Appendix II – Writing Letters of Recommendation

All medical students need letters of recommendation for residency applications. Most programs require at least three letters from attending physicians who have worked with the student. As a result, this is an important task for all precepting faculty.

THE REQUEST

When a student asks you to write a letter of recommendation, they should provide you with a set of information. Feel free to ask for this if it isn’t immediately offered. A request packet should include 1. A copy of the ERAS (Electronic Residency Application Service) Letter Request Form, with your letter ID number. You will need this to upload your completed letter. 2. Details from the student on the purpose of the letter and to whom it should be addressed. 3. Whether or not the student has waived their right of access to the letter. 4. Copies of the student’s CV and personal statement 5. If you wish, a photograph Students are routinely instructed to allow a month for faculty to write a letter. Carefully consider your own schedule and their deadline — if you will have difficulty completing a well-composed letter in the time allotted, it’s better to say no initially than to miss the deadline!

DISCUSSION

If your schedule allows, it can be helpful to have a brief conversation with the student. Asking them to schedule a 15-minute appointment to talk about their goals and achievements is quite reasonable. You may know the students’ performance well from working together clinically, but if you haven’t talked about their background or motivations for their future career, this discussion can be revealing. It can also be very helpful to refresh your memory if time has passed since you worked with the student. It is also appropriate to ask others (residents, fellows, clinical staff) who may have worked with the student to provide input, as long as you reflect the source in your letter.

DECLINING A REQUEST

Be honest with students if you don’t feel you can write a highly supportive letter. Possible ways to put this: I can write you a letter, but I wonder if someone else might be able to write a stronger one. I will write if you like, but I can’t rank you in the top quarter. If there is pertinent negative information that you feel needs to be included, consider discussing that with the student and asking if they still want you to write. Remember it is your professional responsibility to write an accurate letter based on your experience.

SUBMITTING A LETTER

ERAS now requires that all letters be uploaded directly by the author. This will require you to register and submit the letter through their online Letter of Recommendation Portal (LoRP). Further information about the LoRP, letter guidelines, and accessing the portal can be reviewed at the following web address: https://www.aamc.org/services/eras-for-institutions/lor-portal

ADDITIONAL RESOURCES

• DeZee ICJ, Thomas MR, Mintz M, Durning S.T. Letters of Recommendation: Rating, Writing, and Reading by Clerkship Directors of Internal Medicine. Teaching and Learning in Med 2009; 21(2) 153-8. [Recent review of the literature and a survey of a cohort of experienced internal medicine educators] • Friedman RIB. Fantasy Land. NEJM [The classic paper] • Greenburg AG, Doyle J, McClure DK. Letters of Recommendation for Surgical Residencies:

What they Say and What They Mean. J Surg Research 1994; 56:192-8. [Specific recommendation for surgeons] • Irby DM, Milam S. The Legal Context for Evaluating and Dismissing Medical Students and

Residents. Acad Med 1989; 64:639-3. [Advice for negative LORs] • Keim SM, et al. A Standardized Letter of Recommendation for Residency Application. Acad

Emerg Med 1999;6(11 1 141-6. [Detailed explanation of the EM standardized LOR, the only currently used standardized LOR] • Wright SM, Ziegelstein RC. Writing More Informative Letters of Reference, J Gen Intern Med 2004; 19:588-93, [A more detailed and very informative reference for writing LORs]