(NRMP 2018 Director Survey)
Why Ask: Letters of Recommendation, or LORs, are unique in that they provide program directors with a third-party perspective about the kind of student, person, and potential resident you are. Use this opportunity to your advantage – there are many places for you to sell yourself on the ERAS application, but having those praises come from a highly regarded professional holds more weight. As can be seen in Figure 1 above, NRMP Director Survey results showed that letters of recommendation are ranked as the second most important factor in a residency candidate’s application.
Who to Ask: The cold hard truth is that letters from the US are regarded more highly than letters from foreign programs. Letters of recommendation obtained from the US demonstrate that you have experience within the US medical sphere and are thus well adjusted enough to that environment to make for a smooth transition into a US residency. Thus, the ideal letter writer would be someone who you have worked with personally in your US clinical experience, not counting observerships. A letter from someone who can vouch for your proficiency within your desired specialty is also preferred over one who can detail only your general clinical work. Additionally, try to get letters of recommendation from your 4th year in medical school to ensure that they are as recent as possible; having one letter from your 3rd year is valuable too. Keep your eyes out for potential letter writers early during your 3rd and 4th-year rotations, preferably one with experience in your specialty – under no exception should any letter be coming from your first two years of medical school.
How to Ask: You have the option on your ERAS Letter Request Form of whether or not to waive your right to view the letter prior to submission. Although knowing exactly what is being written about you provides peace of mind, allows you to tailor other parts of your application accordingly, and gives you the option of deciding which letters to send to which program, doing so also indicates lack of confidence and reliability to those reviewing your application. Thus, waiving your right is strongly encouraged. A better alternative is establishing expectations and desires about the letter beforehand. As with all correspondence, politeness and gratitude are essential, and the best way to discuss a letter of recommendation is through a face to face meeting, if possible (if not, a Skype call will suffice). When asking, make sure you emphasize that you would like to know if they feel comfortable writing a strong letter for you. Provide them with the ERAS Letter Request Form, deadline your CV, your personal statement, evaluations, information about your chosen specialty and schools, and guidelines on what you would like to be highlighted about you in the letter.
When to Ask: Asking potential letter writers as soon as possible is essential in making your intentions clear from the start and giving your letter writer time to begin observing you from a future residency lens. It is good practice to ask for a letter at least 4-6 weeks before the due date, and continue with follow-ups throughout.