Letter of Recommendation Writing Toolkit

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Developed by Members of the 2022-2023 NPF Clinical Practice Advisory Group

1. PREPARATION (WHAT DO YOU NEED FROM THE CANDIDATE)

a. As the letter writer, the level of recommendation should be discussed with the candidate when agreeing

to write the letter

i. If there are reservations or you do not feel you can recommend the candidate, have a crucial

conversation with the candidate including:

1. Why you cannot provide a positive letter of recommendation

2. Suggestions on what to improve, if applicable, prior to agreeing to write a letter

3. Suggestions on next steps or guidance to the learner to identify a preceptor more

equipped to write the candidate a positive letter of recommendation

ii. Crucial conversations are important in situations with reservations or when you do not

recommend a candidate:

1. The candidate trusts you to guide them to meet their goal and achieve the position, or

to navigate them to someone who can provide a stronger letter

2. Writing a letter with reservations or not recommending without the candidate’s

awareness is unfair to the candidate

b. The date when the letter of recommendation is due

c. The name of the program/organization/job the letter of recommendation is for

i. Highlight specifics if warranted (I.e., community residency, PGY-2 specialty, etc.)

ii. Reason(s) the candidate is interested in the program/organization/job

d. Student Materials

i. CV

ii. Any active involvement in extracurricular activities (local/state/national organizations, intern

position)

iii. Highlights or certain attributes the candidate may want mentioned to help them stand out

(personal achievements, personal statement)

1. Research projects

2. Publications

iv. APPE rotations completed thus far

e. Resident Materials

i. CV

ii. Completed rotations

iii. Highlights or certain attributes the candidate may want mentioned to help them stand out

(personal achievements, personal statement)

1. Research projects

2. Publications

3. Resident projects/presentations

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2. LOR CONTENT

a. Consider briefly describing your interaction with the candidate to provide additional perspective

i. If serving as a preceptor, describe the rotation environment

ii. If serving as a mentor, describe your experiences and interactions with the candidate

b. Communication Skills – Written and Oral

i. Documentation for consults and chart notes

ii. Written and verbal handoff

iii. Communication with other members of the healthcare team

iv. Patient education or other patient interactions

v. Interactions with the healthcare team during an emergency or code blue situations

vi. Case presentations, journal clubs, Grand Rounds, poster presentations, etc.

vii. Interactions with peers, mentors, preceptors, advisors, etc.

c. Assertiveness

i. Is the candidate actively engaged in their learning and actively seeking opportunities?

ii. Consider providing details on the candidate’s self-motivation

d. Clinical Problem-Solving Skills

i. Pharmacy consults (e.g., vancomycin, anticoagulation, renal dosing, etc.)

ii. Clinical recommendations

iii. Drug information questions

e. Acceptance of Constructive Criticism

i. How does the candidate respond to constructive criticism?

ii. Did you notice an improvement in areas that were discussed with the candidate?

f. Independence

i. Does the candidate require more prompting in clinical activities and/or projects, or are tasks

completed relatively independently based on expectations?

ii. If you precept multiple learners, consider highlighting the candidate’s performance if they

exceed normal expectations

g. What to do if you do not know what to write for a section?

i. Ask other preceptors who have worked with the candidate directly for feedback and/or

examples

ii. Ask the candidate to self-assess and discuss examples in which they have showcased their skills

iii. Be honest and note if you are unable to assess the particular skill – though, expand upon other

skills you can speak to from your experience with the candidate

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3. COMPONENTS OF THE PhORCAS Recommendation Form

a. Evaluation of Candidate Characteristics

i. Rating options include:

1. Not observed

2. Consistently fails to meet expectations

3. Room for improvement

4. Meets expectations

5. Occasionally exceeds expectations

6. Consistently exceeds expectations

ii. Example of characteristics evaluated

iii. Candidate characteristics for evaluation include writing, oral communication,

leadership/mentoring skills, assertiveness, organization and time management, ability to

prioritize and meet deadlines, ability to work with peers, problem-solving, effective patient

interaction, dependability, independence and resourcefulness, ability to accept constructive

criticism, emotional stability and maturity, and professionalism

1. Pre-selected rating options are chosen with a scale

b. Description regarding the author’s

relationship to the candidate

i. Nature of the relationship

ii. Where your interaction with the

candidate occurred

iii. Approximate amount of time

spent with the candidate, practice

setting observed, and

circumstances

iv. How often you observed the

candidate’s clinical activities and

level of independence

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c. Additional Narrative comments

i. Additional free text boxes are provided to give the letter writer an opportunity to describe how

the candidate’s performance compares to other candidates

ii. The writer is asked to provide 2 strengths and 2 areas for improvement that may impact their

success in a pharmacy residency program

iii. These free text boxes are an opportunity to elaborate on why you selected the ratings you did

for the candidate characteristics

d. Overall recommendation (see details

below)

i. The writer is asked to select an

overall recommendation

concerning admission

e. Letter of Recommendation/Opportunity to provide additional comments

i. The writer has the option to upload a Letter of Recommendation if they would like to leave

additional comments regarding the application that may not have been covered in the form or

to explain their ratings in further detail

1. If the writer wants to add additional program-specific details for an individual program,

they can do so in their letter of recommendation

a. Examples include details about fit, a desired rotation, etc.

2. It is most helpful to programs reviewing applications if letter writers provide specific,

detailed examples

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f. Once a writer has completed one recommendation, they have the opportunity to reuse the evaluation

for that applicant, as writers tend to receive multiple requests from one applicant.

i. If the writer chooses the reuse option, no additional edits can be made to the evaluation

ii. If the writer wants to submit a letter of recommendation that is program specific, they should

choose to not reuse the evaluation

iii. Additional resources and tools for completing a recommendation can be found at

https://help.liaisonedu.com/Letters_by_Liaison_Help_Center

Images from: https://www.ashp.org/-/media/assets/professional-development/residencies/docs/1023-PhORCAS-Recommendation-Form.pdf

4. LEVEL OF RECOMMENDATION

a. Ensure the final recommendation for a candidate is supported by the written content of the letter

b. Provide your true recommendation based on your interactions with the candidate

i. Inflating a recommendation (e.g., highly recommending when you truly have reservations) can

be misleading to programs

ii. Candidates with “highly recommend” selected are not necessarily more likely to receive an

interview compared to candidates with “recommend”

1. An evaluation reported that 55.2% of candidates with a combination of “highly

recommend” and “recommend” will be considered for an interview, compared to

candidates with at least one “highly recommend” (14.1%) and all references with “highly

recommend” (9.3%) (Skrupky L, et al. J Amer Col Clin Phar 2021;4:379-389)

c. If the application does not have the option to select a specific recommendation (e.g., highly

recommend, do not recommend), ensure your level of recommendation for the candidate is clear in the

written content

5. TIPS AND TRICKS

a. Use strong and illustrative verbs (e.g., Active Verbs | Writing Recommendation Letters Online (psu.edu))

b. Be specific – it is important to demonstrate connection to the candidate to authenticate your credibility

as their letter writer

c. Be honest and genuine

d. Do not agree to write a letter for a candidate if it will not be in strong support of their endeavor

e. Have someone else read your letter to provide insight/feedback

f. Address relevant information and experiences; avoid discussing content not pertinent to the

recommendation or prospective job/residency

Additional Resources:

1. Brazeale, et al, Tips for writing a letter of recommendation as a new practitioner pharmacist,

American Journal of Health-System Pharmacy, Volume 80, Issue 5, 1 March 2023, Pages 245–

248, https://doi.org/10.1093/ajhp/zxac309

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For questions regarding this document, please contact newpractitioners@ashp.org

For similar resources, please visit the ASHP New Practitioner Resources webpage

This resource was developed by the ASHP New Practitioners Forum Clinical Practice Advisory Group, which is providing members the opportunity to share resources that might assist in

professional endeavors. The contents of the document contain general information and may not necessarily reflect current legal developments. ASHP has made reasonable efforts to ensure the

accuracy and appropriateness of the information presented in the document. However, any reader of the information contained i n the document is advised that ASHP is not responsible for the

continued currency of the information, for any errors or omissions, and/or for any consequences arising from the use of the information in the document. Any reader of the document is

cautioned that ASHP makes no representation, guarantee, or warranty, express or implied, as to the accuracy and appropriateness of the information contained therein and ASHP expressly