There are five disciplines in the 2026 R-1 match that require applicants to submit a structured reference letter. These five disciplines do not accept traditional letters of reference. The disciplines are:
- Family medicine
- Emergency medicine
- Orthopedic surgery
- Physical Medicine and Rehabilitation
- Psychiatry
The below chart sets out if previous reference documents will be accepted in the 2026 R-1 match for these disciplines.
| Reference Document Type | Status |
| Family Medicine Structured Reference Letter | Previous Family Medicine Structured Reference Letters will be accepted by programs in 2026 R-1. |
| Emergency Medicine Structured Reference Letter | Previous Emergency Medicine Structured Reference Letters will be accepted by programs in 2026 R-1. |
| Orthopedic Surgery Structured Reference Letter | Previous Orthopedic Surgery Structured Reference Letters will be accepted by programs in 2026 R-1. |
| Physical Medicine and Rehabilitation Structured Reference Letter |
Previous Physical Medicine and Rehabilitation Structured Reference Letters will not be accepted by programs in 2026 R-1. Starting in 2026 R-1 this reference will be an online form that can only be completed in CaRMS Online by your referee. If you are a returning applicant who is applying to Physical Medicine and Rehabilitation programs you will need to complete a new reference request in CaRMS Online when the R-1 match opens. |
| Psychiatry Structured Reference Letter |
Previous Psychiatry Structured Reference Letters will not be accepted by programs in 2026 R-1. Starting in 2026 R-1 this reference will be an online form that can only be completed in CaRMS Online by your referee. If you are a returning applicant who is applying to Psychiatry programs you will need to complete a new reference request in CaRMS Online when the R-1 match opens. |
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