Program Director Letter for Fellowship: Sample
For residency program directors writing a fellowship letter: what programs ask for, what ACGME sends the fellowship, and a constructed annotated sample.
Program Director Letter for Fellowship: Sample
A program director's letter for fellowship should state where the resident stands in the class, name any remediation or leave and how it ended, and say what you would trust the resident to do alone. Fellowship programs list it as its own item: Boston University's cardiology fellowship asks for a "Residency Program Director’s letter" in addition to "At least three letters of recommendation".
When a fellowship lists the PD letter as its own item, it is asking for the residency program's assessment, not one more faculty opinion. A PD letter that reads like a faculty letter, with warm adjectives and one patient story, makes the reader ask what the program director chose not to say. This page is for the PD or associate PD writing it. The resident's own document is covered in the ERAS fellowship personal statement guide, and every residency letter guide sits in our medical school and residency essays hub.
Every program and ACGME page quoted below was checked on November 7, 2026. AAMC's ERAS letters chapter refused our automated request that day (HTTP 403), so this page quotes no ERAS rule; read that chapter before you upload.
What fellowship programs ask the PD for
Programs write the requirement in different ways, and the wording tells you who should sign. Boston University's cardiovascular medicine fellowship lists a "Residency Program Director’s letter" as a separate document from "At least three letters of recommendation (preferably from Cardiology faculty)" (BU fellowship applications, no year stated). Wayne State's cardiology fellowship counts it inside the three: "Three Letters of Recommendation, one must be from the Program Director of your Internal Medicine program" (Wayne State application process, no year stated). Henry Ford Warren asks for "Three Letters of Recommendations (including one from your current Program Director)" and says to "Apply in the PGY3 year" (Henry Ford Warren cardiology, no year stated).
Read the resident's target programs before you write. If a program counts the PD letter inside its three, the PD letter has to do the work of a faculty letter as well. If it is a separate item, it can be shorter and more summative. For the cycle dates, see the ERAS fellowship timeline for 2027.
What the ACGME sends the fellowship anyway
Your letter is not the only record the fellowship receives. The ACGME's 2026 Common Program Requirements (Fellowship), section 3.2.a, says: "Fellowship programs must receive verification of each entering fellow’s level of competence in the required field using … Milestones evaluations from the core residency program." (Which Milestones count, ACGME only or also ACGME-I and CanMEDS, depends on the eligibility option each specialty's Review Committee chose.) Its background note says the final Milestones report "for an active fellow's most recently completed residency program" is available to fellowship program directors "in mid-July".
The same document requires every fellowship PD to "document verification of education for all fellows within 30 days of completion of or departure from the program" (section 2.5.j). The residency requirements give you the same duty for your residents (section 2.6.j), and the background note to both says "Such verification must be accurate and timely."
Our view: write nothing the final Milestones will contradict. The fellowship reads your letter in the fall and your Milestones the next July. A letter that calls a resident "the strongest in a decade" beside Milestones in the middle of the class costs you credibility with every future fellow you write for.
The countercase: some fellows have no Milestones report. The ACGME note lists cases such as a fellow who "completed residency in a program not accredited by the ACGME" and says programs then "must contact the specialty program director from the fellow's most recent residency program". For those residents, your letter and your phone call are the record, so write more detail, not less.
What a PD letter says that a faculty letter cannot
| Element | Faculty letter | PD letter |
|---|---|---|
| Basis | One rotation or project | The full residency: rotations, evaluations, CCC reviews |
| Comparison | Students or residents the writer worked with | The whole class, by number: "one of two in a class of 18" |
| Record | Not the writer's to state | Leave, remediation, probation, or "none", stated once |
| Autonomy | What the writer saw on service | What the program lets the resident do unsupervised |
| Verdict | "I recommend" | The program's recommendation, signed by the person accountable for it |
The Clinical Competency Committee reviews behind this column are yours to summarize. Do not restate the MSPE or the resident's CV; the MSPE vs letter of recommendation page explains what each document already covers.
Remediation, leave and the sentence you cannot skip
Our view: if the resident had remediation, probation or an extended leave, say so in one sentence, with the outcome and the date it ended. You also sign the verification of training, which must be "accurate"; a letter that leaves out what the verification records reads as concealment once the two are read together.
The rule behind this view is in the residency requirements: "At least annually, there must be a summative evaluation of each resident that includes their readiness to progress to the next year of the program" (ACGME Common Program Requirements (Residency), 5.1.f). Your letter is written by the person who signs those evaluations.
The countercase: a medical leave that needs no remediation is the resident's private health information. Write the dates of training and whether they were extended; you do not need to give the reason.
Constructed example: the faculty-style PD letter
Constructed example, written by us, not a real recommendation letter. Context (invented): Dr. K. Oduya is program director of an internal medicine residency with 18 residents per class. Dr. Clara Thorvald, PGY-3, is applying to cardiology fellowship.
It is my great pleasure to recommend Dr. Thorvald for your cardiology fellowship. She is hardworking, compassionate and an excellent team player. On the CCU she cared for a patient in cardiogenic shock and impressed everyone with her knowledge. I am confident she will be an asset to your program.
It gives no class comparison, no record line and no autonomy statement. From a program director, that silence is the message.
Constructed example: the PD letter, revised
Constructed example, written by us, not a real recommendation letter. Same invented writer and resident.
Dear Fellowship Selection Committee,
I am the program director of the internal medicine residency at Halloran Regional Medical Center, and I have overseen Dr. Clara Thorvald's training since she started in July 2024. This letter summarizes our program's assessment, including the reviews of our Clinical Competency Committee.
Dr. Thorvald is one of the two strongest residents in a class of 18. Our committee rated her ahead of her peers in patient care and medical knowledge at each of her last three reviews. She has had no remediation, leave or extension of training.
In her PGY-2 year she was the senior resident on our CCU for two months. On one overnight shift she recognized right ventricular failure in a patient admitted with pneumonia, started the work-up before the fellow arrived, and presented the case at our morning report the next week. Her attendings now let her run CCU rounds with the fellow in a supervising role only.
She asks for feedback and uses it. After a mid-year review noted that her notes ran long, her notes on the next rotation were cited by the attending as models for the interns.
She is the resident I assign to teach new interns on the cardiology wards. Next year she will be one of our chief residents.
Our program recommends Dr. Thorvald for cardiology fellowship with our highest recommendation, without reservation.
Sincerely, K. Oduya, MD, Program Director, Internal Medicine Residency, Halloran Regional Medical Center
The body, from "I am the program director" to "without reservation", is 223 words. That length suits a program that lists the PD letter separately from three faculty letters. If the program counts it among the three, add a second patient episode to bring it to one page; our public rubric page puts the usual norm at roughly 300 to 700 words.
What changed: the opening states the basis (whole residency, committee reviews); the second paragraph gives the class rank with a number and the record line; the CCU paragraph gives one incident with the resident's own action; the autonomy line says what the program lets her do; the closing is the program's verdict.
PD letter checklist
- Read each target program's letter rule: separate PD letter, or one of three?
- Pull the last three CCC reviews and the current Milestones before you write.
- State the basis: your role and the dates you have overseen training.
- Give a class comparison with a number in it.
- Write one record sentence: remediation, leave or extension, or "none".
- Add one patient-care incident and one autonomy statement.
- Close with the program's recommendation, in plain words.
- Check that nothing in the letter is contradicted by the final Milestones.
Questions about program director letters for fellowship
Is a PD letter required for every fellowship?
No single rule covers every program. The three cardiology programs quoted above each ask for one, in different forms. Read each program's own page.
Can an associate program director write it?
Henry Ford Warren names the "current Program Director". If an associate PD knows the resident better, ask the fellowship program whether it accepts that letter as the PD letter, and have the PD co-sign if it does not.
Should the PD letter mention the resident's research?
Briefly, and only what the program verified, such as a presentation at your conference. The research mentor's letter carries the research.
Can the resident read the letter?
That depends on the waiver the resident signed. The page on an applicant asking to read your letter covers how to answer.
Get a free review of the letter
Get a free Quick Review of the letter against GradPilot's residency letter of recommendation rubric, written for narrative ERAS letters, which is the form a PD letter takes. Paste the PD letter and it checks whether your stated basis covers the judgments you make, whether the patient-care incident shows the resident's own action, and whether the strength of the recommendation is plain. The resident's own document is covered in the ERAS fellowship vs residency personal statement guide.
More residency letter guides:
- Residency letter of recommendation sample: an attending's letter for a medical student, annotated.
- Letter for a prelim or transferring resident: when the resident is changing programs, not finishing one.
- Residency letters for SOAP and off-cycle applicants: timing and wording for Match Week.
Sources
Retrieved November 7, 2026, except where noted.
- Accreditation Council for Graduate Medical Education, Common Program Requirements (Fellowship) (effective July 1, 2026), sections 2.5.j and 3.2.a with background note: verification of education, Milestones verification for entering fellows, mid-July reports, residents without reports.
- Accreditation Council for Graduate Medical Education, Common Program Requirements (Residency) (effective July 1, 2026), section 5.1.f: annual summative evaluation.
- Boston University Chobanian & Avedisian School of Medicine, Cardiology fellowship applications (no year stated): residency PD letter listed separately.
- Wayne State University, Cardiology fellowship application process (no year stated): one of three letters from the internal medicine PD.
- Henry Ford Health, Cardiology fellowship, Warren (no year stated): letter from current PD; apply in PGY-3.
- Not retrieved: AAMC, ERAS letters of recommendation chapter (HTTP 403 to our request on November 7, 2026); no ERAS rule is quoted on this page.
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