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.