Med School Done Right: The Letter of Recommendation Series – Who to Ask & How to Ask (Family Medicine)

letterBy Luke Murray

This post is part of a series called “Med School Done Right,” which will look at not just succeeding in medical school in the narrow terms of “getting good grades,” but at shaping the kind of experiences you want to have during these (usually) four very important years of your life.

I’ve already written about how I got MY letters of recommendation, so now let’s look at what I should have done according to the residency directors that read these letters and choose who gets interviewed, and ultimately, who gets in.

This post is an interview conducted with the residency director of a family medicine program. He has been in his position for six years, was on faculty for several years before then, and has even done a faculty development fellowship. He’s looked at hundreds of applications over the years, and these were his answers to what I believe are the three most important questions in the ‘letter of recommendation’ process for a residency applicant:

For students applying to your program, from whom do you prefer they get their letters?

  • Credentials in medical education matter. Other kinds do not. Letter writers don’t need to have lots of degrees, or publications, or be famous in his or her field, or even have a high clinical position, but I do want to see that the individual has a background in education. Specifically, does the individual writing the letter have experience ranking/rating medical students? Such a person is much more useful than, for example, a community doc that has one or two students come shadow him or her a year that thought the student was a real great person to be around. A good letter writer knows this and will often put it in the opening of the letter (i.e. “I’ve been working with medical students for eight years, etc”). The importance of this probably transcends specialties more than any of the other advice I’ll give.
  • The program director of the residency program at your school is THE best person, on paper. Even a ‘normal’ letter from this person can be useful because, from one residency director to another, “this applicant is fine” actually carries more weight than, again, a glowing letter from someone that’s not in the ‘rating medical students’ business.
    Department Chair is NOT necessary. If a department chair writes a ‘blah’ letter, it honestly is like a blank page in a student’s application. However, this letter is (probably) more important in more competitive specialties.
  • Someone that knows you well enough to write about what makes you unique (more on this later).
  • At LEAST three of your four letters need to be from people that can write about your abilities in a CLINICAL setting (more on this later).

When you’re reading a letter of recommendation, what are things you notice that really make a student stand out?

  • A letter should highlight what makes you unique. In an entire page-long letter there might be only one or two things that stand out, but that’s all there needs to be. I look to see if those qualities are reflected in the rest of your application and then evident when you come to visit. I call this “internal consistency.” So make sure that not only does the letter writer know you professionally, but that on a personal level she can add some dimension and depth with her perspective of ‘your thing.’
  • A letter should highlight you in a clinical setting. Think about the job you’re applying for. You’re not getting paid to study, or take tests, or be funny. You’re getting paid to work well on a team, work hard, make the correct decisions, be teachable when you make incorrect decisions, etc. So, while it’s great that first-year teacher thought you were the smartest anatomy student alive, nobody that’s hiring you is looking for you to name body parts all day. Also, the letter writer will often disclose the extent to which he has worked with you in a clinical setting, so if he didn’t work with you that much, don’t expect him to say that they did, or to leave out the topic entirely.

When someone asks you to write them a letter, how do you prefer to be asked, and how could a student get an idea whether the letter you’d write for them would be strong or not?

  • Sit down with each and every potential letter writer and ask very directly, “Do you feel comfortable writing me a good letter?” If you don’t feel like you can even ask this question, then you are probably not asking the right person to write you a letter. Also, if she says ‘no,’ don’t take this as a rejection of you as a human, and certainly don’t let it keep you from continuing to be just as direct with the next person, because a bad letter or even ‘blah’ letter is, again, like a blank page on your application.
  • Offer to send the letter writer a packet of your information. Even if he or she does not ask for it, follow up the conversation with a ‘thank you for being willing to write my letter’ email in addition to basically all the documents from your AMCAS application (CV, personal statement, etc.)
  • It’s okay to get a letter in your third year. It’s not important that the letter writer saw you in your fourth year. It is just important that he worked with you in a clinical setting and that he knows how to judge you compared to your peers. I’ve never heard a medical student regret getting a letter too early.
  • Never ask to see the letter. That’s a huge red flag.

Do you have any advice on how to get great letters of recommendation? Post your thoughts below.


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