Emergency Medicine Residency Letter of Intent (2027)
Emergency medicine residency letter of intent: 2026-27 EM guidance neither requires nor suggests one. When to send it, home-program letters, a sample.
Emergency Medicine Residency Letter of Intent (2027)
Emergency medicine's 2026–27 guidance says: "There is no requirement nor suggestion that post-interview communication be sent to programs." A letter of intent is allowed, not expected, and each program's own instruction controls. EM isn't in NRMP's rank list lock pilot, so a letter can still reach an EM rank list until Wednesday, March 3, 2027, 9 p.m. ET.
Our view: in EM the letter has one job the signal can't do. EM tells applicants not to signal their home program or away rotation sites, so those programs never get a signal from you. If one of them is truly your first choice, a short letter is how you say so in writing. Send one first-choice letter at most, and only if it's true. EMRA puts it plainly: "Do NOT play games with any post-interview communication".
Every OPDA, EMRA and NRMP document quoted below was checked on November 7, 2026. The OPDA guide is the 2026–2027 edition for the 2027 Match. NRMP's rules for all specialties are in the residency letter of intent rules for 2027; below is only what EM changes: ResidencyCAS, no home or away signals, and a neutral letter rule.
What the 2026–27 EM guidance says
The OPDA emergency medicine guide has two communication rules, one for each side of the interview:
"Pre-Interview Communication Guidance: There is no requirement nor suggestion that letters of interest outside of the ResidencyCAS application be sent to programs. There may be a few specific situations where one might be recommended; applicants are advised to speak to a specialty-specific advisor before sending communication."
"Post-Interview Communication Guidance: There is no requirement nor suggestion that post-interview communication be sent to programs. Many program directors will provide specific guidance regarding how they will or will not respond to post-interview communication. If questions about a program arise, students are encouraged to reach out to that program for clarification regarding details of the program or their interview experience."
Three things follow. EM is neutral: it doesn't discourage letters the way the 2026–27 OPDA guides for family medicine and psychiatry do. The program's own guidance is the rule that matters, so read the interview-day materials and the program's website before writing. And questions are welcome: a clarifying question about the program is a message EM's guide invites.
EMRA's Making the Most of Interview Day adds the practical side. It says "you are not required to divulge a program's order on your rank list, even if directly asked by any member of the program" and that "you should never ask a program where you fall on their rank list". Its tip list ends with the line above: "Do NOT play games with any post-interview communication (ie, don't tell every program they're your No. 1 program); it's a small world and it could be very awkward the next time you see a PD to whom you sent a disingenuous message."
EM mechanics that change the letter
| EM rule (OPDA 2026–27) | What it means for your letter |
|---|---|
| Application, SOAP and interview scheduling run on "ResidencyCAS" | Your application went through ResidencyCAS, not ERAS. The letter is a separate email to the program director |
| 5 signals. "Signal home institutions?" No. "Signal programs where they completed away rotations?" No | Your home and away programs got no signal. A letter is the written way to state your interest there |
| "It is recommended that applicants do NOT signal home or away/visiting rotations." | Don't apologize in the letter for not signaling them. The specialty told you not to |
| Virtual interviews; typical offer window September 2026 to January 2027 | Your reason for the program has to come from a virtual day or a rotation. Name the session or shift |
| Second looks "after program rank lists have been submitted" or without "program leadership or other faculty involved with rank list determination" | A second look isn't a stage for your letter. Send it on its own |
| "NRMP Voluntary Rank Order List (ROL) Lock Pilot Initiative: No" | No pilot lock in EM. The March 3, 2027 deadline is the one that counts |
EM's application differs from ERAS specialties in other ways too. Which specialties use ResidencyCAS covers the platform, and the EM ResidencyCAS personal statement guide covers the statement you already submitted.
Late SLOEs. OPDA says "Additional SLOEs can be submitted after the application release date, although program preference may vary as to whether programs will accept additional SLOEs after an interview." A second eSLOE that arrives after your interview is real news. Ask the program whether it accepts post-interview SLOEs before you mention one in a letter.
Should you send an EM letter of intent?
| Your situation | What to send |
|---|---|
| Your home program is your first choice | A short first-choice letter. It got no signal from you, and the letter says what the signal couldn't |
| An away rotation site is your first choice | The same: a first-choice letter naming your rotation month and one thing you saw on shift |
| A program you only interviewed with is your first choice | Optional. It may already have your signal. Write only if you have a reason from the interview day that isn't in your application |
| No clear first choice yet | No letter of intent. A clarifying question or an update if you have one. EMRA's rule: don't tell every program it's No. 1 |
| The program has said it won't respond to, or doesn't want, letters | Follow the program. OPDA says program directors give that guidance |
The countercase: if your home program's faculty already know your plans because you told your advisor or program director in person, a letter repeats what they know. Send it only if it adds something, such as a new eSLOE or a decision you have now made.
Checks before you send:
- Is this program first on your list as of today?
- Has the program said anything about post-interview communication? Follow it.
- Is it before March 3, 2027, 9 p.m. ET?
- Can you name one feature you learned about there, on a shift, at a conference or in an interview?
- Is this the only first-choice letter you will send?
Five yeses: send one short letter. If the program doesn't reply, that's normal. OPDA says many program directors give guidance on "how they will or will not respond".
Constructed EM letter of intent to a home program
Two constructed examples, written by us, not real applicant letters. Context (invented): Ishani Vora is a fourth-year student who did her home EM sub-internship at her school's program in July. She interviewed there virtually in November. By February it is first on her list.
Weak version (69 words):
Dear Dr. Alvarez,
As you know, I didn't use one of my signals on our program, but please don't take that the wrong way. I have always loved this department and the faculty here. I am ranking you highly and I hope I will hear from you soon about where I stand. I know I would be a great fit and I can't imagine training anywhere else.
Ishani Vora
Revised version (73 words):
Dear Dr. Alvarez,
I will rank our program first. During my July sub-internship, the evening shifts in the pediatric emergency area showed me how much of our volume is children, and I want to train where that is part of every block. My second eSLOE, from my November away rotation, was uploaded on January 12. Thank you for my interview on November 19 and for a year of teaching on shift.
Ishani Vora
What changed:
- No apology for the signal. OPDA tells EM applicants not to signal home or away programs, so there is nothing to apologize for.
- One commitment, stated once. "Ranking you highly" plus "can't imagine training anywhere else" is two different claims. "I will rank our program first" is one, and it's true.
- No request about ranking. "I hope I will hear from you soon about where I stand" asks for the program's ranking intentions. NRMP's Code of Conduct for Applicants says applicants "must not request a program director or any member of the recruitment team to disclose program ranking preferences or intentions."
- A reason from her own shifts. "loved this department" becomes a feature (pediatric volume on evening shifts) and where she saw it (her sub-internship).
- A dated update. The second eSLOE is a fact with a date. Check first that the program accepts post-interview SLOEs.
For letters to home and away programs in other specialties, see letters of intent to your home or away program. How signals and letters fit together across specialties is on program signals and letters of intent.
What else EM applicants can send
- A thank-you note. EMRA says the value of a thank-you note "varies greatly among program leaders" and that a note "is unlikely to significantly change the way a program ranks you". Templates are in the residency interview thank-you email guide.
- A question. OPDA invites applicants to "reach out to that program for clarification regarding details of the program or their interview experience."
- An update. A new eSLOE, a released Step 2 score or a publication. The residency update letter guide covers the format.
Questions about EM letters of intent
Do EM programs expect a letter of intent?
No. The 2026–27 OPDA guide says "There is no requirement nor suggestion that post-interview communication be sent to programs."
Can I send a letter of interest before my EM interview?
OPDA says there is "no requirement nor suggestion that letters of interest outside of the ResidencyCAS application be sent to programs" and advises speaking to "a specialty-specific advisor before sending communication." Your signals carry pre-interview interest in EM.
Should I write to my home program if I didn't signal it?
Yes, if it is your first choice. EM's guide recommends not signaling home or away programs, so a letter is how you state that interest.
Can I tell two EM programs they are my first choice?
No. Only one program can be first on your list, and EMRA says "don't tell every program they're your No. 1 program". Your SLOE writers face their own rank-list question; see how EM faculty place students on the SLOE rank list.
Get a free review of your letter of intent
Get a free Quick Review of your letter of intent against GradPilot's residency letter of intent rubric. For a home or away program you didn't signal, it reads whether your reason names what you saw there on shift, whether your first-choice line is stated once, and whether anything asks about ranking. Paste the program's post-interview instruction above your draft, and the review checks the letter against it.
When your draft is ready, the residency personal statement review page lists the residency rubrics. All medical school and residency essay guides are in one place.
Sources
Retrieved November 7, 2026, except where noted.
- OPDA, Program Director Associations Guide for Residency Applicants: Emergency Medicine (2026–2027 cycle): communication guidance, signals, ResidencyCAS, SLOEs, interviews, second looks, lock pilot status.
- OPDA, 2026–2027 guides for Family Medicine and Psychiatry: post-interview communication discouraged, for comparison.
- EMRA, Making the Most of Interview Day (page states no date): rank-list disclosure, thank-you notes, "Do NOT play games".
- NRMP, Match Code of Conduct for Applicants: no requests about ranking intentions.
- NRMP, 2027 Main Residency Match Calendar: Rank Order List Certification Deadline, March 3, 2027, 9 p.m. ET.
Does your letter say why this program, clearly and honestly?
Get feedback on your program-specific reasons, how you state your interest, and any update. Paste your specialty's or program's communication instructions above your draft.