Reference Letter

The Ideal Reference Letter

The ideal reference letter is from a person who is known to the program directors for the programs for which you are applying. In Canada, there are only 16 medical schools and this is a real advantage for you. The academic community in each specialty area is small enough that it is quite likely that they will know the referee you have chosen to write the reference letter if they come from an academic setting. A referee from an academic setting who would be able to confidently say they would want you as a resident in their own program is an ideal one!

Key to Choosing a Referee

Other clinical faculty can provide excellent references, the key to choosing them is to be sure you have spent enough time being observed by them and be sure you did good quality clinical work while under their observation. The programs which you are applying will specify whether or not the referee needs to be in the specialty to which you are applying, but many programs do take reference letters from outside the specialty, and some will take resident referee letters. Be sure to check before you ask!

Who NOT to Choose

Basic science, research only and non-medical letters are not helpful unless the program you are applying involves strong elements of these areas. The main concern of a residency director is that you have the necessary talents to be a resident that can successfully complete the residency programs. Your abilities outside the area of the work you will be doing in the residency are not as important to them as your skills in your work with patients.

Communication with your Mentors
When you start a rotation, if you are interested in that program, tell your mentors. More experience will fall your way and you will be remembered in a way that would make the staff person able to write a reference for you (assuming you have done good work). Make an appointment with the mentor and at that time, make a formal request for a reference letter. Ask the referee if they feel they would be in a position to write a good reference letter for you. Most will be honest with you, if they don’t feel they have observed you enough to write a letter, then they will tell you. As a writer of these letters it is much better to tell the student that you would not make a good referee for whatever reason than to say yes and write a lukewarm letter that is easily recognized as such by the residency program director.

Impress Your Referees

Make it easy for your referees. They will be impressed with someone who arrives with a mailing list of all programs the letters are to be sent. Pre-addressed, stamped envelopes are your best bet. A nice trick is to include a stamped self-addressed postcard that can be sent at the time the letters are sent. Once you know that your reference letters will have arrived at their destination. Please always allow your referees sufficient time to complete the task. References can be requested prior to when they are needed, if you have just completed a block of work with someone you would like as a referee, that is a good time to ask, as their experience with you will be fresh. If you do this, provide them with an outline for writing the letter. This can be obtained from the CaRMS web site.


One of the recommendations of CaRMS is that a reference letter not be seen by the learner, since this is regarded as being more valid than one the learner will see. The idea is that able to be truthful about the candidate when the learner will not see the letter. You do take a risk that the letter may not be what you want it to be; to avoid this you need to choose your referee carefully and ask them if they feel they can write a good reference for you.

Start Early!
To close, take advantage of all opportunities that come your way and create your own, to give yourself the best chance at finding the right referee for you. Start early, don’t leave it until your fourth year, with your CaRMS application in your hand.

Structured Reference Letters for Family Medicine and Emergency Medicine
Starting in the 2022 R-1 Match cycle, both Family Medicine and Emergency Medicine disciplines have received approval from the ARMC for their discipline wide structured reference letters. 
Family Medicine structured reference letter  
Emergency Medicine structured reference letter