Letters of Reference

Whether you are decided or not regarding your specialty choice, you should request a letter from any clerkship or elective supervisor with whom you have good contact and who gives you a sense that he/she feels positive about you and your skills. If you do know the discipline(s) to which you will be applying, certainly seek letters in those fields, but in case you change your mind (and many do!!), it’s always a good idea to have made reference letter contacts with any supervisors who could potentially write you a strong letter.

The ideal letter should be:

1. from a physician who knows you well
2. and can write a strong positive recommendation
3. and is from the specialty you are applying to

2 out of 3 isn't bad, and my advice would be to focus on hitting points 1 and 2.

In general, letters from experiences prior to clerkship are not very highly valued by residency program directors, nor are letters from non-clinical experiences. Unless specifically noted otherwise in the CaRMS Program Descriptions, letters should be written by attending staff or other licensed physicians (NOT residents/fellows).

During or at the end of your rotation, approach the physician and ask if they would feel comfortable writing you a strong letter of reference for your residency applications.

If they hesitate at all, it is likely that this person will not write the strongest letter; accept the letter if offered, but you may ultimately decide not to use it.

If the supervisor agrees enthusiastically, follow up with an email thanking them for agreeing to be a reference for you. This is your "trail" in case you worry they may forget about you. If they would find it helpful, provide them with a copy of your CV, a brief note outlining your interests and specialty choice (if decided), and perhaps a photograph.

You will begin soliciting letters at the beginning of Core Clerkship, and some supervisors may wish to write a letter immediately following clinical contact with you. Since you only have access to the electronic residency application systems starting in the fall of the fourth year, you have a couple of options:

1. Submitting the letter during the CaRMS Application season: You create a reference request from within your CaRMS account, which is sent to your referee. They then have a very simple few-clicks process to upload the letter exactly where it's supposed to go in your account. See the CaRMS help desk article for a complete step-by-step.
2. Submitting the letter early: you email your referee the Early Reference Form in advance of CaRMS season-opening; then your referee will email their letter and this form together to CaRMS according to the instructions on the form. CaRMS will hold onto it for you until the CaRMS season opens, and you can then go on to complete the process of getting the letter added to your account. It's still a simple process but there are a few extra steps. See the full explanation here.

CaRMS has developed a “primer” for referees to indicate the type of material that should be included in a reference letter.
 

There are different kinds of letters or reference: a full list of the kinds accepted in the CaRMS process are detailed in this Help Desk article. You may need standard reference letters, applicant support forms, Structured Letters of Reference (that vary by specialty), or other types. These requirements vary from program to program; therefore, you'll need to read your program descriptions carefully and make a list of the types of references you will need to request.

Often, residency programs will request that you submit three (3) reference letters as part of your application; some want two (2), some only want one (1). Some, notably certain Francophone Family Medicine programs in Quebec, do not want any references at all.

For a standard, 3-letter application, we tend to recommend that most of the letters be from physicians in the field to which you are applying; one can be from a complementary discipline if desired. At least one should be from a physician at the institution to which you are applying (if you have done an elective there).

You might want to request a few more letters than you think you need, especially if you are unsure if all your requests will come through for you, or if you are considering applying to a few specialties, or just as a kind of "just in case" precaution. Either way, remember to thank your referees, even if you ended up deciding not to use their letter.