A strong letter of recommendation is a key part of your residency application.
For program directors, these letters give insight into an applicant’s clinical skills, character and potential performance as a resident.
“Approach your rotation as a month-long interview,” Megan Stobart-Gallagher, DO, assistant emergency medicine residency program director at Thomas Jefferson University Hospital, says.
Eighty-six percent of program directors cited letters of recommendation in their specialty as a major factor when selecting applicants to interview, according to the NRMP 2018 Program Directors Survey. For this reason, it’s important to develop close relationships with preceptors. Here’s advice from preceptors and program directors on securing a standout letter of recommendation.
When to ask for letters of recommendation
Set up a meeting with your attending as soon as possible at the start of the rotation. Ask them if they would be willing to write a letter of recommendation for you at the end of the rotation, says Jennifer Kendall-Thomas, DO, medical director for the HealthEast Spine Center in Maplewood, Minnesota.
“Attendings will look at students who have asked for a letter differently during the rotation,” Dr. Kendall-Thomas says. “They may also give these students more opportunities because they know they are interested in the field.”
When asking for a SLOE, a standard letter of evaluation used specifically to evaluate emergency medicine applicants, Dr. Stobart-Gallagher recommends a similar approach.
“On the first day of the rotation, let them know you’re going to want a SLOE at the end of the rotation,” Dr. Stobart-Gallagher says.
Asking for a letter sooner rather than later will help applicants stay fresh in attendings’ memories.
“If you’re asking for a letter six or nine months later, we may forget the good attributes,” says Damon Schranz, DO, family medicine core clerkship director at University North Texas Health Science Center-Texas College of Osteopathic Medicine.
Should you waive your rights to view the letter?
While it may be tempting to see what recommenders are writing about you, waiving your rights to see your letters will make them more credible.
“If students don’t waive their rights, it may look like the student has something to hide and could make them look like a weaker candidate,” Dr. Kendall-Thomas says.
The importance of asking for a strong letter
“Students need to specifically state they are asking for a strong letter,” Dr. Schranz says. “If they ask for a letter, it can go either way.”
Dr. Stobart-Gallagher has been on both sides of the table; she wrote SLOEs as a former clerkship director and reads them in her current role.
“You learn how to read between the lines and determine if students may not work well on a team or play well with others,” she says.
A survey of pediatric program directors found that they wanted to see phrases such as, “I give my highest recommendation” and were skeptical of phrases such as “showed improvement.”
Ask attendings what qualities and characteristics they look for in students during the rotation, Dr. Kendall-Thomas notes.
Some attendings may have certain requirements students need to meet in the rotation to get a letter of recommendation in their specialty; this could include completing a certain number of exams or procedures.
Keep in constant communication
Meet with your attending during the rotation to ask for feedback on your performance.
“If the recommender has any concerns about the student that could affect the letter, they can have time to make corrections and still receive a strong letter,” Dr. Kendall-Thomas says.
Program directors are looking for details about applicants’ specific traits.
“Be proactive and give the letter writer a well-rounded understanding of who you are,” Dr. Stobart-Gallagher says.
It’s difficult to write a letter of recommendation for students who don’t have a good relationship with their attending, Dr. Schranz says.
“It’s hard, but I have said no to students who were not engaged on the rotation, and I’ve told them why,” Dr. Schranz says.
Know the requirements of the specialty you’re applying to
Students should have at least one letter from a recommender in the field they’re applying for. Two would be better.
“It can be helpful to have a letter of recommendation from a related field, but then the letter should comment on what field the student is applying for,” Dr. Kendall-Thomas says.
She recommends students interested in physical medicine and rehabilitation rotate at an academic program where all the attendings are faculty; they should be accustomed to writing letters and understand what programs look for.
Check with specialty colleges and individual programs for specific requirements.