Friday, June 8, 2018

Letters of Recommendation [LORs] 101

The letters of recommendation are very important for the residency application process. All the programs require a minimum of three and a maximum of four letters of recommendation for a complete application. So, I thought I will put together all the information needed to know about Letters of Recommendation[LORs].

DISCLAIMER: Long post!!

1. How important are LORs?

LORs are compulsory while applying for a residency program. Most of the programs require at least three LORs for a complete application.

2. Do all the LORs need to be from the states?

It is good to have all the LORs from the clinical experience from the states. But, a few programs require a letter from the department head of your med school. In such cases, you need to submit one from your med school.

If you don’t have all the LORs from the states, try to get at least two. Its easier for the program director to believe if someone from the same country says that you are well versed with the system than from someone who is outside the country.

But is there not anyone who matched without any letters from the states? There are!! But there are many terms and conditions involved like stellar scores, strong contacts etc. So, to be on the safe side it's better to apply with letters written by someone in the states.

3. What is the difference between a waived LOR and non-waived LOR?

Waived LOR is uploaded by the LOR writer or someone on his behalf and it by default means you never saw the letter.

Non-Waived LOR is uploaded by you or the letter writer. It means that you have seen the letter and know the contents.

Waived LORs are supposed to carry more value than non-waived. But, if you believe that a non- waived LOR is stronger than a different waived LOR you have, definitely use the strong one.

Value: strong waived LOR> strong Non-waived LOR> weak waived LOR>weak Non-waived LOR.

4. How do I send a request/upload a LOR into the ERAS?

There is a tab for LORs on ERAS. Follow the instructions and it gives a printable form to send to the LOR author to upload the letter. You can also send the request directly via ERAS to the author. It has step by step process on how to upload a LOR.

Remember the author should have an AMA account to upload.

5. When do I ask for a LOR?

Usually in the last week or last day of your rotation. Ask your author for a feedback first and assess what he/she feels about you and then ask for a LOR.


“Hi doctor, it has been a pleasure working with you. I would like to take any feedback you have for me regarding my performance”

“I will be applying for so and so residency this year, will you be comfortable in writing a strong LOR for me?”

If they say yes, ask them if they are comfortable uploading it to ERAS and if they are familiar with it. 
Tell them you will send the ERAS request form once the application season starts. If they are not, offer to help them upload the letter explaining to them the importance of a waived LOR.

Never push them to do what they are not comfortable with. Be polite.

6. My LOR author offered me to write my own LOR, what do I do?

Never leave such an opportunity. It means that the mentor trusts you to write a letter. This is an opportunity to write a strong LOR. Try to include the following in the LOR:
    A) Start with how the author knows you and how long he/she worked with you.
    B) Try to give examples to the positive features described. Ex: Don’t say this student is punctual, say something like he/she always arrived before time and left only after the work is done. It will show you are punctual and committed.
    C) Put in strong adjectives. Ex: Rather than hardworking say very hardworking.
Keep a proforma in handy. Some authors might ask proforma. Try to personalize as much as you can.

7. I did a lot of rotations and have a lot of LORs, which ones do I use?

This usually happens with repeat applicants. First of all, use the LORs which you feel are the strongest. If you believe that all of them are strong enough, use the LORs specifically from the same region as the program. Ex: If you are applying to programs in Michigan, and if you happen to have a LOR written by someone in Michigan-use it.

If any your LORs are from people in higher positions like PD, APD, Chairman and are strong LORs- use them.

8. How do I get my LORs from the previous year?

Just buy the token and login into your ERAS account, LORs would have been transferred.

9. I have a LOR from a specialty different from what I am applying for, Is it useful?

Yes! Although it is better to have a LOR from the same specialty, it is not bad to have LOR from a different specialty.

Any LOR is better than no LOR. But make sure that LOR doesn’t say that you are interested in a specialty different from the one you are applying to. Or ask your LOR author to mention your dedication to the specialty you are applying for.
Ex: If a pediatrics author is writing LOR for IM application, Ask them to mention you are dedicated for IM and not to mention you like peds.

10. How useful are the letters of reference?

Letters of reference are written by a physician who you didn’t work with but know you personally. This is a gray area. It worked for some people and some consider it useless.

1. Use google to find proformas online. Don’t copy paste but try to understand the format.
2. Try to send it to people who matched, they might help you make corrections and make it stronger.
3. Authors might not upload the same LOR you gave them. Remember, they have the liberty to change-they are the authors.
4. If someone offers you to write a LOR after September, ask them to write it and take it by hand to interviews and give it to the PDs. Most PDs will e interested in reading them and will appreciate the effort taken by your mentor. It is a bigggg plus.
5. If your rotations happened well before application season, stay in touch with your mentor through Emails, tell them about your progress. Once the application season begins, remind them of the LOR.
6. ERAS takes a maximum of two weeks to process the LOR during peak times. So, keep that in mind. Don’t keep them not uploaded till the last minute.
7.If your author is not uploading the LOR on time send them Emails with subject “gentle reminder” beginning July 15th and tell them they have to upload by September 1st or else you might not be able to apply for residency. Remember they are very very busy.

This whole information is through personal experience and from questions I usually find online. Hope this compilation helps. Feel free to ask questions or contribute to this. 😊

Give as you live <3
Much love <3

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