Letters of Recommendation

By Michael Fotis posted 07-20-2011 10:54


It will soon be that time of year when many of you will be asked to prepare letters of recommendation for PGY1 Residency candidates. I would like to offer a Residency Director (RPD) perspective. Although I only write a handful, don’t forget, as a RPD, I read about 300-500 letters every year. To start let us assume that the purpose of a letter of recommendation is to advise the residency selection committee. 


Keep your letter to one or two paragraphs. A poorly written letter of recommendation does not improve with length.  Tell us what you do, and how you know the student in two or three sentences. Give us an estimate of the student’s ability. Make your level of support very clear:  “I highly recommend, recommend, recommend with reservation, do not recommend Joe Student for your residency.  I place Joe Student in the top 95%, 90%, 75% etc. of all the students assigned to me from this class. I am very confident, confident, or hopeful that this candidate will be a successful resident.” It is probably better to decline rather than write a negative recommendation or even a recommendation with reservations. Rewriting the students C.V. as your letter of recommendation is not really helpful and is a waste of your and my time. If you really want to help the student and you know the program director, add another sentence or two explaining why you think the student would fit in at Northwestern, or at whatever program is selected by the candidate.  If you are unfamiliar with a residency program, have the student tell you why they are interested in that program, and to list the strengths of a particular program. Try to describe why you think your student is a good candidate for my residency program. If the strengths of all the identified potential residency programs resemble a scatter diagram consider having a serious discussion with your student. A lack of direction in a candidate will be exposed during their interview and will likely reduce their chances to match.


At a minimum of courtesy- PLEASE don’t send a ‘generic letter,’ especially to someone you know. By this, I mean a form letter that is used for all of the students for whom you are writing letters.  When a letter is written to ‘Residency Director,’ but you know the RPD, it looks especially generic.  In such letters, it is difficult to ascertain if you are really recommending a student or not.  Therefore, a generic letter will likely be interpreted as a statement of non-support. Likewise it does not help anyone to “abstain from voting” (i.e. not providing a clear, specific recommendation) on a letter of recommendation. Again, make sure your level of support is crystal clear. Finally proofread for mixed messages in your letter: “You would be fortunate to get this person to work in your program.” “I can’t think of all the good things to say about this candidate.”  Are these favorable or unfavorable statements? Often authors spend a lot of time describing their rotation and informing us how demanding they are as a preceptor. The best way to help your student “score” an interview is to help the candidate screening Committee determine if your student is a good fit for our program.  If the letter is all about you, does that mean you do not recommend the candidate? Once your letters are sent out don’t forget to send a note to inform the candidate.


We all have plenty to do.  I am impressed that so many pharmacists are willing to take the extra time to serve as an excellent preceptor, and that your students think enough of you to ask you for these dreaded letters of recommendation. Thank You for what you do for the future of our profession!


The information in this paper was presented in the July issue of KeePosted the Newsjournal of the Illinois Council of Health-System Pharmacists.



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09-30-2011 12:46

Sorry I missed this when it came out. I couldn't agree more even when I am guilty of some of these crimes. I know ell everyone if you cant give it a number then don't tell me about. Great communicator means nothing to me, especially if I don't know you (the writer). Tell me instead that you witnessed 3 patients or better yet 30. tell me how many days you physically spent at the site with the candidate and for what activities. Tell me how busy your site is? How was it when the candidate was there? Did they handle an average census well or a unusually busy census well.
Every letter should start or contain a "cookie cutter" cutnpaste description of your work environment/practice experience and also include the number of students/employees/students that you have similarly precepted/supervised/taught over the past 2-5 years. I need context to understand your adjectives...actually let me repeat...I need numbers or objectively measurable content not adjectives.

09-26-2011 09:57

Lindsey: I like your suggestion about a standardized application for PGY1s. If we had a process like this woul that ever make my life simpler! However I do not think that those general letters of recommendation help very much, simply because there are so many of them, they are all the same, and they just don't help a program differentiate between the candidates. Sorry to take so long to reply, I missed your comments back in the summer!

07-29-2011 12:47

Thank you for the wonderful advice.
As a student, it is interesting to hear about the process of letters of recommendation from a different viewpoint. I will share this with my colleagues to help us in the process of asking for letters of recommendation for residencies.

07-28-2011 15:42

Mike--great advice. I have passed it on to our preceptors. I would be great if we could get to the point of these letters (that some people put a great deal of effort into) being very helpful in determining fit for a particular residency.

07-28-2011 10:53

I was discussing the idea of standardized residency application (similar to PharmCAS) with a colleague the other day and in thinking about this blog on letters of rec, how would you suggest the letters of rec fit into a standardized residency application?
2 ideas we discussed:
(1) programs requiring letters of rec specifically addressing the candidates fit for the program
(2) one letter that would go to all programs focused on the characteristics that make the candidate a good fit for residency in general.
I'm sure there are many more options out there...what are your thoughts?