How to Plan for the Perfect Letter of Recommendation for Residency

  • /Reviewed by: Amy Rontal, MD
  • Having a well-rounded ERAS application is critical to obtaining the residency you want. Each part of the application is important when a program director is deciding on prospective new residents. Initially your scores and the reputation of your medical institution can help screen your application in the “favorable” pile. But what happens when the program director has to decide on where to rank a few similar candidates? What is the determinant for who stands out? This is where a strong letter of recommendation can help differentiate you from other applicants.

    The search for the perfect letter begins with you… yes you. From the start of 3rd year, an applicant who shows consistent and genuine enthusiasm as well as who is punctual and professional is much more likely to get a strong letter of recommendation. This tip may seem obvious, but is often times taken for granted by medical students who do not take the clerkships seriously. Developing a habit of strong work ethic from the start of 3rd year will have residents and attendings alike associating you with strong performance. With this in mind, here are several steps you should take during the start of your clinical education to secure an outstanding letter.

    1. Consistently show that you want to help in all aspects of patient care, including aiding the nurses and ancillary staff

    This goes along with the theme I presented earlier, maintaining a strong work ethic. Make sure you are showing initiative at all times and be eager to help anybody at anytime. The simple gesture of asking “how can I help” can immediately change a person’s perspective of your enthusiasm and work ethic. As faculty watch you do this, they are more likely to write you a stronger and more personal letter.

    2. Get to know the faculty and chairman

    Know your attending on a personal level. When appropriate, share information about yourself including your aspirations and what you would like to do with your medical education. It is imperative to keep this dialogue professional. A collegiate relationship with your attending will be reflected in a strong, personal letter, if he or she decides to write a Letter of Recommendation for you.

    3. When it is time to ask for a letter, ask for an outstanding letter

    What is the difference between these 2 sentences: “John is punctual, professional, and always willing to help” vs. “John stood out from the rest of his colleagues in his professionalism and punctuality; his enthusiasm was most evident when he came in to work on a snow day and helped the understaffed nurses with their clinical obligations.”

    One is a generic description, which a program director will read many times during interview season. The other sentence is personal, well written, and shows that the letter writer knew you on a deeper level. Asking for “a letter of recommendation” will yield generic results. Asking for “an outstanding letter of recommendation” will yield outstanding results.

    4. Before the end of the rotation provide your letter writer with all the necessary information

    Often times faculty are overwhelmed with their clinical responsibilities and may forget to write your letter (or even who you are!). Make it easier for them to write an outstanding letter by giving them ample information. At the very least, put together a packet comprised of your CV and a personal statement. If pertinent provide the letter writer with other accomplishments such as publications or awards. Provide your letter writer with a 2×2 passport size picture and place it at the top of your file. This should preferably be completed during your 3rd year core rotations. If you are trying to get a letter during a 4th year audition elective, complete this step along with step #5.

    5. Remind your letter writer during application season

    As soon as ERAS opens you should e-mail or inform your letter writer of upload instructions to the ERAS system. He or she will be able to directly upload the letter to ERAS without having to mail anything in. If the letter writer has lost the previous content that you provided step #4, replace it along with instructions on how to upload the letter. 

    6. Send a gift

    Remember, faculty are overwhelmed with clinical duties. Writing a letter may take time away from their personal or family time. Show them that you are appreciative by buying a small gift — like a box of gourmet chocolate — and a thank you card. Make sure the card is personalized! It will make them feel appreciated and will help your colleagues down the line when they ask for letters of recommendation.