OB GYN Residency Letters of Recommendation: A Complete Guide

Letters of recommendation can make the difference between a solid OB GYN residency application and a truly standout one. In a specialty where professionalism, teamwork, communication, and clinical judgment are critical, strong letters often provide programs with the nuanced information that test scores and transcripts cannot. This guide will walk you through everything you need to know about residency letters of recommendation in Obstetrics & Gynecology: from who to ask for letters, to how to get strong LOR, to strategic use of letters across the obstetrics match.

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Understanding the Role of Letters in OB GYN Residency Applications

Letters of recommendation (LORs) are more than a requirement to check off. Especially in OB GYN—a field balancing high-acuity emergencies, operating room performance, and close longitudinal care—letters offer insight into how you function on real clinical teams.

How Programs Use Letters of Recommendation

Program directors in OB GYN commonly use residency letters of recommendation to:

• Confirm your clinical competence beyond exam scores
• Assess your work ethic and reliability on busy services
• Evaluate your professionalism and integrity
• Understand how you handle stressful or emergent situations
• Gauge your teamwork and communication with nurses, midwives, residents, attendings, and patients
• Identify any red flags or concerns not obvious elsewhere

In surveys of program directors, letters consistently rank among the most important factors in deciding:

• Whom to offer interviews to
• How to rank applicants after interviews
• When to advocate for borderline candidates

How Many OB GYN Letters Do You Need?

For the obstetrics match, ERAS generally allows up to 4 letters to be assigned to each program, although most programs require 3 letters. Your safest strategy:

• Aim for 3–4 strong letters total
• Include at least two OB GYN letters
• The third (or fourth) can be from:
  • Another core specialty (e.g., Internal Medicine, Surgery)
  • A subspecialty closely aligned with OB GYN (e.g., MFM, Gyn Onc, REI)
  • A research mentor, if you have meaningful scholarly work

Always check each program’s specific requirements, but as a rule:

• Minimum: 2 OB GYN letters
• Ideal: 2–3 OB GYN letters + 1 from another clinical or research setting

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Who to Ask for Letters: Choosing the Right Writers

Choosing who to ask for letters is often more important than how many letters you have. For OB GYN residency, think quality over prestige alone. Name recognition helps, but a generic letter from a well-known faculty member is less useful than a detailed, enthusiastic letter from someone who truly knows you.

Priority 1: OB GYN Attending Physicians Who Supervised You Directly

Your strongest letters usually come from OB GYN attendings who have observed you over time in:

• Core OB GYN clerkship
• Sub-internships/acting internships (AI) in OB GYN
• Elective rotations in OB GYN (including away rotations)

Ideal letter writers:

• Worked with you for at least 3–4 weeks
• Saw you in both inpatient and outpatient settings if possible
• Observed you managing labor and delivery, gynecologic patients, and/or postoperative care
• Interacted with you across different shifts and teams

Examples of strong potential writers:

• Clerkship director who directly observed you on service
• Sub-I attending on Labor & Delivery who saw you take primary responsibility for patients
• Gynecology attending who observed you in the OR, clinic, and on the ward
• Fellowship-trained subspecialists (e.g., MFM, Gyn Onc, REI) who saw your clinical and academic work

Priority 2: OB GYN Program Leadership

Letters from individuals in leadership roles can carry extra weight if they truly know you:

• OB GYN Program Director
• OB GYN Associate Program Director
• OB GYN Clerkship Director or Sub-I Director
• OB GYN Department Chair (only if they worked with you meaningfully)

These letters are particularly valuable when:

• They reflect direct observation, not just second-hand comments
• The writer can compare you with prior applicants from your institution
• The writer advocates clearly for your fit with OB GYN as a career

Avoid “title-only” letters where the department chair writes a generic note stating support but has never worked with you clinically.

Priority 3: Non-OB GYN Clinical Faculty Who Know You Well

Programs also value well-written letters from:

• Internal Medicine or Family Medicine faculty who saw you provide longitudinal outpatient care
• General Surgery or surgical subspecialty attendings who saw your performance in the OR
• Emergency Medicine attendings who observed you in high-acuity scenarios
• Pediatrics faculty (especially neonatology or adolescent medicine) given the overlap in patient populations

These letters can reinforce themes like:

• Work ethic and reliability
• Patient-centered communication
• Teamwork in busy clinical environments
• Ability to learn and incorporate feedback

Priority 4: Research Mentors

A letter from a research mentor is particularly useful if:

• You have substantial research involvement (e.g., multi-year project, first-author work)
• The project is related to OB GYN or women’s health
• The mentor can speak to:
  • Your intellectual curiosity
  • Ability to work independently
  • Scholarly potential and follow-through
  • Contributions to manuscripts, abstracts, or presentations

However, research letters should supplement, not replace, strong clinical OB GYN letters.

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How to Get Strong LOR in OB GYN: Building the Foundation Early

The most effective way to secure powerful letters is to earn them through consistent, high-level performance and strong relationships over time.

Excel on Your OB GYN Clerkship

Your core OB GYN rotation is your first major opportunity to demonstrate that this specialty is a good fit. To position yourself for strong residency letters of recommendation:

1. Show up early and prepared

• Review patient lists the night before when possible
• Read about common OB issues (HTN in pregnancy, gestational diabetes, labor management)
• Familiarize yourself with common GYN pathologies and surgeries

2. Be proactive but respectful

• Ask residents/attendings, “How can I be most helpful on rounds today?”
• Volunteer to:
  • Gather vitals and labs
  • Write draft progress notes (if allowed)
  • Call consults or follow-up on imaging
  • Assist with patient education and discharge counseling

3. Own your patients

• Know every detail about patients you follow
• Anticipate next steps and discuss your plan proactively
• Follow up on results and communicate relevant updates to the team

4. Demonstrate teachability

• Ask for feedback mid-rotation: “What’s one thing I can improve this week?”
• Implement feedback and let your team see your progress

Maximize Your Sub-Internship (AI) in OB GYN

Sub-internships are crucial for the obstetrics match and are often your best source of detailed letters.

To turn an AI into a strong LOR:

• Act like an intern
  • Take responsibility for admissions, orders (if allowed), and discharge planning
  • Help cross-cover and communicate with nursing staff
• Be dependable on Labor & Delivery
  • Be present for emergent cases and deliveries
  • Learn the workflow of triage, L&D, and postpartum units
• Communicate clearly with patients
  • Introduce yourself confidently as part of the team
  • Explain plans in understandable language
  • Show empathy in emotionally intense moments (e.g., pregnancy loss, complications)

Tell your attending early:
“I’m planning to apply to OB GYN and would really appreciate feedback on how I can perform at a residency level on this rotation.”

This signals your seriousness and invites them to observe you more closely—a key step in how to get strong LOR.

If You’re Doing an Away Rotation

Away rotations can be excellent opportunities to:

• Experience different program cultures
• Showcase your skills to potential future colleagues
• Earn a powerful external letter

To succeed:

• Clarify expectations on day one: ask the site director what distinguishes strong students
• Avoid comparing programs openly or negatively
• Show genuine interest in that institution’s strengths (MFM, Gyn Onc, community vs academic, etc.)
• If you think you might ask for a letter, work particularly closely with 1–2 attendings who see you across multiple settings

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The Process: When and How to Ask for OB GYN Letters of Recommendation

Even if you’ve earned strong letters through your performance, you still need to ask in a way that supports your writer and your application.

When to Ask

Timing matters:

• Near the end of the rotation
  • Ideal: final week, once they’ve seen your full performance
• Immediately after a strong evaluation period
  • E.g., after a particularly good sub-I month, away rotation, or research milestone
• Well before ERAS deadlines
  • Aim to have all letters requested by July and submitted by early September for an on-time obstetrics match application

If you’re applying from a non-traditional path or taking a research year, mention your application timeline early so writers can plan accordingly.

How to Ask for a Letter (In Person and by Email)

Step 1: Ask if they can write a “strong” letter

In person (ideal) or via video/phone if needed, say something like:

“I’ve really valued working with you on this rotation. I’m applying to OB GYN this coming cycle, and I was wondering if you would feel comfortable writing a strong letter of recommendation in support of my application?”

This wording allows them to decline if they cannot wholeheartedly endorse you—far better than a lukewarm letter.

Step 2: Follow up with a concise, organized email

Include:

• ERAS letter request info (or follow instructions from your school)
• Your CV and personal statement draft (even if not final)
• A brief summary of:
  • The rotations/dates you worked with them
  • Specific patients or cases that highlight your performance
  • Any particular strengths or themes you hope they might comment on
• Clear timeline: “Letters are ideally uploaded by [date]”

Example brief helpful paragraph in your email:

“We worked together on the OB service in May 2025, primarily on Labor & Delivery and postpartum. I particularly appreciated your guidance on managing preeclampsia and counseling patients about induction of labor. If you feel it reflects our time working together, I would be grateful if you could comment on my clinical reasoning, communication with patients and staff, and my fit for OB GYN as a career.”

What to Provide Your Letter Writers

Make it easy for them to write a detailed letter:

• Updated CV with:
  • Clinical experiences
  • Honors/awards
  • Leadership, teaching, and volunteer work
  • Research and publications
• Personal statement (even if a near-final draft)
• Any programs or geographic preferences, if relevant
• A brief paragraph on why you chose OB GYN
• If appropriate, a reminder of specific feedback they gave you that you’ve worked on

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Strategy: Matching Letters to Your OB GYN Residency Application

Beyond just collecting letters, be strategic about how you use them in your obstetrics match application.

Balancing Your Letter Portfolio

Aim for a complementary set of letters that, together, tell a coherent story:

• Letter 1 (Anchor):
  OB GYN attending from your sub-I or core clerkship who saw you in high-responsibility situations. Focus on:

  • Clinical reasoning
  • Reliability
  • Teamwork on L&D or GYN service

• Letter 2 (Leadership/Comparison):
  OB GYN program/clerkship director or senior faculty. Focus on:

  • Comparison to past applicants
  • Overall readiness for residency
  • Endorsement of your fit for OB GYN

• Letter 3 (Complementary Perspective):
  Non-OB GYN clinician or research mentor. Focus on:

  • Professionalism and communication
  • Academic potential or procedural skills
  • Longitudinal observation in another setting

• Optional Letter 4 (Depth):
  Additional OB GYN attending (especially if one letter is from an away rotation). Focus on:

  • Fit with different practice environments
  • Adaptability and interpersonal skills

Assigning Letters to Programs (ERAS Strategy)

ERAS lets you choose which letters go to which programs. For most OB GYN residency applications:

• Use the same 3–4 letters for all programs, unless:
  • You have a highly tailored letter for a specific region or institution
  • A program requires a particular type of letter (e.g., chair’s letter)

If you have an away rotation letter:

• Assign it to programs in that same region or with a similar practice style
• Definitely send it to the away rotation program itself, as they will value their own faculty’s assessment

Handling Special Situations

1. What if you had a weaker OB GYN clerkship but improved later?

• Use a sub-I letter to demonstrate growth and stronger performance
• Ask your writer to highlight your trajectory and improvement
• Include non-OB GYN letters emphasizing your consistency and professionalism across rotations

2. What if you’re a DO or IMG applicant?

• Prioritize US-based OB GYN letters if at all possible
• Strong letters that directly compare you favorably to US-trained students can be very powerful
• If clinical opportunities are limited, research mentors and non-OB GYN US attendings can still be quite helpful

3. What if an attending seems lukewarm but not negative?

• If you sense hesitation when you ask for a “strong” letter, consider not using that letter
• You’re better off with three strong, specific letters than four letters with one being neutral or vague

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Common Mistakes to Avoid with OB GYN Letters of Recommendation

Even strong applicants sometimes undercut their applications by mishandling letters. Avoid these pitfalls:

1. Asking Too Late

Waiting until August or September to request letters can lead to:

• Rushed, generic letters
• Stressful last-minute follow-up
• Delayed ERAS submission

Start planning during your third year and have requests out by early summer before you apply.

2. Prioritizing Big Names Over Real Advocates

A department chair or nationally known specialist who barely knows you is unlikely to write a compelling letter. Red flags for a weak letter:

• “I did not work with this student directly, but have heard they performed well.”
• Vague, descriptive statements without concrete examples
• Overly short letter with minimal endorsement

Choose writers who can describe specific cases, behaviors, and growth.

3. Not Waiving Your Right to See the Letter

ERAS gives you the option to waive or retain your right to see letters. Programs strongly prefer that you waive your right, which signals that your letters are confidential and more likely to be candid.

4. Failing to Give Writers Enough Context

If you don’t give your letter writers your CV, personal statement, or reminder of your work together, they may omit important achievements or themes. This makes your letter less specific and less impactful.

5. Inconsistent Story Across Application

Your letters, personal statement, and experiences section should reinforce each other. If:

• Your personal statement says you love L&D, but your strongest letter only discusses outpatient GYN OR
• You emphasize research prominently, but no writer mentions your scholarly work

then your narrative may feel disjointed. Aim for alignment: ask writers, when appropriate, to comment on specific strengths that fit your overall story.

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FAQs About OB GYN Residency Letters of Recommendation

1. How many OB GYN letters of recommendation do I really need?

Most applicants to OB GYN residency should aim for:

• At least two strong OB GYN letters (from attendings who worked directly with you)
• A third (and optional fourth) letter from:
  • Another clinical specialty
  • A research mentor
  • An additional OB GYN attending (including from an away rotation)

More than four letters total is not helpful, since you can only assign up to four per program.

2. Is a chair’s letter required for OB GYN?

Not all OB GYN programs require a department chair’s letter. Many are satisfied with:

• Two OB GYN faculty letters
• One additional clinical or research letter

Check individual program websites. If your school has a system where the chair or program leadership writes a “summary” letter, it can be valuable—but only if it includes direct observation or a meaningful synthesis of faculty feedback.

3. Should I get a letter from an away rotation?

If you perform well on an away rotation and have at least 2–3 weeks of substantial interaction with an attending, an away letter can be very powerful. It:

• Provides an external perspective beyond your home institution
• Often helps for programs in that same region or type (community vs academic)
• Is especially helpful if the away rotation is at a highly competitive or well-known program

Always ask directly if they feel able to write a strong letter after the rotation.

4. What if I’m applying with a lower Step score or other application weakness?

Strong, detailed letters can be especially important if your application has:

• Lower than average Step scores
• A failed exam attempt
• A leave of absence or non-traditional path

In this situation, focus on:

• Securing letters that explicitly endorse your readiness for residency
• Highlighting your clinical excellence, professionalism, and resilience
• Asking at least one writer to comment (if appropriate) on your growth and current stability

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Thoughtfully selected, well-supported letters of recommendation can powerfully strengthen your OB GYN residency application. By understanding who to ask for letters, building strong clinical relationships, and learning how to get strong LOR that align with your overall story, you can present a compelling, authentic picture of who you will be as an obstetrician-gynecologist.