From the ECFMG: Asking for a Letter of Recommendation (LoR)

Source: ECFMG

Strong, comprehensive letters of recommendation (LoRs) can provide you with an extra edge when competing for a U.S. residency position. Residency programs have a limited number of interview slots, so they need to screen a large applicant pool carefully to select only the most promising candidates. Good LoRs may be a deciding factor in whether you are selected for an interview.

In this article, you will find important information about how to maximize your chances of getting those good LoRs, including:

  • whom you should approach for a LoR;
  • how to approach a potential letter writer; and
  • what information to provide the letter writer.

We’ll also show you where to find detailed instructions on how to submit your LoRs to ERAS Support Services at ECFMG.

Whom should I approach for my letters of recommendation?
You should approach those physicians who are most familiar with your clinical abilities, medical knowledge, and work ethic. It is also important to select writers who are aware of your interpersonal skills with patients and their families, and your ability to work as part of a team. Program directors may hold in high regard LoRs from clerkship directors, high-ranking medical school faculty, and physicians in the specialty to which you are applying. Some U.S. residency training programs may request that one of your LoRs be written by your medical school’s department chair for the specialty to which you are applying.

If you have U.S. clinical experience, program directors may expect to see an LoR from someone in that program, reflecting the experience and demonstrating how you performed in a U.S. clinical setting.

If you are submitting LoRs from a country other than the United States, ask your letter writers to evaluate your skills in a way that highlights your ability to succeed in U.S. residency training. To assist with this, consider providing your letter writers with copies of the Accreditation Council for Graduate Medical Education (ACGME) Core Competencies, a defined set of guidelines developed by the ACGME to measure the performance of U.S. residents.

If at all possible, avoid submitting LoRs regarding experiences more than two years prior to your application. Program directors want to see LoRs that measure your most current knowledge and skills.

When should I request my letters of recommendation?
The sooner you request an LoR, the sooner your potential letter writer can begin to note the knowledge, abilities, and personal characteristics that make you a desirable candidate for residency. Allow letter writers plenty of time to reflect upon your performance so they are prepared to meet program deadlines for receiving LoRs.

You should monitor program deadlines. Application timelines for the 2014 residency application season will be available in June on the websites of ERAS Support Services at ECFMG and ECHO; you should review these general resources.

If you are a medical school student, at the start of your clinical rotations, you may want to consider scheduling a one-on-one meeting with the clerkship director to discuss your intention to apply for residency in the United States. Ask if he or she would be willing to provide you with an LoR to support your application, and inquire about performance standards that you would need to meet in order for him/her to write a positive LoR. It is important, however, to not make a potential letter writer feel pressured; your goal is to secure a genuine and sincere recommendation.

What documents should I provide to the letter writer?
Providing a letter writer with certain documents and information about your career objectives will help your letter writer to sculpt a more complete image, illuminating not only your academic accomplishments, but also creating a portrait of you as a person. A copy of your Curriculum Vitae (CV) will help to familiarize the letter writer with your background and past experiences. A copy of the Personal Statement that you will submit with your residency application will provide your letter writer with insights into your passion for pursuing medical education in the United States and your future goals.

What other information does my letter writer need?
It is important to let your letter writer know which specialties you are considering for residency training and why, and to ask for his/her perspective on providing specialty-specific LoRs. A specialty-specific LoR is one that expresses to the program director that you are focused on pursuing a particular medical specialty. It should also directly recommend you for training in that specialty and explain why you are well-suited for that specialty. If a letter writer has recommended you for a position in a specific specialty, it is not advisable to use that LoR to apply for positions in other specialties. If you are submitting the LoR to more than one specialty, request your letter writer to provide a general letter applicable to all specialties, or request multiple, specialty-specific LoRs from that same letter writer.

You should also ensure that your letter writer has a clear understanding of the deadlines for submitting LoRs to your programs. It is best to have your application completed and your supporting documents, including LoRs, ready by the time program directors begin to review application materials. A program may choose not to view LoRs submitted after its deadline for accepting supporting documents.

Finally, you should provide your letter writer with detailed instructions on how the LoR should be submitted to ERAS Support Services at ECFMG.

  • If you are not waiving your right to view the LoR (see below), you can upload the letter yourself using the ERAS Support Services section of your OASIS account.
  • If you waive your right to view the LoR, the letter writer will need to upload it using AAMC’s Letter of Recommendation Portal (LoR Portal). You will need to provide the letter writer with the Letter Request Form which will include information necessary to upload the LoR using the LoR Portal. The Letter Request Form will be made available to you only after you have “designated and finalized” the LoR under the Letters of Recommendation section of your AAMC MyERAS account. Be sure to complete all required information and indicate whether you do or do not waive your right to view the letter. Please note that “non-waived” LoRs can also be uploaded using AAMC’s LoR Portal.

All LoRs should be placed on professional letterhead, should include the letter writer’s contact information, and be signed by the letter writer.

Should I waive my rights to view my letters of recommendation?
When you “waive your rights” to view a LoR, it means that you permanently give up your right to read the letter. Waiving your right to see your LoR sends a message to the program that the letter writer was free to speak openly, honestly, and without influence. It may also display confidence that you made a positive impression on the letter writer. The decision is ultimately up to you.

Is there a standard of etiquette that should be followed when requesting and submitting letters of recommendation?
Directors of the programs you apply to may contact LoR writers during the application screening process, so maintaining a professional and polite relationship with your letter writers is very important.

You may consider writing a thank you letter to those individuals who have submitted LoRs on your behalf. When following up with a letter writer who may be taking longer than desired to submit your LoR, continue to remain professional and polite to everyone involved with processing your request, including office assistants and staff. After matching to a program, you may choose to inform your letter writers and thank them again for their role in your success.

How many letters of recommendation should I submit?
You should submit a minimum of three LoRs in support of your ERAS application. Although there is no limit to how many LoRs you may submit to ERAS Support Services, you can assign a maximum of four LoRs to each program.

How do I submit a letter of recommendation?
There are three ways to submit LoRs to ERAS Support Services at ECFMG. See the LoRs page and click ERAS Document Submission At-a-Glance for more information.