You need at least 3 LOR minimum for most residency program applications. Rarely some will require 4.⁣
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𝐇𝐨𝐰 𝐢𝐭 𝐰𝐨𝐫𝐤𝐬: When PHORCAS opens, you will enter the letter writer’s email and they will receive a link to fill out the letter of recommendation. In the past, this was a traditional letter, but now it is a template with all standard categories. To see what they would fill out, google “PhORCAS recommendation form” or a direct link here. The letter writer will fill this out and submit it. You cannot see what they write from your end.⁣
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You can also request the letter writer fill out different versions of their letter if you need something unique included for a specific program. This is just optional, I would only do this if you feel it is relevant to a specific program like your preceptor knows the RPD, etc or if you plan to apply to different types of programs (such as PGY1 general vs PGY1/2 HSPAL) and you want the same letter writer to speak to different qualities based on the program type.⁣ For most students, I recommend sticking to one general submission for each letter writer.
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𝗪𝐡𝐞𝐧 𝐭𝐨 𝐚𝐬𝐤: Don’t wait until November/December! Ideally, I would ask all letter writers around Sept or Oct, or earlier if needed. ⁣If you happen to have a great rotation with a preceptor in November/December, try to discuss your request with them as soon as you can and ask them if they have time.
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𝗪𝐡𝐨 𝐭𝐨 𝐚𝐬𝐤: Letter writers should be people who can speak upon your fit for residency. You should have had frequent interactions with them, enough that they can write about your skills, knowledge, performance, etc.⁣
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At LEAST one should be an APPE preceptor. Some programs require certain types like 2 preceptors and 1 employer. For PGY1, I had 1 preceptor, 1 my boss, and 1 preceptor/professor. For PGY2 I had 1 my RPD, 2 preceptors. You can ask more than 3 people if you need more of a variety of letter writers, even if all your programs only require 3 LOR. Then you can mix/match and choose what LOR fits best for each program.

What I mean by mix/matching: When you submit your program applications, you can choose which letter writers you want to include for each application. ⁣The letter writers will not know if you use them for all your applications, just a few, or even none at all. Of course, be respectful of their time and don’t request them to write a letter if you don’t plan to use it. In some less common situations, a student may have had a bad experience with a letter writer and no longer wish to use their letter for various reasons – in these cases it is good to know there is no way the letter writer will know you didn’t use them; so no need to worry about repercussions of that.

𝐇𝐨𝐰 𝐭𝐨 𝐚𝐬𝐤: For APPE preceptors, I would be sure to share that you are interested in residency at the start of the rotation. Then either at the midpoint or final eval say something like “As I mentioned before, I am planning on applying to PGY-1 residencies this year. Would you be willing to write me a *𝘴𝘵𝘳𝘰𝘯𝘨* letter of recommendation?”. If you ask at the midpoint (this is what I did), you can also ask them “is there anything I can improve upon for the remaining time of rotation that would help you feel confident in writing me a strong LOR for residency”⁣
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I would ask in a similar way for non-preceptors. Since you may not be scheduled to see them like you would a preceptor, consider asking to meet up for coffee, a phone call or webex, etc. I didn’t ask any of my LOR over email because I found it too impersonal, but I know others that have with no issue. ⁣
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𝐈𝐌𝐏𝐎𝐑𝐓𝐀𝐍𝐓 —> Make sure the preceptor feels comfortable writing a STRONG letter. If they hesitate, are not enthusiastic, or say anything about writing an “okay” or not strong letter — then do not pursue that LOR. Also, consider your performance and interaction with this person. If there are any concerns they may have negative things to say, I would not ask them at all.⁣ A bad or negative letter of recommendation has led to zero interviews for students in the past, so do your best to have all your LOR be from people who want to recommend you for residency.

So I used to previously recommend students to create a LOR Excel Spreadsheet, which contains categories that match the template from PhORCAS. I did this as it was recommended to me by a mentor and current resident. I filled out the category sections as if I was the letter writer. Essentially help your letter writer recall all the accomplishments, interventions, and other notable events that they can write about. Filling these out for my 3 letter writers took me 3-4 weeks. ⁣

My update is that I no longer recommend the “excel sheet” – because it’s likely not needed! If you have reliable letter writers that care about you and your ability to match to a residency, they will be taking the time to write out those things. It is especially unnecessary for preceptors who already have to document these things in your school evaluations. If you have letter writers that you are concerned may not recall your accomplishments or you have doubts they will include pertinent information – first consider if they are an appropriate letter writer to use. If yes, then consider writing an informal short summary of what you accomplished when working with them, such as presentations, patient care (7 patient visits per day, or other specific examples), or projects.
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𝗪𝐡𝐚𝐭 𝐭𝐨 𝐞𝐦𝐚𝐢𝐥 𝐲𝐨𝐮𝐫 𝐥𝐞𝐭𝐭𝐞𝐫 𝐰𝐫𝐢𝐭𝐞𝐫𝐬: (1) your goals for residency and career goals (2) list of programs you plan to apply to (its ok if its not finalized) (3) deadline for them to submit your LOR

𝗪𝐡𝐚𝐭 𝐝𝐞𝐚𝐝𝐥𝐢𝐧𝐞 𝐭𝐨 𝐠𝐢𝐯𝐞: So when I applied to PGY-1, I gave the earliest deadline among all my programs I was planning to apply to. BUT know that this means your LOR may not be submitted until THAT day. This can be very stressful (speaking from personal experience lol). So my best advice is to tell them an earlier deadline than the first real deadline you have.⁣
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𝐍𝐨𝐭𝐞: you can still submit your residency applications without having the LOR submitted yet. HOWEVER, some programs will not look at your application unless ALL of your required materials are in PhORCAS. I would not take that risk if you don’t have to!⁣
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𝐓𝐢𝐦𝐞𝐥𝐢𝐧𝐞 𝐟𝐨𝐫 𝐋𝐎𝐑:⁣
Sept-Oct (or earlier): ask if letter writers are willing to write a strong LOR for you⁣
Early Nov: (1) PHORCAS opens, enter in letter writers information, they are sent link to fill out (2) email letter writers after to let them know they should have received the link and include what is mentioned above⁣
Early to Mid Dec: Watch for an email notification saying a LOR is submitted. Reach out to any letter writers to check in if LOR not submitted by the deadline you give.⁣
End of Dec/Early Jan: Residency application deadlines.⁣