Guide to Writing Residency Letters of Recommendation

Residency Letters of Recommendation (LoRs) are a crucial component of your Residency application package. In fact, these supporting documents are ranked #2 by Program Directors when choosing applicants to interview. So, whether you have been asked to author the letters yourself or your letter writers will be preparing them, it’s important to have a solid understanding of how to streamline the process and develop the strongest letters possible.

(Program Director Source)

The key factors that define the strength of your LoRs are that they are:

  •   Recent
  •   Based on USCE (US clinical experience)
  •   Specialty specific

For more details on these key factors and the appropriate way to request an LoR, review our blog A Guide to Medical Residency Letters of Recommendation.

Below, we have provided a template that you might consider providing to your letter writer or using yourself (if you have been tasked with writing your own letter(s)). This guide will help authors feel confident about developing the content of the letter. Reviewing the guide can also help you determine which of your letters, or letter writers, are the best.

Guide to Writing Residency Letters of Recommendation


Opening Paragraph

  • Provides detailed background on the writer’s relationship with the applicant including length of time known and the nature of the relationship
  • Clearly states the specialty the applicant is applying to

Body Paragraphs

  • Includes specific clinical examples which demonstrate knowledge, skills, and behavior, commenting on growth if applicable
  • Reflects and expands on attributes mentioned in the Personal Statement (or to be mentioned if the Personal Statement has not been written)
  • Discusses each of the ACGME 6 Core Competencies:
    • Medical Knowledge: Evaluation of applicant’s knowledge of the specialty being applied to
    • Patient Care: Effectiveness of hands-on work with patients and applicant’s ability to collaborate with other healthcare professionals
    • Professionalism: Discussion of peer and staff interactions
    • Communication: Evaluation of the ability to communicate with patients, peers, and faculty
    • Practice-based learning: Discussion of applicant’s willingness to receive and act upon feedback
    • Systems-based practice: Evaluation of team leadership skills, interdisciplinary team interactions, and management of transitions of care
  • Highlights additional qualities/characteristics and offers exemplary stories
  • Discusses any notable research/publications that are relevant to the writer’s experience with the applicant and the specialty being applied to

Closing Paragraph

  • Offers summative evaluation and enthusiastic recommendation for the specific specialty being applied to.
  •  Includes handwritten signature, author name, title, academic rank, and contact information

Additional Considerations


  • Enthusiastic and positive, yet honest and not overly grandiose
  • Uses concise detail: “best I have seen in X years,” “truly outstanding,” “excellent,” “very good,” “qualified”


  • 3-5 Paragraphs (1-2 pages MAX, 1 full page recommended minimum)


  • Uses Letterhead with official institution logo
  • Includes the date created (preferably within 1 year, 2 years MAX)
  • Includes institution address (optional)


When you choose your letter writers, it’s important to schedule a one-on-one meeting with them to discuss expectations for the letter. Consider whether providing the above template to your writer would be well received. Alternatively, you can more subtly include it in your manila envelope of documents that you’ll provide to your writers.

If you’d rather not print out this guide for the author at all, we recommend familiarizing yourself with the main points so you can reiterate those which you feel are the most important upon meeting with your letter writer.

If you’d like feedback on existing Letters of Recommendation or help editing drafts, our partner Residency Experts can help! Visit or call 858-221-8580 to learn more.



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