ERAS Residency Letters of Recommendation Guide


ERAS residency letters of recommendation provide residency programs with vital insight into how professional physicians see your work ethic, character, professionalism, specific strengths and attributes, and how well you will contribute to and fit within your chosen specialty.

Continue reading our ERAS letters of recommendation guide for detailed insight into the ERAS residency application process, how residency letters of recommendation work, as well as key strategies for acquiring strong and effective residency letters.


The ERAS Residency Application Process

While ERAS application season technically begins in June, you should be thinking about your application long before this. Utilize the spring to figure out which programs you want to apply to, acquire your letters of recommendation, and choose a direction to take your personal statement.

In early June, contact your Designated Dean’s Office to obtain your token, which is a one-time access code that will grant you access to MyERAS. By mid-June, you should begin filling out your application with your work, research, and volunteering experience. Use the ERAS Tools and Worksheets for Residency Applicants, which will help you determine the information you need to gather in order to complete your application.

As you work on your application throughout June and August, search for programs you’re interested in and save them so that you can properly organize all of the correct documents for each program.

You can only register for ERAS once, so do everything you can to ensure your application is seamless. Do not certify your application until you’re positive it’s everything you want it to be, as once it’s certified, you cannot go back and change it.

Check with your letter writers to ensure your letters of recommendation are confirmed, get feedback on your personal statement, make final decisions about the residency programs you want to apply to, and get everything in order.

During these summer months, you’ll request your relevant transcripts (USMLE, COMPLEX, MSPE, etc.) Utilize this time to begin your interview prep as well.

At the beginning of September, ERAS will start accepting applications. Submit your application well before the deadline, as at the end of September, applications are released to programs, and interview invitations can be sent out as early as the next day. If you submit your application close to the day ERAS sends them out, you could miss out on the first round of interviews.

Follow our complete Residency Application Timeline and Month-by-Month Schedule.

You will also have to apply for The Match, also known as National Resident Matching Program (NRMP), around this time, and this requires a separate application.

ERAS Residency Application Timeline


How Do Residency Letters Work?

Just like your medical school application, your residency application contains many components that all need to come together before you hit submit.

Your residency application will include:

  • A work and experiences section
  • A 1-page personal statement
  • 3-4 strong letters of recommendation
  • A professional 2.5 in. x 3.5 in photo
  • Transcripts (Medical School Performance Evaluation or MSPE)

ERAS Residency Application Checklist

Although you can upload an unlimited number of references, you can only submit a maximum of four letters of recommendation per program. It’s also important to note that your MSPE or Dean’s Letter do not count as one of your letters. Your letters must be standardized instead of addressed to the specific residency program so that your letter writers don’t need to write multiple letters.

Choose writers from a variety of different specialties and experiences who you have worked closely with, who know you very well, and who will praise your skills, professionalism, and work ethic. At least one of these letters should be written by an attending who has worked side by side with you, a department chair, or a mentor in your chosen specialty. This way, they can authentically speak about your many skills as well as your suitability for that specific specialty in detail.

Your program may also require a letter from someone outside the field of medicine. Carefully read each program’s specific requirements, which you can find on their website, to determine exactly what you’ll need.


Residency Letter Strategies

1 | Think About Your Letters Early

The most important part of obtaining strong letters of recommendation is starting early and devoting ample time to planning. Relationships take time to build. Start planning out who you will ask to write you a letter during your MS3 clinical rotations. Introduce yourself to your attendings and begin building personal relationships.

It’s also important to remember that the letters themselves will take time to write, edit, and upload to ERAS. It can be a confusing system to navigate, especially if your letter writers are older or international and haven’t used ERAS before.

2 | Build and Maintain Relationships

Throughout your time with your attendings, make every effort to demonstrate your unique skills and professionalism. Ask relevant questions, always be engaged, and show genuine enthusiasm.

Familiarize yourself with basic knowledge before you begin your rotation in any specialty, and remember to read the syllabus to know exactly how you will be evaluated. Having a good understanding of key topics early on will help prepare you for your Shelf exams, and it will impress your attendings.

In our comprehensive Clerkship series, we cover what you need to know and how to make the most of each rotation.

Be kind to everyone, not only those you want to ask for a letter. Medicine is a team sport, so it’s important to work on your people skills early on in your training. Keep in mind that there’s something to learn from everyone. Watch your attendings closely. Everyone has a different approach to bedside manner, and watching how professionals deal with their patients can give you important insight into how you want to cultivate your own bedside manner.

Demonstrating kindness and professionalism at all times, regardless of how people treat you, is of the utmost importance. Medicine is an extremely tight-knit community, and you never know who is watching your behavior. If you are observed being rude to a receptionist or tech, it can enter your evaluation and negatively impact your grade. Making enemies on a clinical rotation is the absolute last thing you want to do and the wrong way to gain strong recommendation letters.

Being kind, attentive, enthusiastic, and maintaining a continuous improvement mindset will help you positively stand out to your attendings. Be humble, and always remember you’re there to learn. Even if you know it’s not a specialty you ultimately want to pursue, show an eagerness to learn and keep an open mind. Take advantage of your opportunity to ask attendings questions about their own professional development and why they have chosen their specialty.

It’s also important to ask your attendings for feedback on your performance. Asking for feedback while on the rotation and making every effort to constructively apply that feedback means you can improve before you receive your grade. This modesty and dedication will go a long way to demonstrating your commitment to becoming the best physician you can be, and this won’t go unnoticed.

Continue to cultivate and nurture each relationship after your rotation concludes. Use a calendar to plan out and note how often you check in with your prospective letter writers. A robust residency network is invaluable when it comes time to participate in The Match.

3 | Only Obtain STRONG Letters

Just like the letters of recommendation for your medical school application, obtaining STRONG letters is most important. A generic or lackluster letter will only hurt your application. If you ask an attending to write you a letter of recommendation and they express any kind of hesitation, move on to someone else. It could be they’re too busy, don’t actually think that highly of you, or don’t believe they know you well enough to write you a strong letter.

It is imperative that you only secure letters from people who you’ve worked with closely, know you well, and—arguably most importantly—think highly of you. Your letter writers need to genuinely like you and wholeheartedly believe in your future as a doctor.

If they don’t, you could end up with a late letter or one that paints a lukewarm or dull portrait of you. This must be avoided at all costs, so before the writer sits down to write your letter of recommendation, don’t be shy about asking them to write a STRONG letter.

Learn more: How to Get Strong Medical School Letters of Recommendation

4 | Choose Letter Writers Within Your Desired Specialty

Letter writers who are actually from the specialty you want to join are ideal, as they can authentically and articulately speak to your specific aptitude for that specialty. While this isn’t necessarily required, at least one or two of your letter writers should be from your desired specialty, as they will be able to write about your specific skills in the most comprehensive, detailed, and persuasive way. As always, only choose letter writers who you have worked closely with.

5 | Thank Your Letter Writers

Be sure to thank your letter writers for going out of their way to write you a strong letter of recommendation. Express gratitude by sending a thank you email when your letter has been submitted, and consider mailing them a handwritten card once you are accepted into residency.


Preparing for Residency With Med School Insiders

Med School Insiders can help you prepare a stand out residency application. Our team of doctors has years of experience helping medical students get matched with their ideal program. We can help you approach every aspect of your residency application with care and tact to ensure you’re ultimately matched into a program that best suits your skills and interests.

We offer a number of Residency Admissions Consulting Services tailored to your needs, including personal statement editing, USMLE tutoring, interview prep and mock interviews, and one-on-one advising.


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