Letters of Recommendation: Who, How Many and How to Ask

You assign letters of recommendation (LoRs) to programs in MyERAS, but your letter authors upload them through the AAMC Letter Writer Portal. In the 2027 cycle you can assign up to four letters per program, and your job is to choose strong authors, ask early, and track each upload.

How the ERAS letter process works #

1. Create an entry for each letter in the Letters of Recommendation page: the author's name and email, the specialty the letter will go to, whether you request a standardized or narrative letter, whether it must satisfy a department chair requirement, and whether you waive your right to view it.
2. Confirm the entry for upload with your MyERAS password. A Letter ID and a personalized Letter Request Form are generated.
3. Send the request form to the author, either as a PDF or by email from MyERAS. The form is customized and the Letter ID can be used once.
4. The author uploads through the AAMC Letter Writer Portal (or a designee uploads for them), using the Letter ID. The upload is watermarked with the uploader's name and date and time. You get an email when it arrives.
5. You assign uploaded letters to programs. Only uploaded letters can be assigned.

Request statuses are Not Confirmed for Upload, Confirmed for Upload, Uploaded and Imported (from a previous season).

Waiving your right to view #

If you waive, you cannot view the letter under any circumstances, and you are not permitted to upload it yourself. If you do not waive, you can see it, and programs may read that as a less independent letter. This is a convention, not a rule, and the choice is yours. Decide before you confirm the entry, because it appears on the request form.

Who should write your letters (practice) #

Programs want letters from people who observed your work closely and can compare you to other trainees.

Rules of thumb that many IMG applicants and advisors follow (practice, not rules):

• Prefer US clinical letters from physicians in the specialty you apply to, if you have them. See turning USCE into a letter.
• Choose a writer who knows you well over a famous writer who barely knows you.
• Avoid letters from relatives or personal friends.
• A program-director or department-chair letter may be required by some programs. The request form has a field for this.

Standardized and narrative letters #

ERAS now has request options for standardized letters (named in the guide as SLOE, SLOR, eSLOE and SEL) and narrative letters. Some specialties use standardized forms. Plastic Surgery - Integrated does not offer the narrative option. If you choose "General" as the specialty, the standardized and narrative options are unavailable, so use a specific specialty if the author needs a standard form. Check the specialty's own letter requirements; AAMC is also collaborating with several specialties on new standardized formats.

How many letters? #

• ERAS caps assignments at four per program.
• Programs publish their own minimums, often three. Check each program's page.
• It is allowed to assign different combinations to different programs, but keep it simple: the same top letters usually work for most programs in a specialty.
• Do not assign four letters if the fourth is weak. A weak letter can hurt.

IMG-specific points #

• You need an ERAS token from ECFMG before you can use MyERAS, so start the token process before asking authors for upload.
• Authors outside the US will need access to the AAMC Letter Writer Portal. Check AAMC's letter writer page for their requirements and tell them early.
• ECFMG gives guidance to letter writers on its ERAS pages. Ask your authors to read it.
• Letters should be on institutional letterhead with contact details, because program directors may call to verify.

Asking for a letter #

1. Ask in person or by a polite message at least several weeks before you need it, and ideally while the experience is fresh.
2. Ask "Could you write me a strong letter?" rather than just "a letter". It gives them a graceful way to decline.
3. Send a packet: your CV, a draft of your experience descriptions, the specialty, the program types you are targeting, and a few specific cases or moments they might remember.
4. Send the request form through MyERAS, and tell them the date you hope it is uploaded.
5. Follow up politely. AAMC says it is the applicant's responsibility to follow up with authors.
6. Thank them once uploaded.

Common mistakes #

• Asking someone who barely worked with you.
• Giving authors only a few days.
• Forgetting to confirm entries, so the author has no Letter ID.
• Sending one request form to several authors.
• Not tracking statuses until after the application opens.