The ERAS letter of recommendation is a fundamental piece of your residency application. When you are competing with other equally qualified applicants, your letters of recommendation can help set you apart from the crowd.

According to the latest NRMP Program Director Survey, 70% of residency programs rank the letter of recommendation 5th after interpersonal skills and interactions with staff and residents when deciding how to rank applicants. Also, 70% of programs consider the letters of recommendation over USMLE/COMLEX scores when ranking candidates.

In this blog, we will provide you with everything you need to know to help make your letters of recommendation stand out. Plus, you will get to read TWO sample ERAS letters of recommendation!


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What is the ERAS letter of recommendation? 

The ERAS letter of recommendation reflects your academic performance, non-academic involvement, and personal characteristics that set you apart from other applicants. As you start to prepare for you residency application, keep in mind that the letter of recommendation can showcase your attributes that may otherwise be impossible to include in your application. The letter of recommendation allows program selection committees to understand how other professionals view you, get an idea of your work ethic, and your ability to contribute to the field of medicine in your chosen specialty. A strong letter of recommendation can be the deciding factor between receiving an interview invitation or not and even which candidate a program ranks higher when faced with two equally qualified applicants. 

Did you know that 70% of residency programs consider your ERAS recommendation letter over USMLE/COMLEX scores when ranking candidates:

Should recommendation letters be addressed to specific residency programs?

No, letters of recommendation should be standardized. Addressing letters to specific residency programs would result in your letter writers needing to prepare multiple letters. This is not feasible. It is general practice to use standardized letters, and residency selection committees do not expect students to have program specific letters. 

How to get a strong letter of recommendation 

Give your best effort in everything you do. If you enter a class, clerkship, volunteer, or research activity with this mindset, you will stand out to possible letter writers. Your letter writers are only able to craft a recommendation based on their experiences with you, so make that experience an amazing one. 

At the beginning of any clerkship, job, volunteer or research activity, sit down with your attending, supervisor, or principal investigator and ask them their expectations. Do your best to meet or exceed those expectations and check in with them bi-weekly or monthly to ask for constructive feedback. Your dedication and integrity will not go unnoticed. Having a great relationship with your superiors will make asking for recommendation letters easier, as they will be more eager to provide you with one.

Who should be your writers? 

Diversity is key. You want letter writers from a variety of specialties and experiences. These can include pre-clinical professors, research advisors, volunteer or extracurricular managers or advisors, clinical clerkship attendings, or department heads. Your letter writers should be individuals who you have worked or interacted with and who can speak to your character, work ethic, and aptitude. 

When considering who should write your letter, it is very important to identify individuals who have gotten to know you on a professional and personal level while you interacted with them as a student or colleague. These kinds of writers will provide strong letters of recommendation as they will be able to speak in detail to your particular strengths and achievements. Combined, your letters should give a comprehensive and holistic insight into who you are as a student, person, and future doctor in that specialty. 

You should have at least one letter from a mentor, attending you worked with, or department chair in your specialty of choice, as most programs will require at least one letter that supports your suitability for the specialty you are pursuing. In fact, 84% of programs cite the specialty letter of recommendation as the second most important factor for deciding who to invite for interviews.

Some programs might also require a letter from someone outside the field of medicine. Be sure to look up the program specific requirements on their website. 

Tip: Ask upperclassmen for advice on who writes strong letters of recommendation. They will have firsthand knowledge of who the best faculty writers are. Also, ask your advisor or mentor for advice. They will know which of their colleagues write strong letters. Some specialties require a department chair letter. Be sure to clarify whether you need a department chair letter with your faculty advisor. They will know how to go about requesting this letter if needed. 

Who should NOT be your writers? 

You do not want writers who you have not worked with personally or who you only had brief interactions with. These individuals will not be able to provide you with a strong letter as they have not had time to evaluate you and your skills.

Also, avoid those individuals who are hesitant in their response when you request a letter from them. They may not feel they can provide you with a strong letter, and it would be better to seek someone else. If you have tried to contact an individual multiple times using different modalities (in person, phone, email) and received no answer, avoid asking them again as they may not have the time to devote to writing a strong letter. 

How to ask for a letter of recommendation

When possible, you should ask for your letter of recommendation in person. If you are asking someone you are currently working with, simply ask to speak with them after your duties for the day are completed. 

If you are asking someone you have previously worked with, send an email requesting to meet with them in person. This will allow you to gauge their initial reaction to your request. Those more likely to write you a strong letter will be enthusiastic in their response and offer their support. Those less likely to write you a strong letter may hesitate in responding or seem surprised at your request. In this case, you might reconsider asking them for a letter.

Regardless of the setting, the approach is the same. Ask specifically, “Would you be willing to write a strong letter of recommendation for residency on my behalf?” If you must ask for your letter via email, be sure to remind them of when you worked together and that you can provide them with supplemental materials. Below are samples of how to ask for a reference letter in person and via email. 

When requesting a letter, you should always let your writer know that you will provide them with supplemental materials to aid them in their writing. You should provide them with your residency personal statement, residency CV or resume, a short biography to fill in any gaps in your background or accomplishments, USMLE or COMLEX scores, medical school transcript, and ERAS letter request form. If you have not written your personal statement yet, compose a short document of why you are interested in your chosen specialty. If your letter writer has previously evaluated you, you can provide them with their prior comments. Also include any other relevant information that you would like your writer to focus on.

Try answering the following questions and providing them in a document to your letter writer:

This is good practice for when you start brainstorming your answers for residency interview questions before you meet the program directors for your interviews!

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When to ask for a letter of recommendation 

The earlier you ask, the better. You want to give your letter writers ample time to compose your letter as they are busy professionals and need the proper time to prepare it. You also do not want them to feel rushed in needing to complete your letter.

At a minimum, you should request your letters 2 months prior to the submission deadline (which is usually September 15). You do NOT have to wait until you are preparing your ERAS application to ask for letters of recommendation. Feel free to ask while you are working with that individual, during your classes, clerkships, volunteer, or research activities. This way their impression of you will be fresh and they will be able to highlight your strengths and skills in detail. Asking for letters earlier will give your writers ample time to reflect on your candidacy and provide stronger letters. If you ask early, they can start working on it as soon as it’s convenient for them.

Then, you can check in as residency application season becomes closer. 

How to enter your letters of recommendation into ERAS

ERAS will allow you to create an endless amount of recommendation entries, but you can only assign up to 4 letters of recommendation to each residency program you apply to.

We recommend having 5 to 6 letters of recommendation so that you can vary which letters you assign, as some letters may be stronger than others. You should have a minimum of 3 letters of recommendation per program. Make sure to check each program’s website for their specific letter of recommendation requirements. 

In ERAS, you must create a separate entry for each letter of recommendation. You will need your writer’s name, title/department, and email address. You will also include the specialty to which you will assign this letter. You will need to designate if the letter writer is a program director or department chair.

You will then indicate whether you waive your right to view the letter for each entry created. It is important that you WAIVE YOUR RIGHT TO VIEW the letter. This means you will not view or obtain the letter. Not waiving your right to view can be seen as a red flag in your application. Program selection committees may interpret your choice to view your letter prior to submission as you selecting only strong letters to be included in your application. If your letter writers know that you will be viewing their letter, their evaluation may be less candid, and less weight may be given to these letters. By waiving your right to view, you are attesting that you have not seen nor will you attain the letter, and you had no prior knowledge or sway over what your writer chose to say. 

A step-by-step guide for how to submit your recommendation letter through ERAS:

Once you have entered all the information, you must also confirm the letter entry. Mark the check box for the letters to be confirmed, click confirm at the top right of the page, and enter your MYERAS password and click confirm to finish the process.

Once letter entries have been confirmed, each letter will be given a separate letter ID and the letter request form will be available. You may save and print the letter request form and take it to your letter writer, or you can choose to email the letter request form directly from ERAS. Your letter writer, or a person they designate, must upload your letter using the letter of recommendation portal. They will need to use the letter ID on the letter request form to upload your letter.

You may personally upload a letter for your writer, if and only if, you did NOT waive your right to view that letter. You would upload in the same manner, using the portal and letter ID for that specific letter.

Once a letter has been uploaded, you will receive an email notification. Then, the letter can be assigned to programs. You can assign your letters via the letter of recommendation page by choosing Assign under the Actions column of the specific letter. You can also assign letters by program via the Assign option under the Actions column on the Saved Programs and Programs Applied To pages. You can only assign letters that have been uploaded, and only 4 letters are allowed per program, not including the medical student performance evaluation (MSPE).

Keep in mind that you cannot change a letter of recommendation assignment once you have applied to a program. 

How to thank your letter writers

It is important to thank your letter writers for taking the time to write a letter on your behalf. You should thank them once you have received notification that your letter has been uploaded to ERAS.

You should send or deliver a handwritten thank you card to them, as it has more of a personalized touch. You can also send them an email to thank them. 

Sample ERAS Letters of Recommendation

Now, let's take a look at two sample residency letters of recommendation. Pay attention to how well the two letters complement each other and create a holistic portrayal of the applicant.

Sample Academic Letter of Recommendation

August 12, 20xx

Dear Program Director, 

It is a privilege to write this letter of recommendation for Ms. Anne Smith in support of her application to your family medicine residency program. Ms. Smith expressed an interest in family medicine early on and completed a summer preceptorship with me in my private practice clinic following her first year of medical school. She has also completed two months of elective time in my clinic during her fourth year. I have over 30 years of experience in private family practice, and I greatly enjoyed my time working as her clinical preceptor. Her clinical skills, leadership capabilities, and passion for caring for the underserved truly set her apart. 

During her time at the clinic, Ms. Smith displayed a high level of professionalism when interacting with patients and staff. She has an innate ability to work with individuals from diverse populations and make them feel heard and understood. She is attentive and compassionate with patients and respectful and patient with staff. She is a joy to work with and brings a light to our clinic. 

Ms. Smith has been one of the most eager to learn and curious students I have had the pleasure of working with. She takes initiative and is not afraid to be hands on and try new things while learning. She is unafraid to ask questions to clarify her understanding and seeks out additional knowledge through reading and research. I have enjoyed learning from her just as much as I enjoy teaching her. She is detail oriented and thorough, and her documentation is already at an intern level. 

I have watched Ms. Smith’s knowledge, skills, and passion for family medicine grow throughout her time in my clinic. She is one of the most knowledgeable and skilled students with whom I have worked in the last 30 years. I believe her caring personality, upstanding character, and exceptional skills will make her a wonderful addition to your program and an excellent family physician. It is an honor to give her my highest recommendation. 

Sincerely,

Emma Jones, MD

Sample Volunteer Letter of Recommendation

August 15, 20xx

Dear Program Director,

It is an honor to write a letter of recommendation on behalf of Ms. Anne Smith for her application to your family medicine residency program. I have had the pleasure of working with Ms. Smith for the last 10 years. I am founder of a non-profit mentoring organization, and she has volunteered and served in many capacities within our organization since its beginning in 2010. Ms. Smith has served as a mentor, teacher, motivational speaker, and health educator to the young ladies in our organization and now carries the title of Director. 

Ms. Smith has been an extraordinary role model and teacher to the young girls in the organization. She displays incredible interpersonal skills through her vivacious personality that reaches out to our girls and makes them feel comfortable sharing with our group. She has a keen ability to relate to and work with diverse populations. Ms. Smith has created lessons to encourage, motivate, and inspire young ladies to embrace who they are and help lay a foundation for their future. She encourages the young ladies within our organization to open up and share about their lives by being transparent about her own life and the obstacles she has faced on the journey to her dream of becoming a physician.

As Director, Ms. Smith genuinely cares about our mission and is consistent with her service. She offers ambition and drive to never stop expanding the services we can offer the young ladies, as well as the community. She is excellent at helping to organize and plan our big events, monthly activities, and our summertime series. She offers pioneering ideas on ways to improve the organization. She is very observant and possesses the ability to quickly assess the needs of people around her and produce effective solutions to problems. She is trustworthy and reliable to deliver much more than expected from her.

Ms. Smith not only works diligently to help the young ladies within our organization, but she works to reach, give back to, and educate the communities we work in as well. She is passionate about serving underserved communities and educating them to promote healthier lifestyles. She is solely responsible for developing and coordinating the health and wellness aspect of our organization. Last year, Ms. Smith created a health education curriculum for use in our organization and community. The curriculum focuses on raising awareness and providing education about health issues and health behaviors on a variety of health topics. Ms. Smith is a passionate person committed to our organization and the growth, empowerment, and health of everyone around her. I am amazed by her level of dedication to our organization while also being a medical student. I am beyond grateful to have her as a part of our organization. I know she will be an outstanding asset to your family medicine program, the community, and the medical field. I give her my highest recommendation. 

Sincerely,

Leah Brown, Ed.S., LPC

FAQs

1. What is the ERAS letter of recommendation?

The ERAS letter of recommendation reflects your academic performance, non-academic involvement, and personal characteristics that set you apart from other applicants. The letter of recommendation allows program selection committees to understand how other professionals view you, get an idea of your work ethic, and your ability to contribute to the field of medicine in your chosen specialty. 

2. Should letters of recommendation be addressed to specific residency programs?

No, your letters should be simply addressed as "Dear Program Director".

3. How many letters of recommendation do I need?

Because the strength of letters will vary, we recommend 5 to 6 letters of recommendation. You will only be allowed to assign 4 letters to each residency program you apply to. But, it is best to ask for more letters so that your application is not lacking, and you can vary which letters you assign to programs.

4. How do I get a strong letter of recommendation?

Put your best foot forward in every situation. At the beginning of any clerkship, volunteer, or research activity, sit down with your attending, supervisor, or principal investigator and ask them their expectations. Do your best to meet or exceed those expectations and check in with them frequently to ask for constructive feedback. 

5. Who do I ask for a letter of recommendation?

Each program may have its own requirements, so check with them first. Generally, hhen considering who should write your letter, it is very important to identify individuals who have gotten to know you on a professional and personal level. These writers will provide strong letters of recommendation as they will be able to speak in detail to your particular skills. These can include pre-clinical professors, research advisors, volunteer or extracurricular managers or advisors, clinical clerkship attendings, or department heads.

6. Who should I avoid asking for a letter of recommendation?

Avoid asking individuals that you did not work with personally and who you only had brief interactions with. Also, avoid individuals who are hesitant when you request a letter. These individuals may not be able to provide you with a strong letter.

7. How do I ask for a letter of recommendation?

It is always best to ask for letters in person. If you are currently working with the individual, ask to meet them after work.

If you have previously worked with an individual, send an email reminding them who you are and ask to meet with them in person. You should specifically ask, “Would you be willing to write a strong letter of recommendation for residency on my behalf?”

Be sure to provide your writer with the letter request form, your CV or resume, residency personal statement, brief biography to fill in any gaps, USMLE or COMLEX scores, medical school transcript, and any specific characteristics or experiences you would like them to include in your letter. Also be sure to give them the deadline you would like the letter completed. 

8. When do I ask for a letter of recommendation?

The earlier you ask, the better. At minimum, you should ask for a letter 2 months prior to the submission deadline of September 15.

9. How do I send my letters of recommendation to ERAS?

Your writers, or someone they designate, will upload your letter using the specific letter ID through the ERAS letter of recommendation portal. You may personally upload a letter for your writer, if and only if, you did NOT waive your right to view that letter. You would upload in the same manner, using the portal and letter ID for that specific letter. Once a letter has been uploaded, you will receive an email notification. Then, the letter can be assigned to programs. You can find detailed specifics on entering letters into ERAS above or in the residency user guide. 

10. How do I thank my letter writers?

You should thank them once you have received notification that your letter has been uploaded to ERAS. You should send or deliver a handwritten thank you card to them, as it has more of a personalized touch. You can also send them an email to thank them.

11. How long should the ERAS letter of recommendation be?

Typically, the letter should be no longer the one page.

To your success,

Your friends at BeMo

BeMo Academic Consulting

Sources: NRMP Program Director Survey


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1 Comments

Aaron C

You not that 70% of PD rely on LORs but, no where does it say they look unfavorable on applicants that didn't waive their right to look at them. It does make sense why a PD would care. Please explain why they would?

Reply

BeMo Academic Consulting

Hello Aaron, thank you for your question. Typically, the programs want to see that you did not have any influence on what the writer said about you. Even if you look only after the letter has been submitted, the programs might think that the writer was influenced by the fact that you would look at the reference. Hence, it's always best to waive your right to view it. 

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