Spring 2021 update: As I was preparing to apply to residency, toward the end of my family medicine acting internship, I emailed my clerkship director requesting a letter of recommendation for my ERAS application. She surprised me with this brief reply: “I am happy to provide the letter. If you can draft it, I am happy to edit. The feedback has been positive thus far.” Disclaimer: I did not send the first draft to my director because I started that acting internship, my third, with about a week before the ERAS application deadline, and residency directors at my top programs told me that an additional letter would not make a difference by that point. However, as I wrote the first draft, I considered the ease that I felt relative to the likely struggle a clerkship or elective director might have, pulling from short conversations and potentially nonspecific feedback from other evaluators. I found Christina Berchini’s Huffington Post article on the matter helpful and would recommend that all applicants at least offer to draft their own letters when reaching out to potential letter-writers.
Back to the original post:
Recently a friend asked for my input on requesting letters of evaluation (LOE) as part of his medical school application. Here are three things I learned from my own experiences:
1. Request letters from people who can write you strong and personal recommendations.
When I was a student, one of my professors gave me a piece of advice that has stuck with me. She told me that the best way to request a letter of evaluation is to ask your potential writer whether he or she knows you well enough to write you a strong recommendation. The reasoning is that anything less than a strong, personal recommendation is almost never worth the effort, and this particular question gives your potential writer an easy way out, saving face and time for both of you.
Let’s be clear. The medical school admissions process is competitive. Every year, admissions committees read many letters submitted for many accomplished applicants. The letters that stand out to committee members are likely those that make a movie or book stand out—those that tell an engaging, compelling story. The better your writer knows you, the more easily he or she will be able to pull from their experiences of you to tell that story—one that includes specific, concrete details about how qualified you are.
If that’s not motivation enough, Dr. Joshua Klein at U.S. News cites a 2007 survey of internal medicine clerkship directors involved with medical admissions. This survey found that, when rating LOEs, the most important factor was depth of understanding of the trainee. (Ninety-eight percent of respondents rated this factor as essential or important.)
Because people who know you well will write the best LOEs, it is important to build relationships with your potential letter-writers. Consider taking relevant courses with small class sizes or multiple courses with the same professor. Take advantage of other opportunities to connect with potential writers, such as attending office hours.
Once you feel like you have built a relationship with a letter-writer, make sure to request your LOE while you are still fresh in his mind. If you are think that your freshman biology professor will write you a great letter, ask at the end of your freshman year. Do not wait until you are applying to schools. Ask early and ask often—you can always request that your freshman professor update her letter your senior year after you take genetics with her.
2. Request letters from people who meet your medical schools’ requirements.
Each medical school has its own requirements for LOE, which apply to the minimum and (sometimes) maximum number of letters, and/or the type of letters, the school wants to see. Per the AAMC’s website, AMCAS accepts three different types of letters, and each letter type is equivalent to one letter entry. In a nutshell:
Committee Letter: A letter authored by a pre-health committee or pre-health advisor and intended to represent your institution’s evaluation of you.
Letter Packet: A packet or set of letters assembled and distributed by your institution, often by the institution’s career center.
Individual Letter: A traditional letter written by, and representing, a single letter author.
I recommend participating in the process to obtain a letter from your pre-med or pre-health committee, if your school has one. Dr. Carleen Eaton at Dummies.com writes, “If your school provides a committee letter, you should take that option; medical schools prefer, and sometimes even require, that you use a committee letter when it’s available.” However, if your school does not have a pre-health committee, you are not at a disadvantage because using the other letter types does not reflect poorly on your application.
If you plan to apply to certain schools, be proactive and check out what their LOE requirements are. I waited until the end of the application to research schools (not something I recommend to most people), which led me to ask for one additional letter late in the process, since I did not have all of the letters that my goal schools required.
Based on that experience, I recommend that applicants request two letters from natural science professors (biology, chemistry, etc.), one from a non-natural science professor (humanities, social sciences, etc.), and one from a person who has supervised you through an extracurricular activity (work, volunteering, sports, etc.). Request letters from professors rather than graduate students or teaching assistants. And if you have done any serious research or shadowing, I’d also recommend asking your principal investigator or the physician you shadowed. You may not use all of these letters for all schools, but at least you will cover your bases.
For non-traditional applicants who have been away from school for a while (each school has its own definition of “non-traditional applicant”), make sure to get an LOE from a supervisor who has worked with you since you graduated. Again, refer to the medical school’s specific requirements whenever possible.
3. Make things as easy as possible for your letter-writers.
You may not be writing the LOE, but there is a lot that you can do to make the process go smoothly for both your letter-writer and yourself. Remember that your writer does not owe you a letter, and that this person is doing you a big favor. Do NOT wait until the last minute to make the ask. Because these letters are so important, and because there are probably many other students asking for letters at the same time, I recommend giving each writer three weeks to complete his or her LOE, and touching base at the two-week mark.
One strategy for your letter-requesting timeline: work backwards from June 1, the approximate date that the application opens. Because medical schools have rolling admissions, it’s best to apply as early as possible. (As of 2017, you may submit your application prior to submission of your letters.)
Another way to make things easy for your writers is to give them all the resources they will need to write a great LOE. Send an email with a copy of your curriculum vitae (CV), the latest draft of your personal statement, and any of your grades, coursework, and/or accomplishments relevant to the writer. I also recommend including the AAMC’s LOE guidelines and brief instructions for submitting letters to AMCAS.
Finally, make sure to send a handwritten note thanking each of your writers. Small tokens of appreciation like that can go a long way. Remember that you are in control of how this process plays out, from start to finish.
Kevin T Beel 