Writing a Letter of Intent for Medical Residency

Writing A Letter of Intent for Medical Residency

The letter of intent is a final, meaningful opportunity to connect with your top program(s) before match day. More than just expressing interest, it’s a chance to remind programs of the genuine connection you felt during your interview and articulate why that connection matters. When done well, these letters convey your enthusiasm and sincerity to program directors while highlighting what makes you a perfect fit for their team.

Unless a program has explicitly stated not to send letters of intent/post-interview communication, you should definitely send a letter to your top-choice program. Telling them they are #1 on your rank order list shows commitment and helps them make informed ranking decisions.

Timing & Delivery

While you might feel eager to write your letter immediately after interviewing (that post-interview enthusiasm is real!), patience yields better results. Send your letter about 3 weeks before rank order lists are due. At that point, most programs are actively contemplating their rankings, making it the perfect moment to remind them of the connection you shared during your interview and/or how your strengths can benefit their program. When your letter is ready, send it as text in the body of your email (not an attachment). Address and send to the program director, and copy the program coordinator.

Before we dive into the components of an effective letter of intent, let’s address a common question:

Beyond Your #1 Program: Is it okay to send letters to your 2nd and 3rd ranks?

Deciding whether to send letters to programs ranked #2-3 is complex. Usually, these letters indicate an intent to “rank the program highly” or note that the program is “one of my top 3 choices.”

Potential Benefits:

Programs understand the realities of the match process and know that strong candidates often have multiple excellent options. A thoughtful letter showing genuine interest, even without a #1 ranking, demonstrates professional maturity and honest communication.
Many programs focus more on fit than ranking position. If your letter articulates specific, meaningful connections to their program, the fact that they’re your #2 or #3 choice might matter less than your potential contribution to their community.
Programs create their rank lists based on multiple factors, and transparent communication can be viewed positively. A candidate who is honest about their “high ranking” rather than making disingenuous #1 claims might be seen as having the integrity they want in their program.

Potential Drawbacks:

A program may explicitly prioritize candidates who express #1 intent. In a field of equally qualified applicants, knowing that you prefer another program might lead them to favor candidates who have demonstrated stronger commitment to their program specifically.
Programs might interpret “ranking highly” as diplomatic code for “you’re not my first choice,” potentially diminishing their perception of your enthusiasm. Even if you’re genuinely excited about their program, the implicit comparison could work against you.
When programs are making their final ranking decisions, they often look for reasons to move candidates up or down their list. Indicating that you’re ranking them #2 or #3 could become the deciding factor that moves you down.

Ultimately, choosing whether or not to send multiple letters depends on your specific situation, the strength of your connections with the program, and your comfort level with transparent communication. Whatever you decide, ensure your letter(s) remain genuine and specific to each program.

Creating an Effective Letter of Intent

Make It Personal

The best letters of intent feel like a continuation of the conversation had during your interview day. Maybe you spent time talking about the program’s surgical training pathway, or perhaps you connected with a faculty member over shared research interests. These genuine moments of connection are ideal content for your letter. They show you’re not just looking for any program, but that you’ve found one that truly fits.

When brainstorming, think about what truly excited you during your visit. Was it the program’s innovative approach to patient care? A commitment to community health? The way their fellowship placement aligns perfectly with your career goals? These specific details, when woven together with your strengths and aspirations, create a compelling narrative about why you and this program would be perfect together.

Keep It Brief

The letter of intent should be around 250-350 words, so focus on your strongest connections and most compelling points. Every sentence should serve a purpose.

3 paragraphs is just the right length:

Opening: Set the tone with warmth and sincerity; convey your intent to rank.

Body: Let your genuine connections shine.

Closing: Thank the program for their consideration, and reiterate your desire to match with their program.

While concise letters are ideal, in cases where there are multiple layers of connections with the program (such as research alignments, specific clinical experiences, and community ties), a longer letter can be warranted.

The Heart of the Matter

Remember, authenticity is everything. Only tell a program you’re ranking them 1st if you genuinely plan to do so. Focus on real connections that are unique to your application rather than generic praise (esteemed faculty, renowned training facilities, etc.). Share specific moments from your interview that stuck with you, and don’t be afraid to let your enthusiasm shine through!