Letters of recommendation are “high stakes” and are important to candidates (letter-seekers), recommenders (letter-writers), and evaluators (letter-readers). For the candidate, a well-crafted, vibrant letter offering positive insight into his or her academic capabilities could be the factor that allows an extraordinary professional opportunity to become possible. On the other hand, a letter of scant praise, even when not intended to inflict harm, could become a real obstacle in attaining a hoped-for career goal. For a recommender, a thoughtful, detailed letter communicates (or not) the merit of the applicant but also is a direct reflection of the judgment of the recommender. For the third stakeholder in the process, the evaluator, learning how to interpret the nuances in recommendation letters may mean the difference between choosing truly outstanding individuals who will thrive in the new role, or a mismatch, disappointing to all.

Letters of recommendation are also acts of professionalism. As a component of an application, the set of letters “paints a portrait” of the applicant, and the comments of referees are often weighed as heavily as grades or other evidence of academic merit (1). For these reasons, “getting it right” matters. The emphasis on a truthful assessment of the personal qualities of a candidate, not readily conveyed in quantitative scores or usual measures of academic performance, is particularly important in psychiatry, where our individual humanity and personal nature help to shape our work—these qualities are often as important as our intellectual strengths with respect to our ability to serve in our field. In seeking a formal recommendation, the applicant is asking for a candid evaluation of his or her work, ability, and suitability for the position that is being sought. The candidate hopes that the referee’s comments will be positive and will help advance his or her career, but the realistic candidate should also know that a sound letter is not an expression of enthusiasm, but, rather, an honest appraisal. In this process, the applicant trusts that the letter-writer and letter-reader will act with integrity and honesty and will not allow factors such as conflicts of interest to come into play. The integrity of the recommender is thus expressed in the thoughtfulness, rigor, and accuracy of the letter. The evaluator similarly carries professional responsibility for seeking to understand the candidate, the role, and the “goodness of fit” between the two in a fair and unprejudiced manner (see Table 1).

Thus, each of the three participants—seeker, writer, and reader—should approach the letter of recommendation with care and with the other members of the professional triangle in mind. This column is intended to lay out basic suggestions, or “tips,” for best practices for the three stakeholders involved in letters of recommendation.

Under many circumstances, it is the applicant’s responsibility to approach a senior colleague to request a letter. In general, letters that derive from longer-standing and more substantive relationships are better-grounded and better-received. Under some circumstances, the recommender must have a particular role or have attained a particular rank in order for the letter to be used in the decisional process—the applicant should clarify these issues before approaching a potential recommender. Ideally, the applicant should know this colleague well and have confidence in his or her ability to write a careful and positively-framed but accurate letter. Specifically, the applicant should ask for a strong letter of recommendation (1) and create an opportunity for the potential letter-writer to accept (delightedly) or to decline (gracefully). If the potential author states that he or she is unable to write a “good” letter or indicates that the deadline might not be met because of other commitments, it is in the best interest of the applicant to approach someone else. An applicant who receives several polite refusals should try to understand the pattern and speak with a trusted mentor about the issues that may be relevant.

When a letter-writer has been identified, the applicant should provide relevant information to assist the recommender—an up-to-date curriculum vitae, recent publications, a list of other activities or accomplishments, and, sometimes, a personal statement may be helpful. It is imperative that the information provided to the writer be completely accurate and presented in a manner that does not leave mis-impressions. For example, manuscripts that are accepted but not yet published should be noted as such, and volunteer work that speaks to “citizenship” (e.g., extra service, volunteer efforts outside of one’s usual role or duties) should be quantified. The applicant also should provide to the writer any specifics that are known about the role being applied for—whether it is a residency spot, an award, a scholarship, a job, or a promotion. The candidate may also need to give formal permission allowing grade information to be seen and discussed in the letter (2). The applicant must also decide whether to waive his or her right to see the letter—this is a matter of personal opinion and some controversy—some believe that signing away the right to see the letter creates unnecessary vulnerability for the candidate, although others believe that the waiver helps to facilitate greater candor and more valuable letters.

Being asked to write a letter represents a “teachable moment.” The writer who is pleased to serve in this role should take the time to talk with the candidate about his or her past work and hopes for the future. This conversation will have intrinsic value and will also help the writer frame his or her comments in the letter. If a recommender finds that he or she cannot in good conscience write a positive letter, rather than simply declining the invitation, he or she may talk with the candidate about realistic career goals, the issues of concern, and what the applicant could do to strengthen his or her candidacy (2, 3). Such a conversation may have a very positive formative effect on the candidate, and it may also provide information or clear up misunderstandings that will permit the writer to undertake the task of preparing a letter of recommendation that is positive.

It is then the job of the writer to craft a worthy letter. To begin, the writer should state his or her relationship to the applicant (2), clarifying the duration and depth of the relationship, and the sources of information used in formulating the letter, such as the CV, publications, and evaluations. These disclosures help the reader to place the letter in context. The writer should then describe and discuss his or her observations of the applicant. The letter should be organized according to the criteria for the position sought, as understood by the writer. Descriptive statements as well as quantified data, such as where the applicant stands among his or her peers in relation to these criteria, will further strengthen the letter in the eyes of the reader (3). To the extent possible, the writer should offer a prediction, on the basis of the candidate’s past performance, on how well the applicant will fulfill the goals of the role being applied for. As a rule of thumb, letters of recommendation should exceed one page but not be several pages in length (3). Shorter letters may be a sign that the writer is not especially enthusiastic about the applicant, whereas long letters, although perhaps well written, will often be placed at the bottom of a reader’s list and not read with a thorough eye. A conservatively sized, memorable letter will serve best (see Table 2).

Honest letter-writing poses many challenges. One such challenge is how to characterize a good applicant who, nevertheless, has some negative characteristics. The writer should communicate a sense of the candidate’s strengths, offer a careful description of the issue, and provide evidence that serves as the basis for the concern. The writer, furthermore, should give a sense of proportion and a solution for the problem. For example, a trainee who is an outstanding early-career physician with an excellent fund of knowledge and strong clinical habits, but who performs poorly on standardized examinations should be described as such. Small problems may be quite reasonably expressed as opportunities for learning or growth (see Table 3). Another alternative is that the writer may very obviously omit information in an area in which the applicant is lacking (3) or suggest that the evaluator contact the letter-writer for more detail. The writer may indicate areas where he or she is unable to judge the candidate’s strengths or performance. These steps, although subtle, send a distinct signal to the reader that the applicant may have a shortcoming that is difficult to document in the letter.

Another challenge is finding the right balance in praising a candidate. Too little praise may signify a weak candidate, and it may also imply insufficient knowledge of the candidate. On the other hand, “dressing up” a letter with exaggerated laudatory comments will be obvious to an astute reader and damage the credibility of the document as an element of the application (4). Similarly, thesaurus-enhanced letters filled with overly ambitious word choice and florid prose may bury relevant information about the applicant (and raise questions about the writer!). A precise and clear writing style is best (2). Finally, although it is perhaps obvious, letters should not contain irrelevant or untrue information. Extraneous or unverified information may adversely affect the candidate, even though this was not the letter-writer’s intention.

Evaluators, or letter-readers, must think about the “fit” between the candidate and the role for which he or she is applying. The qualifications for successful candidates should be explicit and tied directly to the aims of the role. The expectations for knowledge and achievement will differ according to these aims, whether an early-career applicant seeks a training slot or a senior member of the profession seeks a national award.

With these criteria in mind, readers must evaluate the content of each letter with a discriminating eye (2). The reader should begin by considering who the letter writer is—does the writer have a special role in the applicant’s life (e.g., training director, research mentor) and does the writer have experience or special expertise that is relevant? Does the writer have a perspective that will lead to a particular emphasis (or bias) in the letter?

The reader should next seek to understand the evidence used in developing the letter—is the writer acquainted personally with the applicant? Has the writer directly observed the applicant in enacting professional duties? Or is the letter based on a review of documents (e.g., publications and CV) instead? Any of these perspectives can be valuable so long as the viewpoint is well understood. For example, a professional at “arm’s length” can objectively say much about the accomplishments of a candidate in relation to peers. A close colleague or mentor can speak more fully to the character of the candidate. The reader should then simply read the letter for the story it tells, seeking to be as fair as possible about the positives and negatives of the candidate and looking for specific information and observations that are relevant to the selection decision.

Although it can be difficult to do so, the reader should look carefully for omissions or gaps in the letter. Just as unreported years on a CV should be scrutinized in understanding a candidate’s professional path, what a letter does not say may be just as important as what it does address (2). If the referee invites the reader to get in touch, particularly if there are negative comments or obvious omissions in the letter’s content, calling the referee may be a wise step. Contacting a reference is, under many circumstances, permissible. (If the reader is new to this role, he or she may wish to seek advice from someone knowledgeable before making personal contact with a reference.) A direct conversation with a reference may provide reassuring “good news” or lead to a discussion of issues that were too awkward to include in a formal letter of recommendation but are relevant to the selection decision (2). It is important that unsubstantiated impressions or gossip communicated in these conversations should be taken with some skepticism, however. This is the difference between professionalism and prejudice. The evaluator should inform the recommender that the conversation will be carefully documented for future reference, and the evaluator should be certain to do so, particularly if the information conveyed is relevant to the decision.

Letters of recommendation are instrumental in advancing careers and in bringing candidates into the right roles in our profession. Writing (honest) letters of recommendation is clearly important work, although it is underrecognized for its significance as a service to the field. For each of the key individuals in the process—the applicant who seeks a letter, the recommender who writes the letter, and the selector who reads the letter—there is much to do with professionalism and much at stake for the profession.