples of your contributions and efforts, demonstrating that you are not only knowledgeable but also passionate and diligent.
- It illustrates your personal qualities. These letters can emphasize personal attributes that are difficult to demonstrate in your CV, such as empathy, resilience, and leadership. They offer a holistic view of your abilities and character.
- It complements your application. Recommendation letters reinforce other parts of your residency application, such as your Personal Statement and ERAS Application. Consistency across these documents strengthens your overall profile and present a unified case for your candidacy.
How to Ask
Approach the process thoughtfully and with careful planning. Here are some steps to guide you when requesting letters:
- Schedule a Meeting Early: Set up a meeting with your potential recommender well in advance. Ideally, this should be done during your clinical rotations when attendings can closely observe your performance and get to know you better. Ensure you request a letter at least one month before the deadline. Keep in mind that faculty members have busy schedules, may be traveling, or have multiple letters to write, and thus may not be immediately available.
- Provide Relevant Documents: During your meeting, give the recommender your updated Curriculum Vitae (CV) and personal statement. Additionally, provide clear instructions for uploading the letter to ERAS. This ensures that your recommender has all the necessary details to write a comprehensive and supportive letter.
- Discuss Specifics: Talk about your experiences during the rotation, what you learned, and why you are specifically asking for a letter from them. Be clear about your chosen specialty, as this will help guide the content of their recommendation.
- Letter Request Form: Every letter writer will require a unique Letter Request Form tailored to the specific application for which you need a recommendation. This form will include an individual ID number. You must generate this form through your MyERAS Account and provide it to your letter writer, either in print form or via email.
- Ensure Confidence: Ask if they feel confident in writing a strong letter that aligns with the ACGME core competencies for you. Their confidence in your abilities will translate into a more compelling recommendation.
- Follow-Up: You are responsible for following up with you to ensure timely submission. If you have not received an email notification from the ERAS infoming you of the letter writers’ submissions two to three weeks before the deadline, consider sending a gentle reminder.
- Express Your Gratitude: A thoughtful thank-you note or email after the letter is submitted reaffirms the applicant’s professionalism and maintains a positive relationship.
How many letters should I request?
Residency applications generally require a minimum of three letters of recommendation, and most programs will only review three letters. However, the EMAS Portal allows you to upload an unlimited number of letters and assign a maximum of four letters to each program. Check individual program requirements to see how many letters they need.
Who to Ask
Selecting the right individuals to request letters of recommendation is crucial for a strong medical residency application. You should prioritize recommenders who have closely observed your academic and professional prowess.
Here are some key points to consider when choosing your recommenders depending on your situation:
- Third or Fourth-Year Medical Students: Identify potential letter writers early in clinical rotations, especially those in your intended specialty. Establishing a rapport early allows the recommender to provide a detailed and favorable account of your abilities and character.
- Recent Graduates/First-Time Applicants: Reflect on past interactions and choose recommenders who know you well, such as supervisors or colleagues from previous work or academic settings.
- Older Candidates/Re-Applicants: Secure updated letters of recommendation by engaging in US clinical experiences or reconnecting with previous supervisors in relevant fields. This demonstrates continued competence and commitment to the medical profession.
Ensure that your recommenders are familiar with your work and willing and able to convey your suitability for a residency program effectively. Avoid relying solely on prestigious titles unless the recommender knows you well enough to provide a substantive evaluation.
Does the MSPE count as a letter of recommendation?
While the Medical School Performance Evaluation (MSPE) (also known as the Dean’s Letter) is a required part of your ERAS application, it does not count as a residency letter of recommendation.
How to Write
Here’s a guide to help you write a strong and compelling ERAS letter of recommendation:
Step 1: Introduction
Use an official letterhead that includes your institution’s logo and address, along with the date created. Begin the letter by clearly stating the purpose of the letter with enthusiasm. Introduce yourself, stating your position and providing context by detailing the length and nature of your relationship with the applicant.
Step 2: Body Paragraphs
The body of the letter should contain two to three (no more than four) paragraphs.
Begin each paragraph with a topic sentence that highlights the applicant’s knowledge and skills relevant to the opportunity they are pursuing, including attributes mentioned in their personal statement and the ACGME Core Competencies. Follow this with specific clinical examples and anecdotes that illustrate and support the statement.
In addition, consider sharing anecdotes or exemplary stories that showcase their competencies and strengths, providing a well-rounded view of their capabilities. Comment on their growth and development, if applicable.
Below are the six Core Competencies and how you may demonstrate them in your letter of recommendation according to the ACGME Guidelines:
-
Patient care and Procedural Skills: Emphasize how you have witnessed their capabilities through practical application.
- Example: In our cardiology unit, John assisted in a complex percutaneous coronary intervention on a patient with a history of multiple cardiac surgeries. Their precision and understanding of the procedure, along with thorough pre and post-operative care, demonstrated advanced procedural skills and a deep understanding of patient care.
-
Medical Knowledge and Clinical Reasoning: Refer to specific assessments and clinical encounters that highlight these abilities.
- Example: Ariana’s medical knowledge was evident during our weekly case reviews, where she consistently provided insightful differential diagnoses. For instance, she identified a rare case of pheochromocytoma in a patient presenting with atypical symptoms, demonstrating exceptional clinical reasoning and the ability to synthesize complex medical information.
-
Professionalism: Illustrate the applicant’s behavior using feedback from various sources.
- Example: During a complex patient care conference involving a terminally ill patient, Isabella handled the emotionally charged atmosphere with grace and empathy. She communicated honestly and compassionately with the patient’s family while maintaining professional boundaries: “I understand how difficult this news is, and I want you to know we are here to support you through every step.” Despite receiving bad news, the patient’s family expressed their gratitude for Isabella’s support during such a difficult time.
-
Interpersonal and Communication Skills: Focus on specific instances where the applicant demonstrated these abilities effectively.
- Example: In our multidisciplinary team meetings, Martin’s ability to articulate his thoughts and listen to others fostered a collaborative environment. For instance, during a particularly challenging case, Martin noticed that a nurse’s observation had been overlooked. He respectfully brought it to the team’s attention, saying, “I think we should consider Hailey’s input on the patient’s symptoms; it might give us a clearer picture.” This act not only validated the nurse’s contribution but also led to a crucial adjustment in the patient’s care plan.
-
Practice-based Learning and Improvement: Discuss how the applicant engages in continuous learning and self-improvement.
- Example: Reece is committed to continuous learning and improvement. He frequently engages in evidence-based practice reviews, applying the latest research to patient care. For instance, he conducted a thorough review of the latest treatment protocols for sepsis and implemented these findings during their clinical rotations, resulting in improved patient outcomes.
-
Systems-based Practice: Detail the applicant’s involvement in quality improvement and patient safety initiatives.
- Example: Jenna’s understanding of systems-based practice is impressively comprehensive. She actively participated in quality improvement initiatives and used performance data to enhance patient safety. For example, she took the lead on a project that reduced hospital readmission rates by 15%, demonstrating her ability to navigate and improve healthcare systems effectively.
Step 3: Conclusion
Conclude the letter by summarizing the applicant’s strengths and reaffirming your recommendation. Provide a final endorsement and summarize their performance, focusing on their suitability for the residency program.
End the letter with a handwritten signature, followed by your name, title, academic rank, and contact information.
Step 4: Submission
Once the letter is finalized, save it in PDF format and ensure the file size does not exceed 500 KB. Use your AAMC account to upload the letter through the EMAS Letter of Recommendation Portal (LoRP). You must use the Letter ID from the Letter Request Form the applicant provided to submit the letter.
Submission by the Applicant
An applicant can upload recommendation letters only if they have not waived their right to view the letters on the ERAS.
Residency Letter of Recommendation: Examples
Example 1: Attending Physician Recommending College Senior
[Institution Letterhead]
To Whom It May Concern,
I am writing with great enthusiasm to recommend Marshall North for the Pediatric Residency Program at the Children’s Hospital of Philadelphia. As an attending physician in the Pediatric Department at University Medical School, I had the pleasure of supervising Marshall during his clinical rotation in pediatrics, where I closely observed his interactions with patients and his clinical skills over several months.
Marshall’s patient care and procedural skills were exemplary throughout his rotation. I vividly recall a challenging case where he managed a young child presenting with a severe asthma attack. His quick assessment, administration of appropriate treatments, and consistent monitoring showcased his ability to handle high-pressure situations with competence and care. His dedication to ensuring the child’s stability and comfort was commendable and demonstrated his deep commitment to patient care.
Marshall also stood out in our weekly case discussions, where his medical knowledge and clinical reasoning were consistently impressive. During one such discussion, he correctly diagnosed a rare case of Kawasaki disease in a child with prolonged fever and rash. His ability to synthesize complex clinical information and arrive at accurate diagnoses highlighted his exceptional analytical skills and deep understanding of pediatric conditions.
Additionally, Marshall showed an understanding of systems-based practice. He participated in a quality improvement project aimed at reducing wait times in the pediatric emergency department. His contributions helped streamline the triage process, which significantly improved patient flow and reduced wait times, showcasing his ability to enhance healthcare delivery systems.
In conclusion, Marshall North is an outstanding candidate for the Pediatric Residency Program at the Children’s Hospital of Philadelphia. His clinical skills, medical knowledge, and professionalism make him well-suited for this prestigious program. I am confident that he will make significant contributions and excel in his residency.
Sincerely,
Ivanna Clark, M.D.
Attending Physician, Pediatric Department
University Medical School
[email protected]
(123) 456-7890
Example 2: Manager Recommending Staff
[Company Letterhead]
To Whom It May Concern,
I am pleased to recommend Megan Voltz for the Family Medicine Residency Program at the University of Florida. Over the past three years, I have had the pleasure of supervising Megan, a Clinical Research Associate at XYZ Pharmaceuticals, whose skills and dedication have consistently impressed me.
Megan’s commitment to patient care was evident in her management of clinical trials. During a particularly complex trial for a new diabetes medication, Megan excelled in patient recruitment, data collection, and follow-up procedures. Her meticulous attention to detail ensured high-quality patient care and reliable data collection, reflecting her dedication to the well-being of participants.
Her medical knowledge and clinical reasoning are equally commendable. Megan frequently contributed valuable insights during our study design meetings. For example, her suggestion to include a broader range of patient demographics in a hypertension drug trial significantly enhanced the study’s applicability and robustness. Her ability to apply clinical knowledge to real-world scenarios demonstrates her analytical skills and clinical reasoning.
Megan also actively engages in practice-based learning and improvement. She continuously seeks ways to enhance her knowledge and skills. For instance, after noticing inconsistencies in patient data collection methods, she researched and implemented a new standardized protocol, significantly improving data accuracy and consistency across trials.
In conclusion, Megan possesses the skills, knowledge, and professionalism required for a successful career in family medicine. Her dedication to patient care, strong clinical reasoning, and excellent communication skills make her an ideal candidate for the Family Medicine Residency Program at the University of Florida. I am confident she will excel in her future endeavors and make significant contributions to the field of family medicine.
Sincerely,
Carlos Bayes
Clinical Research Manager
XYZ Pharmaceuticals
[email protected]
(789) 012-3456
Example 3: Practitioner Recommending Previous Rotation Student
[Institution Letterhead]
To Whom It May Concern,
It is with great enthusiasm that I recommend Natalia Lovette for the Sports Medicine Fellowship Program at NYU Langone’s Rusk Rehabilitation. As a Sports Medicine Specialist at ABC Sports Clinic, I had the privilege of working with Natalia two years ago during her rotation in our department; throughout our time together, she displayed remarkable dedication, clinical skills, and a passion for sports medicine.
Natalia’s patient care and procedural skills were evident from the beginning of her rotation. I vividly recall an instance where she managed a young athlete with a severe ACL injury. Natalia’s thorough assessment, combined with her precise execution of the initial treatment plan, demonstrated her exceptional clinical skills. She effectively coordinated the patient’s care from initial assessment through to physical therapy, ensuring a comprehensive and well-rounded approach to treatment.
Natalia’s professionalism is one of her standout qualities. She consistently exhibited a high level of professionalism in all interactions, whether with patients, colleagues, or other healthcare professionals. Her ethical approach and dedication to patient confidentiality were always apparent. Natalia’s commitment to maintaining the highest standards of care, even in high-pressure situations, was truly commendable.
Interpersonal and communication skills are also among Natalia’s strengths. She effectively communicated complex medical information to patients and their families, ensuring they were well-informed and comfortable with the treatment plans. Her ability to build trust and rapport with patients was particularly evident during her work with young athletes, who often require a compassionate and understanding approach.
In conclusion, Natalia Lovette is a highly capable and dedicated individual with a strong passion for sports medicine. Her clinical skills, medical knowledge, professionalism, and excellent communication abilities make her an outstanding candidate for the Sports Medicine Fellowship Program at NYU Langone’s Rusk Rehabilitation. I am confident that she will excel in any program and make significant contributions to the field.
Sincerely,
Sarah Coleman, M.D.
Sports Medicine Specialist
ABC Sports Clinic
[email protected]
(456) 789-0123
Residency Letter of Recommendation Sample
Copy the sample below or download a customizable residency letter of recommendation template.
___________________ [Recommender’s name]
___________________ [Recommender’s institution/entity]
______________________________________ [Recommender’s address]
___________________ [Recommender’s phone or email]
___________________ [Date]
___________________ [Recipient’s name]
___________________ [Recipient’s institution/entity]
______________________________________ [Recipient’s address]
___________________ [Recipient’s phone or email]
Dear ________________________ [Recipient’s name],
I am writing to enthusiastically recommend ___________________ [Candidate’s name] for the ___________________ [Program applied for] at ___________________ [Institution/entity name]. Having had the pleasure of engaging with ___________________ [Candidate’s name] as their ___________________ [Relation to Candidate] for ______ [Time] at ___________________ [Institution’s name], I have been impressed by their interactions with patients and clinical skills. This positions me well to attest to their suitability for this application.
During their tenure, ___________________ [Candidate’s name] has consistently demonstrated ___________________ [Skill or expertise]. A notable achievement was their commitment to _____________________________________ [Description of achievement]. As a result, _____________________________________ [Result of achievement].
Moreover, ___________________ [Candidate’s name] has shown remarkable ___________________ [Skill or expertise] through their involvement in _______________________________ [Description of achievement]. Because of this, ___________________________ [Result of achievement].
In addition, ___________________ [Candidate’s name]’s capacity for ___________________ [Skill or expertise] was demonstrated by their contribution to _____________________________________ [Applicant’s accomplishment]. Because of them, ______________________________ [Result of achievement].
In conclusion, ___________________ [Candidate’s name] possesses the skills and knowledge required for a successful career in medicine. Their dedication to patient care make them an ideal candidate for the ___________________ [Program applied for] at ___________________ [Institution/entity name]. I am confident they will excel in their future endeavors and make significant contributions to the field.
I am happy to provide any additional information or discuss ___________________ [Candidate’s name]’s journey further. I can be reached at ___________________ [Recommender’s phone or email].
Sincerely,
___________________ [Recommender’s name]
___________________ [Recommender’s title]
___________________ [Recommender’s institution/entity]
___________________ [Recommender’s phone or email]
Frequently Asked Questions
How should a letter of recommendation be formatted for the ERAS?
For ERAS, the letter of recommendation should be formatted on a page size of 8.5 x 11 inches, ideally on professional letterhead, and must be signed by the author. It is crucial to review the letter thoroughly for accuracy and grammatical correctness before uploading. Additionally, the letter should be dated and include the signature of the letter of recommendation author.
Should I waive my right to view the letters?
It is strongly recommended by most program directors that you waive your right to view your recommendation letters, as this suggests confidence in the recommender and adds credibility to the letters. Once waived, you cannot view the letters under any circumstances. The waiver status is visible to residency programs, and they may view non-waived letters with suspicion.
Can I use a specialty-specific letter of recommendation to apply to another specialty?
No, using a letter written for one specialty to apply to another specialty is strongly discouraged. Program Directors expect to see passion and dedication for the specialty their program focuses on. Submitting a letter of recommendation for a different specialty can be perceived as careless or even disrespectful.
I am an IMG. Can I use letters of recommendation from my home country?
Yes, as an International Medical Graduate (IMG), you can use letters from your home country if they are relevant to the specialty. However, it’s important to note that recommendation letters from outside the US are generally given less consideration than those obtained from U.S. Clinical Experience (USCE).
Can I ask someone from one specialty to write a recommendation for another specialty?
Yes, you can ask a medical professional from one specialty to write a recommendation for a different specialty. Just ensure you inform them about your specialty preference before they write the letter.
