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Letters of Recommendation

Discussion in 'Pre-Medical - MD' started by mimelim, Feb 19, 2013.

  1. mimelim

    mimelim Vascular Surgery
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    I am on Trauma call every night this week. Going to try to put together some thoughts that I've had for a while and just haven't had time to write out. Also nearing the 1000th post barrier, so might as well try to put some good stuff together to justify the time on here ;)

    Preface: This is a philosophical treatise of the entity letters of recommendation (LOR) in medical school applications, it is not the end all, be all. It is a compilation of my observations and opinions on LOR after 12 medical school interviews and 80+ residency interviews. I have close association with faculty adcoms based on family, family friends and having worked on/with medical school adcoms developing their selection criteria for schools. It certainly does not represent every adcom's opinion and I would not presume to speak for most or even many of them.

    Letters of Recommendation
    The greatest letter of recommendation of all time: "This man is a genius." - R.J. Duffin, professor of Mathematics at Carnegie Tech for future Nobel winner John Nash. I hope to illustrate why this was the epitome of a strong letter and demonstrate what relavence it has to pre-med LOR.

    Why are they important?
    LOR are subjective. This fundamental characteristic is what makes them dispensible for some and vital for others. LOR can be grouped with one's ECs and PS to make up the non-hard, non-objective portion of one's application. Unlikely your ECs and PS however, LOR are an opportunity for someone else to vouch for you or more often than not a part of you. This is important because you are as a pre-med a non-known entity. Your evaluation of your contributions, skills and abilities is without benchmark. Your professors, PIs etc. are established in their fields and do not suffer from these two inadequacies. They carry a reputation as well as an implied access pool of other students to compare you to. No other part of your application replicates the information that is contained in a LOR. Thus, it becomes an important component.

    What makes up a strong letter? Not a good letter, but a STRONG letter.
    There are three components to every letter. #1 Who is writing the letter. #2 What the letter writer's relationship is to you. #3 What the letter writer can vouch for. A strong letter maximizes all three of those categories.

    Who the writer is.
    Who recommends your skills and abilities is important. Fundamentally, their credentials answer the question, "Why should I listen to what you have to say about this applicant?" A graduate student has 4 years of undergraduate experience and a couple of years TAing and living in a lab. A post doc has completed their graduate work and a couple more years of TAing. A first year assistant professor has experience in a classroom plus the afformentioned experience. The chair of a department has likely all of the above, plus years of teaching, plus
    years of dealing with department/university politics. When a post doc says that you are the best student they have seen, even if true, it leaves the posibility that you are simply better than the few students that the post doc can compare you to. On the other hand, when a tenured professor says the same things about you with a couple of decades worth of students to compare to, it is assumed that it is a little harder to impress them and thus their opinions carry more weight.

    What is your relationship with the writer?
    You can't write about what you don't know. Nobody can. Even the smartest people in the world can't write about topics that they know nothing about. You are the topic of a LOR and are no exception. It is easy to tell reading a letter whether the writer actually knows who the student is. Word choice, example choice and of course content all give away the nature of one's relationship with the writer. A relationship is NOT about brown-nosing or shmoozing. This is not about being introverted or extroverted. This is about the quality and quantity of time that the writer has had to observe and evaluate you.

    It should be self evident, but the better a letter writer knows you, the more weight a letter will carry. It adds to the validity of what a writer can say about you. Some writers will flat out state the nature of their relationship with a student, others leave how they write their letters to exemplify it. The best way to improve this quality of letter is to simply be productive in the realm of the letter writer. This is NOT about academic prowess, I can NOT state that enough. Your grade in a given class and your GPA overall will atest to your classroom ability. A writer who has witnessed first hand your abilities can relay to an admission's comittee the intangibles that make you a good future physician.

    What can the writer vouch for?
    This is by far the most important aspect of a letter of recommendation. I once wrote an essay entitled, "100 Adjectives that Should Describe My Doctor" This is an expansion on that concept. What are the qualities, skills and abilities that make you desirable for medical schools. Medical schools like diversity. This isn't just gender, race and ethnicity diversity, this is diversity of personality, character and skill sets as well. They are also looking for productive individuals. Yes, they want to train people to ultimately be good doctors, but that is THEIR job and the job of the student's future residency. Their other goal is to find people that are going to make their school proud and transcend from good to great. Certainly not every medical student will do this and this is not the expectation, but schools are always looking for that potential mixed in with the makings of a good physician.

    The bigger the skill set that someone can vouch for, the more desirable you are. People that produce in high school go on to produce in college, medical school and beyond. That isn't to say the person that did nothing in high school won't be very productive in college and beyond, but our pasts are the best predictor of our futures. One of my favorite interview questions is, "What is your greatest accomplishment?" or "What are you most proud of?" It is a hard question, it asks people to be immodest, something we are normally raised to avoid. At the same time, it affords the opportunity for you to showcase exactly why a medical school should offer you a spot in their class. The only difference between answer that question and a LOR is that someone gets to be immodest for you, which is far less awkward, IF they have something to talk about.

    There is nothing worse than a letter coming from someone that knows a student well, but really can not attest to anything. As one Wash U faculty adcom put it, "Being called nice is a kiss of death." As he further explained, if someone doesn't have something more important to say in the limited space of a LOR than that you are a nice person, then they don't have much to say. Many people when they say they are getting a "good" recommendation fall into this trap. They assume that since the person knows them well and will say nice things about them that it will be a strong letter. What people don't realize is that nobody writes bad things in a letter of recommendation. Being a nice, hard working, good student is the baseline, not the pinnacle. If you can't be bragged about, it isn't a strong letter.

    So at the end of the day, what makes a weak letter?
    Letters written by people you shadow. Letters written by professors you took a class with and got an A with. Letters written by someone you worked for, but didn't get to know. Any letter that has only one or none of the three qualities I talked about is simply not worth getting. One major problem area that I have seen in the past is in research labs where someone will work primarily with grad students or post docs. It is perfectly fine for a post doc/graduate student to draft a LOR for a student for a PI or professor to edit and sign. There are risks and benefits of doing this, first the letter will be stronger because it will be more personable and will be able to go into more detail because of the nature of your relationship with the writer. At the same time, it will be limited because no post doc/grad student will speak for a professor/PI when it comes to over the top adulation. It is difficult to go nuts over a student when representing someone else.

    So at the end of the day, how do I get the best letters that I can?
    #1 Start planning early. Take multiple classes with the same professor. Get involved with projects early. Get involved with volunteering or teaching early. Plant a lot of seeds early in your undergrad and see which ones blossom as your career progresses. Identify who would be strong letter writers in your area. If it is someone that is too busy to write you a strong letter themselves, plan out who in a particular lab or wherever can write one on your behalf.

    #2 Be direct and up front. My first lab that I worked in, I got an appointment with the PI and told him that I had a track record for getting jobs done and being productive, regardless of what the problem was. That was the image that I wanted. After that experience, I never applied for or looked for another lab or job. That PI simply mentioned that he had someone that had the skillset that I claimed to have and got things done and I had offers coming in left and right of people that needed or wanted help. If you don't have confidence in your abilities, how can you expect others to have confidence in you? At the same time, if you feel like you don't have much to offer right now, find something that you are good at and people need and work your ass off to be the best at it. The willingness and ability to learn new things to be productive is a very desirable trait in a medical student.

    Alright, so that is what my mind could put together in 15 minutes at 3:30am. Comments, criticisms, concerns, questions and snafoos welcomed.
     
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    #1 mimelim, Feb 19, 2013
    Last edited: Feb 19, 2013
  2. 911 Turbo

    911 Turbo middle schooler aspiring doctor
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    In

    first

    thx for doing this
     
  3. SOMBound13

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    Thanks
     
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  4. 487806

    487806 Life of the Party!
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    Thanks for your help! Really appreciate it.

    Also, hopefully you weren't late for the job. 3:30 is a bit early
     
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  5. OP
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    mimelim

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    Nah, I'm covering the Trauma service all night every night this week. Things tend to be quiet or completely nuts at 3:30am!
     
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  6. dextor2003

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    This is awesome. Thank you so much!
     
  7. MedPR

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    Mirin

    Sent from my SGH-T999 using SDN Mobile
     
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  8. 487806

    487806 Life of the Party!
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    Man, residency is challenging! I'm going to link your advice in my signature for future reference.
     
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  9. 487806

    487806 Life of the Party!
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    Updated. That way, if a sticky wasn't created, it would still appear in my signature whenever I post.

    Also, my hats off to you mimelim. You, TheProwler, Winged Scapula and others all take the time to contribute to the forum and aid premeds and med students in the path to medicine despite your busy time. It would seem to others that your act would be "pointless", but in reality, your selfless and dedicated act is truely inspirational, and you are clearly one of my role models. :thumbup:
     
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  10. MedPR

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  11. Shinobiz11

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    You're the man.

    Sent from my LG-MS770 using SDN Mobile
     
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  12. Mel Belle

    Mel Belle Cooler than absolute zero
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    First of all, thank you for this. I actually found this from AgentB and I really appreciate you using your precious time to write this. :)

    I assume by "a class" you mean only one class? Because the first time I read that I was like, "Wait, how would getting a As damage a LoR?" :oops:
     
  13. Mt Kilimanjaro

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    You interviewed at 80 residency programs? I must be missing something.
     
  14. Aerus

    Aerus Elemental Alchemist
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    Thank you for this! Amazing thread.
     
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  15. Mt Kilimanjaro

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    Thank you. I like your posts. You write in complete sentences and always have something useful to add.

    But I'm legitimately curious: How do you differentiate between arrogance and confidence? My reservation regarding your general approach is that not everyone has the personality or swagger to roll up to a PI (or interviewer) and say something along the lines of "I'm the most intense, efficient bad***** you have ever met." One could criticize people who lack this swag as weak or unsure of themselves, but I don't think it necessarily means that they aren't confident in their abilities -- it's a difference in style that probably has a lot to do with household socioeconomic factors and upbringing.
     
  16. qwe7791

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    Very compelling read. I have a question. What if I didn't start early? How can I remedy the situation now that I'm an upperclassmen in college?
     
  17. OP
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    mimelim

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    This is correct. I mean only one class. Certainly doing well in a class doesn't hurt you!

    18 residencies, each had 3-6 interviews per program.

    Confidence vs. over-confidence/arrogance
    You have to be able to sell yourself. You have to take pride in your acomplishments and abilities. You simply can't expect someone who has never met you before to be able to figure out how good you are without you helping. This doesn't mean you need to rub it in their face or put down others. It does mean that you need to be able to be confidently say, "Yes, I did that and I did it well." or, "Yes, if you asked me to do X, Y and Z, I would be able to do that." At the end of the day if you don't have that kind of confidence in yourself, it will be very difficult to be a good physician.

    Confidence and arrogance are differentiated by attitude. Confidence compares yourself to an internal standard or a standard metric. Arrogance stems from a comparison between yourself and others AND a component of global/misplaced feeling of superiority over others. For example, if you asked me right now to put a central line in an actively dying patient, I would not hesitate to do it and have the confidence to not defer the line to others. Arrogance would be me telling others that I am better than others at it or thinking that it matters.
     
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  18. GatsbyK

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    This is a really good post for students looking to make some LOR requests to their professors. Thanks for the great information to help others!
     
  19. qwe7791

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    I have another question regarding LOR. What if I know a professor who can write good things about me and my personality, but I know their vocabulary is very basic? Should I even ask then? I feel if they can't articulate sentences in a strong manner, my LOR will be looked down upon.
     
  20. OP
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    mimelim

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    I don't have a good answer to this. Ideally, if the writer knows they are a poor writer, you can talk to them about it and discuss your concerns and have someone (TA, grad student, yourself) help them out with the non-content part of the letter. On the other hand, if that is inappropriate to discuss, you are stuck between a rock and a hard place.
     
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  21. Mel Belle

    Mel Belle Cooler than absolute zero
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    I'm only a freshman, but some people have suggested that if I can find better colleges/universities that have research programs that would be better for me that I should transfer. Perhaps to a place like Cornell.

    But in thinking about it... How is that going to affect my LoR? Wouldn't I be in a way sabotaging myself in that sense if I transferred elsewhere for junior year? Since I would only have two years to foster the relationships necessary for stellar LoR. Because people generally apply around June of junior year, am I right?

    While I love my college and it is a respected Jesuit institution, if I can't get the right kind of research opportunities I would need for if I decide to do PhD/MD... Then wouldn't it be the wise thing to just transfer? Though another question I have following that is... Would a school like Cornell, even if it has amazing research opportunities, be a place where it's more difficult to foster relationships with professors? Just because of the nature of big schools.

    Thank you! :)
     
  22. Americano12

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    Thank you for taking the time to post this! I will be a 2nd time re-applicant this upcoming June 2013. Can letters that are written in 2012 be accepted for this upcoming 2014 cycle? I can't seem to find this information. Thank you so much!
     
  23. IslandStyle808

    IslandStyle808 Akuma residency or bust!
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    You should be able to use old letters for the majority of schools. Here is where you can start in order to find the requirements for each LOR.

    https://www.aamc.org/students/applying/amcas/faqs/63226/faq_amcasletters.html

    (Just a side note that not all the links lead to the LOR requirements; for a few of them you need search the site)
     
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  24. Americano12

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    Thanks so much for your reply :)
     
  25. 487806

    487806 Life of the Party!
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    Time to bump this thread to address the several questions in new LOR threads (and save mimelim's work ;))
     
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  26. 487806

    487806 Life of the Party!
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    Quoted. :thumbup:
     
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  27. DocGodfather

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    Wow, I just noticed this thread. I have a LOR from an EC who is going to write me a great letter. He asked me if it would be ok to attach a copy of an award certificate I received last week along with the letter? I'm not sure, as this would add another page, as well as not knowing if Interfolio would accept a copy of an award. Thanks!
     
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  28. DocGodfather

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    I just realized I didn't have my AMCAS or AACOMAS ID added to Interfolio, and already have two letters of recommendation saved in there. I know my writers had some kind of attachment they included with the letters. Am I still ok, or was I supposed to have my ID number on the attachment with the letters?
     
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  29. mmmmd

    mmmmd tasty
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    I think you're good. I'm in the same boat. Called AMCAS and they said we will be able to input those numbers during the transition from interfolio --> AMCAS.
     
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  30. golfguy510

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    Question: If I am getting a LOR from a student body president, can I say that the author is associated with a school? My initial notion is yes..
     
  31. 487806

    487806 Life of the Party!
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    Let's bump this up for the upcoming 2014/2015 cycle
     
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  32. Oh_Gee

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    could you post "100 Adjectives that Should Describe My Doctor" or PM me if you still have it and want to share. i am interested in reading it
     
  33. catchthecat

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    I would be interested in the 100 words to describe my doctor as well please. @mimelim
     
  34. ScienceBrah

    ScienceBrah insufferable know-it-all
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    So the standard protocol for LOR from my program managers at peace corps is that we write it and then they go through it and add final touches. Any advice when youre writing your own letter?
     

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