You’ve been through one of the , and you need a referee to write a strong family medicine structured reference letter. Because of the specific form and structure required, your referee might need to know a little bit extra before writing out your reference letter. A will be your friend, and the friend of your referee.
To that end, we have written this article, which will go over everything you need to know about the CaRMS family medicine structured reference letter, how to select a good referee, and what your referee needs to know.
The main thing that you need to think about is how to find the best referee. You need to look for a referee who knows you very well and who has observed you in situations relevant to family medicine. For your best chance of getting into the programs, you need a person who has direct experience with you in the field you are applying to.
Want to know 5 simple steps to master CaRMS interview prep? Watch this video:
They Should be a Specialist in Family Medicine
Your best recommender will be somebody who knows you specifically from a family medicine context. You won’t get very far with a specialist from any other discipline, even if they are somewhat related to family medicine. You are facing stiff competition, so if you want a shot, get a person who has direct experience with you in the context of your specialty you are applying to.
A Referee Who Knows You
Get a recommendation letter written by somebody who knows you as an individual. You need somebody who knows details about yourself, who has worked with you, or seen you in an academic capacity.
It goes without saying that this person should think highly of you, but this can’t just be a person who read your or your . Your referee needs to know you personally, for quite some time, and from your more recent accomplishments.
Once you have decided on your ideal referee, you have to ask them to write the reference letter. This will take them a lot of time and effort, so ask them in a professional manner. You can reach out via email, telephone, or in person – the method doesn’t matter – but the way you approach them does.
First, you need to approach them early – at least three months in advance of when you need the letter of reference. Your approach needs to be polite, respectful, and professional. Your best referee will be somebody with whom you have a good working relationship, but that doesn’t mean you should approach in any way that is less than professional. Be polite and unassuming.
If you receive any hesitation or trepidation with writing the letter, it’s better to find a different referee. You want somebody championing your case with enthusiasm.
Once you get that enthusiastic response, make sure to clearly state what you will need: deadlines and what the letter should focus on. This is when you need to make sure that your referee has whatever they need to support you in their letter. Obviously, you can’t tell them what to write, but you can give them information.
Send your referee everything they will need to succeed and write you an ideal recommendation letter. For that, give your referee information across five main areas:
- Example of the
- How to send in the letter
- Links and emails for CaRMS
- Personal info such as your full name, and any information the referee will need, like you and . You should also include the content of your from your .
- A timeline for the work you’ve done with your referee
Your referee has to know when to send their letter of references. Of course, deadlines change from match to match, and from year to year. Here are, roughly, when each match’s submission deadlines are – for reference letters, anyway:
FM/ES is Family Medicine/Enhanced skills, which makes it the most relevant to you.
How to Send the Letter
The reference letter starts with you logging into CaRMS online. Select “reference requests” from the drop-down menu. Click the + icon. You need to fill out the required fields, click “save,” review the information, and select “finalize.”
Next, use the “send to referee” button to notify your referee.
From the referee’s point of view, they need to create a CaRMS account to fill out their structured reference letter and submit it.
The referee then clicks on the Actions column, then on “Create online,” at which point they can write out the structured reference letter.
When finished, the referee clicks on “view letter,” to review what they have written. Finally, clicking “submit,” finalizes and sends the letter.
The upload option is not available for structured reference letters.
Links and Emails
Send your referee all necessary information about yourself. They might need your full name, for example. They might know it to say it or hear it, but might not remember how to spell it. Assume that there is information about yourself, like your resume and transcript, that your referee will need.
Timeline of Your Experience with the Writer
Two timelines are relevant here: deadlines – which we have covered – and a timeline going over your work with the referee. The second timeline is so the referee doesn’t have to wonder about the first time you worked together, the project name, and so on. While this might seem straight forward to you, keep in mind that the referee knows hundreds of students and might find such a timeline useful.
That is not to say you’re telling the referee what to write, just that you should provide them with the facts.
CaRMS highlights the following skills as essential:
- Cognitive skills and knowledge
- Problem solving and patient management
- Behaviour and attitudinal skills
- Communication skills and working relationships
- Ability to work in a team
- Motivation and punctuality
- Sense of responsibility
- Procedural skills specific to the discipline
These are the qualities that will be valuable in a candidate – at least, according to CaRMS.
Additionally, you should take the mission statement of the program into account. Here is an example of a mission statement taken from the family medicine residency program at the University of Western Ontario:
“A Centre of scholarly excellence committed to developing exemplary family physicians and future leaders in healthcare through clinical excellence, professional education, administrative leadership and robust research."
This mission statement emphasizes leadership, clinical skills, education, and research. Search for key terms in any mission statements, vision statements, or lists of appreciated qualities with whichever program this application is going to. Most emphasize a similar list of qualities, but not all schools are exactly the same, so make sure to check it out.
The majority of the CaRMS family medicine structured reference letter is clicking on boxes to check them off, however, there is one place in-particular that allows for a narrative answer.
Narrative answers follow the rule of show-don't-tell, and speak to specific times that demonstrate a candidate’s suitability for family medicine. This is the perfect place to highlight mission statement compatibility as well as the CaRMS recommended qualities. Use the narratives to show the readers what a perfect match the candidate is.
In any case, your referee should know you from a family medicine context, and be using narratives that not only show your qualities according to the program you are applying to, but who can pull these stories from actual experiences you have had working with them in family medicine.
Want to learn how to prepare for your CaRMS interview? Check out this infographics:
Below is a breakdown of the structured reference letter to the CaRMS emergency medicine structured reference letter. We cover each section and what you need to know about it.
Applicant and Referee Information
The first part of the reference letter is just pure information – the names of candidate and the referee as well as the referee’s contact information.
Confidentiality of Content
This is a yes or no, with no elaboration, and asks if the candidate has viewed the reference letter or influenced its content. Honesty is requisite, and this should be a “no.” If you are a candidate, you should not influence the writing of the referee in any way. Trust that they have your best interests at heart and so you will not need to see the letter of reference.
Conflict of Interest
Another yes-or-no section, simply asking whether or not your referee has any bias towards you, such as being a family member.
Context of Working Relationship
This section will quickly glean answers about the relationship between the candidate and the referee. These details are entirely brief and factual:
When did you work with this applicant?
Referee lists the start and end date. This is a good time to remind you that sending a timeline to your referee is a good idea so they don’t have to worry about this at all.
At what stage of training did you work with this applicant?
The referee selects pre-clerkship, early clerkship, mid-late, or post-clerkship.
How well do you know the applicant?
Four possible ratings here, from very well to not very well. If you have picked your referee properly, they will select “very well.”
Do you feel you have had adequate exposure in a work environment to assess this applicant fairly?
A yes-or-no question; again, if you have done your selection work, your referee says, “yes.”
Is your assessment of this applicant based on direct clinical observation?
This answer is yes-or-no, but because pre- and post-clerkship are options for when your referee might have known you, neither answer will be a problem in and of itself. With that said, it’s ideal to have a referee who has seen you in a family medicine context, specifically.
Practice Setting – Location
Three options here: (1) primarily urban or suburban; (2) primarily rural or regional; or (3) combination of rural and urban.
Practice Setting – Type
Three options here: (1) primarily clinic based; (2) primarily hospital based; or (3) combination of clinic and hospital.
Assessment of Applicant
The next section is a series of statements, each of which is rated on a scale of 0-5, as follows:
- Excellent (among the best, better than many R1s)
- Very good (functioning like an early R1)
- Good (ready for R1)
- Fair (teachable but still needs work to be ready for R1)
- Poor (below expected level despite practice opportunities, not ready for R1)
- Unable to assess (not observed)
Those ratings will be applied to the following statements:
- Demonstrates appropriate knowledge base.
- Gathers data efficiently and effectively.
- Able to define problems and formulate appropriate management plans.
- Tolerates clinical uncertainty and avoids concrete thinking.
- Demonstrates compassion and is sensitive to patient needs.
- Communicates effectively and is able to build rapport with patients.
- Demonstrates respect for all members of the team including clinical and administrative staff.
- Demonstrates a positive learning attitude by seeking out and receiving feedback without defensiveness or undue deference.
- Recognizes own limitations, asking for help when needed without overly relying on the preceptor.
- Demonstrates reliability and responsibility by attending regularly, being punctual and avoiding leaving early.
- Demonstrates respect and responsibility by completing tasks as expected, communicating issues appropriately and being responsive to emails or other notices.
- Demonstrates honesty and integrity by taking responsibility for their actions.
- Demonstrates a positive learning attitude by seeking out opportunities and showing initiative.
- Demonstrates stamina and resilience when coping with unexpected stressors and situations.
- Demonstrates appropriate procedural skills.
- Demonstrates cultural and social sensitivity providing a safe environment for all
Have you observed any behaviours that cause you to have concerns about the following:
This section has the referee select “yes” or “no” on a series of areas of potential concern. If the answer “yes” is selected, the referee is then prompted to describe their observation. Here are the areas of potential concern:
- Collegiality (e.g. conflict with staff, issue with other learner)
- Clinical judgement (e.g. over confident, dangerous decision, overly hesitant)
- Patient-centred care (e.g. disrespect, conflict, boundaries)
- Reliability or responsibility (e.g. excessive absences, incomplete records, missed calls)
- Receiving feedback or maintaining professionalism (e.g. disruptive behaviours that impede feedback or disrupt clinic flow).
- Other observed behaviour(s) or trait(s), not otherwise described, that may impact this applicant’s suitability for a position in a Family Medicine residency.
In this section we invite you to highlight what makes this applicant stand out as a candidate for Family Medicine.
The most open-ended and subjective section of the entire structured reference letter, this allows the referee the option to include a narrative answer, which will show clear, specific examples of behaviours which demonstrate competence and excellence in your history. This section needs to be written with a “show-don’t-tell” idea in mind. Examples cannot just say, “The candidate is good with patients,” but rather should demonstrate it with a narrative. For the way to approach this, take a look at some , which will share similarities of method at least.
It's rare to see a candidate of Mary’s strengths. She was part of my family medicine clinic during her clinical rotations, and I thought her assignment would be anathema to her. I was very wrong. Many medical students find the rural environment of my clinic to be not to their taste. Mary did not seem to even notice.
There were two areas where Mary really impressed me. The first was on one day where a family had come in for their checkups. It was a routine day, and all five family members were very different people, but Mary engaged with each of them in their own way. She had the three-year-old son laughing and at ease. She conversed with the eight-year-old daughter about her storybooks. She even got the taciturn thirteen-year-old daughter opening up, talking about her favorite classes at school. As she spoke with each family member, I could see her ability to relate to each patient, being friendly while taking histories and answering questions.
The second area was in regard to her explanations. I have a patient who has been struggling with health concerns relating to diabetes. One of the problems we face with this patient is a non-compliance with diet. This person was one of the first encounters Mary had, and I have seen real progress since she has worked with them. Mary used active listening techniques to affirm the patient’s concerns, then introduced the complications that come up with any diet. While she spoke of complications, she got the patient asking questions, and Mary used those questions to help the patient talk himself into starting a new diet. Mary relates to people quickly. She also has an excellent facility for explaining complex issues to patients. My long-time non-compliant patient is making much better progress for Mary’s careful work.
The penultimate section of the document contains three sub-headings which are intended to quickly summarize your ability as a potential family medicine resident, or lack thereof.
Did this applicant demonstrate an interest in Family Medicine? (Choose one best answer):
- Definitely yes! For example, the applicant specifically described how to apply this experience to their future in Family Medicine.
- Yes. For example, the applicant was interested in and curious about a career in Family Medicine.
- Possibly. For example, the applicant mentioned consideration of Family Medicine
- Not really but the applicant did not speak negatively about Family Medicine.
- No. For example, the applicant demonstrated negative attitudes towards Family Medicine.
Do you believe this applicant demonstrates the skills and personality traits supportive of suitability for a rural family medicine residency? These would include being self-directed, having a spirit of adventure, and demonstrating a tolerance for working in professionally or socially isolated environments.
- Definitely yes!
- I’m not sure
- Definitely no.
- Not in a position to adequately assess
If given the opportunity, would you want to work with this applicant for two years?
- Definitely yes!
- I’m not sure
- Definitely no.
This final point also comes with a section at the end to describe your reasons. This allows the referee to explain this answer. Likely, this is to allow for a potential explanation for the yes or no. For example, if the referee answered “no,” they might say:
While I believe Stan will be an excellent physician, I am moving my practice to a rural environment and I know Stan is looking to practice in an urban area. I have no problems with Stan, but our goals are different.
The very last item on the CaRMS family medicine structured reference letter is a simple, singular statement – a choice between five ranks: strongly recommend, recommend, hesitate, not recommend for family medicine, and not recommend for any position.
Even an is tight, so make sure you are gathering referees early – at least three months early. Getting a good referee who knows you personally from a family medicine context is just part of a top-grade . Just make sure to supply them with everything they need to write that enthusiastic reference letter – like your , for instance. Always remember to be polite and professional and always get that enthusiastic "yes” from your referee.
1. What does CaRMS stand for?
CaRMS stands for the Canadian Resident Matching services.
2. What if my referee hasn’t seen me in a family medicine clinic?
If you’re considering asking somebody who has no idea of what you are like in a family medicine setting, you need another referee. You need somebody who can speak directly to your family medicine knowledge. If you don’t have that, you won’t get int.
3. How do I thank my referees?
Send them a letter or email. It doesn’t need to be elaborate, just sincere.
4. What if my referee says no?
You’ll need three references, so approach each reference and wait to receive your answer before moving on to somebody else. You don’t want to have to ask for a reference and then rescind your request later.
5. Do I use more than one reference?
Yes, you need at least three letters of reference.
6. How many residencies should I apply to?
Don’t spread yourself too thin, as each application adds more to your plate and could split your focus. We recommend you apply to between 15 and 35 residencies.
7. Can my referee edit letters post-submission?
Post-submission editing is fine, and your referee just needs to follow the steps to create a new letter. The referee cannot modify the letter after the deadline, however.
8. Do I have to email my referees or talk in person?
Any method of contact is fine, as long as you are professional and polite.