How to Get the Perfect Letter of Recommendation for Your ERAS Application

  • /Reviewed by: Amy Rontal, MD
  • As you’re getting ready to start working on your ERAS application, hopefully, you have started to consider whom you should ask for letters of recommendation (LORs). If you haven’t already, you should start asking your letter writers soon, as you want to give them as much time as possible to craft their letter. The number of letters will depend on your intended specialty, but it is often 3-to-4 with possibly one from your department chair. The letters can (and often should) be a mix of clinical, volunteer, and/or research letters. As you’re making your list, here are some tips to obtain the perfect LOR.
    Choose a letter writer who really KNOWS you. 
    The letter writer should be someone who can speak to your character, knowledge, career aspirations, and clinical skills. Think about all of the attendings you have worked with clinically or on research projects. Depending on the specialty, your letters may need to all come from the specialty you are applying in (i.e., neurosurgery) or you can use a letter from another specialty if that person knows you well and can write a strong letter (i.e., pediatrics). Often, great letters come from people you have worked with longitudinally. For example, a research mentor or faculty advisor for a volunteer clinic who has worked with you throughout medical school. Further, at least one letter should come from a subinternship that demonstrates your preparedness for residency. In some cases, it is possible to have one letter from a non-physician (e.g., PhD or MPH) if you did significant volunteer or research work.
    If all else is equal, choose a letter writer with a higher rank. 
    If you can choose between two writers, pick the writer with a higher academic title. For example, the chair of medicine would be preferable over an assistant professor. HOWEVER, a weak letter from the chair that is generic is worth much less than an emphatic well-written letter from a junior attending who can sing your praises. Always err on the side of the stronger letter regardless of rank. Also note, DO NOT use letters from residents or fellows.
    Give them all the information they need to make the letter personal. 
    Most letter writers will want you to send them your CV to help them write your letter. Many will also want to see a draft of your personal statement, and some may want to meet to discuss your career ambitions. The more you can provide your letter writer, the more detailed and personal your LOR will be. They will want to make sure their letter reflects all of the amazing things you have done and your future goals.
    Consider different letters for different programs. 
    In ERAS, you can assign different letters to different programs. If you are applying to multiple specialties, you should have different letters for those specialties (e.g., internal medicine and general surgery). Even if you applying to one specialty, you can strategically assign letters to programs. For example, you can use a letter from a sub-I in California for West Coast programs to demonstrate your interest in the area.
    Have a backup plan. 
    To save yourself some anxiety later, ask for more letters than you need. Just in case someone flakes or submits their letter late, having extra letters will put your mind at ease. Unless they are on the admissions committee at a given program, the writer will never know which letters you used.
    If you have any questions about the residency application process, please reach out to us to review your application and brainstorm how to put your best foot forward!
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