Sample letter of intent medical residency: Insider Tips for Standout Apps

A residency letter of intent is your final, powerful pitch to the single program you want above all others. You send it after your interview, and its purpose is simple but critical: to explicitly state your commitment to ranking that program #1. Think of it as the move that can separate you from the pack in the final moments before the Match.

Why Your Residency Letter of Intent Matters

In the hyper-competitive scramble for residency spots, every little edge counts. After a while, thousands of highly qualified candidates start to look the same on paper—great scores, solid grades, well-written personal statements. It all blends together.

This is where a sharp, sincere Letter of Intent (LOI) stops being just another piece of paper and becomes your personal closing argument.

Program directors aren't just filling slots; they're building a team. They need to create a rank order list that brings in residents who will not only succeed but also genuinely thrive in their program's culture. They want to rank applicants who really want to be there. An LOI speaks directly to that need.

Standing Out in a Crowded Field

The sheer number of applications is mind-boggling. The 2025 ERAS cycle saw a record 49,048 applicants fighting for spots, a significant jump from the year before. For International Medical Graduates (IMGs), the competition was especially fierce, with applications soaring to 18,500. The applicant pool is deeper than ever.

A personalized LOI cuts through all that noise. It reinforces the personal connection you hopefully made during your interview and gives you one last chance to remind the program director of your unique strengths and genuine excitement for their program specifically.

Intent vs. Interest: Know the Difference

It's crucial to understand that not all post-interview communication is created equal. The distinction between a Letter of Intent and a letter of interest is huge.

• A Letter of Intent (LOI) is a binding promise. You only send one. It goes to the single program you will rank as your #1 choice, no exceptions. Its power comes from its exclusivity.
• A Letter of Interest is a more casual note expressing strong enthusiasm. You can send these to a few programs you really liked, but they don't carry the same weight as a true LOI because there's no promise attached.

Sending an LOI signals that you've done your homework, completed your interviews, weighed all your options, and made a final decision. Program directors value that clarity immensely as they try to predict how their own rank list will shake out. This fits right into the bigger picture of what residency programs look for in a candidate.

To make this distinction crystal clear, here’s a quick breakdown.

LOI vs Letter of Interest Key Differences

Understand when to use each letter with this clear breakdown of their purpose, timing, and strategic impact on your residency application.

Knowing when and how to use each of these letters is a key part of your Match strategy. One is a polite nod of appreciation; the other is a powerful statement of commitment.

Key Takeaway: An LOI is not just a glorified thank-you note. It’s a strategic statement designed to influence a program's final ranking decisions by showing them your unwavering commitment and proving you're the perfect fit.

Crafting a Compelling Residency LOI

Think of your residency letter of intent as your closing argument. Every single sentence has to count. Your mission is to go way beyond generic praise and build a case for yourself that is personal, specific, and impossible for a program director to ignore. This isn't the time for broad strokes; it's about the fine details that prove you've done your homework.

Let's walk through how to build each piece of your letter to make the strongest possible argument for your candidacy.

Nailing the Opening Statement

Your first paragraph has one job: state your intention clearly and with confidence. Leave no room for ambiguity. Get straight to the point in a way that is professional but incredibly direct.

This is your one written shot at a first impression post-interview. Address the program director by name and state your purpose right away.

Example Opening:

"Dear Dr. [Program Director's Last Name],

I am writing to express my sincere enthusiasm for the Internal Medicine residency program at [Institution Name]. Following my interview on [Date], I am more confident than ever that your program is the ideal environment for my training, and I am excited to inform you that I will be ranking your program as my #1 choice in the upcoming Match."

This opening works because it's direct, names the program, references the interview, and makes the #1 ranking commitment absolutely clear. No guessing required.

Building a Powerful and Personalized Body

This is where you connect the dots for the program director. The body of your letter is your chance to show them why you're a perfect fit, using specific evidence from your interview experience and personal background. It’s your opportunity to build a narrative that goes beyond the data points in your ERAS application.

Think back to your interview day. What really stood out?

• A Memorable Conversation: Did you have a great discussion with a faculty member about their research in diabetic nephropathy? Name them and mention it.
• A Unique Program Feature: Did the resident-led global health track resonate with your volunteer experience in rural clinics? Explain that specific connection.
• The Program's Culture: Were you impressed by the easy camaraderie during morning report or the mentorship model a PGY-2 described? Share what you observed.

This level of detail shows your interest is real. It proves you were paying attention and are making an informed decision, not just blasting out a form letter. As you craft these connections, tap into the same storytelling skills you honed when you learned how to write a personal statement for residency.

Example of a Specific Connection:

"My conversation with Dr. Evans about the program's dedicated ultrasound curriculum particularly resonated with me. Her description of the hands-on POCUS workshops for interns confirmed my desire for a training environment that prioritizes procedural competence from day one. This aligns perfectly with my goal to integrate diagnostic ultrasound into my future practice as a hospitalist."

See how that works? It names a person, mentions a specific curriculum feature (POCUS), and ties it directly to the applicant's own career goals. That's the stuff that sticks.

Concluding with Professionalism and Commitment

Keep your conclusion short, sweet, and professional. The goal here is to wrap things up politely while leaving one last positive impression. You don’t need to introduce any new information.

Just reiterate two key things:

1. Your absolute commitment to their program.
2. Your gratitude for their time and consideration.

This reinforces your main point and ends the letter on a respectful note. A strong, clean closing professionally seals your argument and shows your maturity.

Example Closing:

"Thank you once again for the opportunity to interview and for your thoughtful consideration of my application. I am truly excited by the prospect of joining the [Institution Name] community and am confident that I would be a dedicated and enthusiastic member of your residency team.

Sincerely,
[Your Name]
[AAMC ID Number]"

This conclusion is polite, reinforces your excitement, and includes your AAMC ID for easy lookup. It's a clean, professional finish.

Sending Your LOI for Maximum Impact

A killer letter of intent can fall flat if it lands in an inbox at the wrong time or gets lost in the shuffle. How and when you send your LOI is just as strategic as what you write inside it. The timing, the subject line, and even the delivery method all play a part in making sure your message actually gets seen when it counts.

Think about it: send your LOI too early in January, and it could be old news by the time program directors are finalizing their rank lists. Send it too late in February, and you’ve missed your shot because many programs have already locked their lists in. There's a definite sweet spot where your letter can make the biggest difference.

Pinpointing the Perfect Timing

The ideal window to send your letter of intent is between late January and early February. Hitting this target is a strategic move for a few key reasons:

• You've Finished Your Interviews: By now, you've likely completed your interview circuit. This gives you the clarity you need to genuinely identify your #1 program without any guesswork.
• It's Rank List Season: This is precisely when program directors and faculty are meeting, debating candidates, and actively building their rank order lists.
• You'll Be Top of Mind: A well-timed email shows up as a fresh, relevant piece of information right as those critical decisions are being hammered out.

This timing is a key piece of the puzzle. To see how this fits into the bigger picture of your application journey, take a look at our complete ERAS application timeline.

Choosing Your Delivery Method and Subject Line

Let’s be clear: email is the only way to send your LOI. It’s professional, immediate, and leaves a digital trail. Snail mail is far too slow and can easily get misplaced in a hectic administrative office.

But just sending an email isn’t enough—it has to survive the deluge. Program directors are absolutely swamped. A decent-sized Internal Medicine program might get 3,000-4,000 applications, and they still receive dozens of LOIs from applicants vying for the top spots. Your subject line is your first—and maybe only—chance to get noticed.

It needs to be direct, professional, and impossible to misinterpret.

Pro Tip: Your subject line's main job is to make it easy for the program coordinator to immediately identify and file your email. Clarity always wins over creativity here. Make sure to include your name, AAMC ID, and the purpose of the email.

Here are a few subject lines that work well:

• Letter of Intent – [Your Name], [AAMC ID]
• Your #1 Ranked Applicant – [Your Name]
• Post-Interview Correspondence: [Your Name] – [AAMC ID]

This flow chart gives you a bird's-eye view of how to structure your letter, from the opening handshake to the final commitment.

As the visual guide shows, every part of the letter has a job to do. You start with a professional intro, move into a specific and heartfelt body, and end with a decisive closing. Sticking to this structure makes your message powerful and, just as importantly, easy for a busy program director to quickly understand.

Annotated Sample Letters for Different Applicants

Theory and structure are great, but seeing a sample letter of intent for medical residency in action is where the lightbulb really goes on. Every applicant's story is different, so a cookie-cutter template is never going to cut it. The real skill is adapting the core principles to your specific situation.

Below are three distinct, fully annotated sample letters. Each one is built for a common applicant scenario, showing how to play up certain strengths and handle potential weaknesses. Don't just copy them—use them as a framework to build your own powerful, personalized letter.

Sample 1: The Top-Choice U.S. Medical Student

This is the classic scenario: a U.S. senior med student writing to their clear number-one program after an amazing interview. The goal here is to balance professionalism with genuine, specific excitement.

Subject: Letter of Intent – Jane Doe, AAMC ID 12345678

Dear Dr. Reynolds,

I am writing to express my profound enthusiasm for the Pediatrics Residency Program at University Hospital. Following my interview on January 15th, I can say with complete certainty that your program is the perfect fit for my educational and career aspirations. I am thrilled to inform you that I will be ranking University Hospital as my #1 choice in the upcoming NRMP Match.

[Annotation]: This opening gets straight to the point. It states the letter's purpose and drops the #1 rank commitment right in the first paragraph. No ambiguity, no fluff.

The passion for community-centered care was evident in every conversation I had, especially with Dr. Chen during our discussion about the mobile health clinic initiative. Her insights into serving the city's underserved pediatric populations resonated deeply with my own volunteer work at the free clinic during medical school. I was also incredibly impressed by the resident-led advocacy curriculum, which aligns perfectly with my goal of becoming a pediatrician who actively addresses social determinants of health.

[Annotation]: This paragraph is where the magic happens. It names a specific faculty member (Dr. Chen), brings up a unique program detail (the mobile clinic), and connects it all back to the applicant's own experiences and future goals. This is proof of genuine interest, not just flattery.

I am confident that the rigorous clinical training, combined with the supportive and collaborative environment I witnessed among the residents, would provide me with the ideal foundation to become a compassionate and competent pediatrician.

Thank you again for the opportunity to interview. I am incredibly excited about the possibility of joining your team this July.

Sincerely,
Jane Doe
AAMC ID: 12345678

Sample 2: The International Medical Graduate (IMG)

For an IMG, the LOI is a golden opportunity to showcase a unique clinical background and prove a powerful commitment to that specific program and location. The letter needs to scream, "I don't just want any spot, I want this spot."

Subject: Your #1 Ranked Applicant – Raj Patel, ECFMG/AAMC ID 87654321

Dear Dr. Armstrong,

I am writing to convey my sincerest appreciation for the opportunity to interview for the Internal Medicine residency at Metropolitan General Hospital on January 22nd. The experience solidified my decision, and I am writing to inform you that I will be ranking your program as my number one choice for the Match.

[Annotation]: Once again, a clear and direct opening. A bold subject line like "Your #1 Ranked Applicant" is a confident move that can really make your email stand out in a crowded inbox.

My clinical training in Mumbai provided me with extensive hands-on experience in managing complex pathologies with limited resources, an experience I believe would be a great asset to the diverse patient population at Metropolitan General. During my interview, Dr. Ramirez mentioned the program’s focus on high-value care, a principle that has been central to my training. I am eager to contribute my perspective while learning from your faculty's systematic approach.

[Annotation]: Here, the applicant expertly frames their international training as a unique strength. By connecting their background to a specific value mentioned in the interview (high-value care), they show they were paying close attention.

Furthermore, my family in the adjacent suburb of Oakwood would provide a strong personal support system, allowing me to fully dedicate myself to the rigors of residency. I am committed to putting down roots in this community and envision a long-term career in the area.

[Annotation]: This is a critical paragraph for an IMG. Mentioning local ties directly tackles a program's potential concern about retention. It signals stability and a real desire to be in that specific geographic area. Looking through a complete sample ERAS application can give you more ideas on how to weave your story together.

Thank you for your time and consideration. I am truly hopeful for the opportunity to train at Metropolitan General.

Best regards,
Raj Patel
ECFMG/AAMC ID: 87654321

Sample 3: The Re-Applicant

For a re-applicant, the LOI has to demonstrate growth, persistence, and a renewed, more focused dedication. It isn't about dwelling on the past; it's about showing why you're a stronger candidate this year.

Subject: Letter of Intent: Re-Applicant – Michael Chen, AAMC ID 11223344

Dear Dr. Wallace,

It was a privilege to interview with you again for the Family Medicine residency at Community Medical Center on January 18th. I am writing to reaffirm my strong commitment to your program and to inform you that I am, once again, ranking Community Medical Center as my #1 choice.

[Annotation]: The applicant addresses their re-applicant status head-on but frames it positively by "reaffirming" their long-standing commitment. It shows resilience, not desperation.

Since last year's Match, I have focused on strengthening my clinical skills and deepening my commitment to primary care. I completed a six-month position as a clinical research coordinator for a diabetes study, which resulted in a co-authored publication in the Journal of Community Health. This experience not only enhanced my understanding of chronic disease management but also confirmed that my passion lies in building long-term patient relationships, a value that is at the core of your program’s mission.

[Annotation]: This is the heart of the letter. The applicant clearly spells out what they've done to improve their application. They don't just say they "worked"—they give specifics: the role, the tangible outcome (a publication), and what they learned from it.

My second interview experience further solidified my belief that your program’s emphasis on behavioral health integration and resident wellness is unparalleled. I am more prepared and more certain than ever that I would thrive as a resident at your institution.

Thank you for considering my application once more. I am hopeful for the chance to contribute to the Community Medical Center team.

Sincerely,
Michael Chen
AAMC ID: 11223344

Each applicant has a unique angle. The key is to identify your specific scenario and lean into a strategy that highlights your strengths while directly or indirectly addressing any potential concerns a program director might have.

Key LOI Customization Points by Applicant Type

Ultimately, these examples show that the most effective letter of intent moves beyond a simple statement of interest. It tells a compelling story about why you and that specific program are the perfect match.

Common LOI Mistakes You Must Avoid

A fantastic letter of intent can be the final nudge that bumps you up a program's rank list. On the flip side, a sloppy one can do real damage, undoing all the hard work you’ve put into your application and interviews.

Certain mistakes scream a lack of professionalism or genuine interest, and that's the last impression you want to leave with a program director. Let's walk through the most common pitfalls I see applicants fall into every year so you can sidestep them entirely.

The Generic Copy-Paste Letter

This is, without a doubt, the most common and damaging mistake. Program directors are experts at spotting a generic, impersonal letter from a mile away. It's the one that vaguely praises the program’s “excellent faculty” and “diverse clinical opportunities” without offering a single specific example.

When you send a letter that could be addressed to any program in the country, it tells the director one thing: you're just not that into their program. It’s a massive missed opportunity to build on the connection you hopefully made during your interview.

Key Takeaway: Your LOI has to be hyper-specific. Mention a unique curriculum element you discussed, a memorable conversation with a resident, or a faculty member whose research genuinely aligns with your career goals. Prove you’ve done your homework.

The Cardinal Sin: Telling Multiple Programs They're Number One

The entire power of a Letter of Intent comes from its sincerity and exclusivity. It’s supposed to be a heartfelt promise to one single program. Telling more than one program they are your "#1 choice" isn't just unethical—it's a dangerous gamble.

The medical community is surprisingly small, and word gets around. Program directors talk to each other, and if you get caught making false promises, it can tarnish your professional reputation before your career even starts. Commit to one program, and one only, for your LOI.

Overlooking Typos and Grammatical Errors

You’re applying for a job that demands meticulous attention to detail. Sending a letter riddled with typos or grammatical errors suggests you’re either careless or rushed. Neither of those is a quality anyone wants in a resident physician.

Professionalism matters immensely. While it might seem like research is king, other factors can make a huge difference. For example, in competitive fields like orthopedic surgery, up to 47% of matched U.S. applicants had zero publications when they applied. This shows that a polished, professional presentation—like a flawless LOI—can absolutely swing things in your favor. You can learn more about how non-research factors impact matching.

Proofread your letter multiple times. Then, step away, come back, and proofread it again. After that, have a trusted mentor or advisor give it a final look.

Other Common Pitfalls to Sidestep

To make sure your letter only strengthens your application, be sure to steer clear of these missteps:

• Being Overly Emotional or Casual: Maintain a professional, respectful tone. Genuine enthusiasm is great, but avoid overly casual slang or dramatic, emotional appeals.
• Making It Too Long: Keep it concise and to the point. Program directors are incredibly busy people. A rambling, multi-page letter is far more likely to get skimmed than read. Aim for under one page.
• Simply Restating Your CV: This isn't the place to re-list your accomplishments. The LOI's job is to connect the dots between your experiences and the program's specific culture and opportunities.
• Sending It Too Early or Too Late: As we've covered, timing is everything. Sending your letter outside that sweet spot of late January to early February will seriously dilute its impact.

By avoiding these common mistakes, your letter of intent will do exactly what it's supposed to: serve as a powerful final testament to your commitment and make a compelling case for why you belong at your top-choice program.

Common Questions About Residency Letters of Intent

Sending off your letter of intent can feel like the final, nerve-wracking play in a long game. Even after you hit "send," a dozen "what-if" questions can start swirling. Let's walk through some of the most common ones I hear from applicants every year.

Should I Put My USMLE Scores in the Letter?

My advice? Don't. Your letter of intent has a very specific and personal job to do, and it’s not to rehash your ERAS application. The program directors already have all your stats, scores, and grades right in front of them.

This letter is your chance to build on the personal connection you made during your interview. Focus on the things your application can't say—your genuine excitement for their program, specific reasons you know you'd thrive there, and your unequivocal commitment to ranking them #1. The only time you might even hint at a score is if it came up in a specific, memorable conversation during your interview, and even then, keep it brief and contextual.

What if I Send My Letter and Never Hear Back?

First, take a deep breath. This is completely normal and, in most cases, means nothing at all. Program directors are juggling an incredible amount, especially as rank list deadlines approach.

On top of that, many institutions have strict policies that prevent them from replying. They do this to avoid giving any applicant a perceived advantage or making a statement that could be misinterpreted as a promise.

A lack of response is not a negative sign. Your letter has successfully served its purpose by clearly communicating your intentions. Resist the powerful urge to send a follow-up email. Trust that your message was received and focus on finalizing your own rank list.

Sending another email won't help; it can actually come across as needy or bothersome. Have confidence in the letter you sent and let it speak for itself.

Is It a Good Idea to Mention My Personal Ties to the Area?

Yes, absolutely! This can be an incredibly powerful part of your letter. Residency programs aren't just looking for good applicants; they're looking for future residents who will be happy, well-supported, and likely to stick around. Highlighting a genuine connection to the location is a great way to show that.

Mentioning these kinds of details adds a compelling layer of commitment:

• Family in the Area: Having parents, siblings, or other family nearby shows you have a built-in support system.
• A Partner's Commitments: If your spouse or partner has a job or is in school in the city, it demonstrates a serious, shared investment in the location.
• Previous Connections: Maybe you grew up nearby, went to college in the state, and are genuinely excited about the chance to come back.

These personal details help paint a picture of a stable, grounded applicant who is thinking about their life both inside and outside the hospital. It tells the program you’re serious about putting down roots. For a broader look at the entire application journey, take a look at our complete guide to the residency match.

Can I Send a Letter if I Was Waitlisted for an Interview?

This is a tricky situation where the type of letter you send is critical. In this case, you should send a Letter of Interest, not a Letter of Intent. The difference is huge.

A Letter of Intent is reserved exclusively for the program you've interviewed with and decided to rank as your number one choice. Sending one without an interview is jumping the gun and comes off as inappropriate.

A Letter of Interest, however, is the perfect tool for this scenario. Use it to:

1. Reaffirm your strong interest in their specific program.
2. Briefly highlight any significant updates since you applied (e.g., a new publication, a meaningful award, or a relevant clinical experience).
3. Politely explain why you remain convinced the program is an ideal match for your career goals.

Taking this step shows your continued dedication and professionalism. Sometimes, it's the exact nudge a program needs to look at your file again and offer you one of the last remaining interview spots.

Navigating the complexities of residency applications and exams can be challenging, but you don't have to do it alone. At Ace Med Boards, we provide expert one-on-one tutoring for USMLE, COMLEX, and Shelf exams to help you achieve your goals. Learn more at https://acemedboards.com.