Programs may ask you to submit both personal and professional letters of reference. Most people don't have any problem identifying personal references. It is the letters of reference from particular department heads or faculty that present the greater problem.
These letters can be very valuable to program directors looking for some distinguishing characteristics among the many applications they receive. After reading through this manual, everyone will know how to write a good CV and personal statement ­ the quality of your letters of reference may be the strength of your application.
The following outline of thoughts on letters of reference was developed by the Department of Family Medicine with contributions from medical students at the University of Washington in Seattle. (Leversee, Clayton and Lew, Reducing Match Anxiety, University of Washington, Department of Family Medicine, 1981.)

• Importance

Your letters of reference often become an important reflection of your academic performance and can also serve as an important source of information about your noncognitive qualities.

• Number of Letters

1. Most residency programs request three letters of reference. Sometimes they specify certain departments or rotations from which the letters should originate.
2. Be sure to follow directions from the program brochure. For example, some programs will require letters from particular departments, others require letters from attendings rather than residents. Occasionally, a letter from a person not involved in the profession of medicine will be requested.
3. Do not send more letters than are requested unless you have one that is especially dazzling. Some selection committees suspect "the thicker the application, the thicker the student". Some programs review only the first letters to arrive up to the number they request, and subsequent letters are ignored.

• Time Line

Starting

1. It is easy to procrastinate. Common reasons include:
• "I don't know anyone well enough to ask for a letter."
• "I hate asking for recommendation letters ... I'll wait until August."
• "I did well on surgery, but that was six months ago ... they won't remember me ..."
• "Dr. Scholarmann is on sabbatical, and I'll just wait until he gets back."
• "I'm an average student, so I'll just get a two-liner from one of my attendings later on...a quick phone call will solve that problem when the time comes."
• "I'll really impress them on my next rotation and get the best letter yet."
2. It is a courtesy to make arrangements for obtaining letters as soon as possible. You may begin now by requesting letters from previous rotations. Sometimes there is a real point in postponing a letter request until you have had a specific rotation if it is obviously an important one for your particular interest.
3. Try to allow at least a month from the time you request a letter until it will have to be at its destination. Bear in mind that faculty are often out of town and that faculty members usually have multiple letters to write.

Requesting a letter

• In most instances, you will choose to request a letter from a rotation in which you did well or one that relates to your chosen field or one that was requested by the program brochure.
• When possible, choose someone who knows you well over someone who doesn't. Choosing at least one person who is likely to be recognized by the program is also a good idea. Choose someone who can judge your clinical skills and intentions, not just a friend.
• Make it easy for the person preparing your letter. Even when you think he or she knows you well, provide a curriculum vitae, a personal statement and a photo to the preparer.
• Make an appointment with the letter writer for about fifteen minutes to review your CV personally. Help the letter writer with additional personal information, particularly if you can remind him or her of some specific event or situation in which you think you performed well on his or her rotation.

ERAS

ERAS allows you to request as many letters of reference as you deem necessary; however, MyERAS will allow you to assign a maximum of four letters to each program. For example, you may request letters of reference from twenty (20) different individuals; however, you may only assign a maximum of four of the possible twenty letters to each program. Writers must submit the letters directly to your designated dean's office. Talk to your designated dean's office to find out what their preferred format is. MyERAS is able to print out an instruction memorandum customized for each writer explaining how to prepare the letter of reference for ERAS and where the letter should be sent.

What About the Dean's Letter?

The dean's letter is also an important part of your application for residency training. It usually is not as valuable as a strong letter of reference, however, because it cannot reflect the same level of personal and professional interaction. In many schools, the process of obtaining a dean's letter entails a meeting with your dean or his or her designee so that the letter can reflect some personal insight into your performance and career goals.
The content of your dean's letter is largely dependent on the process through which it is evolved. Rest assured that most program directors are aware of the process and will weigh the value of your dean's letter accordingly.
Perhaps you have already been notified about the details of this process in your medical school. If not, you need to be aware of how the process works and, in particular, what the time lines are for each step.
If you are applying to programs which require you to make an early decision prior to the Match, you may be required to submit deans' letters in advance of the standard procedure. The same is true for programs in the Uniformed Services. Find out what provisions there are for these situations.
Other features you will want to know about for obtaining dean's letters are:

• When can you begin scheduling appointments to prepare for the drafting of the letter?
• Who should you contact to schedule an appointment?
• How should you prepare for your meeting with the dean? Should you have a draft of your CV and personal statement ready? What other information, such as transcripts, list of potential residency programs, etc., should you bring along?
• How do you obtain transcripts to send to residency programs that are not participating in ERAS?
• How long does it take for letters to be drafted, signed and sent out?
• Will you have the opportunity to review your letter before it is sent out?