Letters of Recommendation

An important part of your residency application, Letters of Recommendation (LoR) provide qualitative information on your personal and professional characteristics.

Letters should be written by physicians you have worked with in a clinical setting.

  • If you have done extensive research and are applying in a specialty that requires research, you could ask your research lead for a letter.
  • Letter writers may ask for copies of your CV and personal statement, so be prepared with drafts of both.

Requesting LoR

Programs require three or four letters of recommendation.

  • Check the requirements for each residency to which you are applying by:
    • Reviewing UWSOM Specialty Career Advisors FAQ
    • Speaking with Specialty Career Advisors
  • Depending on the specialty to which you are applying, specific types or numbers of letters may be required.
  • Refer to the Specialty Career Advisors FAQ for more information.

ERAS and SF Match allow you to store as many LoR’s as you like and designate different letters for each program.

  • No more than 4 letters can be assigned to any one program in ERAS
  • No more than 3 letters can be assigned to any one program in SF Match

Summer C grades will not show up on your transcript. If you are taking an important rotation in Summer C, you should plan to request a LoR from a faculty on that clerkship.

You can continue to add LoR, even after your residency application has been released to programs. This allows you to update your application with recommendations from your 4th year electives, APCs, sub-internships, and clerkships.

Attendings cannot submit their letters of recommendation until the residency application system opens in the summer of the year you apply and you send them a link to upload their letter. Ask attendings to keep letters in their files if you do not yet have access to the residency application system.

Select attendings who know you best and can speak most persuasively about your clinical and research strengths.

A resident or fellow may help the attending with the letter, but they cannot be the primary letter writer.

You need at least three letters of recommendation, and depending on the specialty to which you are applying, specific types or numbers of letters may be required. Refer to the Specialty Career Advisors FAQ for more information.

Think about who your strongest advocates are who can write a detailed, personal, and positive letter. As you go through your clerkships, anticipate who you might be able to ask for a letter. Try to work enough with this individual so they will possess the firsthand experience to advocate for you.

For specialty-specific advice about letters, review the Specialty Career Advisors FAQand speak with your Specialty Career Advisor(s).

Don’t wait until the end of your 3rd year to request letters!

  • At the latest, request LORs in June, July and early August before your fall application deadline.
  • Aim to have all of your writers submit their letters by the time you submit your final application. While letters are accepted throughout the application process, many programs require you to have a minimum of 2 before they will schedule you for an interview.

Your attending may offer to write you a letter at the conclusion of your rotation.

  • You may also request that an attending write you a letter – you may prefer to wait to receive your grade before doing so.
  • Letters are stronger and more specific if you solicit them at the end of clinical rotations.

Ask attendings to keep letters in their files if you do not yet have access to the residency application system (typically in June of the year you are applying).

Letter writers need at least 4-6 weeks of advance notice to complete a letter. Clearly communicate your deadlines.

  • When possible, request a letter directly via an in-person or online meeting.

When requesting a letter, begin by saying, “I am applying for a residency in X specialty. Do you feel that you know me well enough to write me a strong letter of recommendation?”

  • Provide writers with:
    • CV
    • Personal statement
    • Consider including a short reflection or anecdote that highlights a meaningful situation that occurred during your time in clinical and/or demonstrates your clinical skills development. This will remind the writer about your key clinical experiences and your skills.

Always waive your right to see your letters of recommendation. Program directors may see a student’s decision not to waive as a red flag.

When it comes time to apply to residency, reconnect with clinical attendings and ask to have the LOR updated with the current date and in the format required by the application system you are using.

 

Uploading LoR Into Application Systems

Letters must be uploaded to the Letter of Recommendation Portal (LoRP) by the letter writer before the final application deadline.

  • Authors and/or their designees use the unique Letter ID on each form to upload LoRs for applicants.
  • A designee may not be a member of the hospital in an advising role or medical school staff supporting in the application process.

Letters must follow specific guidelines as set by the LoRP system. Read the user guide, found under LoRP Guidelines.

Attendings cannot submit their letters of recommendation until the residency application system opens in the summer of the year you apply and you send them a link to upload their letter. Ask attendings to keep letters in their files if you do not yet have access to the residency application system.

Uploading Letters into ERAS:
  • Use the Letters of Recommendation Portal (LORP)
  • You will create a Letter Request Form (LRF) for each LoR you are requesting and then you provide the relevant LoR author with the form
  • If you are considering programs with different requests of letter types (traditional letters, standardized letters, etc.), you will create multiple letter request forms for your faculty writer to upload the various documents to
  • When you are generating the letter slot and cover letter, you can create multiple slots per writer and indicate the letter type in the specialty field
    • For example:
      Dr. Ima Doctor, Plastic Surgery – Traditional LOR
      Dr. Ima Doctor, Plastic Surgery – Standardized Form
      Dr. Ima Doctor, Plastic Surgery – LOR and Form Combined

Since you will not be able to view the letters, this naming convention will allow your letter writer to upload the correct single or combination of documents to your ERAS profile, and allow you to select the appropriate letter type later in the fall when you are applying to the different programs.

For students applying to the SF Match, review the Residency Applicant Instruction Manual for submitting letters to the Central Application Service (CAS).

Ophthalmology
  • There is no limit to how many LoR you can request
  • 3, and only 3, letters are allowed to be assigned to each program you apply to
Uploading Ophthalmology Letters into SF Match CAS:
  • Go to the Documents tab and select LoR. Click the request button and enter the letter writer’s contact information to generate a request
  • An e-mail will be sent from SF Match to the author including a hyperlink that allows them to upload the LoR into the SF Match system
  • Make sure to follow up with letter writers to ensure they received the e-mail from SF Match and are able to upload the letter
Plastic Surgery

As of May 2021, Plastic Surgery mandates a Plastic Surgery Recommendation form.

  • There is no limit to how many LoR you can request
  • 3, and only 3, letters are allowed to be assigned to each program you apply to
Uploading Plastic Surgery Letters into SF Match:
  • Go to the Documents tab and select LoR. Click the request button and enter the letter writer’s contact information to generate a request
  • An e-mail will be sent from SF Match to the author including the standardized recommendation form and a hyperlink that allows them to upload the LoR into the SF Match system
  • Make sure to follow up with letter writers to ensure they received the e-mail from SF Match and are able to upload the letter

If the Medical Operational Data System website (MODS) system is only available to computers on the military CAC-enabled network this year, your letter writers can submit their letters directly to the email address your branch contact specifies.

  • Details are included in BUMEDNOTE 1524, updated annually.

If your letter writer does have access to MODS, have them upload LoR to the MODS system.

Each branch has specific guidelines for letters and the number of letters. Check with your branch for details:

  • Army – information is posted in MODS and emailed
  • Navy
  • Air Force

 

Commonly Asked Questions about Letters of Recommendation

Review the Specialty Career Advisors FAQ, and speak with your Specialty Career Advisor(s) for specifics on if a Chair Letter (also known as Departmental Letter) is necessary for your specialty area(s).

  • Be sure to research what your particular specialty/residency program(s) require
  • Confirm with your Specialty Career Advisor what you need to do in order to get a letter from the department or Chair.

The Chair’s Letter is written by the Chair (head) of the department or by a designated faculty team that is selected by the Chair for this purpose.

Since Chairs often do not know medical students, they may rely on others’ evaluations of your performance when writing your letter. They may also ask you for an interview prior to writing the letter.

  • Provide a copy of your CV and personal statement at the interview

Alternately, the Chair or faculty team may request to view your student file. Due to COVID, student files are not currently accessible. However, you can provide copies of your internal transcript and clerkship evaluations to your writers by downloading the information from AADM or eValue and sharing it directly with them.

Several specialties utilize a Standardized Letter of Evaluation/Recommendation (SLOE/SLOR) either in addition to or in place of a traditional letter of recommendation.

  • A SLOE/SLOR counts as one of your 3 or 4 letters of recommendation.
  • Sometimes the traditional letter of recommendation and the SLOE are uploaded into the application system as one combined document.

The Standardized Letters are intended to provide a more comparative and concise review of a candidate.

The following specialties are currently using a standardized letter – note: this list is not exhaustive. Many specialties shift their preferences year to year and others may adopt standardized letters part way through the season:

  • Emergency Medicine
  • Plastic Surgery
  • Ophthalmology
  • Orthopaedic Surgery
  • Radiology

Speak with your Specialty Career Advisor(s) regarding your application. They will be able to address any questions/concerns you have about this particular item.

An attending agreeing to write you a letter does not end your responsibility for this process. You will be able to see which letters have been uploaded in the application system. Follow up with the writers who have not turned in their recommendation.

Example Reminder Email:

“I am sending you a note to thank you again for agreeing to write me a letter of recommendation. I also wanted to let you know that your letter has not yet arrived and am looking forward to completing my application. The deadline for my letter submissions is __. Let me know if there is any additional information that you need from me. Thank you again for all of your help.”

You assign specific letters to specific program applications. Be careful to not make a mistake while assigning letters!

If you have a letter writer who is writing for both specialties, there are two different routes you can take:

  1. You can ask LOR writers to write the letter and not indicate a specialty
  2. You can create two separate letter slots in ERAS – one for each specialty – and then have the letter writer upload their respective letters accordingly. If you do this, be sure to designate which specialty the letter is being assigned to when creating the letter slot in the ERAS form. This is crucial for ensuring that your writer uploads the correct letter to the correct slot and that you will be able to assign the correct letter to the correct applications. Be very careful when assigning letters in this fashion.

Or you can have two different letter writers, with one writing for one specialty and the other letter writer writing for the second specialty.

If you are applying to a preliminary medicine program:
  • You will need an Internal Medicine department letter as one of your letters. Contact Ruth Sanchez to request a department letter from Medicine.
If you are applying to preliminary surgery or transitional programs:
  • You can generally use the same letters that you are using for your advanced programs.
  • Check with your preliminary programs for any program-specific letter requirements. These will be posted on their program websites.
If you are applying to prelim medicine and categorical medicine at the same program:
  • You will only be able to submit one application and one set of letters for both – you will not be able to distinguish between the two.

This can be tricky if you are dual applying. For example, if you are applying to an advanced radiology program and a prelim medicine program, and you are dual applying to a categorical medicine program, you need to strategize around your letters.

  • If your prelim medicine letter mentions that you are going into radiology and you assign that letter to your application for a particular program, it means that the categorical medicine program at the same program would receive that prelim medicine letter that mentions radiology.

The Emergency Medicine, Family Medicine, Internal Medicine, and OB-GYN departments collaborated to create a resource for letter writers.

Writers should also review the resources available to them on the ERAS LOR Portal as there are specific requirements to which they need to adhere.

To help reduce bias in LoR, faculty may reference the following articles: