Frequently Asked Questions, Tips, and Perspectives:
Writing a Standardized Letter of
Recommendation in Psychiatry
How is a Standardized Letter of Recommendation (SLOR) different from a Standardized letter
of Evaluation?
A standardized letter of recommendation is intended to highlight specific student strengths
within a uniform template. A standardized letter of evaluation is intended to evaluate students
compared to peers and may be more comprehensive and less strengths focus.
Is the SLOR mandatory for psychiatry?
While the SLOR is not mandatory, applicants are encouraged to identify one or more letter
writers to use the SLOR template. The template is designed to ensure letter writers are
commenting on attributes most important to program directors (Russo, 2022).
What ongoing evaluation is being done to determine the outcomes of SLOR use?
Ongoing feedback on SLOR effectiveness and usability is being sought from students, letter
writers, and residency program directors. Please sign up if you would be willing to provide
feedback: https://forms.office.com/r/u1Ktg01XdL [forms.office.com]
The SLOR will certainly be imperfect in these first iterations, but, like Emergency Medicine and
other specialties, if we refine our SLOR every year based on feedback from the ADMSEP,
AADPRT, and PsychSIGN members, it will increasingly become a more meaningful and helpful
part of the application.
Are other specialties using standardized letters of recommendation?
Yes. While Emergency Medicine was the first to standardize their letters of recommendation in
the 1990s, many other specialties are following suit. This includes dermatology, internal
medicine, med-peds, neurological surgery, obstetrics and gynecology, orthopedic surgery,
plastic surgery, and diagnostic radiology.
Why can I not put this on my institution’s letterhead?
There is no place to put a formal letterhead on the current template. Some letter writers have
shared their preference to copy the PDF text and type it into a Word Document. That way they
can add their signature and letterhead. If you choose to transfer into Word or not, remember,
that to upload a letter one must sign into the AAMC ERAS LOR portal, which is password
protected. This should help ensure the process is secure. We will continue to explore the
option to upload letterhead onto the PDF.
If I select two of the five suggestions for Characteristics and Clinical skills, does that imply
they aren't great at the others? We think the program directors reading the SLORs recognize
that most applicants will have strengths in multiple or almost all areas. We recommend
choosing the two characteristics that you most observed or that are most documented
spontaneously in the preceptors’ narrative comments on the student’s clerkship
performance. If the SLOR is being used as a Chair letter, we recommend using direct quotes
from preceptors where applicable.
Why are there character limits?
The character limits were designed to ensure letter writers stay concise and all students receive
the same amount of devoted space. If needed, one option is to compose each narrative section
in a Word document, edit, then click Review, and Word Count, to check the character count
before copying and pasting back into the SLOR template.
Why would anyone comment about extra support that an applicant may need in a letter of
recommendation?
The SLOR does ask for a quality or skill that may be an area of growth for the applicant. We
recommend using this area to describe an area for future growth the student seeks, e.g., more
exposure to a specific subspecialty of interest or a robust psychotherapy training program. The
SLOR also asks “how much guidance this applicant may need as they begin residency in
comparison to their peers.” One approach to this is to quote if any, relevant comments from
the clerkship preceptors regarding the level of supervision the student required. Most
comments are quite positive; if the student struggled during the psychiatry clerkship and
needed undue supervision, then Psychiatry may not be the best specialty choice for them.
Will the SLOR take longer to write?
Initially, writing letters in the SLOR format may have a learning curve. We are hopeful that with
increased experience using the SLOR, the new format will not require additional time. One goal
of the SLOR is to prompt the letter writer to think more clearly about each candidate’s specific
strengths and goals, making this input more meaningful.
How will the SLOR apply to “chair letters”?
Generally, the chair will know the preceptors and sites well and may have met with and
mentored students. Though they may not have worked directly with the individual student on
clinical services, the letter writer should have access to their grades, professionalism, and
preceptor feedback. The student should indicate when they request the ERAS upload
document that your letter is from the “Chair.” When you get the ERAS upload document, you
can check two boxes: one to confirm you are providing a letter as “Chair” and one to document
that you are submitting a SLOR.
Russo, R. A., Hameed, U., Ibrahim, Y., Joshi, A., Kerlek, A. J., Klapheke, M., Kovach, J. G., Raml, D. M., Schatte, D., Thomas, L. A.,
& Rakofsky, J. J. (2022). Psychiatry Residency Directors' Attitudes Toward and Uses of the Medical Student Performance
Evaluation and Other Potential Tools for Residency Selection. Academic psychiatry: the journal of the American Association of
Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 46(5), 622–626.
https://doi.org/10.1007/s40596-022-01636-x
