How to Write a Letter of
Recommendation
Angela Jackson, MD
Associate Professor of Medicine
Associate Dean for Student Affairs
Emelia J. Benjamin, MD, ScM
Professor of Medicine & Epidemiology
Vice Chair for Faculty Development and Diversity, DOM
Objectives:
- Identify the key components of an
effective letter of recommendation
- Identify common mistakes to avoid
- Discuss responsibilities involved in
writing a LOR
Points to Cover:
– Purpose of the LOR
– Getting Started
– Letter content and structure
– Do’s and Don’ts of letter writing
– When to say “no”
– Review of examples
Limitations of the LOR:
– No agreement on expectations
– No uniform adjectives
– Reliability limited
– Limited time observing trainees
– Pressure to be overly positive
– Still, can be a very useful component of
a portfolio
Purpose of the LOR:
• Provide truthful information about the
candidate to assist the reader in selecting
the best/appropriate candidate:
–Obligation to candidate, reader and patients
–Obligation to your own integrity and reputation
• Highlight the individual’s qualities in
which the reader would be interested
Purpose of a LOR:
Student:
• Unique or
Personal
characteristics
• Performance
description
Future resident
Purpose of a LOR:
Student:
• Unique or
Personal
characteristics
• Performance
description
Objective AND Subjective
-Your opinion
Future resident
Fund of knowledge
Clinical reasoning
Communication skills
Current functioning
Future potential
Personal qualities
Getting Started:
• How do you get started?
Getting Started
1. Meet with the trainee/faculty
- Career goals
- Purpose of the letter
2. Review CV, evaluations, your notes
3. Honestly assess your ability to write a
STRONG letter
4. Define the timeline and due date
5. Recheck the timeline and due date
Letter Content and Structure:
– The “Opening”
– The “Middle”
– The “Summary”
Letter Content and Structure:
1. Opening:
– Reason for letter
– FERPA
– Your qualifications
– Context and duration (how you know the student:
duration and intensity, role of the student)
– Quantify and compare (# trainees you have worked
with, ranking of the trainee)
Family Educational Rights and
Privacy Act of 1974- FERPA
• Federal law protects privacy of student education records
• Applies to students, but often extended to residents
• Students have the right to consent to disclose their
“educational record” or not
• Most institutions require a waiver
Example:
I am writing this letter at the request of Stella Studs,
currently a 4th year medical student, who is applying to
your internal medicine residency program. I am delighted
to enthusiastically support her application. She has waived
her right to read this letter. I was Stella’s attending during
her four week Internal Medicine subinternship on a busy
inpatient service, where she carried 4-6 patients, and
admitted up to 8 patients a week. I have served as ward
attending twice a year for the past 12 years, and have
worked with over 100 students. As such, I feel that I am
able to accurately assess her abilities and potential as a
house officer.
Letter Content and Structure:
The “Middle”
“The Middle”:
2. Details of the students performance
– Address important competencies: FOK,
communication, clinical acumen, technical skills
– Personal qualities, linked to success in next
endeavor
– Current accomplishments, linked to future success
– Provide specific examples whenever possible
“The Middle”:
– Quantify and compare, if possible
– Describe relevant skills
– Comment on
• Professionalism
• Work ethic
• Personality
• Team work
Example:
Stella is among the top 15 of the 100 students that I have
worked with to date. Among a group of very strong
students, her excellent communication and clinical
reasoning skills set her apart, and were at the level of a
seasoned intern. This was evidenced by her management
of a particularly challenging patient with a new diagnosis
of diabetes and severe pneumonia. She…
Example:
Stella is an engaging and committed student, well liked by
all of the team members. Her patient assessments were
appropriately detailed, both written and verbal and her
clinical decisions were sound, and appropriately carried
out. It is important to add that her fund of knowledge is
not accurately reflected by her standardized exam scores.
In every clinical situation, it was clear to me that her fund
of knowledge exceeded/was on par with that of her fellow
students.
Letter Content and StructureThe Summary:
3. Last paragraph:
– Summarize overall achievements
– Potential
– Would you recruit here?
– Clear overall recommendation
Do’s and Don’ts:
– Do’s:
Do’s:
• Set a realistic timeline for yourself
• Be honest- responsibility for the reputation of the
institution, society, to the student
• Email the student when the LOR has been submitted
• Keep it to 1-2 pages, in general
• Review some sample letters if new to the game
• Highlight something memorable about the student
• Use clear, declarative statements and specific
examples, rather than flowery generalities
Don’ts:
Don’ts:
• Say yes if you can’t write a helpful letter or
meet the deadline
• Ask a trainee to write a draft of a LOR
• Include criticism – not expected in a LOR
(vs. to evaluations, summary assessments)
• Assume a word is just a word – SOLID,
improved
• Underestimate the damage from what you
LEAVE OUT
When to say “No” and other
challenges:
Challenges: Not enthusiastic…
• Rather than include negative comments,
consider omitting comments about
weaknesses (organization, FOK, etc.)
• If critical skill lacking, mention but frame in
a positive light (“I am sure his presentations
will improve with continued practice…”)
• Tell the student what “temperature letter”
you can write
• Truthful but POSITIVE – progress made
Faculty Letters
Features Not Typically in Trainee LORs
• Discuss whether “arm’s length” evaluation,
– Not mentored, trained, coauthored, or on grant
• Emphasize specific unique contributions to field
– How changed research or clinical practice
– Well cited publications [Google Scholar]
• Funding
• Service
• Teaching & mentoring
• Would he/she be promoted at your institution?
Be Aware of Racial Bias
• African American applicants rated lower than
whites
• However, asking evaluators to use controlled
processing, slowed down their evaluation, led
to less bias
Morgan et al., J Appl Soc Psychol. 2013;43:2297. PMID 91929414
Be Aware of Gender Stereotypes
Accomplishments Emphasized
• Research
• Skills and abilities
• Career
Stereotypical
• Ability & Success
adjectives
• Achievement
Women
Short
Letters of minimal
assurance
Doubt raisers
Diminished
• Teaching
• Training
• Application
• Grindstone
• Compassion
Personal life
Commented on
Letter length
Men
Long
Stand out adjectives
Omitted
https://www.aamc.org/members/gfa/faculty_vitae/148590/successful_nominations.html
Trix & Psenka Discourse & Society. 2003;14:191.
Schmader, et al. Sex Roles. 2007;57:509. PMID 18953419
Tip for Reducing Bias
• Write LOR for candidate & switch the pronouns
– If it sounds odd, reconsider
• https://implicit.harvard.edu/implicit/
– Test for your unconscious biases