The Reference Letter Toolkit

With the ERAS process fast approaching, medical students across the country have started putting together applications. When not battling procrastination on the part of the application that students do have control over (i.e., the personal letter and CV), many students stress about the other part of the application that they feel they have less control over: the mysterious and all-important reference letter (1).

As a student in EM, you will work with a variety of physicians during your weeks on rotation. Med students often ask how they can maximize their chances of getting the “strong” reference letter from a physician that they have only had the opportunity to work with once, twice, or a handful of times.  It’s important to know that EM attendings expect that you’ll ask them for a letter of recommendation despite having only worked with them a few times (Editor’s note: Some of us have even successfully procured letters of recommendation after only a single shift!) Most staff are used to writing reference letters after only working a few shifts with a student. As a helpful hint, it is often useful to check the schedule to see who you are working with, and if you are with a staff for more than 3 shifts, you may want to approach that staff after a couple a shifts and enquire into whether they would be willing to write you a letter.

Lest you think this process is entirely out of your control once you’ve asked for a letter, take heart! There are details you can attend to as an applicant to ensure that you provide your referees with the tools they need to write you a great letter of recommendation.


The Reference Letter Toolkit:

Many students will provide a CV to their referee. While this may be sufficient for mentors who know you well, it is inadequate for attendings you meet on away electives or over a few ED shifts. Providing your referee with a package of information ensures that you give your writer all the tools necessary to write you the best letter that they can provide. It also demonstrates organization and professionalism, key traits to show someone who is about to write such an important letter for you!

Reference letter Toolkit:

  • Cover letter: This is a great opportunity to thank your referee again for writing you a reference letter.  In this intro, you can write a small personal note about your experience during your rotation, or anything that shows a little bit of who you are and why you want to do EM. Keep it short and sweet! It is also useful to state what the package includes and to also outline the ERAS deadline for submission. 
  • Fact sheet: List and reflect on your personal experiences while on your EM rotation, preferably while working with that physician. You want your staff to have the examples to back up your “hard working” skills in EM.  The more detailed you can be about specifics, the more opportunity the attending has to strategically place strong examples in your letter, leading away from a generic letter and instead a more personalized one that is more likely to stand out! Some attendings appreciate when you are explicit about the types of characteristics you’re hoping they will discuss in their letter, so take this opportunity to highlight the aspects of their letter that will lead to a well-developed and nuanced description of you as a student. 
  • CV: This should be your final copy, and the same one you will be submitting on ERAS.  The CV should highlight and your interest in EM, but does not need to be entirely focused on emergency medicine. Anything that is unique and shows that you are well-rounded is great! 
  • Professional photo: Preferably the one you will be submitting to ERAS. Give your best EM smile. If you wore a different hairstyle or eyeglasses on your rotation, your referee may find it helpful if you include a casual photo as a memory aid. 
  • Daily shift rotation evaluations: Scan a copy of your shift evaluations and format these into a second PDF document. This will give your referee a global appreciation of things you were able to do on rotation, and let them know what their colleagues thought of your EM potential.

A few other things to note:

Let them put a face to the name!

If possible, ask your attending for a letter in person. ED physicians work with many students within the same week, and it is helpful to ask for a reference letter at a key moment, like after a great shift together, when you feel you’ve developed a good rapport. Check out the “reference letter triple crown” for an outline of potential reference letter writing candidates.


Just like writing that paper the night before it’s due won’t turn out your best work, giving your referee minimal time won’t result in a strong letter of recommendation.

GIVE LOTS OF TIME! Remember that references often write reference letters for many students and are living busy personal and professional lives. Try to give at least 1-2 months notice before the deadline. If your letter has not been submitted a couple of weeks before the deadline, you can send a friendly email reminder!

What happens if you meet an attending that you just had an amazing shift with, but your elective happens to fall within the month deadline before reference letters are due? Don’t worry! Everyone understands that the ERAS deadlines don’t always match up well with ongoing electives. For a discussion and opinions on the “Late Letter” situation, check out this MedIC case on ALiEM (1).

To Summarize:

  • Ask your attending physician, in person, if he is willing to write a strong letter of recommendation.
  • Contact/email your referee at least 1month ahead of the ERAS deadline to write you a letter of recommendation. Attach your prepared Reference Letter Toolkit. If you meet a staff that you think could write you a letter but it falls less than 1 month prior to the deadline, don’t worry! EM docs understand – they once went through this, too! Check out ALiEM’s Medic case on the “Late Letter”.
  • Check out the “Reference Letter Triple Crown” for an outline of possible strong letter referees
  • Reference letter toolkit:
    • Part 1:  (pdf 1)
      • Cover letter
      • Fact sheet
      • CV
      • professional photo
    • Part 2: (pdf 2)
      • Daily shift rotation evaluations

Best of luck with your ERAS applications!


  • Case of the Late Letter. Academic Life in Emergency Medicine. Accessed last on Oct 6, 2015. 
  • “Reference Letter Triple Crown”. Accessed last on October 6, 2015.