Standardized Letters of Recommendation by Specialty

Standardized Letters of Recommendation by Specialty

We confirmed standardized letters in six specialties: dermatology requires at least one SLOE for the 2026-27 cycle, the orthopaedic eSLOR replaces the narrative letter, OB/GYN strongly recommends one SLOE, neurosurgery recommends a home SLOE and away SLORs, psychiatry's SLOR is optional, and emergency medicine runs its SLOEs through ResidencyCAS.

This page is for the person writing the letter. The form decides how much you can write, where it goes and whether a separate narrative letter is wanted, so find out which form the specialty uses before you draft. If you are writing a plain narrative ERAS letter, the residency letter of recommendation sample covers that document, and the ERAS letters of recommendation guide covers how programs read the whole letter set.

Every specialty-society page quoted below was checked on November 7, 2026. Each row names the cycle its own document states. Several specialties named on other societies' lists did not publish a form we could load, and the table says so.

On this page:

• The table: which form each specialty uses
• What each form asks of you
• SLOE vs SLOR: what the difference means for your draft
• Before you write: a six-question check
• Questions about standardized letters

The table: which form each specialty uses

Not verified. ADMSEP's Match 2026 document says standardized letters are also used in "internal medicine, med-peds, neurological surgery, … plastic surgery, and diagnostic radiology." Neurosurgery's form is on the Society of Neurological Surgeons' site and is in the table. On November 7, 2026 we loaded the home pages of the internal medicine and radiology educator societies and found no form; the plastic surgery society's site did not respond; the general surgery program directors' SLOR address opened a general program-director page with no SLOR content. For those specialties, read the applicant's program requirements.

What each form asks of you

Dermatology: one SLOE is required this cycle

The Association of Professors of Dermatology statement for the 2026-27 cycle is the newest rule on this page:

"For the 2026-27 cycle, we are requiring applicants submit a minimum of *1* SLOE written by a dermatologist. This should come from either a home dermatology program, or, if applicants do not have a home program, from a dermatology program where the applicant completes an away rotation. All remaining letters may be the new SLOE or narrative format, but use of the SLOE is encouraged."

The applicant chooses the format when they create the request: "Applicants will identify whether they are requesting a narrative letter or a SLOE from a potential letter writer when they enter the letter request into the ERAS portal." So the request in your inbox tells you which document to write.

The same statement has a line aimed at faculty: "faculty are discouraged from communicating on behalf of applicants to program directors and faculty at other institutions, either before or after interviews." Your letter is the channel. A follow-up call to a colleague's program is not.

Orthopaedic surgery: the eSLOR is the whole letter

The AOA eSLOR page answers the question writers ask, "Is the eSLOR sufficient, or do you recommend the letter writer create an additional summary-type letter?", with "No, no additional summaries are required." It says the form exists to "serve as the sole letter for applicants." Its rules for authors:

• "Do place an applicant on your hypothetical rank list. Be as accurate as possible." The page adds: "An applicant placed into the middle third of a hypothetical list will still be viewed as a competitive candidate."
• "Do use the “Personal Comments” field to explain responses and highlight distinctive accomplishments."
• "Don’t append any additional information or letters of recommendation. The eSLOR is meant to be a stand-alone document."

Who can write it: "any board eligible or board certified orthopaedic surgeon who has useful information about the applicant." After you sign it, you download the PDF and upload it yourself, and you "make sure to check the box “This letter contains or is a SLOE.”" The page warns that the PDF can exceed "1MB which is the maximum file size permitted by AAMC."

Neurosurgery: a home SLOE, away SLORs and one letter of any kind

The Society of Neurological Surgeons' 2025-2026 Recruitment Guidelines say "the SNS recommends that each applicant obtain the following recommendations": one SLOE from the home program, one to two SLORs from external programs, and "One (1) letter of any kind". The guidelines set the comparison group: "the comparator group should include all students who have rotated with the department in the past 3 years." They also allow a narrative: "Narrative comments can be included within the template or attached to it as a companion, traditional narrative letter." The page we read carries the 2025-2026 guidelines; no 2026-27 version was posted.

The standardized form (updated May 2026) says "Multiple evaluators may pool their feedback into a single letter" and asks you to place the applicant "Compared to neurosurgery applicants your program evaluated in the last 3 years", on a scale from "1% - will rank to match" to "51-100% - may or may not interview". Its comment box asks you to "Include specific examples supporting the overall rating, particularly for applicants in the top categories."

OB/GYN: four sections, and a narrative box of 250 words

The APGO SLOE writing guide is dated May 1, 2025 and written for the 2025-26 cycle. It is the most detailed form guide we found:

"The submission of one SLOE is strongly recommended for each applicant for the 2025-26 application cycle. While it is not universally mandatory, many programs may require a SLOE to apply to their program."

You first state your capacity: a Chair's letter, a composite group or committee assessment, or an individual letter based "solely on their direct observation of the applicant." Then four parts:

Two rules sit under the narrative: "Do not attempt to summarize the applicant’s CV" and "This is not intended to be a shorter version of a typical letter of recommendation." For DO and international graduates, APGO says the SLOE "may be best completed by an individual letter writer rather than a composite" letter from the school. If you supervised an international graduate on a US rotation, the USCE letter of recommendation page covers what you can attest to.

The ResidencyCAS letter help page adds the route: "you'll complete the SLOE using an online form (instead of uploading a PDF). If you need to complete a SLOE for an applicant in both ResidencyCAS and ERAS, you can fill it out in ResidencyCAS first, then download a PDF copy for upload in ERAS."

Psychiatry: optional, one writer, character limits

ADMSEP's letter-writer tips for Match 2026 say: "While the SLOR is not mandatory, applicants are encouraged to identify one letter writer to use the SLOR template." The template is a Word document so you can "transfer onto institutional letterhead and provide a wet signature if they desire before uploading in pdf form to ERAS." Each section has a character limit, "to ensure letter writers stay concise and all students receive the same amount of content."

Emergency medicine: four SLOE types

CORD's SLOE page carries the instructions for faculty for the 2026-27 cycle and says that "only the eSLOE, which is to be written by EM faculty at a site with an EM residency program, asks where a student will fall on the rank list." The ResidencyCAS help page lists the types:

• "eSLOE: written by faculty at an EM residency program who are familiar with all students rotating through the program and are involved in creating the rank list."
• "Non-residency-based SLOE: written by EM faculty after a rotation at a site without an EM residency program."
• "Sub-specialty SLOE: used for rotations focused on EM sub-specialties such as ultrasound, pediatrics, or toxicology."
• "Off-service (O)SLOE: written by off-service faculty based on a clinical rotation outside the ED, including but not limited to internal medicine, anesthesia, or surgery."

It adds: "Narrative letters are typically used for non-clinical experiences such as research, volunteering, leadership, or mentorship." For a SLOE you get an email with a link to the CORD eSLOE Portal and "a unique ResidencyCAS Letter ID", which you enter before you submit. The comparative ranking question is covered in how to rank students on the EM SLOE.

SLOE vs SLOR: what the difference means for your draft

ADMSEP defines the two: "A standardized letter of recommendation is intended to highlight specific student strengths within a uniform template. A standardized letter of evaluation is intended to evaluate students compared to peers and may be more comprehensive and less strength focused."

The label tells you the job. An evaluation (OB/GYN, EM, dermatology, the neurosurgery home SLOE) asks you to place the student against peers; APGO's guide says "a truthful assessment of the applicant is paramount." A recommendation template (psychiatry, orthopaedics, the neurosurgery away SLOR) gives more room for strengths, though the eSLOR still asks for a rank-list position.

Our view: in a specialty with a standardized form, the narrative you add should carry only what the form cannot hold: one or two observed moments that explain your ratings. Restating ratings in prose, or summarizing the CV, spends your limited words on things the reader already has. APGO and the AOA both say this in their own rules.

The countercase: where we could not verify a form (internal medicine, general surgery, plastic surgery, radiology), write the document the request asks for; when that is a narrative letter, the full letter structure applies. The same is true if you supervised the student on research rather than a clinical rotation: in EM, the ResidencyCAS page routes that to a narrative letter.

Constructed example: an OB/GYN SLOE narrative, before and after

Constructed example, written by us, not a real letter. Context (invented): Dr. P. Schreiber supervised a fourth-year student, Leila Kinsella, on a four-week OB/GYN sub-internship and is completing the SLOE as an individual writer.

Weak version (62 words):

Ms. Kinsella completed her OB/GYN clerkship with honors and a sub-internship on our service. She has presented at two regional meetings, served as class vice president and volunteered at a free clinic. She was a strong member of the team, knowledgeable and hardworking, and she was well liked by residents and nurses. I recommend her highly for residency in obstetrics and gynecology.

Revised version (95 words):

Two things set Ms. Kinsella apart. First, she follows up without being asked. On a night when a postpartum patient's blood pressure crept up between checks, she rechecked it on her own, recognized the trend, and called the senior resident before the next scheduled vitals. Second, she takes feedback the same day. After I told her that her counseling on a failed induction was too technical, she rewrote her explanation and used plain words with the next family that week. I saw both habits repeatedly, and they are why I rated her at acting-intern level.

The weak version breaks both APGO narrative rules: it summarizes the CV and reads as "a shorter version of a typical letter." The revised version names two characteristics, gives one observed incident for each, and ties them to the rating, well under the 250-word limit.

Before you write: a six-question check

1. What did the request ask for? In dermatology ERAS requests and ResidencyCAS requests, the applicant chooses SLOE or narrative. Write the document requested.
2. Is this an orthopaedic eSLOR? Then write no separate letter. Put your explanation in the comment field and place the applicant on your hypothetical rank list.
3. Is this OB/GYN? Name your capacity, vary the ratings to match what you saw, list up to three areas of focus, and keep the narrative to one or two characteristics in 250 words or fewer.
4. Is this neurosurgery? Rate the applicant against the neurosurgery applicants your program evaluated in the last three years, and give specific examples if you choose a top category.
5. Are you the psychiatry writer the student chose for the SLOR? Use the template on letterhead and stay inside its character limits.
6. Is the specialty one we could not verify? Read the program's letter requirements, then write a full narrative letter built on patient-care incidents.

Questions about standardized letters

Is a SLOE required for residency?

It depends on the specialty. Dermatology requires at least one SLOE written by a dermatologist for the 2026-27 cycle. OB/GYN's 2025-26 guide calls one SLOE "strongly recommended" and says many programs may require it. Psychiatry's SLOR is not mandatory.

Can I write a narrative letter in addition to the orthopaedic eSLOR?

The AOA says no additional summary is required and tells authors not to "append any additional information or letters of recommendation." Use the eSLOR's comment field instead.

Does the OB/GYN SLOE go to ERAS or ResidencyCAS?

APGO's guide says the SLOE has been submitted into ResidencyCAS since the 2024-25 cycle. The ResidencyCAS help page says you can complete it there first and then download a PDF copy for ERAS.

Do I have to rank the student?

On the orthopaedic eSLOR, yes: the AOA tells authors to place the applicant on a hypothetical rank list. In EM, CORD says only the eSLOE "asks where a student will fall on the rank list." The neurosurgery form asks you to place the applicant against applicants your program evaluated in the last three years.

Should the letter repeat the MSPE?

No. The AOA tells eSLOR authors not to reiterate what is in the transcript or Dean's Letter. The MSPE vs letter of recommendation page covers what each document already carries. Dental residencies use their own standardized form, the ADEA PASS Professional Evaluation Form.

Get a free review of the letter

Get a free Quick Review of your recommendation letter against GradPilot's residency letter of recommendation rubric. Paste the narrative you write beside the form, or the narrative letter itself where the specialty has no form: the review checks that it states how you know the candidate, rests on patient-care incidents with the student's own action, and is a letter only this candidate could get. The recommendation letter review page explains how it works.

More residency letter pages are in the medical school and residency essays hub.

Sources

Retrieved November 7, 2026, except where noted.

• Association of Professors of Dermatology, Information Regarding the 2026-2027 Application Cycle (May 1, 2026; 2026-27 cycle): SLOE requirement, ERAS route, faculty communication.
• American Orthopaedic Association, Electronic Standardized Letter of Recommendation (eSLOR) (updated April 2024): replaces the narrative letter, author rules, upload steps.
• APGO, OB/GYN Standardized Letter of Evaluation (SLOE) Writing Guide (May 1, 2025; 2025-26 cycle): status, capacity, sections and limits.
• ADMSEP, Letter Writers Psychiatry SLOR – Tips and Tricks for Match 2026 (Match 2026): optional status, format, SLOR vs SLOE, specialty list.
• Society of Neurological Surgeons, Recruitment Guidelines & Letters of Recommendation, with the 2025-2026 SNS Recruitment Guidelines and the Neurological Surgery Standardized Resident Letter of Recommendation Form (updated May 2026): recommended letters, comparison group, rating scale.
• Council of Residency Directors in Emergency Medicine, CORD Standardized Letter of Evaluation (SLOE) (2026-27 cycle): letter of evaluation, rank-list item.
• Liaison, Complete a Recommendation (no year stated): ResidencyCAS EM SLOE types and OB/GYN SLOE route.
• Not verified: the general surgery SLOR address (opened a page with no SLOR content); the plastic surgery society's site (no response); AAMC's ERAS letters chapter (HTTP 403).