What Reviewers Look For in the Residency Letter of Recommendation (ERAS)
This rubric reviews whether a narrative residency letter clearly explains how the writer knows the candidate, provides firsthand patient-care evidence, and gives an individualized assessment of readiness for residency. It also looks for a clear, credible recommendation, plain professional writing, and consistency with visible ERAS conventions.
What We Check
Whether the letter establishes the writer's basis for judgment - role, clinical setting, time period, and direct observation - and whether every later claim stays inside that vantage.
Whether the letter's claims are proven by described patient-care incidents: a situation, the candidate's own action in it, and what followed.
Whether the letter covers the dimensions residency selectors actually read for, each anchored in behavior.
The letter's verdict the way programs read it: the University of Washington guidance warns writers that the closing summary "may be the only paragraph that they read," and lists the comparative statements residencies…
Whether the letter would survive swapping in another candidate's name - the test that separates an individual assessment from a template.
Mistakes We Flag
- Unclear relationship to the candidate
- Readers need to know the writer’s role, clinical setting, time period, and direct experience with the candidate. Long familiarity alone does not show a basis for judging clinical work.
- Praise without patient-care examples
- Lists of positive traits, grades, or evaluation comments do not show what the candidate actually did in patient care. Brief observed situations with the candidate’s actions and their result are more useful.
- Claims that exceed what was observed
- A writer should stay within their own direct vantage and the candidate’s stated role. Do not credit a student with a team outcome or make claims unsupported by the letter’s examples.
- Vague or hedged recommendation
- Words such as “solid,” “competent,” or “should do well” can sound less supportive than intended. The letter should clearly state what the candidate is being recommended for and make the basis of any comparison clear.
- Generic or padded language
- Ceremonial openings, flattery of a receiving program, repeated abstractions, and a retold CV take space away from evidence that identifies this particular candidate. A reader should be able to see what makes the assessment specific to them.
References
Frequently Asked Questions
What kind of letter does this rubric cover?
It covers free-prose narrative ERAS residency letters used in internal medicine, surgery, pediatrics, family medicine, and most other specialties, including letters for international medical graduates. It does not cover structured specialty forms such as eSLOE, eSLOR, SLOE, or SLOR.
What should the opening of the letter establish?
It should explain who the writer is, where and when they worked with the candidate, the writer’s role, and what direct observation supports the assessment.
What evidence is most useful in a residency letter?
Brief patient-care anecdotes that describe a situation, the candidate’s own actions, and what followed are useful. The letter should also connect observed behavior to clinical abilities, medical knowledge, work ethic, interpersonal skills, teamwork, and response to teaching or feedback.
How long should a narrative residency letter be?
The usual norm is about one page, roughly 300 to 700 words, though a program, specialty, or ERAS instruction stated for the letter takes priority.
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