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So it's clear that research rec letters from PIs are extremely important. I am curious though what the effect of rec letters from class instructors (still required for the MD application) are on an application. As long as they're "good" (nothing too remarkable, but not necessarily weak), am I okay? My feeling is that MSTP adcoms will gravitate towards the PI-LORs and research experience/CV to determine competitiveness for the PhD, and stats+EC's+PS/commitment to medicine for the MD. Perhaps they are more useful for the Top X programs, where too many applicants excel in the aforementioned categories, and an additional parameter is needed to weigh applicants?