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Letters of Reccomendation

Letters of recommendation are rated as the second most important part of the ERAS application by residency directors in the NRMP Residency Program Director Survey.


  • Narrative: Most letters of recommendations are considered narrative letters. These are letters that speak to your character, knowledge, skills, and abilities. These should be written by clinical faculty who know you well and are able to write you a strong, supportive letter
  • SLOE or SLOR: The Standardized Letter of Evaluation or Standardized Letter of Recommendation is a comparative evaluation that assesses each candidate using the same format
    • These are expected in specialties such as Emergency Medicine, OB/GYN, and Orthopedic Surgery
  • Chair: Provided by the chair of the department at IUSM. It may be written by the chair her/himself or it may be a group effort. It is similar to a SLOR but may also pull in more historical information and be very specific about your interactions with the department.
    • Specialties that tend to require a chair letter are Internal Medicine (categorical and preliminary), General Surgery, Pediatrics, and OB/GYN. To schedule your meeting for your Chair letter, please contact:
  • The MSPE – sometimes referred to as the Dean’s Letter – is not a letter of recommendation and does not count toward the letter requirement

Who to Ask

  • Clinical physicians with whom you have worked and who know you well
  • Physicians within your intended specialty. At least one letter, but possibly more, should come from someone in your intended specialty
    • Your career mentor can help you determine who should write your LOR’s
  • Avoid letters from residents, pre-clinical faculty, and non-physicians

How to Ask

  • Be polite!
  • Ask when you are with your preceptor in person, if possible. Zoom or via email are also acceptable
  • Ask the writer if they have time to write you a STRONG, SUPPORTIVE letter of recommendation
  • Provide the letter writer with a deadline
  • Offer copies of your CV and personal statement
    • You can also include evaluations from the rotation and a photo to remind the letter writer of who you are if you are returning to a rotation to ask after a few months
  • Provide the letter writer with your ERAS ID number to include in the letter.
  • Offer to meet up to discuss the letter

Requesting your Letter in ERAS

  • Once a preceptor agrees to write your letter, you will need to submit the request in the ERAS LOR Portal
  • In the letter of recommendation portal, select “add new”
  • Fill out information about your letter writer
    • Author name
    • Author title/department
      • This will likely be something like, “Associate Professor, Department of Internal Medicine
      • Confirm with your writer what they would like you to use in this section
    • Specialty to which this letter will be assigned
      • If you are parallel planning and are asking a single preceptor to write you two letters, you will need to submit two separate requests
    • Additional information
      • You will only select the department chair box if you’re requesting a chair letter; otherwise, you will select “none of the above”
      • You SHOULD select that you waive your right to view your letter of recommendation
  • Once you have saved your entry, you can select “actions” next to the writer’s name and choose
    • Download letter request (if you plan to hand deliver the letter request)
    • Email letter request (the preferred option)

Assigning Letters

  • While you can collect as many letters of recommendation as you want in your ERAS file, you can assign a maximum of four letters to each program.
  • It is your responsibility to know how many and what types of letters each program requires
    • Program requirements will be listed on each residency’s individual webpage
    • If a program specifically states they only want three letters, do not submit a fourth
    • You can choose which letters go to which programs
  • It is strongly recommended to try to get all of your letters submitted by writers to ERAS by the date applications open to programs at the end of September. If you have a letter uploaded after applications are submitted to programs, you will need to go into your ERAS application and assign that letter to all the programs you would like to receive the new letter.
    • It is encouraged to reach out to the program via email to let them know a new letter has been submitted.
  • Example of program requirements: