Mastering Letters of Recommendation for Medical Genetics Residency

Understanding the Role of Letters of Recommendation in Medical Genetics

Letters of recommendation (LORs) are one of the most powerful narrative components of your medical genetics residency application. In a relatively small specialty where programs know one another well, your letters do more than confirm that you are competent—they help programs understand your potential as a future clinical geneticist, researcher, educator, and colleague.

Unlike some larger specialties, a medical genetics residency (or combined programs such as pediatrics–medical genetics or internal medicine–medical genetics) places particular emphasis on attributes that are harder to measure via grades and scores: curiosity about rare diseases, comfort with uncertainty, interdisciplinary collaboration, communication skills with families, and interest in lifelong learning. Strong, specific letters can highlight all of these in ways your CV cannot.

In this guide, we will cover:

• How program directors in medical genetics use letters in the genetics match process
• Who to ask for letters and how many letters you need
• How to get strong LOR tailored to medical genetics
• Timing, etiquette, and strategy for letters
• Common pitfalls and how to avoid them

Throughout, we’ll focus on applicants pursuing medical genetics residency pathways, but most advice applies whether you are applying to categorical medical genetics, combined pediatrics–medical genetics, internal medicine–medical genetics, or transitioning from another residency.

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What Program Directors Look for in Medical Genetics LORs

Why letters matter so much in a small specialty

In medical genetics, program directors (PDs) frequently know each other and may personally know your letter writers—especially if your institution has a genetics department or is active in the American College of Medical Genetics and Genomics (ACMG). This gives letters particular weight:

• Letters are often read carefully and in full, not skimmed.
• Subtle wording differences are recognized (e.g., “good” vs “outstanding”).
• A strong letter from a well-known geneticist can significantly enhance your application’s credibility.

Even if your letter writers are not geneticists, the content of your letters helps PDs answer key questions:

1. Is this applicant genuinely interested in medical genetics?
2. Can they handle the complexity and uncertainty of genetic diagnosis and counseling?
3. Do they communicate clearly and compassionately with patients and families?
4. Are they collaborative and collegial in multidisciplinary environments?
5. Do they have potential for scholarship, quality improvement, or academic work in genetics?

Core competencies highlighted in strong genetics letters

Strong letters of recommendation for medical genetics residency will usually address:

• Clinical reasoning with rare or complex presentations
  • Ability to construct differential diagnoses that include genetic/metabolic conditions
  • Comfort with ambiguous or evolving clinical pictures
• Communication skills
  • Explaining complex concepts (e.g., inheritance patterns, genetic testing) to patients and non-specialists
  • Delivering difficult news with empathy
• Interdisciplinary collaboration
  • Working with genetic counselors, lab medicine, neurology, oncology, pediatrics, maternal–fetal medicine, etc.
• Curiosity and lifelong learning
  • Independently reading and following up on unusual cases
  • Engaging with primary literature, guidelines, and gene databases
• Professionalism and reliability
  • Following through on tasks, consult recommendations, and documentation
  • Reliability when coordinating complex outpatient workups
• Fit for a career in genetics
  • Demonstrated sustained interest (electives, research, case reports, ACMG/ASHG involvement)
  • Insight into what the field entails beyond “interesting rare diseases”

Letters that connect your behaviors or achievements directly to these competencies are especially persuasive in the genetics match.

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Who to Ask for Letters of Recommendation in Medical Genetics

Choosing who writes your letters is as important as what the letters say. For a competitive medical genetics residency application, you should think strategically about both credibility and relevance.

How many letters do you need?

Most programs participating in the genetics match via ERAS require 3 letters of recommendation, and some allow or recommend a 4th. Always verify each program’s requirements, but a typical, strong set for a medical genetics applicant might be:

• 3 required letters, plus
• 1 optional supplemental letter (used if allowed and meaningful)

Aim for quality over quantity. A concise set of outstanding, detailed letters is far better than several generic ones.

Ideal mix of letter writers for a genetics applicant

When thinking about who to ask for letters, consider the following types of writers:

1. A clinical geneticist (if available)

   • This is ideal but not mandatory.
   • A letter from a physician who directly supervises you on a medical genetics or metabolic genetics rotation carries enormous weight.
   • If your school does not have a genetics department, consider:
     • Visiting rotations / away electives in medical genetics
     • Tele-genetics experiences where you worked closely with a geneticist

2. Subspecialists with strong genetics overlap
   If you lack direct genetics mentors, these services still strongly support your interest in medical genetics:

   • Pediatric neurology or adult neurology
   • Maternal–fetal medicine / high-risk obstetrics
   • Pediatric oncology / heme-onc
   • Metabolic or biochemical genetics clinics
   • Neonatal ICU or PICU with complex genetic/metabolic cases

3. Core clinical faculty who know you very well
   Particularly:

   • Pediatrics (for peds–genetics paths)
   • Internal medicine (for IM–genetics)
   • Family medicine with robust genetics exposure
   • Medicine–pediatrics

4. Research mentors (selectively)
   Consider a research letter if:

   • Your project is in genomics, rare diseases, bioinformatics, molecular biology, gene therapy, or related fields, and
   • You had a substantial role: designing, analyzing, presenting, or publishing work.
     This can be your 3rd or 4th letter, but clinical letters should still anchor your application.

A recommended combination for a strong medical genetics residency application might be:

• Letter 1: Clinical geneticist or genetics subspecialty mentor
• Letter 2: Core clinical faculty from a major rotation (pediatrics, internal medicine, or Med-Peds)
• Letter 3: Another clinical subspecialist with genetics exposure OR a research mentor in genetics/genomics
• Letter 4 (optional): Additional clinical or research letter that adds new information rather than repeating content

What matters more: title or familiarity?

In the context of medical genetics:

• A “big name” geneticist who barely knows you → weak
• A less-famous clinician who supervised you closely for four weeks → much stronger

Programs can tell when a letter is generic. It is better to choose someone who:

• Observed you directly and frequently
• Can describe specific cases or projects you worked on
• Knows your work habits, communication style, and growth trajectory

If you can combine high familiarity with relevance to genetics, that’s ideal—but if forced to choose, depth of knowledge about you usually outweighs prestige alone.

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How to Get Strong LOR for Medical Genetics: Step-by-Step

You probably know that you need “strong letters,” but many applicants struggle with the practical side of how to get strong LOR. Below is a structured approach tailored to medical genetics.

1. Plan early around genetics-related experiences

To set yourself up for strong letters:

• Schedule a medical genetics elective (or a rotation with heavy genetics exposure) as early as feasible in your 3rd or early 4th year.
• If your school lacks a genetics service:
  • Seek away electives at institutions with robust genetics departments.
  • Explore virtual or telehealth electives in genetics or genomics.
• Think ahead about which rotations:
  • Will showcase your interest in rare diseases and diagnostic puzzles
  • Involve multidisciplinary teams where you can stand out
  • Offer sustained contact with an attending who might become a recommender

Document cases you’ve worked on, especially those with genetic implications—these will be useful when you later discuss letters.

2. Be intentional on rotations where you may request a letter

Once on a relevant rotation, act with the potential letter in mind (without being performative):

• Show proactive curiosity about genetic differentials and tests:
  • Ask: “Could there be a genetic etiology here?”
  • Read primary literature and bring back concise summaries.
• Work closely with your attending when possible:
  • Volunteer to present complex or puzzling cases.
  • Ask to help draft consult notes, family letters, or genetic test justification letters.
• Engage with the entire team, including genetic counselors and fellows:
  • Programs value applicants who know how to work with counselors and respect their expertise.
• Seek mid-rotation feedback:
  • Ask: “What can I do better?” then visibly implement their suggestions.

Concrete example:
If you work up a child with developmental delay and dysmorphic features, you might:

• Construct a thoughtful differential (single-gene disorder, copy number variant, inborn error of metabolism).
• Propose appropriate first-line genetic testing.
• Read about similar syndromes and summarize a paper for your team.

Later, your attending can describe this case in your letter to illustrate your approach to genetic medicine.

3. Ask directly for a strong letter

When you are ready to request a letter, the way you ask matters. Aim to ask:

• In person if possible (or via video), supplemented with an email.
• At or near the end of the rotation, while your performance is fresh.

Use specific wording such as:

“I’m planning to apply to medical genetics residency and I’ve really valued working with you on this rotation. Would you feel comfortable writing a strong letter of recommendation for my medical genetics applications?”

This phrasing does three things:

1. Signals that you value their judgment.
2. Gives them an honorable way to decline if they cannot write a positive letter.
3. Emphasizes that you need more than a generic note.

If they hesitate or give a lukewarm response, thank them and consider asking someone else.

4. Provide targeted supporting materials

Make it easy for your writers to describe you in ways aligned with medical genetics. When they agree, send a brief, organized packet including:

• Your CV
• Your personal statement (especially if already tailored to genetics)
• A one-page summary of:
  • Your interest in medical genetics
  • Specific experiences that shaped that interest
  • Key cases or patients from their rotation that you found meaningful
• A short bullet list:
  • “If helpful, here are a few qualities I hope my letters can speak to…” (e.g., clinical reasoning with rare diseases, communication with families, teamwork with genetic counselors, interest in genomics research)

This is not “writing your own letter”; it’s giving them raw material and context. They will choose what to use.

5. Gently remind and follow up

Faculty are busy, and genetics departments are no exception. To ensure your letters arrive before deadlines:

• Request letters at least 4–6 weeks before you plan to submit ERAS.
• Send a polite follow-up email:
  • 2 weeks after your initial request (if they haven’t confirmed)
  • 2 weeks before your personal deadline
  • 1 week before the ERAS deadline, if still incomplete

Always include:

• Your full name and AAMC ID/ERAS ID
• The deadline
• A quick thank-you and acknowledgment of their time

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Content and Structure of Strong Medical Genetics LORs

You don’t control what your writers say, but by understanding what makes a letter strong, you can select and prepare recommenders more effectively. When faculty ask you for guidance, you’ll be ready with thoughtful suggestions.

Key features programs want to see

1. Clear description of the relationship and context

Program directors want to know:

• In what role did the writer supervise you?
• For how long, and in what setting? (clinic, inpatient consults, research lab, etc.)
• How many trainees at your level have they worked with, providing a comparison group?

Example:

“I supervised Dr. X during a four-week inpatient medical genetics consult rotation at our tertiary care children’s hospital, where I served as attending on the genetics service.”

2. Specific examples, not vague praise

Generic:

“They are hard-working, compassionate, and interested in genetics.”

Powerful:

“On our rotation, Dr. X took the initiative to review several complex exome reports, correctly summarizing variants of uncertain significance and communicating these findings to the family in understandable terms.”

Specifics differentiate you from other applicants.

3. Alignment with competencies important in genetics

Letters should ideally address:

• Analytical and diagnostic skills with complex or rare conditions
• Communication, especially explaining risk, uncertainty, and prognosis
• Collaboration with genetic counselors and other disciplines
• Comfort with evolving evidence and “not knowing yet”
• Ethical sensitivity around genetic testing and disclosure

4. Comparative statements

Program directors pay close attention to phrases like:

• “Among the top 10% of students I’ve worked with in the last five years.”
• “Clearly in the top tier of residents I have trained in their clinical reasoning and empathy.”

These allow readers to calibrate your performance.

5. Explicit support for medical genetics as a career choice

Since you’re applying specifically to a medical genetics residency, it’s helpful when a letter directly affirms your fit:

“I strongly believe Dr. X is an excellent match for a career in medical genetics and will develop into a thoughtful, compassionate clinical geneticist.”

Addressing weaker areas

Letters can also help contextualize potential red flags or weaker aspects of your application:

• If you have a low Step score but excel clinically, a letter can emphasize your strong bedside performance and reasoning.
• If you came to genetics later in training, a writer can describe your rapid growth and well-considered decision to change paths.

You should not ask a letter writer to “fix” red flags dishonestly, but if a mentor knows your context and trajectory, they can authentically provide reassurance.

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Timing, Logistics, and Strategy in the Genetics Match

Beyond choosing writers and cultivating strong letters, you must manage timing and logistics for the genetics match.

When to ask and upload

• Aim to have your letters uploaded to ERAS by the time programs begin reviewing applications (usually mid-September; check the current year’s calendar).
• For students: Ask for letters toward the end of 3rd year or early 4th year, especially after your key genetics-related rotations.
• For residents switching into medical genetics:
  • Request letters from your current program director or core faculty
  • Add at least one letter from a geneticist or genetics-aligned subspecialist if possible

How many letters per program?

In ERAS, you can assign up to 4 letters to each program. Strategy:

• Prioritize 3 strong clinical letters, ensuring at least one speaks directly to genetics.
• Use a 4th letter if:
  • It adds a distinct dimension (e.g., research in genomics, leadership, or education).
  • It is truly strong and not repetitive.

Avoid overloading programs with many similar-sounding letters.

Customizing letter sets for different programs

If you’re applying to multiple program types (e.g., pediatrics–genetics and internal medicine–genetics), you might:

• Use a pediatrics-heavy set for peds–genetics programs.
• Use a medicine-heavy set for IM–genetics programs.
• Keep any strong genetics-specific letter in all sets.

Within ERAS, you can assign different combinations of letters to different programs—take advantage of this to match the program’s clinical focus.

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Common Mistakes to Avoid with Genetics Residency Letters

Even excellent applicants can undermine their applications with preventable mistakes. Be mindful of these issues:

1. Relying solely on non-genetics letters when you have access to genetics

If your school has a clinical genetics service and you never worked with them—and all your letters are from unrelated areas—PDs may question the depth of your commitment to genetics. At minimum, try to:

• Do a short genetics elective and get one letter from that experience, or
• Obtain a letter from a subspecialist who can speak directly about your interest in genetic etiologies.

2. Using generic or template-like letters

Red flags for PDs include:

• Nearly identical letters from multiple writers.
• Letters filled with clichés and no details.

Prevent this by:

• Carefully choosing writers who know you well.
• Providing personalized material (CV, personal statement, key cases list).

3. Missing or late letters

In a small specialty like medical genetics, a missing letter can stand out. It may suggest:

• Disorganization, or
• A recommender who chose not to submit (raising questions).

Track your letters in ERAS and follow up gently but consistently. If a writer cannot meet the deadline, thank them and pivot to another recommender if necessary.

4. Overemphasizing research at the expense of clinical ability

Research in genomics is valuable, but genetics programs need clinically capable physicians above all. An application with:

• 2–3 research letters,
• but only 1 superficial clinical letter

will concern PDs. Aim for:

• At least two strong clinical letters, regardless of research strength.

Use research letters to supplement, not replace, clinical endorsements.

5. Not waiving your right to view letters

In most contexts, you should waive your right to view your letters in ERAS. This signals that:

• Faculty can be fully candid.
• The letter likely carries more credibility with programs.

If you do not waive this right, PDs may suspect that the letter is less candid and weigh it accordingly.

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FAQs: Letters of Recommendation for Medical Genetics Residency

1. How many letters of recommendation do I really need for a medical genetics residency?

Most programs require three letters, and many allow a fourth. You should plan for:

• Three strong clinical letters (with at least one clearly supporting your interest in medical genetics), and
• An optional fourth letter if it brings a new angle (e.g., genomics research, leadership, or education).

Always double-check each individual program’s requirements in ERAS, as some may have specific preferences (for example, one letter from your current program director if you’re already in a residency).

2. Who should I prioritize if I can’t get a letter from a clinical geneticist?

If you cannot secure a letter from a clinical geneticist, prioritize:

1. Subspecialists who frequently deal with genetic conditions, such as pediatric neurologists, oncologists, or maternal–fetal medicine specialists.
2. Core clinical faculty (pediatrics, internal medicine, Med-Peds) who have seen you manage complex or rare conditions.
3. Research mentors in genetics/genomics—especially if they also see your clinical work or can speak to your analytical skills and persistence.

Explain in your personal statement and interviews how you developed your interest in medical genetics despite limited direct exposure.

3. Is it better to have a famous geneticist write a brief letter, or a lesser-known clinician write a detailed one?

A detailed letter from someone who knows you well almost always carries more weight than a short, generic note from a well-known geneticist who barely supervised you. Name recognition can help, but content and specificity matter far more. The best-case scenario is a recognized geneticist who also worked closely with you—but if you must choose, choose depth of knowledge over title alone.

4. Can I use the same letters for all specialties if I’m applying to both genetics and a different field?

You can reuse some letters across specialties, but for a medical genetics residency application, at least one letter should be explicitly aligned with genetics. If you are dual applying (for example, to general pediatrics and peds–genetics):

• Use more general strong clinical letters for both sets, and
• Add a genetics-focused letter specifically to the programs where you’re applying for a genetics pathway.

ERAS allows you to assign different combinations of letters to different programs, so use that flexibility to tailor your application.

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Letters of recommendation are one of the most powerful tools you have to convey your readiness and fit for a career in medical genetics. By choosing the right writers, preparing them thoughtfully, and aligning your letters with the core values of the specialty, you give program directors a clear, compelling picture of the future geneticist you can become.