Updated
Residency Letters of Recommendation: ERAS Rules and SLOEs
Most residency specialties ask for three or four letters of recommendation, and ERAS lets you assign up to 4 to each program. Once you apply to a program, the letters assigned to it are locked. Dermatology, urology and plastic surgery now require standardized letters written in the AAMC Letter Writer Portal. OB/GYN requires a SLOE and emergency medicine strongly recommends one, and both apply through ResidencyCAS instead of ERAS.
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How many letters of recommendation do you need for residency?
In ERAS the cap is per program. The 2027 MyERAS user guide says “Applicants may designate the assignment of up to four (4) LoRs to each program.” The floor is set by each specialty and each program. Of the 18 2026-27 specialty guides from the program directors' organizations (OPDA) we read, 12 ask for at least three letters. Family medicine asks for at least two, OB/GYN for at least one SLOE, and ophthalmology, which uses the SF Match, for no more than three. Programs can be stricter, so the AAMC tells applicants to check each program's requirements before assigning letters.
Which specialties expect a standardized letter?
A standardized letter is a form, not a free-form narrative (a SLOE, SLOR or SEL, depending on the specialty). For the 2027 season, “Dermatology, Plastic Surgery-Integrated and Urology are participating in a standardized letter pilot.” For those three, “You cannot upload a PDF of the standardized letter form.” The writer fills in the form inside the portal. Other specialties offer them through their own societies. What each 2026-27 guide says:
Emergency medicine: eSLOE strongly recommended
Letters: At least 3, No more than 4. Applies through: ResidencyCAS
One eSLOE from an emergency medicine rotation, and ideally a second from a different one. Applications go through ResidencyCAS.
The guide says “It is strongly recommended that an applicant submit 1 eSLOE from an Emergency Medicine rotation”
Obstetrics and gynecology: SLOE required
Letters: At least 1, No more than 4. Applies through: ResidencyCAS
One SLOE is required. Who writes the other letters is up to each program. Applications go through ResidencyCAS.
The guide says “Each applicant needs a SLOE”
Dermatology: Standardized letter required
Letters: At least 3, No more than 4. Applies through: ERAS
Three letters. At least one is a standardized letter from a dermatologist, written in the AAMC Letter Writer Portal's online form.
The guide says “At least one letter should be a standardized letter (SLOE) from a dermatologist”
Urology: Two standardized letters required
Letters: At least 3, No more than 4. Applies through: ERAS
At least two standardized letters from urologists, written in the portal's online form. No chair letter is required.
The guide says “Urology will require at least two standardized letters (SLOEs) from urologists”
Plastic surgery (integrated): All three letters standardized
Letters: At least 3, No more than 4. Applies through: ERAS
All three required letters use the online standardized form, mostly from academic plastic surgeons who worked with you closely.
The guide says “All three required letters should use the digital SLOE online form submission process”
Orthopaedic surgery: eSLOR encouraged
Letters: At least 3, No more than 4. Applies through: ERAS
At least two letters from orthopaedic surgeons, from your home school or an away rotation. Programs encourage the AOA/CORD eSLOR.
The guide says “Programs encourage all applicants/recommendation writers to use the AOA/CORD Electronic Standardized Letter of Recommendation (eSLOR).”
Neurological surgery: Home SLOE and away SLORs recommended
Letters: At least 3. Applies through: ERAS
The Society of Neurological Surgeons suggests a home SLOE, a SLOR from each away rotation and one letter of any kind.
The guide says “One (1) Home program: SNS Standardized Home Letter of Evaluation (SLOE)”
Otolaryngology: Standardized letter recommended
Letters: At least 3. Applies through: ERAS
At least three letters. The guide lists faculty, chairs, program directors, away preceptors and research mentors as writers.
The guide says “Personnel such as research mentors who may have close personal knowledge of an applicant”
Internal medicine: IM SEL recommended
Letters: No specialty guidance. Applies through: ERAS
No set number. The structured evaluative letter (IM SEL) from AAIM is the recommended standardized format.
The guide says “The AAIM Internal Medicine Structured Evaluative Letter (IM SEL)”
Diagnostic radiology: Standardized letter recommended
Letters: No specialty guidance. Applies through: ERAS
No set number, and programs differ on the standardized letter.
The guide says “Some programs would like to have a standardized letter, others do not have a preference.”
Psychiatry: Standardized letter optional
Letters: At least 3, No more than 4. Applies through: ERAS
Three or four letters, with someone in psychiatry among the writers. A standardized format from ADMSEP is optional.
The guide says “There is an option of a standardized letter of recommendation”
7 more specialties that use narrative letters
Anesthesiology: Narrative letters
Letters: At least 3, No more than 4. Applies through: ERAS
Three or four letters, at least one from anesthesiology. Others can come from research mentors or faculty in other fields.
The guide says “At least one LOR (many programs require at least 2) should be from the field of Anesthesiology.”
Family medicine: Narrative letters
Letters: At least 2, No more than 4. Applies through: ERAS
Two to four letters from physicians who can speak to your clinical skills. A chair or program director letter is not required.
The guide says “When possible, at least one letter should be authored by a family physician.”
Pediatrics: Narrative letters
Letters: No specialty guidance. Applies through: ERAS
No set number. APPD asks programs to require only one pediatrics letter.
The guide says “Recommend at least one letter from someone in the specialty.”
General surgery: Narrative letters
Letters: At least 3. Applies through: ERAS
At least three letters from people who worked with you directly.
The guide says “Should be someone who has directly worked with the applicant”
Neurology: Narrative letters
Letters: At least 3. Applies through: ERAS
At least three letters, including someone in neurology. Away rotation letters are usually not required.
The guide says “Most programs do not require letters from away rotations.”
Radiation oncology: Narrative letters
Letters: At least 3, No more than 4. Applies through: ERAS
Three or four letters, with someone in radiation oncology among the writers.
The guide says “Someone within the specialty (e.g., faculty, attending)”
Ophthalmology: Narrative letters, SF Match
Letters: No more than 3. Applies through: SF Match
Up to three letters, with two recommended from ophthalmology. Applications go through the SF Match, not ERAS.
The guide says “It is recommended for applicants to obtain 2 letters from Ophthalmology.”
Applying to urology? Its own Match rules and interview season are in our urology Match interviews guide.
What is the SLOE in emergency medicine?
The SLOE comes from CORD, the Council of Residency Directors in Emergency Medicine. CORD's instructions to faculty start with “The SLOE is a letter of evaluation and not a letter of recommendation.” It rates you against a benchmark and against other students, and CORD tells writers “Residency programs prefer an honest letter over an inflated one.”
The eSLOE and the other SLOE versions
The main version is the eSLOE, written at a site with an emergency medicine residency. It is “Usually written by a group including PD/APD/CD.” (program director, assistant program director, clerkship director), and it is the only version that “asks where a student will fall on the rank list”. There are also SLOEs for faculty without a residency, for subspecialty rotations, and an off-service SLOE for rotations outside the emergency department.
CORD asks every emergency medicine program to use ResidencyCAS for 2026-27. Its best practices say “all Emergency Medicine programs should utilize the ResidencyCAS Application Platform for both the Main Residency Match and SOAP”, so you request the SLOE in ResidencyCAS and the writer submits it there. On timing, the OPDA emergency medicine guide says “It is strongly recommended that applicants have 1 eSLOE uploaded to their application prior to application release date.” A second eSLOE from a different emergency medicine rotation is also strongly recommended, but “program preference may vary as to whether programs will accept additional SLOEs after an interview”.
How do letters of recommendation work in ERAS?
Beginning with the 2027 season, ERAS letters “will be submitted through the new AAMC Letter Writer Portal”, which opened on June 4, 2026. Requests sent before that date and not yet fulfilled had to be made again. Your side happens in MyERAS. “Applicants must create a separate LoR entry for each LoR they intend to use during the application season.” Each entry asks “Do you need this letter to fulfill a Department Chair requirement?” and whether you waive your right to see the letter. The steps:
1. Create one entry per letter
On the Letters of Recommendation page, add the writer's name and email, the specialty, whether you want a standardized or narrative letter, whether it fills a department chair requirement, and whether you waive your right to see it.
2. Pick the specialty with care
The specialty label is seen by you, your dean's office and the writer, not by programs. Choose "General" for a narrative letter you will send to more than one specialty. For a dermatology, urology or plastic surgery standardized letter, the specialty must be right when you request it, or the writer gets the wrong form.
3. Confirm the entry to get a Letter ID
Confirming creates the Letter Request Form with a Letter ID. After that the entry is locked, and a mistake means making a new entry.
4. Send the Letter Request Form
Email it from MyERAS with a short personal message, or download the PDF and hand it over. Each form is for one writer only.
5. Your writer uploads in the AAMC Letter Writer Portal
Writers can submit as a guest from a secure email link, with no AAMC account. You get an email when a letter is uploaded.
6. Assign up to four letters to each program
Only uploaded letters can be assigned. Check each program's own requirements first, since a letter you assign to a program you have applied to stays there.
Request forms, writers and the waiver
Letter Request Forms “contain a unique Letter ID that can only be used once”, so never copy one form to two writers. Writers don't need an account: “Letter writers can submit letters as a guest using a secure email link without creating an account.” And the chasing is yours. “It is the applicant's responsibility to follow up with LoR Authors regarding LoRs.”
On the waiver, the guide is blunt: “Applicants who waive their right to view a LoR are not permitted to view or obtain the LoR under any circumstances.” The ERAS guide doesn't say which choice to make, so ask your advisor.
Applying to medical school instead? See our medical school letters of recommendation guide.
What can't you change after you apply?
Assign letters before you apply to each program. The guide says “LoRs assignments to programs that have been applied to cannot be changed.” and “Letters cannot be replaced after being assigned to any given applied program.” The AAMC terms add that your choices stay locked “even if the author has withdrawn or edited their letter”.
You can still add a letter to a program that has fewer than 4, but “programs are not guaranteed to view or review newly assigned LoRs received after initial application to their program”. The AAMC says letters can arrive after you submit, but “applicants should be aware of program deadlines and review timelines to ensure materials are available when programs evaluate applications”.
Most of the rest of your application, like the Experiences section, is also locked once you certify and submit. Personal information and the personal statement can still change.
Applying again? Importing last season's letters
You can import letters from a prior season (the AAMC terms say since the 2020 season) if that application was certified and submitted. “These letters still count toward the total of four LoRs that can be assigned to designated programs.” Their details can't be edited, but the writer can upload a new version.
Who should write your residency letters?
The specialty guides answer most of this. The joint OPDA and AAMC guidelines for writers ask for a focused evaluation of your performance “rather than a general endorsement of the applicant”, with concrete examples. That favors people who watched you work:
Someone in your specialty
Most specialty guides ask for at least one writer in the field. Orthopaedics asks for two, urology for two urologists, ophthalmology recommends two.
People who saw your clinical work
The OPDA and AAMC tell writers to give a focused evaluation with concrete examples, not a general endorsement. A writer who supervised you on a rotation can do that.
Chair letters only where a program asks
MyERAS asks whether a letter fills a department chair requirement. Urology needs no chair letter, family medicine and anesthesiology don't require one, and orthopaedics asks programs to consider dropping it. Check each program's website.
Transitional year or preliminary residents
Anesthesiology and emergency medicine guides advise a letter from your current program director, and neurology generally expects one.
International medical graduates
Anesthesiology and family medicine suggest at least one letter from a US physician, and neurology generally expects one from a US neurologist.
Our advice: ask the writer who knows you best
A detailed letter from an attending who worked with you for weeks usually says more than a short one from a famous name. Ask directly whether they can write you a strong letter.
International medical graduates have more on letters and interviews in our IMG residency interview guide.
When should you ask for residency letters?
Third-year ERAS tokens already let you “upload Letters of Recommendation (LoR) in preparation for the following season”, so a letter can be ready before the season opens. For the 2027 Match, residency programs could start reviewing ERAS applications on September 23, 2026. Several guides set a later limit: anesthesiology, family medicine and psychiatry all want letters in by interview time. Dates for the rest of the season are in our residency interview season guide.
Pediatrics is lighter on letters. APPD's 2026-27 recommendations say “Programs should only require one pediatrics-specific letter.”
What to send your writers when you ask
The guidelines for writers say “Ask for a CV and a draft personal statement if the applicant does not provide them.” Send both with the request, plus the specialty you are applying to and two or three cases you worked on together (our advice). A draft of your personal statement helps the letter and the essay tell the same story.
Will interviewers ask about your letters?
Interviewers may have read your letters along with your MSPE. A question like the one below asks how you think others see you. You won't have read a waived letter, so answer from what your writers saw you do. More questions like it are in our residency interview questions list.
“What would your letter writers say about you?”
A strong answer picks one or two qualities, backs each with a moment a writer saw, and admits one thing you are still working on. Aim for about a minute.
Example answer, written by our team (the applicant is invented)
I think Dr. Patel, who supervised me on my emergency medicine sub-internship, would say I'm steady when the department gets busy.
On one overnight shift I had four patients at once, and she watched me reprioritize when a chest pain patient came back with an abnormal ECG.
My surgery clerkship director would probably say I take feedback well. She told me my presentations ran long, and by the end of the rotation I had them under two minutes.
They would also say I'm still building speed with procedures, which is why I asked for extra ultrasound shifts this fall.
Sources: the 2027 MyERAS Applicant User Guide, AAMC ERAS for Letter Writers page and FAQ, AAMC Letter Writer Portal terms, OPDA and AAMC narrative letter guidelines, CORD SLOE instructions, CORD 2026-27 best practices, APPD 2026-27 recommendations and the 2026-27 OPDA specialty guides linked in each row above. All checked October 29, 2026, except the ERAS user guide, read October 28, 2026.
Frequently asked questions
How many letters of recommendation do I need for residency?
Most specialties ask for three or four. 12 of the 18 2026-27 specialty guides we read ask for at least three, family medicine asks for at least two and OB/GYN for at least one SLOE. Each program can set its own number, so check program websites.
How many letters can I send to each program in ERAS?
Up to four letters per program. The cap is per program, so different programs can get different sets of letters.
Can I change my letters after I apply?
No. Once you apply to a program, the letters assigned to it are locked and can't be replaced, even if the writer edits the letter. You can add letters to that program later while it has fewer than four, but programs are not guaranteed to review letters that arrive after you apply.
What is a SLOE?
A Standardized Letter of Evaluation is a form-based letter that rates you on set skills and compares you with other students, instead of a free-form narrative. Emergency medicine, OB/GYN, dermatology, urology and plastic surgery use them, and other specialties have similar SLORs or SELs.
Do I need a SLOE for emergency medicine?
The 2026-27 OPDA emergency medicine guide strongly recommends one eSLOE from an emergency medicine rotation, uploaded before applications are released, and a second from a different rotation. Emergency medicine programs are asked to use ResidencyCAS, so the SLOE goes there, not to ERAS.
Should I waive my right to see my residency letters?
MyERAS asks you to choose for each letter. If you waive, you can't view or get the letter under any circumstances. The ERAS guide doesn't tell you which to pick, so talk it over with your advisor and your writer.
Can I reuse letters from last year's ERAS application?
Yes, if last year's application was certified and submitted. Imported letters count toward the four per program, and their details can't be changed, but the writer can upload a new version.
When should I ask for residency letters of recommendation?
Our advice is to ask during or right after the rotation, while your work is fresh. The AAMC Letter Writer Portal opened June 4, 2026, programs could start reviewing on September 23, 2026, and several specialties want all letters in by interview time.