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Obtaining a Residency Letter of Recommendation

12 min



We are thrilled to bring you another invaluable recorded session from Elite Medical Prep’s Residency Roundtable series. This session, titled “Obtaining Letters of Recommendation,” is hosted by the esteemed Dr. Emily Zelinski. In this session, Dr. Emily Zelinski will guide you through essential strategies for securing strong Residency Letters of Recommendation (LORs) that will elevate your application. For a comprehensive understanding of the residency application process, explore more recorded sessions from this series here, and find a roadmap to your ultimate residency application timeline here.



Initiating the Conversation: Choosing Your Letter Writers


Start your journey by engaging potential letter writers as early as July, ensuring that you can confirm your chosen writers by August.


Start by compiling a list of faculty members within each specialty you’re applying to. Focus on those with whom you’ve fostered a close working relationship. While compiling your list, aim for three LORs from each specialty you’re targeting.


Consider the inclusion of non-MD or DO faculty. If you’ve collaborated with mentors in research or have earned advanced degrees like a PhD or MBA, their unique perspectives could strengthen your application.


Arrange the list according to the depth of your connection and the duration of your association with each writer. While it can be helpful to get letters from writers whose name carries weight in a specialty, we always recommend prioritizing letters from those know know you best.


Sift through your list with a current residency advisor or mentor, and perhaps glean insights from recent program graduates who’ve walked your path. Recent graduates can provide insight as to which faculty members are likely to craft unique, personalized letters.


Prioritize writers who’ve witnessed your growth over time and can contribute custom, thoughtful insights that set you apart.


For IMG applicants pursuing US residencies, everything stated above is still relevant. However, securing at least one LOR from a US medical professional who can attest to your readiness for the American medical landscape is important.



Requesting a Residency Letter of Recommendation


We recommend scheduling a meeting to request an LOR, rather than asking via email. This will allow you to discuss your letter with your writer, and gauge your writers’ willingness to write you a strong letter. Here are a few things to keep in mind:


1. Timing is everything


    1. Aim to ask faculty during the last week of service, while your work is fresh in their memory.
    2. Reach out via email to schedule a meeting within 1 week of the rotation ending.
    3. An in-person meeting is preferred. Asking for the LOR in person shows a lot of confidence on your part. In addition, your writers are more likely to be honest with you about whether they are comfortable writing a strong letter when you meet with them in person.


2. Ask each faculty member if they would feel comfortable writing a STRONG residency letter of recommendation on your behalf.


    1. You don’t want a standard or average letter. These won’t help set you apart from other applicants.
    2. What to do if the answer is no?
      • Respect their honesty.
      • Rather than pressuring them, express gratitude and seek feedback.
      • If the reason is a lack of familiarity with you, you can offer to spend additional time on service, if your schedule allows.


3. Once you have a positive response, consider using the rest of your meeting to…


    1. Remind your letter writer of any specific interactions you had while on service. Talk about how much you learned from a specific surgery or patient interaction. Remind them of a differential diagnosis you were involved in, etc.
    2. Discuss your competitiveness for the specialty you are applying to.
    3. Ask for feedback on your rotation.
    4. Ask for their opinion on specific programs to consider.


4. Be prepared to provide…


    1. A copy of your CV.
    2. A copy of your personal statement or draft.
    3. Specific information you would like included.
    4. Information on specialty-specific standardized letter requirements. Be prepared for this ahead of time. This faculty member may or may not be familiar with current standardized letter requirements. Especially if they are from a different specialty, let them know about the standard ahead of time, if your desired specialty has one.



Residency Specialty and Program Specific Letter of Recommendation Requirments


  • Requirements can vary by specialty AND program. Do your research.
  • Check program websites to determine the number of letters allowed. While you are able to upload up to 4 letters per program, some programs will only accept 3 letters. If you upload more than the allowed number of letters, the program will just disregard some of your letters. Make sure you check this ahead of time.
  • Specific standard LOR requirements per specialty:
    • Internal Medicine – Standardized Evaluation Letter (SEL)
    • Emergency Medicine – Standardized Letter of Evaluation (SLOE)
    • Orthopedics – Electronic Standardized Letter of Recommendation (eSLOR)



Uploading LORs onto ERAS


  • You must create an entry for each letter of recommendation that you intend to have uploaded.
  • Each entry will need to include:
    • Author name.
    • Athor title/department.
    • Selection of whether you waive the right to review (we highly recommend waiving your right to review). Some letter writers may still send you your letter for review outside of ERAS, but this box waives your right to review the latter after it has been uploaded to the ERAS system.
    • Specialty to which the letter will be assigned. This selection will not be viewble to programs, only to you. The programs will only see the letters associated with their specialty. This is to help you make sure you are associating your letters correctly to your programs.
    • Program director/Department chair designation. You will be able to indicate this when adding the author title and department, but this additional checkbox will allow you to add this designation in case a department chair letter is required for your specialty.
  • Send upload link to your letter writers to upload within ERAS. You will have a button to click to send this link, ERAS will send it on your behalf and you will have a free text box available to write them a personalized message.



Confirming and Assigning LORs


Within the ERAS portal, there is a “letters of recommendation” section. Here you can see the identifying information you have input, including the specialty assignment, as well as whether the letter has been uploaded yet by your LOR writer. This allows you to confirm that all of your letters have been uploaded. If one remains outstanding, you can employ the option to send a reminder email through ERAS to your writer.


Once your letters have been uploaded, you can start assigning them to programs (this option will not be available before a letter has been uploaded). You will be able to do this by going into each program that you are applying to and clicking the checkboxes next to each of your letters to assign them to this program.


If you are looking for additional help with your residency application, consider enlisting the help of an Elite Medical Prep residency advisor! Schedule your complimentary consultation today to learn more about how we can help you succeed!


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About the Author

Elite Medical Prep

The Elite Medical Prep team consists of MD and MD candidate tutors from the top medical schools and residency programs, our founders, Dr. Brus-Ramer and…

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