How to Write a Letter of Recommendation

15+ Years' Experience

With over 15 years’ experience in guiding candidates in applying for medical residency, fellowship and other educational, training and career opportunities, I have seen firsthand what it takes for a letter of recommendation to stand out as a strong one to program directors and hiring managers.

How does it reflect on the candidate? Does it offer something insightful?

In this article, I will describe the key steps for writing a strong letter of recommendation.

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Step 1: Use a Professional Letter Format and Layout

Nothing will shape how the program director or hiring coordinator will read your letter of recommendation like the format and layout of the letter. It is your letter of recommendation’s first impression, and it will dictate whether it is more likely to be read word for word or simply skimmed or even dismissed.

In the same way that the suit or dress you choose for an interview will be the one to make your first impression, the formatting and layout of your letter of recommendation will indicate how much you care about what you are presenting for consideration.

The more you care about what you are presenting, the more your reader will care.

Step 2: Open the Letter by Clearly Stating Its Purpose

Once you have engaged your reader’s attention with the formatting and layout, follow through by opening with a clear, direct statement introducing the purpose of your letter.

Assume that the hiring coordinator or program director has a stack of 1,000 applications to read, and that what he or she will appreciate most is a candidate whose letter of recommendation does not take any more time than is necessary for them to review.

Limit the purpose of your letter to one to two sentences, getting directly to the point.

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Step 3: Introduce Yourself and How You Came to Know the Candidate

Once the purpose of the letter is established, the next step is to establish your point of view and authority as the recommender. You can do this either as a continuation of the introduction or as a new paragraph.

Start by stating your title and the position in which you came to know the candidate. It can be as simple as “I am the lead attorney in our firm’s labor law department and first met John Rogers when he joined us for our summer internship program” or “I am an attending in the Internal Medicine Department and got to know Jenny Nguyen during her third-year internal medicine rotation.”

When introducing yourself, make sure to include important contextual details to help the reader’s understanding of your position, the time you've held it and the environment in which you developed your understanding of the candidate.

This also should be a straightforward statement, with something like “The purpose of our internship program is to give third-year law students live training in the core principles of litigation” or “Our hospital is the only Level I Trauma Center in the region.”

Include any details regarding previous positions you've held if they are relevant to the context of your recommendation. For example, if you are now an attending and previously served as a program director, make sure to mention both experiences, even if it is as an attending that you got to know the candidate.

Step 4: Candidly Describe Specific Details of the Candidate

After you have established who you are and the context in which you got to know the candidate, the program director or hiring manager will be fully prepared for reviewing the details of the recommendation. As with all other parts of the letter, these should be clearly and directly worded. The tone should be objective and professional, and the details that are described should be ones you know first-hand and are unique to the candidate.

What you describe should be specific details related specifically to the candidate’s personal and professional character, and should show them rather than tell them.

For example, instead of simply writing that the candidate “has a passion for teaching,” the recommender should expand on or replace this statement with a specific example, like that the candidate “would often be the first to volunteer to research a particular topic to present to the group, and the presentations were always well researched and insightful.”

For applications for medical residency and fellowship, consideration should be given to organizing these details around the ACGME's Six Core Competencies: Patient Care (PC): the ability to provide compassionate, appropriate, and effective patient care for the treatment of the patient's health problems; Medical Knowledge (MK): the ability to demonstrate and apply knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences in patient care; Interpersonal and Communication Skills (ICS): the ability to demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals across varying cultures and backgrounds; Professionalism (P): the ability to demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles, including compassion, integrity and responsiveness to the needs of others; Practice-Based Learning and Improvement (PBLI): the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on continual self-evaluation and lifelong learning; and Systems-Based Practice (SBP): the ability to demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

This portion of the letter represents the body, or core, of the recommendation and can take as many paragraphs as you need to communicate the points you wish to describe about the candidate. Each paragraph should have its own subject or theme, and there is no limit to the number of paragraphs as long as they progress the understanding of the candidate and are engaging to read.

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Step 5: Close by Summarizing the Candidate’s Character and Offering to Answer Any Questions

There are two easy principals to follow for concluding a letter of recommendation well. The first is to avoid any wording like “In conclusion,” “In summary,” etc. Instead, trust that the program director or hiring manager will know it is the conclusion.

The second is to avoid simply repeating what you have previously stated in the letter. The conclusion instead should summarize the candidate’s character in a way that ties together what you have previously described using a statement that does not occur elsewhere in the letter. This will progress the program director or hiring manager’s understanding and give them something fresh to read, even if it is just one or two sentences.

This should then be followed by an offer of availability to answer any questions the recipient might have, without any additional commentary.