Essential Guide to Letters of Recommendation for DO Graduates in Clinical Informatics

Understanding the Role of Letters of Recommendation for a DO in Clinical Informatics

Letters of recommendation are one of the most influential—and misunderstood—parts of a residency or fellowship application. For a DO graduate interested in Clinical Informatics, strong letters can do far more than “check a box.” They can:

• Validate your technical and analytical potential for informatics
• Explain your unique DO background and osteopathic training
• Demonstrate your ability to bridge clinical care, data, and systems
• Mitigate weaker parts of your application (e.g., a low board score or nontraditional path)

Whether you’re applying directly to an ACGME residency with plans for a later Clinical Informatics Fellowship, or to programs that emphasize health IT training and data-driven care, your letters help programs see you as more than a transcript and a CV. They provide narrative proof that you can thrive in the informatics-focused, team-based environment these programs value.

This guide is tailored specifically for a DO graduate and will walk you through:

• Who to ask for letters (and why)
• How to get strong LOR that highlight informatics-relevant skills
• How to support your writers so they can advocate effectively
• Special considerations for the osteopathic residency match and later Clinical Informatics Fellowship applications

Throughout, we’ll keep a focus on Clinical Informatics and health IT training pathways.

---

How Clinical Informatics Programs View Letters from DO Graduates

Clinical Informatics is still a relatively small specialty, but its influence is expanding rapidly through both residency programs that emphasize informatics and dedicated Clinical Informatics Fellowship slots. While most applicants will match into a core specialty first (e.g., Internal Medicine, Emergency Medicine, Family Medicine) and pursue a Clinical Informatics Fellowship afterward, your interest in informatics should shape your letter strategy from day one.

1. The Dual Lens: Clinician and Informatician

Programs are looking for two major things in your letters:

1. Evidence of strong, reliable clinical performance

   • Sound medical knowledge
   • Solid clinical reasoning
   • Professionalism and communication
   • Teamwork and reliability

2. Signals that you can grow into an informatics-minded physician

   • Comfort with technology and data
   • Curiosity about systems, workflows, and quality improvement
   • Ability to think in terms of processes, not just individual patient encounters
   • Initiative in projects related to EHR optimization, analytics, or telehealth

Your letters should speak clearly to both dimensions. As a DO graduate, you also bring a distinct lens:

• Whole-person, systems-based thinking
• Often strong communication skills and patient-centered care
• Exposure to osteopathic principles that align well with population health and system redesign

Letter writers who can articulate how your osteopathic training complements informatics are particularly valuable.

2. DO Graduate Residency Context: Allopathic vs Osteopathic Pathways

With the single accreditation system, DO graduates now apply broadly to ACGME programs. However, some dynamics still matter:

• Some programs may be less familiar with DO training. A strong, detailed letter that explicitly affirms your performance compared with MD peers can help.
• Osteopathic residency match history and performance may still influence how some committees interpret your file. Letters that describe your adaptability, resilience, and clinical strength can mitigate any bias or uncertainty.
• For later Clinical Informatics Fellowship applications, fellowship directors will look at your residency letters to see whether your informatics interest is long-standing and consistent, not a last-minute switch.

Actionable takeaway: You want letters that simultaneously say, “This DO graduate is an excellent clinician” and “This person is already thinking like an informatician.”

---

Who to Ask for Letters (and How to Choose Strategically)

Knowing who to ask for letters of recommendation is often more important than how many you collect. Programs usually require 3–4 letters; for most DO graduate residency and eventual Clinical Informatics Fellowship applications, focus on quality and relevance over quantity.

1. Core Clinical Letters: Your Foundation

For residency applications (the step before a Clinical Informatics Fellowship), most programs expect:

• At least two strong clinical letters from attending physicians who supervised you directly
• Ideally, at least one from your intended core specialty (e.g., IM, EM, FM, Peds, etc.)

For example, if you’re applying to Internal Medicine with future plans for a Clinical Informatics Fellowship:

• 1–2 letters from IM attendings who supervised you on inpatient or outpatient rotations
• 1 letter from an attending in a related area (e.g., ICU, ED, subspecialty)
• 1 letter from someone who can highlight your informatics potential (more on that below)

These core clinical letters are critical in both the osteopathic residency match and the allopathic landscape. They prove you can handle the day-to-day work of being a resident.

2. Informatics-Oriented Letters: Your Differentiator

Because you are specifically interested in Clinical Informatics and health IT training, it is highly advantageous to have at least one writer who can:

• Speak to your involvement in data-driven quality projects
• Describe your role in EHR optimization, workflow analysis, or clinical decision support
• Highlight your curiosity about systems, technology, and population health

Potential informatics-focused letter writers include:

• A Clinical Informatics physician you worked with directly (ideal)
• A physician champion for the EHR or quality improvement who knows your work well
• A faculty member or preceptor in a clinical informatics elective or health systems rotation
• A non-physician health IT leader (CMIO, data scientist, pharmacist informaticist) if they collaborated closely with you and a physician co-signs or supplements the letter

Programs recognize that not all DO schools have formal informatics departments. However, any supervisor who can credibly discuss your involvement in:

• EHR build or implementation
• Data analysis for QI projects
• Clinical decision support tool design
• Telemedicine workflows or remote monitoring
• Health IT training initiatives

is extremely valuable.

3. Academic and Research Letters: When They Help Most

If you’ve done research in informatics, data science, or quality improvement, asking for a letter from a research mentor can be powerful—especially for future Clinical Informatics Fellowship applications.

An academic/research letter can:

• Demonstrate your ability to work with data and statistics
• Show initiative in scholarly inquiry
• Highlight collaboration with multi-disciplinary teams

However, programs still weigh clinical performance heavily. Avoid replacing core clinical letters with research letters unless you have a strong reason and are sure the program welcomes it.

4. Who Not to Ask (Common Pitfalls)

Avoid letter writers who:

• Barely know you or supervised you only briefly
• Can only comment on generic traits (“hard-working, pleasant”) without specifics
• Are high-status but distant (e.g., department chair you met once at grand rounds)
• Are outside the clinical environment with no clear relevance (e.g., non-healthcare volunteer supervisor)

A strong letter from a mid-level faculty member who knows you well beats a lukewarm letter from a famous name almost every time.

---

How to Get Strong LOR: Step-by-Step Playbook

You cannot control what someone writes—but you can dramatically increase the odds of receiving powerful, specific, supportive letters of recommendation.

1. Build Relationships Early and Intentionally

For a DO graduate interested in Clinical Informatics, start cultivating potential recommenders as early as possible:

• On rotations, introduce yourself as someone interested in informatics and health IT.
• Volunteer for tasks that overlap with informatics:
  • Helping optimize note templates
  • Participating in QI data collection
  • Joining meetings on EHR workflows
• Ask for feedback mid-rotation and adjust based on what you hear.

Faculty are more willing to write strong letters when they have seen your growth over time.

Example:
During an inpatient IM rotation, you mention to your attending that you’re interested in Clinical Informatics. When a problem arises with medication reconciliation in the EHR, you offer to help track the issue, collect data, and present a short summary of your findings and potential solutions. That attending now has specific stories demonstrating your informatics mindset and initiative.

2. Ask for a “Strong, Detailed Letter”

When the time comes, be explicit in how you ask. Instead of:

“Could you write me a letter of recommendation?”

Use:

“Would you feel comfortable writing a strong, detailed letter of recommendation for my residency applications? I’m a DO graduate interested in Clinical Informatics and health IT training, and I’d be grateful if you could comment on my clinical performance as well as my interest in informatics.”

This phrasing does two things:

• Gives them an “out” if they can’t support you fully (better to know this early).
• Signals that specifics matter, not just a generic endorsement.

If someone hesitates or seems uncertain, thank them and do not press further—consider that a sign to ask someone else.

3. Provide a Helpful “Letter Packet”

To help your letter writer produce the best letter possible, prepare a concise packet. This is one of the most effective ways to strengthen your residency letters of recommendation.

Include:

• Updated CV
• Personal statement (or at least a one-page summary of your story and goals in Clinical Informatics)
• A short “brag sheet” or bullet list:
  • 4–6 specific patient encounters or projects they supervised you on
  • Your contributions to any health IT or QI initiatives
  • Qualities you hope they might address (e.g., system-level thinking, teamwork, leadership)
• A list of programs or program types you are applying to (e.g., IM programs with strong informatics or QI tracks)
• Submission instructions and deadlines (be respectful of their time; aim for 4–6 weeks lead time)

This is not about telling them what to write; it is about supplying raw material so they can write a detailed, accurate letter efficiently.

4. Align Their Letter with Your Informatics Story

Most faculty are comfortable addressing clinical skills. To help them connect your performance to Clinical Informatics:

• Briefly explain why you’re pursuing Clinical Informatics or a future Clinical Informatics Fellowship:
  • Interest in population health and data
  • Passion for EHR design and workflow improvement
  • Experience with analytics, coding, or data tools
• If they supervised you on a relevant project, remind them:
  • “You might recall I worked with you on the readmission dashboard QI project, where I…”
• Gently note any themes you hope they might emphasize:
  • “Programs are particularly interested in my ability to work with multi-disciplinary teams and my comfort with health IT systems.”

By doing this, you focus the letter on the aspects of your performance that matter most for informatics-oriented programs.

5. Mind the Logistics and Deadlines

Small logistical missteps can delay or derail an otherwise strong application:

• Confirm how your school or ERAS handles LOR submissions.
• Clarify whether any programs you’re targeting for osteopathic residency match have additional requirements.
• Track who has submitted letters and send polite reminders 1–2 weeks before deadlines if needed.

Always send a sincere thank-you note once letters are submitted, and consider updating your recommenders after you match or later when you secure a Clinical Informatics Fellowship—these relationships often continue to matter.

---

Content of a Strong Letter: What Program Directors Look For

Understanding what makes a letter strong will help you recognize who to ask and what information to share with them.

1. Specific, Narrative Examples

Program directors want:

• Concrete stories of times you:
  • Managed a complex patient
  • Showed leadership during a busy call night
  • Identified a systems problem and helped fix it
• Comparative statements:
  • “Among the DO students I’ve supervised over the past five years…”
  • “She performs at the level of an intern in terms of reliability and clinical reasoning.”

For informatics, valuable narratives might include:

• You noticed a recurring EHR error and took initiative to escalate and help solve it
• You helped design or pilot a new order set, note template, or telehealth workflow
• You participated in data collection and analysis for a QI project and presented the results

These detailed examples carry far more weight than generic praise.

2. Explicit Endorsements and Rankings

Many letters include some form of ranking or categorical support. Program directors pay attention to:

• Phrases like:
  • “I give my highest recommendation”
  • “I would rank them in the top 10% of students I’ve supervised”
  • “I would be delighted to have them as a resident in our own program.”

If a letter uses cautious or lukewarm wording (“solid,” “adequate,” “competent”), it may be interpreted as mixed or negative—even if the overall tone seems neutral.

3. Addressing DO-Specific Context Transparently

For a DO graduate, strong letters may also directly address:

• How you compare to MD peers in the same environment
• Any additional strengths your osteopathic training provides (e.g., communication, holistic assessment)
• Explanations of any contextual factors (e.g., limited research opportunities, resource constraints)

When thoughtfully written, this can strengthen your application and reduce uncertainty among programs less familiar with DO training.

4. Signals Relevant for Future Clinical Informatics Fellowship

Even if you’re applying first to a core specialty residency, letters that describe traits relevant to informatics will serve you well later. Fellowship directors read residents’ historical letters when considering:

• Evidence of sustained interest in informatics and health IT training
• Early leadership in technology or QI initiatives
• Comfort with multidisciplinary teams involving IT, nursing, pharmacy, and administration

Examples of key traits:

• Systems thinking
• Initiative in process improvement
• Effective communication between clinical and technical staff
• Resilience and adaptability during change (e.g., EHR transitions, new workflows)

---

Special Situations for DO Graduates: Gaps, Career Changes, and Nontraditional Paths

Many DO graduates progress through a straightforward path, but Clinical Informatics often attracts nontraditional applicants—those with prior careers in IT, engineering, data science, or business.

1. Addressing Gaps or Weaknesses

If you have:

• A gap year
• Lower-than-desired COMLEX or USMLE scores
• An initial mismatch or change in specialty

Letters can strategically address these issues.

How?

• Ask a letter writer who has seen your recent work and can attest to growth:
  • “Since returning, they have been consistently prepared and clinically sharp.”
  • “Any past academic struggles are not reflective of their current capabilities.”

Avoid asking letter writers to make excuses. Instead, they should:

• Provide context where appropriate
• Emphasize your current performance and reliability
• Show that your struggles are behind you and that you have developed resilience and insight

2. Leveraging Prior IT or Data Experience

For Clinical Informatics–bound applicants with pre-med careers in IT, data analytics, engineering, or software:

• Consider whether a former supervisor can write about your technical skills and teamwork.
• These letters can be very helpful—especially for fellowship applications—if:
  • The writer knows you well
  • Can speak concretely about your contributions
  • You supplement this with strong medical/clinical letters

Programs appreciate applicants who can bridge clinical and technical worlds. Your letters can explicitly highlight this dual expertise.

---

FAQ: Letters of Recommendation for DO Graduates in Clinical Informatics

1. How many residency letters of recommendation do I really need as a DO graduate?

Most residency programs expect 3–4 letters. For a DO graduate interested in Clinical Informatics:

• Aim for at least two strong clinical letters from attendings who directly supervised your patient care.
• Try to obtain one letter from someone who can highlight your informatics or systems-thinking strengths (e.g., Clinical Informatics physician, QI mentor, EHR project leader).
• Only add extra letters if each one adds a distinct, clearly positive perspective—avoid redundancy.

2. Who to ask for letters if my school doesn’t have a formal Clinical Informatics department?

You can still build a compelling informatics-focused profile:

• Hospitalists or subspecialists involved in QI or EHR committees
• Faculty who mentored you in a health systems, QI, or population health project
• Physicians who saw you use data or technology creatively in clinical care
• Non-physician health IT or QI leaders, as long as at least one physician provides a primary clinical letter

Explain your Clinical Informatics interest to them clearly and remind them of relevant cases or projects you’ve worked on together.

3. How do I ask for strong LOR without sounding demanding?

Use clear but respectful language:

“I’m applying to residency with the goal of pursuing a Clinical Informatics Fellowship in the future. Would you feel comfortable writing a strong, detailed letter of recommendation that discusses my clinical performance and interest in informatics and health IT training?”

This is professional, transparent, and gives the writer space to decline if they cannot strongly support you—which ultimately protects you.

4. Do letters of recommendation still matter for my future Clinical Informatics Fellowship, or just for residency?

They matter at both stages:

• For residency, they help you match into programs that value informatics and health IT training, which makes your future fellowship path smoother.
• For Clinical Informatics Fellowship, fellowship directors review your residency and sometimes medical school letters to:
  • Confirm your long-standing interest in informatics
  • Assess your clinical foundation and professionalism
  • Look for early signs of systems thinking, team collaboration, and comfort with technology

Investing effort now in excellent letters will pay off both in your residency match and later in your Clinical Informatics Fellowship applications.

---

By approaching your letters of recommendation with the same strategic mindset you bring to informatics—clarifying objectives, identifying the right stakeholders, and providing high-quality data—you position yourself as a compelling DO graduate who understands both patients and systems. That dual strength is exactly what Clinical Informatics programs and future fellowship directors are looking for.