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From residencyandfellowship.com

Reference Letters & Letters of Recommendation

• An important part of the medical residency application process is getting strong letters of recommendation. These reference letters are the residency program director’s insight into your personality and clinical ability. Therefore, the recommendation letters should depict you as a confident, dependable and academically strong physician.

• Remind the physician writer about your background, accomplishments and medical career goals by giving him a copy of your residency CV and personal statement.

• Choosing your physician reference letter writer is a difficult task. Enlist the help of colleagues and senior residents to find the right one. An ideal physician letter writer is one who

Has expressed appreciation of your medical work 
Has a good standing in the medical academic community
Is well known to the residency or fellowship program you are applying to
Knows how to write a strong recommendation letter.
Addresses the key points that residency program directors are looking for (see below) 

• Expect Physician writers to take 4 weeks to write your recommendation letter and plan accordingly. Frequent reminders, say once a week, though not always appreciated by the Physician writers, may be necessary to get your recommendation letters out in time.

• When applying to competitive fellowships, Residents from community programs are sometimes perceived by fellowship program directors as weak candidates. You can make yourself appear as a serious candidate by requesting your Physician reference letter writers to give your recommendation letter on the official letterhead of the residency program. This ensures that your university affiliation is prominently displayed.

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• Generally, letters of recommendation do not say negative statements about you. They all say positive things. There are some key points that residency and fellowship program directors look for in a recommendation letter. These include

Communication and interpersonal skills
Positive points in medical school
Hospital work ethic
Clinical skills and performance during medical rotations
Fund of medical knowledge
Relationship with colleagues and nursing staff
How patients perceive you (like you, easily bond with you)
Medical research experience
Dependability
Level of responsibility
Efficiency and time management
Easy to work with?
Your personality