Even though it is early August, most 4th year medical students currently have their focus squarely on spring and Match Day. The day they find out if they have been accepted into their chosen specialty and where they are going for residency training. In order to get there and have a solid application packet, it is important to get great letters of recommendation.
When thinking about your letters of recommendation, you need to consider how these letters fit into your overall application. The letters help the residency program get to know a little bit more about you as a person. They help to answer the question, “What is this student going to be like as a resident?” In an ideal world, I would like to work with each and every applicant for a day, a week, a month, a shift, something in order to see how they are in a real clinical situation. Unfortunately, with so many students and so many places to apply, this is just not feasible. So, residency programs find other ways to assess what you will bring to the table as a resident including clerkship comments from your Medical Student Performance Evaluation (MSPE), your CV and letters of recommendation.
I get a number of questions from students regarding letters of recommendation. The following are the top questions and some answers to help guide you further.
Q: Whom should I have write a letter of recommendation?
A: The person you choose to write a letter of recommendation for you is important, although not necessarily for the reasons you might think. Students often times try to go for a “big name” in the field thinking that just the endorsement of that person will push their application over the top. However, if this person doesn’t know you all that well and is just going to regurgitate your CV and throw in the all too common “This student is one of the top 10% of students I have every worked with”, you may find that this letter of recommendation was not as helpful as you hope.
Q: Okay, smart guy, then what is a better choice for a letter writer?
A: Glad you asked! Pick someone that you have had a great working relationship with. Someone who has seen you in action on the wards or in the clinic doing patient care. Ideally, this is during your 4th year as you will have more independent activity and higher level clinical experience to base the letter on. Look for someone that will speak to characteristics about you that may not come across in other parts of your application, such as diligence, empathy, compassion, passion for medicine, belief in truth, justice and the American way…. If they have a specific example or encounter that illustrates this characteristic that they can discuss in the letter, even better.
Q: Should I waive my right to see my letter of recommendation?
A: On the whole, my advice is that you should waive your right. If you do not feel like the letter writer is going to be able to write you a good letter of recommendation, then I would not have them write one.
Q: How should I be prepared to make sure my letter writer writes the best letter that she can for me?
A: Not every letter writer will want a copy of your CV and personal statement, but it is not a bad thing to have on hand, just in case. Remember that the AAMC has changed the process for uploading letters, so you should also make sure that you have already added them into your ERAS application and confirmed them so that you can generate the unique code that they will need to upload your letter.
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Most importantly, you should be prepared with reasons why you want the person to write your letter of recommendation. Phrases like “Remember that patient we had together where I …” or “You really taught me a lot about [insert topic], with that patient JR last month…” can prime the letter writer to think about specific experiences she has had with you that she would then write about in the letter.
Q: Are there any unique letter of recommendation situations to consider?
A: Some specialties (OB/Gyn, Internal Medicine and some Orthopaedic Surgery programs, to name a few) really want you to have a letter of recommendation from the Chair. Typically, programs that want this will explicitly say this in on their website or in ERAS when you look them up. If a specialty or program wants this, then you better make an appointment with the Chair to get this letter if you want any shot at matching.
Additionally, Emergency Medicine and some Orthopaedic Surgery programs are going to a Standard Letter of Evaluation (SLOE). This is a standardized form that a faculty member would fill out after working with you to try and get away from the “This student is in the top 10% of students I have ever worked with…” phenomenon mentioned above. Again, if programs want these, you better get them if you want to match.
Finally, some competitive specialties (Neurosurgery, ENT and Emergency Medicine to name a few) really want you to get letters of recommendation from faculty members not at your home school. This means that when you are building your 4th year schedule you need to make sure you use VSAS to apply for away rotations and get letters of recommendation while you are there. The reasoning behind this is that faculty at other institutions have no vested interest in whether or not you match, so in theory they will be more objective.
Q: When are letters of recommendation due?
A: Technically, this varies by program. However, the earlier you can get them in, the better. Your ERAS applications can be sent starting on September 15th. The San Francisco match applications (mainly for Ophthalmology) need to be in by September 2nd. However, MSPE’s are not released until October 1st, so you have some time if all of your letters are not in place by mid-September. You should definitely still send applications on September 15th when ERAS opens, but some programs may not seriously consider your application until all of your letters are in place.
As the deadline gets closer, you should be in contact with letter writers that have not uploaded their letters yet. It is okay to gently remind them that the due date is approaching and I recommend offering if there is anything else that you can do to help, just to be extra friendly.
Good luck! If you have any other letter or recommendation related questions, feel free to email me or leave comments below!
Dr. McKenna is a graduate of IU School of Medicine, where he also completed a pediatric residency. He served as chief resident and was an Assistant Professor in the Department of Pediatrics and the Associate Program Director for the pediatric residency program until 2017, when he left IU School of Medicine for a new position. MD students at all nine campuses can access mentoring and advising support through IU School of Medicine.