Letter of Intent Residency: The 2021 Guide

Updated: January 1, 2021

If you've completed your residency interviews, it's a good idea to send a letter of intent for residency to help improve your standing with your preferred residency program. In this blog, you'll learn everything you need to know about the residency letter of intent including what to include, how to format the letter and common mistakes to avoid. Lastly, you'll have the chance to review a sample residency letter of intent.

What is a residency letter of intent and how can it help me match?

What to include in a residency letter of intent

Common mistakes to avoid

Sample residency letter of intent

Would you like us to help you match with your dream residency program?

What is a letter of intent for residency and how can it help me match?

A residency letter of intent is a short, concise letter that is designed to tell your number-one program choice for residency that they are your top choice, as well as the reasons behind your decision. As with entry into medical school, admission into residency programs is highly competitive. Let's go back a few steps in the process to understand where the residency letter of intent comes into play.

Many of you will be familiar with The Match. It's the method by which the National Resident Matching Program (NRMP) facilitates and organizes the application process in the US. Thousands of residency applicants will use the ERAS or CaRMS to apply and compete for residency spots offered throughout the United States and Canada. Programs will then respond to applicants by inviting them for interviews during the fall and winter of their final year of medical school. Once interview season has come to an end, applicants will create and submit a Rank Order List (ROL), which is a list of programs, in order, that applicants would accept a contract with. Programs will also submit a ROL of applicants that they would like to accept as residents. The Main Match algorithm plays “matchmaker” in setting up applicants and programs. Essentially, it pairs medical students and residents to postgraduate training programs based on these three factors:

1. Number of available positions for each program

2. List of preferred applicants from each program

3. List of preferred programs from each applicant

The first factor is out of your control, but you have the power to influence the second and of course, you have full control over the third factor. On the Monday of Match Week in March, residency hopefuls are notified whether or not they have matched, but the specific program that they have matched to remains unknown. For applicants that are not successful in matching, residency positions that remain unfilled are made available for applicants to attempt to secure before the official Match Day results are released. Students are informed of which program they have matched to on Friday of Match Week.

If you've been lucky enough to sit down for a handful of residency interviews and know which program is your number-one choice, it's time to maximize your chances of getting ranked and matched to that program by sending a residency letter of intent. While sending this letter isn't required, it may increase your chances of appearing high in the program's Rank Order List, in turn, facilitating a match. Ultimately, this letter can help you match because programs want to rank and match with students that also want to rank and match with them, so letting a program know you're a guaranteed match can give you a competitive edge.

What to include in a letter of intent for residency

First and foremost, your residency letter of intent should be a maximum of one page in length. This is designed to be a short, sweet, concise, easy to read document, not a recitation of your residency CV. Keep in mind that this is a formal letter so using bullet points or casual language isn't appropriate. In terms of timing, the letter should be sent after your interviews, in late January to early February, but well before the final ranking deadline. This allows your letter to be genuine because you'll have had a chance to learn more about the program at your interview, and will also potentially have had other interviews at other programs. Essentially, you're showing, not just telling, your preferred program that you’ve really taken the time to consider all program options available to you, and they are still your number 1 choice. The letter can be handwritten or typed and should be sent either by mail or by email.

Just like with your residency personal statement, you need to start by brainstorming before you begin to craft your letter. You need to know what you like about the program, how the program aligns with your short and long-term goals, what about this branch of medicine interests you, and why you want to attend a particular program, as opposed to other programs in the same specialty. Hopefully, while you were at your interviews, you had a chance to learn more about each program, school, and residents by asking your interviewers questions. Be sure you review any notes you made during these interviews or while you were on campus to jog your memory regarding what you loved about a particular program. Obviously, you have the intention of ranking one program as your first choice, so really take the time to think about why they are your first choice, and be sure to include this in your letter. In general, your residency letter of intent should have an opening paragraph, body paragraphs, and a conclusion.

Opening Paragraph:

The opening paragraph is where you'll introduce yourself, briefly mention your interview date and then clearly state your intention to rank the particular program as your number-one choice.

Body Paragraphs:

This where you'll discuss what you specifically like about a school's program. As previously mentioned, be sure to do your research. You need to know why you're interested and why this program stands out compared with other programs. For example, did you learn something specific in the interview that really stood out for you? Do you love this program's research opportunities? Does this school's mission and core values resonate with you? Did you happen to complete an elective at this program during clerkship and really enjoyed it? Don't just tell them, be sure to give specific examples throughout your letter. You likely already encountered some of these common residency interview questions during your interview, so use your responses to help you craft your letter. You also want to discuss why you would be a great fit for the program. Try to brainstorm how it matches with your areas of interest. How will this program help you achieve your short- and long-term goals? What you can bring to the table? What are your skills related to their program? You can also address the location of the program. Is the program in a big city or a rural area, and how will that help you become a strong physician in that specialty?

Lastly, if there are any favorable updates to your application materials, such as a presentation you participated in, a research paper that has been accepted for publication, or even a new relevant volunteer or employment experience, be sure to include this in your letter.


Your conclusion should briefly mention the reasons for your decision and should re-iterate that you will be ranking this program as your number-one choice.

Check out our video for a quick recap:

Common mistakes to avoid

1. Sending the letter to space.

So, you've taken all this time to write a great letter of intent and then you email it to [email protected] This is a big mistake and can result in your letter getting lost in the email world. It's therefore essential that you address and send your letter to the residency program director, the actual person responsible for making applicant decisions. You'll have to do your research - check the school's website or make a few phone calls, just to ensure your letter makes it to the right person.

2. Listing unrelated items.

Listing anything in your residency letter of intent is not appropriate. Don't forget, this is a formal letter. Don't use bullet points and don't list your hobbies or random items off your CV. If it doesn't relate to your interests and suitability for the program, don't mention it.

3. Beating around the bush.

In your opening sentence, don't simply state that you like the program and will be ranking it highly. Tell the program director that they are your number 1 choice.

4. Sending multiple letters.

Sending residency letters of intent to more than one residency program is a massive no-no. The letter of intent is designed to genuinely inform your program of choice that you will be ranking them number 1. It's misleading and unethical to send this letter to more than one program. The point of the letter is to make an exclusive commitment to one program only.

5. Sending a letter of intent inappropriately.

Do not send a letter of intent for the sake of it; if you don't have a preferred program that you're in love with, it's best not to send anything, to any programs. Remember, if you send a letter of intent to a program and end up matching, you're ethically bound to that program.

Sample residency letter of intent

Dear Dr. Vincent Bennett, Program Director, X University.

My name is Rebecca Smith and it was an honor to share my goals and learn more about X University's Dermatology Residency Program during my interview with Dr. James Taylor and Dr. Sophie Miller on January 4, 2019. I am writing you this letter to express my strong interest in Dermatology and to let you know that I am ranking X's program as my number-one choice for residency. In addition, I'd like to provide a brief update to my application materials.

During my first contact with patients as a research assistant at Innovaderm Research, I developed a genuine interest in this specialty. Witnessing the effects of severe and refractory dermatological diseases on quality of life sparked my empathy and a desire to strengthen my knowledge in order to help others. This empathy grew over the course of my rotations, as I observed the distress brought on by a melanoma diagnosis, the debilitating pruritus associated with atopic dermatitis and the emotional scars left by acne.

Driven by this experience, I founded the I've Got Your Back Race with my devoted and inspiring team. Together, we raised close to $18,000, which was donated to the Canadian Cancer Society for the advancement of malignant melanoma research and prevention strategies. This project allowed me to serve as a leader and a strong team player. I was also granted the hands-on opportunity to take concrete steps towards promoting prevention and advocating for patient health – competencies that will serve me as a devoted dermatologist.

Although I have considered many Dermatology programs, the University of X's program remains my top choice for four main reasons. First, I found my shifts and academic days to be enjoyable and effective. The staff and residents I encountered were eager to teach and I felt welcomed by a strong sense of community when I attended Journal Club, SIM sessions, and resident meet-ups. Second, the program serves the second-largest catchment area in the state, leading to a great breadth and diversity of presentations that allow for the appreciation of different patient populations and complexities. Third, I am attracted to the extensive support for research, as well as the opportunity to train in the highly regarded Xavier Western Hospital. Finally, I value the opportunity to live and train in [City]. After living outside of [City] for most of my life, I would welcome and appreciate the opportunity to experience a new city. [City] impressed me with its potential for outdoor activities, as well as cultural experiences.

Lastly, I would like to provide a brief update to my application materials. I was recently invited to give a presentation on [Title of Presentation] to an audience of approximately three hundred people at the annual American Academy of Dermatology conference. I have also been promoted to Research Associate II in Dr. X's lab where I am now responsible for writing protocols, managing research projects, and training junior colleagues.

During my residency, I look forward to being challenged and surrounded by new ideas and perspectives. The University of X's commitment to patient care, dedication to knowledge, and pedagogical approach has instilled a sense of belonging in me. It is with you that I hope to set the final puzzle pieces of my medical training into place. I would, therefore, be honored to become a member of your campus community. For all the aforementioned reasons, I am ranking The University of X's Dermatology Residency Program as my first choice. Thank you for your consideration, if there is any other information I can provide, please don't hesitate to get in touch.


Rebecca Smith

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