The Letters of Recommendation (LORs) are an essential part of the application for residencies and fellowships. LORs need to be uploaded on the Electronic Residency Application Service (ERAS) website. Therefore, knowing “How to ask and upload a letter of recommendation in ERAS” is critical for any applicant. Furthermore, there are several considerations to keep in mind, including the best ways to ask for a letter, how to approach the letter writer, what information to provide, how much in advance to request it, and others that we will cover in this post.
WHAT MAKES A LETTER OF RECOMMENDATION “STRONG”
The best letters are the ones that describe the best of you, showing that you will be unique and valuable for the desired program. Ideally, a letter of recommendation should provide specific examples and supporting information that shows the unique characteristics of a candidate. It is now enough that a letter says that an applicant is strong if no particular validating information is provided. Therefore, a letter of recommendation should be written by someone who knows you well and can speak about your qualities and achievements. What makes a letter of recommendation “strong” is an interesting and controversial topic. In general, letters of recommendation should include information about the letter writer (position, workplace, specialty, etc.), the relationship with the applicant, observations and evaluations of their work and behavior, shared experiences and projects, work ethic comments, and why they are recommending the candidate for the position. Certainly, there are personal preferences that programs and faculty members may look for in LORs that others may not pay as much attention to. For example, some interviewers may look for the academic performance and comparison to other students/physicians that the letter writer has had as attendings. A letter with the words “he or she is in the top 3 of the best medical students I have worked with in my 20 years of experience as an attending” can catch the reader’s attention, and more if there are examples that support the statement. Others may focus more on volunteering, research experience, and/or others.
An important consideration for applicants is understanding that programs prefer that a candidate waives the right to see the letter uploaded to ERAS by the writers. Therefore, negative experiences or impressions that an attending had with a student or resident could be written in your letter without the applicant being aware. A letter of recommendation could provide the existence of “red flags” or concerns about an applicant. For this reason, carefully selecting who to ask for a letter of recommendation is crucial. Letters could also describe if a candidate is a good fit for the program. For example, an academic center that focuses most of its attention on research may not consider a candidate described as clinically oriented in a letter of recommendation. When thinking of a LOR, the more personal it gets, the “stronger” it will be. You can review the following website that includes recommendations and examples of good and bad letters of recommendation.
University of Illinois – College of Medicine Advise about letters of recommendation
You can also review the ECFMG information regarding letters of recommendation in the Certificate Holders Office ECHO resources:
ECFMG ECHO Asking for a letter of recommendation
HOW TO ASK FOR A LETTER OF RECOMMENDATION:
Making a good decision about our letters of recommendation is vital. Our first task is to choose the potential letter author. As we mentioned, someone who knows you well and has worked with you would likely be a good choice if your experiences were positive and you believe they may have seen enough of your qualities and aptitudes to be described in your letter. LORs written by U.S.-based faculty are more valuable than international writers for most programs. However, if there is an international faculty who worked with you and you think could write a good letter of recommendation, you could select that author for your LOR. Finding letter writers can be challenging for International Medical Graduates (IMGs). Usually, this can be accomplished by obtaining a research, volunteer, or clinical experience in the United States (externships, internships, clerkships, etc.).
Good qualities to look for in a letter writer include:
- Well respected.
- The title or department of the author is important as well. Letters from Program Directors (PD) are the most regarded.
- Specialty-focused letter of recommendation.
- Knows you well enough to write something positive and “personal” about yourself.
- Mid to late-career faculty member (although not mandatory).
Finding a LOR author can be quite challenging, particularly for IMGs. This reflects why it is so important to search for any positions in which you can be in contact with faculty members to become potential letter writers. To find out more about how to get U.S. Clinical Experience (USCE), please, go to the following link:
WHEN TO ASK FOR A LETTER OF RECOMMENDATION
Once we have identified a letter writer, one should discuss the request for a letter of recommendation. Most applicants contact their attendings at the middle or end of their shared experience, such as an observership. However, it is best to let that attending know as soon as possible that you would like them to write you a letter of recommendation at the end of your experience. This can help them put more attention into certain details they can describe in your letter. Play it by heart and inquire about it when it feels like a good time. It could be odd to ask for a letter during your first contact with that person. Importantly, keep a clear communication of deadlines and periods of your application process to the writers so that they dedicate enough time to write the letter and deliver it to ERAS on time. Please, remember that attendings are very busy with their activities and may not be able to write a good letter for you if not enough time is provided. The expectation will likely be that the attending will be writing your LOR close to the residency application deadline (usually in September every year). You may work with someone a long time before that deadline. Communicating the deadline and letting the attending know about it will help them plan and have a letter ready for you, even if the time to submit it is several months after your experience with them.
Composing a LOR is not an easy task. Authors need to spend a considerable amount of time preparing the letter. Therefore, ask to meet or chat with the desired author and communicate your request to get a letter of recommendation. There are a few tips to consider when doing this part. Please, DO NOT ask an attending if they can write a “strong” or “good” letter for you. Although this may seem innocent or trivial to you, the writer could get extremely offended to be “forced” to say something good about you. Instead, you can ask if they feel comfortable writing a letter of recommendation for you. Attendings have plenty of experience with LORs and know how important such a document is for you. Some attendings will tell you that they don’t know you well enough to write a letter. In those situations, it is in your best interest to say thank you and find another author (you wouldn’t want a letter to be generic without “personal” information). Don’t be afraid to ask a LOR since this is a common process in the United States for medical school, residency, and fellowship applications.
HOW TO ASK FOR A LETTER OF RECOMMENDATION
The preferred method to ask for a LOR is by meeting in person with the attending. Our preference is to contact the attending via email or in person to set up an in-person meeting with them. When asking for a letter, we recommend providing your CV and personal statement (if available) so that the author can get to know more about your experience and education. Setting up a meeting allows you to ask for the letter professionally. It will allow you to tell the author about your interests and which specialty and programs you are applying to. Some faculty may contact the program to endorse your application. Don’t be late for the meeting. Bring a copy of your CV and personal statement (if available) to facilitate the process. Provide the desired timeline for the letter. We recommend you mention to the attending that you would like to waive your right to view the letter. Most attendings know the ERAS process. However, it is okay to mention that you will communicate with them as the application deadline is closer and the application portal has opened so that you can start uploading your information. The residency application timeline is available in ERAS (ERAS 2023 Residency Timeline).
Overall, maintain good communication with your letter author and let them know if you have any questions or concerns. It is better not to ask anything specific about what the author is going to write but rather tell them the information that they need when asked for it during your meeting or communications. The recommended number of letters of recommendation for residency and fellowships is 3-4. Each program will describe how many letters they require on their website. You can find program-specific information in the Association of American Medical Colleges FREIDA Database:
AAMC FREIDA Residency & Fellowship Database
HOW TO ADD A LETTER OF RECOMMENDATION TO THE ERAS APPLICATION
In our “MyERAS” application dashboard, we will see a “documents” section. Click on the letters of recommendation option and the “add new” button. You will see the following window:
- LOR Author Name: we will include the writer’s name, for example, Dr. Joe Davis.
- LOR Author Title/Department: we will describe the author’s position. We should ask the writers what their titles are. Examples include Program Director, Assistant Director, Assistant Professor, Associate Professor, and others.
- The specialty to which this letter will be assigned: Include the specialty you are applying to. If you are applying to more than one, select the one for which that author will write a letter. Remember that this information will be visible only to you; programs will not see this.
- Select the option if you are getting a letter from a Program Director.
- Finally, in the “I waive my right to view my Letter of Recommendation” section, select your choice. It is highly recommended to waive the letter so that the writer feels free to give an honest opinion about us.
The steps are described on the ERAS website like this:
-
- Click Add New to enter and save LOR information.
- Confirm the LOR entry by marking the associated check box and selecting Only checked in the Confirm drop-down list. Note: You may only edit and/or delete a LOR entry before confirming.
- Select Download Letter Request or Email Letter Request in the associated Action column to provide your LoR Author with the form.
Once you have the letter request, send it to your writer so that he or she can start preparing it and upload it. If you do not waive your right to see the letter, you can upload it yourself (not recommended). Remember, once the author uploads the letter, it takes a few days to be available. Therefore, do it as soon as you can. If your author has not uploaded the letter in a reasonable amount of time, you can contact them politely asking for it (contact them only once unless you do not hear back and think they may not have gotten the request). Do not insist. Remember that an author has the choice of revoking or not writing a LOR at any time. Always maintain a good relationship with the letter writer.
WHAT TO DO AFTER THE LETTER WAS UPLOADED IN ERAS
Once the author has written and uploaded the letter, do not forget a “thank you” message via email or phone. Congratulations! You have uploaded your letters and are a step closer to the position of your dreams. We hope that you found this information helpful.
Please, do not hesitate to contact us by using the comments below or contact information.
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