Residency Letter of Recommendation Sample (Attending)
An annotated, constructed residency letter of recommendation from an attending: salutation, one-page length, patient-care examples and a calibrated close.
Residency Letter of Recommendation Sample (Attending)
A narrative residency letter from an attending runs about one page, opens "Dear Program Director," or "To whom it may concern:", and is not addressed to any one program. In between it needs three things: how you know the student, two or three patient moments you watched, and a recommendation the moments support.
Our view: three observed patient moments and one comparison you can defend do more than any "top 1%" template. University of Washington's faculty tip sheet gives the reason in one line: "Letters that are effusive or positive in excess of what the student deserves will ultimately hurt future students, as your letters will be considered by program directors to be unreliable."
The ECFMG and University of Washington guidance quoted below was checked on November 7, 2026. The AAMC's ERAS letter pages returned HTTP 403 to our scripted check that day, so this page states no ERAS upload, Letter ID or per-program assignment rules; read those on the AAMC's ERAS letters of recommendation page. For the applicant's side of letters, see the ERAS letters of recommendation guide.
What two published guides say about the letter itself
| Element | Guidance (source) |
|---|---|
| Salutation | "Your letter writer should begin the letter with a general salutation, such as “Dear Program Director,” or “To whom it may concern:”." (ECFMG) |
| Addressee | "Letters should not be addressed to specific programs or program directors." (ECFMG) |
| Length | "short enough to read (1 page) but detailed enough to make the student distinctive." (UW) |
| Identifiers | "Put the student's ERAS ID number on it at least once" and "State that the student has waived the right to see the letter." (UW) |
| Format | "Print it on letterhead. Include your personal contact info (email below your signature line)." and "SIGN THE LETTER." (UW) |
| Specialty | A specialty-specific letter "should directly recommend you for training in that specialty and explain why you are well-suited for that specialty." (ECFMG, written to applicants) |
Sources: ECFMG, Asking for a Letter of Recommendation (last updated May 20, 2025, written for applicants); University of Washington School of Medicine, Tips for writing Letters of Recommendation (updated 2016). The UW waiver line applies only when the student actually waived; check before you write it.
Constructed sample from an internal medicine attending
Constructed example, written by us, not a real recommendation letter. Context (invented): a hospitalist supervised a fourth-year student on a four-week internal medicine sub-internship. Names, IDs and the institution are invented.
The letter (284 words):
Dear Program Director,
I am pleased to recommend Marta Pazmino (ERAS ID 0000000) for residency training in internal medicine. I am a hospitalist and associate professor of medicine at Glenmoor University Hospital, and I supervise fourth-year sub-interns on our teaching service. I was Marta's attending for four weeks in July 2026, rounding with her daily, and she has waived her right to see this letter.
Marta carried four to five patients and was the first call for their nurses. On her second day, a patient admitted for cellulitis had a new oxygen requirement on morning vitals. Marta examined him before rounds, found new crackles at both bases, reviewed his fluids, and presented a plan for diuresis and a repeat chest film. She was right, and she told the night team what she had found so they would know.
She also learns fast. After I showed her how I structure a family meeting, she ran the next one herself for a patient with new heart failure, used plain words for the ejection fraction, and asked the daughter to repeat the plan back. The daughter called the unit the next week to say the discharge instructions made sense.
When I told Marta her presentations ran long, she cut them to the active problems the next morning and asked me whether the cut lost anything. That is how she handles feedback: once, and without defensiveness.
I have supervised about forty sub-interns in seven years. Marta is one of the three I would most want as an intern on my own team. I recommend her for internal medicine residency with my highest recommendation and without reservation.
Sincerely,
Hira Iwasaki, MD Associate Professor of Medicine, Glenmoor University Hospital hira.iwasaki@glenmoor.example
How each paragraph maps to the residency letter rubric
GradPilot's residency letter of recommendation rubric lists five mistakes. Here is where the sample avoids each:
| Rubric mistake | What the sample does instead |
|---|---|
| Unclear relationship to the candidate | Role, hospital, month, four weeks, daily rounds, all in the first paragraph |
| Praise without patient-care examples | The oxygen requirement and the family meeting each show a situation, her action and what followed |
| Claims that exceed what was observed | Every claim is from the four weeks the attending was present; the daughter's call is a fact the attending learned, not a credit for the team's work |
| Vague or hedged recommendation | "highest recommendation and without reservation" with a group size and a rank inside it |
| Generic or padded language | No ceremonial opening, no CV recital, no flattery of the program |
The rubric's own test for the last row is "Whether the letter would survive swapping in another candidate's name." Swap a name into the sample and the crackles, the family meeting and the shortened presentations stop being true.
Hedge words that sink a letter
UW's tip sheet names the words directly: "Avoid any language that makes the student sound average: “competent”, “solid”, “good”." It also warns against "improved", which "implies they were bad to begin with", and against "damning with faint praise: saying a student is “reliable”, “punctual”, or a “hard worker” without praising clinical skills". GradPilot's rubric flags "solid," "competent," and "should do well" for the same reason.
| If your draft says | Replace it with |
|---|---|
| "a solid student" | the patient moment that made you trust her |
| "she improved over the rotation" | what she did in week four, stated on its own |
| "reliable and punctual" | the clinical judgment you saw, then reliability if you still want it |
| "should do well in residency" | what you are recommending her for, and how strongly |
Comparisons you can defend
UW lists comparative statements such as "Best student in xx years, top xx%" as "optional, but often valued by residencies." Our recommendation: use one only when you can name the group and the window: "about forty sub-interns in seven years" lets a reader weigh "one of the three." A bare "top 1%" from a writer who does not say how many students they have seen gives the reader nothing to weigh.
The countercase: if you have supervised only a few students, skip the number and let the patient moments carry the letter. If the specialty asks for a standardized letter form instead of a narrative letter, the standardized letters of recommendation by specialty page covers it; the residency letter rubric covers narrative letters, not those forms.
Before you sign: a checklist
- The first paragraph says who you are, where and when you worked with the student, and how often.
- The letter recommends the student for one named specialty.
- Two or three patient moments each show a situation, the student's action and the result.
- No sentence credits the student with something you did not see.
- None of "competent", "solid", "good", "improved", "should do well" survives without evidence beside it.
- Any comparison names its group and time window.
- The last paragraph states the recommendation and its strength. UW: "This may be the only paragraph that they read."
- Letterhead, signature and contact details are on the page, and the salutation names no program.
Questions about residency letters of recommendation
Writing as a program director for a resident applying to fellowship? The program director letter for fellowship covers what the PD letter adds.
Writing for a resident rather than a student? See the letter for a preliminary-year or transferring resident.
Should I write "Dear Program Director" or "To whom it may concern"?
Either. ECFMG lists both as general salutations and says letters "should not be addressed to specific programs or program directors."
How long should a residency letter of recommendation be?
About one page. UW: "short enough to read (1 page) but detailed enough to make the student distinctive."
Can one letter support two specialties?
ECFMG tells applicants that a specialty-specific letter should not be reused for another specialty, and to "request a general letter applicable to all specialties, or request multiple, specialty-specific LoRs from that same letter writer." If the student is applying in two fields, ask which they want.
Should I say I would want the student in my own program?
UW's tip sheet says: "If you would want them in your own residency, say so." State it as your judgment of the student, as the sample does.
Get a free review of the letter
Get a free Quick Review of your recommendation letter against GradPilot's residency letter of recommendation rubric. It reads for how you know the candidate, patient-care evidence, the qualities programs screen for, the strength of the endorsement, and whether the letter would survive swapping in another candidate's name.
Students working on their own file can use the residency personal statement review.
More residency letter guides:
- Residency letters for SOAP and off-cycle applicants: when the timing is not the main Match.
- MSPE vs letter of recommendation: what the dean's letter already says, so yours does not repeat it.
- US clinical letter for an IMG: what an observership attending can attest to.
- How long a letter of recommendation should be: length rules across systems.
- All medical school and residency essay guides.
Sources
Retrieved November 7, 2026, except where noted.
- ECFMG, Asking for a Letter of Recommendation (LoR) (last updated May 20, 2025; written for IMG applicants): salutation, addressee, specialty-specific letters.
- University of Washington School of Medicine, Tips for writing Letters of Recommendation (2016): one page, ERAS ID, waiver statement, letterhead, signature, summary paragraph, comparative statements, words to avoid.
- GradPilot, Residency Letter of Recommendation (ERAS) rubric: the five listed mistakes and the name-swap test.
- AAMC, ERAS letters of recommendation: HTTP 403 to our scripted check on November 7, 2026; nothing quoted.
Review the Letter Before It Is Submitted
See how the letter reads against the rubric for its destination.