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Accruing ERAS letters of recommendation is one of the greatest sources of stress for students during residency application season. In the dozens of students I’ve coached through their ERAS residency applications, I’d estimate that over 80 percent of them saw this as a large cause of anxiety in their application.

Asking a busy attending (who is starting the day with negative amounts of time) to stop what they are doing to write a letter all about you can be a daunting task!

But don’t worry — you can do this! Even students in worse positions have gotten great things accomplished with some appropriate planning and forthright, explicit request.

How to Get a Great ERAS Letter of  Recommendation

1. You should develop a strategy early for who will be your ERAS letter writers.

A great folio of letters doesn’t get conjured up by chance. You should have a sense of who will be writing your letters, including close, personal mentors, and attendings in your chosen field. Early on in medical school (first and second year), you can see what relationships develop organically, and who would be able to say great things about you.

After all, you probably don’t know your specialty at this point, and you might not end up using an average letter from an out-of-specialty attending. However, if you have a research mentor with whom you’ve worked hundreds of hours, your relationship is probably worth documenting in a letter of recommendation, regardless of their field.

As you plan your third and fourth year clerkships and electives, start to think about who would be able to write you a great letter. Remember, the significance of your relationship trumps the status of their title.

2. Ask for a letter of recommendation early in your rotation.

When you get to this point, and know that you want to finish a rotation with a letter of recommendation, your best course of action is to ask early on in the clerkship, probably on the first or second day:

“Dr. So-And-So, I’d like to get a letter of recommendation from you at the end of this rotation, and want to know what I can do to excel and really earn a strong and solid letter.”

“Doing well” on a clerkship is not enough for your attending to wax poetic about. But trying to read their minds about what they are looking for is also tough.

Asking them how you can prove your worth is a surefire way to get held to a higher standard, and have an opportunity to perform at this level. If they lay the groundwork for what they want to see, and you consistently deliver, you can expect an excellent letter in return.

3. Writing letters of recommendation is part of the job description of your attendings.

Your attendings aren’t just there to collect a paycheck. Their job is to further your education and train the next generation of physicians. Part of that job includes writing letters of recommendation for excellent students. Naturally, some attendings will be more (or less) willing, and can produce better (or worse) letters than one another. But it shouldn’t be asking for a Herculean task for them to produce a one page letter about what makes you great.

4. You have to do a superior level of work worth a recommendation.

As above, ask your attending how you can do amazing work. Maybe they will ask for a presentation on a particular subject to your peers. Or perhaps you can lead a journal club on a topic relevant to the study. Be creative and think of a way you can add value to the rotation for yourself, your mentors, and your classmates.

When given the opportunity, knock it out the park! Go above and beyond in order to cement your work ethic and ability into your attending’s mind. You asked for this opportunity, now do what it takes to do truly excellent work.

5. Be patient.

While it’s important to ask early, use your judgement for frequency of checking up. Asking every day, “Where’s my letter? Have you finished my letter?” is just plain annoying. Make a correspondence somewhere on the order of once every 10-14 days, increasing frequency to weekly as it gets closer to due dates. These aren’t hard and fast timelines, just ballparks to keep in mind.

6. Give the letter writer as little to do as possible.

Just putting out a request for a letter is not enough; it’s hard for anyone, even your esteemed writers, to get going while staring at a blank page. Therefore, you should offer some food for thought to remove any roadblocks your letter writer might face. If they accept your request, promptly deliver an updated CV, your personal statement, and the ERAS paperwork for them to fill out. Bonus points for offering these via email and printed out. By placing everything into your attendings hands, there is one less excuse for not getting around to your letter.

7. Be genuinely grateful and explicitly express it.

Someone has taken hours of our their busy schedule to extoll your virtues. That’s a really wonderful thing. Make sure to thank them in person, as well as via email or hand-written note. It’s the kind thing to do.

Read on for a complete list of what information you should provide your attendings to ensure a great letter of recommendation.

Photo by Clay Banks on Unsplash

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Dr. Brian Radvansky

Dr. Brian Radvansky

Brian believes that excellence comes from never taking "no" for an answer, and putting as much work into organizing one's studying as into studying itself. After producing an incredibly average MCAT score, he decided he was going to quadruple his efforts in preparing for Step 1. His greatest successes have brought students who were going to drop out of medicine altogether for fear of not matching to matching into their specialties of choice. He reminds students the importance of performing well on a single test, or even learning how to sell themselves can make an extreme difference in their futures. Students can rely on Brian to hold them accountable and make sure that they don't sabotage themselves with excuses. He can help them to totally reevaluate their approach to USMLE questions in a methodical, protocolized way that ultimately leads to more correct answers and a higher score. With his help, you will trim the excesses, and put all of your collective efforts into only the work that will improve your score. Through his residency admissions consulting, Brian has consistently revamped students applications by helping them to highlight their best (and sometimes hidden) characteristics, and get them to match into the programs they had ranked number one. He can help you to master your personal statement, and craft the story as to why your program of choice needs to have you as a resident. Brian will help you find that all too difficult balance of being proud of and selling your accomplishments, without coming forth as someone who is merely checking boxes to bolster their application.
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