HTML Preview Medical School Letter Of Recommendation page number 1.
LTC Kent J. DeZee, MD MPH FACP 7 Oct 2011
General Medicine Fellowship Director, USUHS
Letters of Recommendation:
How to Rate, Write, and Use Them in Your Evaluation of Applicants
Writing a Letter of Recommendation (LOR):
1. When approached by an applicant to write a LOR, ask the applicant to be specific about the purpose of
the letter, to whom it is to be addressed, how it is to be submitted, and whether or not the applicant
waived their right to see the letter (should be waived). Be honest with the applicant with regards to the
quality of letter if it may not be supportive. For example, “Bob, I will write a letter for you, but I can not
place you in the top third”. The applicant may then select someone else if they want. Also, writers should
generally not write an LOR for a specialty that is not similar to their own (subspecialties are fine, such as
infectious disease writer for a cardiology application). Exceptions may be made for unusual
circumstances, such a lengthy research project where a medicine attending worked with a surgical student
for a long period of time. Lastly, recognize the responsibility to the profession of medicine when writing
this letter. Grossly inaccurate letters that portray a poor candidate as an exceptional one are
unprofessional.
2. In the opening of the LOR, include the reason for the letter (“for application to internal medicine
residency”). Anecdotally, some readers look for comments in the beginning of the LOR that indicate the
writer actually wanted to write the letter because the applicant was high quality (“Mr. Bob Johnson asked
me to write this LOR for his application for internal medicine residency and I enthusiastically agreed”).
3. State whether or not the applicant waived their right to see the letter.
4. Convey a great depth of understanding of the applicant. The reader should believe that the writer had
the opportunity to really get to know the applicant. Always include the context and the length of the
relationship. For example, “I worked with Bob for 4 weeks on the General Medicine Service where he
cared for 10 new patients”. While some statements may be “cut and paste” from previous LORs, specific
examples about the applicant should be frequently included to make the reader believe the LOR isn’t just
generic comments the writer makes about all applicants. Direct quotations from the applicant’s evaluation
are generally helpful. If possible, describe multiple spheres (knowledge, clinical skills, professionalism,
interpersonal skills, etc.) Ensure all comments are “factual, truthful, and made in good faith.” (Wright
2004)
5. Provide a numerical comparison with peers, including a denominator. For instance, state “within the
top 1/3 of students I have worked with in the past 5 years (n=20)”. Do not simply describe the student as
“Excellent” or “Outstanding” without quantification as these words have different meanings at different
institutions. Comment on areas of weakness if appropriate, particularly if there is an explanation. Also,
comment on the applicant’s potential.
6. Provide a clear summary statement. Examples include “I would accept for my program”, “strongly
recommend, without reservations”, or “will be a good resident, but won’t be a star”. Do not give coded
answers that force the reader to attempt to interpret what is actually meant. Think of what comments
would best help the reader of the LOR.
7. Provide medical school affiliation/academic rank of the writer. This should always be included by
writers who are surgeons.