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Letters of Recommendation: Lead the Witness

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When pre-meds, medical students, residents, nurses, and physician colleagues asked me to write them letters of recommendation (LORs) when I was Assistant Residency Director, the first thing I requested was that they send me background information to make my letter robust…and my job easier. Accordingly, whether you are applying to medical school, dental school, residency, or fellowship, I strongly recommend you create a “LOR packet,” which can include the following:

1. A brief, well-written cover letter defining all of your important accomplishments
2. Your curriculum vitae (CV)
3. Your personal statement in its final form and/or
4. Your transcripts.

With regard to the cover letter, keep it streamlined: Thank the writer and highlight your pre-professional achievements on one page. The point of the cover letter is to supplement a writer’s knowledge of your candidacy and offer flattering content for inclusion. A college professor may know  you made the only A in an organic chemistry class, but her LOR for medical school will be more complete, and she will demonstrate a more intimate familiarity with you if she knows enough to write that you volunteer regularly at a homeless shelter.

With regard to the CV and personal statement, these make useful supplements to the LOR packet only if they are in professional and final form. Don’t include rough drafts. Poorly organized background information leaves your writer with the impression that you are a disorganized person. Also, only include the transcript if it bolsters your candidacy, demonstrating academic achievement. Don’t shoot yourself in the foot if you have some bad grades you’d rather not showcase.

Bottom line: An applicant who offered me a list of her accomplishments in a tidy, accessible package was more likely to get a strong, comprehensive letter that was submitted promptly. She also distinguished herself from the majority of candidates who requested letters without demonstrating a comparably sophisticated understanding of the demands this process made on my time. If you can make a letter writer’s job easier, your forethought is likely to pay dividends in the letter you receive. The savvy applicant can take subtle advantage of her ability to “lead the witness.”

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Inaccuracies in Medical Student Grades Translate into a Residency Application Strategy

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Here’s an oldie-but-goodie New York Times piece by Dr. Pauline Chen on medical student grade inaccuracies. In reading the article, medical students should reflect on how important the quality and content of their letters of recommendation are for residency applications, especially in the setting of medical school grades that may be inflated or faulty. The 2020 NRMP Program Director Survey (which is the most current version) supports the importance of letters, as well, with statistics. Make sure your letters are very strong; remember that mediocre letters should not be a part of your residency package.

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An Offer you Can’t Refuse: Writing Your Own Letter of Recommendation

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In the last few weeks, several medical school applicants have contacted me saying that potential letter of recommendation writers are asking the candidates to write their own letters.

If you have this opportunity for medical school, dental school, residency, or fellowship, first, realize that it is not unethical to write your own letter if you’re asked to do so. If you’d like to explore the scruples of this issue, take a look at this New York Times Ethicist column about the topic.

The mistake I see candidates make in this situation is that applicants don’t write strong enough letters for themselves because they feel awkward about showcasing their accomplishments fully. If you have the opportunity to write your own letter, craft a glowing one. Be effusive and full-throated in your remarks about yourself! Remember that the letter-writer can choose to tone down the recommendation if s/he doesn’t agree. But if s/he does, you’ve utilized an opportunity fully and bolstered your candidacy tremendously.

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Positively Influence your Letters of Recommendation by Making the Job of Letter Writing Easy

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When pre-meds, residents, nurses, and physician colleagues asked me to write them LORs when I was Assistant Residency Director, the first thing I requested was that they send me background information to make my letter robust…and my job easier. Accordingly, whether you are applying to medical school, dental school, residency, or fellowship, I strongly recommend you create a “LOR packet,” which can include the following:

1. A brief, well-written cover letter defining all of your important accomplishments
2. Your curriculum vitae (CV)
3. Your personal statement in its final form
4. Your transcripts.

With regard to the cover letter, keep it streamlined. No one will skip the beach or her two-year-old’s birthday party to read your exhaustive biography :), so you want to thank the writer and highlight your pre-professional achievements on one page. The point of the cover letter is to supplement a writer’s knowledge of your candidacy and offer flattering content for inclusion. A college professor may know that you made the only A in an organic chemistry class, but her LOR for medical school will be more complete, and she will demonstrate a more intimate familiarity with you if she knows enough to write that you volunteer regularly at a homeless shelter.

With regard to the CV and personal statement, these make useful supplements to the LOR packet only if they are in professional and final form. Don’t include rough drafts, as poorly organized background information leaves your writer the impression that you are a disorganized person. Also, only include the transcript if it bolsters your candidacy, demonstrating academic achievement. Don’t shoot yourself in the foot if you have some bad grades you’d rather not showcase.

Bottom line: An applicant who offered me a list of her accomplishments in a tidy, accessible package was more likely to get a strong, comprehensive letter that was submitted promptly. She also distinguished herself from the majority of candidates who requested letters without demonstrating a comparably sophisticated understanding of the demands this process made on my time. If you can make a letter writer’s job easier, your forethought is likely to pay dividends in the letter you receive. The savvy applicant can take subtle advantage of her ability to “lead the witness.”

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Medical School Letters of Recommendation: Asking the right people 

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For those applying to medical school this cycle, if you haven’t already, it’s time to start asking for letters of recommendation (LOR).

Beyond simply fulfilling requirements, you want to get the strongest letters you possibly can from the most influential writers. Choosing the right individuals can be a challenge, and advisees often ask me what to look for in a letter writer. Here is my suggested wish list for potential letter-writers:

1. Explicitly state they will write you a strong LOR

2. Senior faculty

3. Weighty academic titles
4. Well known in their field
5. Spent significant time with you
6. Experienced letter-writers

Of course, all of these qualifications are not possible for all writers. But the more of these you can garner the better. 

With regard to #1, don’t be afraid to ask a potential letter-writer if she will write you “a very strong” LOR. It may seem awkward at the time you ask, but, believe me, getting a wimpy letter will be much thornier. If the faculty member says no, hesitates, or tells you in March that she has to plan her Thanksgiving get-together ;), politely thank her and move on. Although disappointing, acknowledge that she has done you a huge favor. You are far better off avoiding her letter, and you now have the advantage of substituting a stronger LOR written by someone who loves you.

With regard to #2 through 4, admissions officers are human just like the rest of us: Receiving a LOR from an accomplished, known colleague will be weighed much more heavily than one from someone deemed less successful and unfamiliar. If you are better connected to someone without a title, consider asking the professor (a more senior person who has a weightier title) if she would consider writing the LOR with significant input from your closer contact (i.e., the TA who taught your section, or the postdoctoral fellow who directly supervised your research project). That way you get a LOR that includes insight from someone who knows you, signed by a name that packs a punch.

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to
stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital.
She was appointed to the Assistant Residency Director position for the Harvard Affiliated
Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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