Letters of Recommendation: Applying to Residencies
Asking for letters of recommendation (LOR) can be daunting; however, it is a critical piece of the residency application. It is one of the ways that a program director can get a better understanding of who you are as a person.
The requirements for letters of recommendation can vary by the type of specialty you’re applying for and also between residency programs within the same specialty. In general, for Internal Medicine, programs expect you to have a departmental letter and at least two more letters. Most programs also allow an additional letter should you choose to have a total of four letters. I would spend the time to look up each program's requirements and mark down their preferences in a spreadsheet. In general, I would advise providing asking for letters one to two months before the deadline. Also, remember to provide your letter writers with materials, including your CV and application draft early on.
It is expected that at least one of your letters elaborates on your clinical performance, and most people would get that letter from their sub-internship. Fourth-year letters are generally better regarded than letters from earlier clinical rotations, especially as they can better demonstrate your learning. Some applicants wait until the last day of rotations with an attending before they ask for a letter, but I would consider asking for the letters early on in your time working together. Specifically, I recommend asking the attendings what they would like to see demonstrated to help them write the best letter. Another thing I would also advise you to do is keep track of meaningful patient interactions so you can ask the attending to speak about those in the LOR to demonstrate your character.
If you participated in research during medical school and hope to pursue an academic residency, I would also consider requesting a research letter of recommendation from your research mentor. There are several things to consider when approaching a research mentor for a letter. If you’re certain of who you would be asking a LOR early in the application process, I would advise that you discuss openly the expectations that your mentor has for you to write you a good LOR. Research letters can elaborate on your ability to adapt to situations in addition to your curiosity and teamworking abilities. It would also be helpful to have a discussion with your mentor about the type of career you’re planning to have so that they can tailor your letter.
In addition to these residency-specific tips, there are some general tips for asking for LORs, some of which we detailed in our letters of recommendation for medical school article. In general, I would advise that you ensure you ask for strong letters of recommendation and double-check the requirements for each program. Asking for letters of recommendation can be stressful, but careful planning can increase your chances of obtaining strong letters that will help you stand out in the medical residency application process.