What Makes a Good Residency Application Letter of Recommendation?

Source: Med School Insight


Medical School Blog

I’m sure by this point everyone has lined up at least 4 letters of recommendation to include with their ERAS (or equivalent) application…right?  Just kidding, but in all seriousness, it’s certainly time to consider who is going to write your LORs and to begin asking for letters, if you haven’t already.

After having gone through the process just last year, I hope I can provide some basic info and my personal experience to help make this process easier to traverse and to ensure that you end up with high quality letters.

The basics of LORs:

  • Letters should generally be from attending physicians (i.e. not residents or other providers) or senior researchers.
  • Most programs require 3 letters but will allow you to send a 4th letter, so you should plan to get at least 3 or 4 letters
  • Almost every program requires at least 1 letter from a department chair or program director.  You should plan on this and try to meet with the program director and/or chair at your home program to inquire about this and see what their process entails.  Sometimes the chair writes the letter himself/herself, but it isn’t unheard of for a chair to co-sign a letter.
  • A letter from someone who knows you well and can write a personalized letter often means much more than getting a stock letter from a “big name.”
  • To help ensure your letters are personalized, be absolutely certain to provide your letter writers with your CV and personal statement.  It probably wouldn’t hurt to meet with them one-on-one if they have the time.
  • If you have done research, you should really try to get a letter from that experience.
  • A letter from an away rotation indicating solid performance likely helps open doors at additional programs for a couple of reasons: it gives an “outsider” (i.e. not home program) opinion of you and it can show your desire for a certain geographic location.  If you really want to go to a specific region, you should try to do an away in that region and get a letter from that away rotation.
  • The earlier you can get your LORs turned in to your school, the better off you will be, because often someone in the office can take a look at your letters and tell you generically if they are good letters or not – this can help influence your decision whether to send an “extra” letter or to decide between 2 letters.

My experience:

I ended up getting 6 LORs.  I know, it sounds excessive, but hear me out.  I applied to ortho, so my letters were all from ortho attendings, however one program to which I applied required a non-ortho LOR so I had to get an extra LOR for that program only.  Thus, I had 5 ortho letters to choose from for my ERAS application.  I was able to get a letter from the chair of my home program, as well as 3 additional faculty at my home program with whom I had either worked extensively either clinically or on research, or both.  My final letter was from one of my awayrotations, and actually happened to be from the chair, so that was an added bonus.

When deciding which 4 letters to send, I ultimately sent my home program chair letter to every program to which I applied.  I sent the away rotation chair letter to all but my home program.  I ended up using 1 of the letters only twice, sending it to my home program and to the program where that staff had trained for fellowship.  I sent my 2 other ortho letters everywhere else, because I had done both research and been in the clinic/OR with those 2 faculty and I knew they were both outstanding letters because I had someone in our med school office take a quick look at them.

At the end of the day, getting LORs can be very important and can really open doors for you at some programs.  Choosing letter writers and choosing which letters to send to which programs is actually more complicated than it seems like it should be, so I absolutely recommend getting additional advice on the process from past students who have entered your desired specialty or from the program director at your home program.

Good Luck!