Planning ahead

Recommendation letters: A student experience

Let’s focus on some of the common questions: When should you ask, who should you ask, what should you say and how many letters do you need?


Rotations can be a daunting task. At the beginning of my third year of medical school, recommendation letters were the last thing on my mind. Rotations require a steep learning curve, and a lot of rising third-years (including myself) feel overwhelmed. Now that I have a few rotations under my belt, I’ve learned some tips on how to navigate the recommendation letter process without adding more stress to my life.

Let’s focus on some of the common questions:

How many letters do I need?

The number of letters you’ll need varies for different specialties and programs. For instance, family medicine and internal medicine programs typically require 3-4 letters of recommendation. There may be additional program-specific requirements like the structured evaluative letter (SEL) for internal medicine, and the standardized letter of evaluation (SLOE) for emergency medicine. Being acquainted with the different criteria is a good start.

The American Medical Association’s Frieda is a great resource for determining program-specific requirements. You can also visit a specific residency program’s website to find their requirements and deadlines.

You know what else is a good start? Knowing what specialty you want to pursue! Check out The DO’s residency quiz if that’s something that you’re still trying to figure out for yourself.

Who should the letters be from?

Your attendings and preceptors are the best people to ask to write your recommendation letters, especially those who work in a specialty you hope to match into.

General letters are great, but programs want to know you’re serious about your goals and where you want to end up. They want to hear that you’d be a good fit for their specialty from their colleagues and peers. Keep in mind that some programs may not accept letters from residents and fellows. Double check first, so you don’t waste anyone’s time.

Throughout your rotation, you can demonstrate dedication to your goals by showing up prepared to round, taking ownership of cases, volunteering to present and soliciting feedback.

When do I need to work on getting letters?

The start of your rotation is the best time to lay the groundwork for a recommendation letter. A typical one-month rotation can go by really fast, and you don’t want to miss any deadlines.

A letter is a collaboration between the attending and the student. If they aren’t aware of it, an attending with a long list of administrative and clinical tasks may not keep an eye out for your contributions. Asking ahead of time allows you to demonstrate skills that make you a unique fit for that specialty. You may even get a chance to meet about the letter and have it turned into the Electronic Residency Application Service (ERAS) before you’ve completed the rotation.

Start asking as early as you can. Even general letters can be useful in a crunch. Outside of your specialty, letters can highlight other valuable aspects of your strength as a candidate, including medical skills, flexibility and general ability to be a team player. At the end of your third year, it’s better to have too many letters to pick from than to not have enough.

What other materials are needed?

I always offer letter writers my updated CV, whatever portion of my personal statement I have completed, and my time (to answer any further questions). This is usually enough to provide a sense of your intentions and goals. If they have any questions, let them know that you are available to answer them. Or, better yet, ask to set up a quick meeting where you can highlight some of the strengths that make you a strong candidate.

To those third-years who read “personal statement” and get worried: Don’t stress if you don’t have anything on paper yet. Just say so, and reference your CV. A small list of your noteworthy accomplishments and examples can be used in lieu of a personal statement. You can make it a goal to work on your personal statement while your recommendation letter is being written.

It’s important to confirm with the preceptor at the end of the rotation that they feel comfortable writing a strong letter for you. Just because someone is willing to write a letter doesn’t mean it will be a strong or positive one, and since many students waive the right to read their letters, it may not be easy to figure out which ones are the strongest.

These are just a few of the tips I’ve picked up along my journey. They’ve helped me communicate with letter writers and successfully walk away from rotations with strong recommendation letters. I hope these tips help steer you in the right direction. Good luck!

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Related reading:

7 tips on letters of intent for residency applications

Applying to residency: Tips for personal statements and letters of recommendation

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