The Do’s and Don’ts of Writing Effective Letters of Recommendation

Writing letters of recommendation (LORs), whether for medical students applying to residency programs or colleagues applying for other professional opportunities, can be viewed as unwelcome drudgery or a rewarding professional responsibility. As a seasoned program director, I read literally hundreds of LORs each year, which has given me some unique insights about what to do and what not to do when writing them.

The following tips offer simple ways to make your letter writing more effective.

Do use official letterhead. If you are affiliated with a university, hospital, or health system, use their letterhead. If you are in private practice, develop a simple and professional template, ideally with your practice name or logo, that conveys who you are affiliated with and your specialty. This allows readers to quickly gain insight into your professional situation and capacity to give valuable insights about the applicant.

Do introduce yourself. Briefly describe your background, experience, relationship to the applicant, and the amount of time you’ve known them. For example, stating that you are a department chair who has been teaching family medicine for 30 years and knows the applicant well establishes your authority. If you are a new family doctor who just started working with medical students, you can still frame your letter in a way that conveys credibility, such as “I’ve worked with five medical students since establishing my practice, and this applicant proved to be the most accomplished in the following ways…”

Do state high-value characteristics. Focus your comments on core competencies the applicant exemplifies, such as patient care, professionalism, and communication skills. Include brief, specific examples of how their behavior epitomized these valued traits. Examples might include previewing or pre-charting clinic patients prior to seeing them each day or demonstrating practice-based learning and improvement through self-directed study.

Do break out your applicant. Statements such as “best medical student I’ve worked with in 20 years” or “top 5% of medical students I’ve ever worked with” help an applicant stand out. These positive, distinguishing statements can strengthen your LOR more than anything else you write.

Do limit yourself to one page. If the first page of an LOR doesn’t distinguish a candidate, more pages won’t help. Shoot for three paragraphs as described above — one briefly describing your background and relationship to the candidate, a second outlining distinct high-value behaviors the applicant demonstrated, and a third that honestly breaks out the applicant in the context of their peers and your history with other medical students. This concise formula should help you avoid going over one page — without resorting to tricks like making your font smaller or margins narrower.

The following tips describe what to avoid in your letter writing.

Do not agree to write an LOR if you cannot write a strong LOR for the applicant. Be prepared to give a polite “no” if you can’t write a sincere recommendation. If needed, consider “pause/delay” tactics such as “I’m flattered and would be glad to consider it. Can you e-mail me your CV?” That gives you time to compose a thoughtful response such as, “I’m sorry, but I just don’t think we’ve worked together enough” or “I imagine others who have spent more time with you can write a stronger LOR.”