"Strong" LOR 's

[epsilonprodigy]

A couple of third year students have asked me about who to ask for LOR's recently. I agreed with their concern that in the more "malignant" specialties, it can be hard to figure out who your allies are (or if you have any!) I remember being a little baffled for the same reason, and thought discussing their question might be useful for current third years. So, I present this question with the full understanding that a perfect generalization can't be made: if a student uses that loaded question, "Dr. Attending, do you feel that you could write me a STRONG LOR?" How seriously should a "yes" be taken?

It seems that it would be least awkward to just say yes even if the writer was only going to write a lukewarm one, or if s/he wouldn't have great things to say if someone were to call them up and ask about the student. Then again, I'm not sure if doing these things is considered a major breach in professionalism, or if faculty really see LOR's as a serious investment of reputation capital.

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[J ROD]

I asked faculty that knew me and I felt that liked me and thought I did a good job. Obviously, when I was on my preferred specialty I tried more and was more involved so getting those LORs were no problem. And then, I tried to get a strong LOR from a general area like IM and FM. So, I added them both. Only one was from a clerkship director.

I went away from using the biggest names I could because I felt they did not know me as well. I chose to use the ones that knew me best and I felt could and would write me the best LOR.

 

[mvenus929]

One of my letters was from my sub-I. I worked with 2 attendings most of the month, and asked the younger one that I thought I clicked with pretty well for a letter. She said she would be thrilled to write me one, but that I should ask the other, older attending because he was well known in the field and his letter would have more weight. I asked him, and he very quickly said yes and wrote one of the best letters I have read (granted, I haven't read that many), and it was commented on several times on the interview trail.

Another letter came from an attending who had worked with my class since literally the first day of medical school, and also happened to be the program director of our home program. She had me come in to do an interview in which she got to know more about my non-clinical side. I thought that was a good method to feel out what the letter might contain.

The third letter came from our clerkship director who I never worked with clinically, but he had the clinical comments from my clerkship and had a meeting with me to tease out some of the other things.

I asked for a fourth letter from an attending I worked with one-on-one and he said yes, and then never responded to my e-mails again. I was nervous about not having another good clinical letter, but it all worked out in the end.

So, I think if you are attuned to it, you can pick up on how enthusiastic they are to write you a letter pretty quickly, and can decide which letters to use from there. If you're pulling from third year clerkships, finding out what those attendings commented on for your clerkship evaluations will likely be a good guide.

 

[URHere]

I would say that the best letters (in order) are probably:

1) Those that come from someone who has worked with you in multiple capacities. (e.g. research mentor and clinical attending, attending during both MS3 and MS4 year, etc.)
2) Letters from big name people in your field who you have also worked with during MS3/4
3) Letters from Sub-Is
4) Letters from anyone who is visibly thrilled to write you a letter, even if they aren't in your field of interest. I had one attending actually stop me on the sidewalk and ask if she could write me a LOR. It was completely unexpected, but many of my interviewers on the trail mentioned that letter very positively. There are some limits here: surgery would probably laugh at a psych letter, but an excellent FM letter would be fine for someone applying in peds or IM.
5) Letters from MS3
6) Letters from big name people in your field of interest who you have had minimal contact with.

The obvious extension here is that students can make a LOR stronger by seeking out rotations with certain people. If a clinical mentor or department chair (in a student's field of interest) is on service during a particular month, I would highly encourage students to schedule a clinical rotation with them.

As for trusting a "yes" - if an attending seems genuinely happy to write a letter...just trust that. Unless someone visibly hates the student or thinks they are incompetent, I doubt they would write a hostile letter...especially since students aren't seeking those people out for LORs in the first place.

 

[tatsuchi]

The corollary is yes, I have had colleagues back during medical school who were told straight by the attendings that "apologizes, but I do not think I would be able to write a strong LOR for you."

In that case both sides took it amicably and she ended up finding another attending to write what would turn out to be her best LOR.

The impetus behind choosing an attending for an LOR is first someone who can write most personably about you, and second someone who has weight in the field you are applying into. Second guessing as to an attending's true intentions when they have accepted to write you an LOR is a needless exercise in frustration and paranoia.

That being said, anyone may be willing to write a letter, your task as the applicant is to find who will write you the best one.

 

[Gymnast89]

anyone may be willing to write a letter, your task as the applicant is to find who will write you the best one.

I always thought attendings would be too damn busy to write for people they couldn't be strong advocates for.

 

[mvenus929]

I always thought attendings would be too damn busy to write for people they couldn't be strong advocates for.

Slightly different beast, but I had a friend who was asking for letters for fellowship, and one attending told her 'I'll write you a letter, but it won't be the best and programs will be able to read between the lines'. So, I guess it depends on the attending.

 

[Temeraire]

Exchange with my anesthesia mentor:

Me: "Could you write me a strong letter of recommendation?"
Mentor: "As opposed to a sh*tty one?"

This guy's a riot.

 

[Psai]

Exchange with my anesthesia mentor:

Me: "Could you write me a strong letter of recommendation?"
Mentor: "As opposed to a sh*tty one?"

This guy's a riot.

Look him straight in the eye
"Don't let me catch you writing a ****ty one"

 

[Temeraire]

Look him straight in the eye
"Don't let me catch you writing a ****ty one"

I just made this face ¯\_(ツ)_/¯ irl and walked away

 

[JKinSC]

Exchange with my anesthesia mentor:

Me: "Could you write me a strong letter of recommendation?"
Mentor: "As opposed to a sh*tty one?"

This guy's a riot.

We actually have a faculty member that, when asked to write a strong letter, asked the student, "Are you sure you want a letter from me?" Idiot actually took the letter.

 

[CopaceticOne]

We actually have a faculty member that, when asked to write a strong letter, asked the student, "Are you sure you want a letter from me?" Idiot actually took the letter.

I suppose they could have "saved face" by saying yes but never assigning the letter to any programs. Either that student is lacking some self awareness or the attending thought their were better people available to write one. Based on my gut, I'm going with the former.

 

[JKinSC]

I suppose they could have "saved face" by saying yes but never assigning the letter to any programs. Either that student is lacking some self awareness or the attending thought their were better people available to write one. Based on my gut, I'm going with the former.

Knowing the student, I assure you that it was the former

 

[hmockingbird]

One of my letters was from an attending who offered to write me a letter without me asking so I knew it would be good. Another was just the standard department chair letter.

Of the other two - one was a research letter, and I did ask if my mentor if they could write me a "strong" letter just because (probably normal for research!) we had gone through the occasional miscommunication. The other one I wanted from my sub-I. I worked with 3 attendings pretty equally, but one I did more in their clinic and that was the area of the rotation where I felt like I got to work most independently. I asked that attending but also said I was hoping for one from that rotation and if they thought one of the other attendings would be better to write one for me that would be fine (e.g. more experienced attending, or to give an out). They agreed to write it though.

I also had another attending who always gave me positive feedback as a backup but they were in a different specialty so I preferred getting the letter from my sub-I.

I've been told on the interview trail that I had really good letters so I think outside of the department chair (for some specialties this is an unwritten requirement/you should try to get one), go first for people who want to write your letter because you know that will be good, and then don't be afraid to have an honest chat with someone if you think they will write you a good letter but you aren't 100% sure.