How Should I Get Recommendation Letters for Residency?

Geoffrey Talmon, MD


October 01, 2008

I am getting ready to apply for residency. Who should I ask to write my letters of recommendation, and how should I approach them?

Response from Geoffrey Talmon, MD
Surgical Pathology Fellow, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota

As a medical student applying for residency, I found it very uncomfortable to solicit letters of recommendation (LORs). After all, I needed letters from professor-level attendings who had the potential to affect my future. On top of that, I had heard that I was not supposed to review the letters before they were submitted. Questions percolated through my brain, ratcheting up my stress: Who, and how, should I ask? Would they say "yes"? Did they know me well enough to recommend me? What do these letters even say? It was not until I was involved as a resident in recruiting other house officers that I truly understood how LORs are used by programs and what constitutes a good one.

In several ways, the residency Match process mirrors the job application process in the business world. LORs can be viewed as professional references. As such, they should discuss attributes that are not explicitly outlined in other application materials. Qualities, such as work ethic, willingness to learn, enthusiasm, and teamwork skills, give the audience (ie, interviewers and program directors) insight into how you would function as a resident in their program.

In keeping with this purpose, the individuals who you ask should have worked with you enough to comment on these points, hopefully in a positive manner. To carry the most weight, this person should be a faculty member or practicing physician, not a resident. This can prove to be more difficult in certain specialties. On an internal medicine service, a medical student may work with the same team for an entire rotation. In my field of pathology, however, I worked with no fewer than 10 attendings during my 1-month rotation. I ended up having to ask for recommendations from those staff members who I believed were the best teachers and who saw glimpses of my enthusiasm.

Asking an attending physician to write an LOR can be a daunting experience, especially if it is a person with whom you have not worked extensively, as is often the case with a department chair. Keep in mind that most physicians who regularly deal with medical students have experience in writing LORs and understand what is required. They often will ask for the perspectives of your supervising residents and other faculty to garner the required information. In fact, you can explicitly suggest this to the person writing your letter. In reviewing applications, I have seen writers mention that their letter represents a sort of "consensus opinion," which usually makes that letter at least as strong as any other.

It is most effective to approach your potential writers during a time when you are not on their service; the earlier in your application process, the better. I found that scheduling an appointment with the staff physician's secretary was the most practical approach. Having a dedicated time gives you the opportunity to discuss your goals and plans while refreshing their memory about your time working with them. At the very least, you should provide a copy of your curriculum vitae and personal statement.

The best LORs that I have encountered integrate specific observations from the writer with information in the applicant's personal statement. (For example: "On a daily basis I saw the dedication to patients' spiritual needs that Ms. Smith mentioned in her personal statement as being an important part of her life.") The more information that you can provide (conversations, application materials, etc), the easier it will be for your writer to write a strong LOR. Finally, agree upon a "due date" for the letter, preferably about a month in the future.

Resist the urge to review an LOR before it is submitted; although it may be difficult to accept that this portion of your application is outside your control, you should realize that residency programs view this "blindedness" as a control for bias. If you are overly concerned about what someone might write, you may want to reconsider asking that person to provide a recommendation.

Another important aspect is ensuring that your letters are submitted on time. The writers likely are incredibly busy individuals, and they may need to be reminded of the deadline; at the same time, you do not wish to be a pest. If you see that your LOR has not been submitted by the agreed upon date, send a polite email asking whether the writer needs more information, and then reiterate the due date. This is where giving your writer ample time is helpful.

In summary, the LOR is a professional reference that is meant to provide residency programs with additional information to determine whether you will fit in with their team. Strategies, such as setting up an appointment to converse with your potential writers, providing them with as much information as possible, and giving them plenty of lead time, can help them write an effective letter that ultimately benefits you the most.


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