You Can Lead the Witness: Letters of Recommendation Part 2

This is my second blog entry regarding actions you can take immediately to help you obtain strong letters of recommendation (LORs). The first entry describes two initial strategies for improving your medical school letter of recommendation process.

As a Harvard Assistant Residency Director, I bore witness to how weak – or even mediocre – LORs had the potential to bomb an otherwise competitive candidacy. Once you’ve followed directions and asked the right people (see my previous entry), it’s time to influence the content of your letters by making the job of letter writing easy:

Influencing the Content
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, 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 in one page. The point of the cover letter is to supplement a letter writer’s knowledge of your candidacy and offer flattering content for inclusion. A professor may know that you made the only A in an organic chemistry class, but her LOR 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 or an incomplete 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. This is not a court of law, so the savvy applicant can take subtle advantage of her ability to "lead the witness."

Medical School Applicants, Don't Mess Around with Your Letters of Recommendation

Today’s topic will be letters of recommendation (LORs), a part of your application you should get moving on immediately if you haven't already. Having read many LORs as a Harvard Assistant Residency Director, I can tell you that these letters matter much more than I originally thought when I was applying to medical school and residency myself.

I have a distinct memory from years ago of a colleague’s pointing out the word “shy” in an applicant’s LOR and asking me what I thought it meant. I didn’t make much of it, but my admissions colleague was worried about what the writer was trying to convey about the candidate. If one ambiguous word can make an admissions reader balk, you can imagine what a weak letter can do.

This brings me to one of the most important points about medical LORs: Mediocre letters (not to mention frankly bad ones) are a lost opportunity at best and a fast way to bomb your application at worst. It is critical that you get strong letters of recommendation…so let’s review how to do that.

Getting the best letters of recommendation for medical school, residency and fellowship is dependent on multiple factors:

1. Following Directions
2. Asking the right people
3. Influencing the content of your letter by making the job of letter-writing easy

Because there is so much advice to offer on these topics, today’s blog entry will cover #1 and #2, and I’ll focus on #3 in a follow up piece.

Following Directions
Different medical schools are seeking different sources of your letters. It’s worth checking online to ensure you meet the varied requirements of each institution.
Many medical schools require at least two science professors and one non-science professor to submit LORs on your behalf. Some also require a letter from your principal investigator (PI) if you’ve done research. Other medical schools may prefer a composite letter from a premedical advisor or committee. (For students attending schools that do not provide this service, individual letters from faculty members can be substituted.)

If you are currently attending graduate school, you may have a different set of letter writer requirements altogether, so it’s worth looking into this issue at each medical school before you apply. Furthermore, if you are employed in the workforce or on active duty in the military, some schools will require that you have a letter from an immediate supervisor. Also, some medical schools mandate "expiration dates" on their letters; they may require that no LORs be older than a year.

The reality is that medical schools are (generally) not malevolent institutions bent on creating confusion for their prospective applicants; being able to read and follow their directions is a basic and reasonable prerequisite for consideration as a candidate. If you can't be bothered to follow instructions as an applicant, how can they expect you to learn the nuances and complexities of caring for patients :)?

Asking the right people 
Now, beyond fulfilling a school’s requirements, you want to get the strongest letter you possibly can from the most influential writer. Choosing the right professors 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. Senior faculty
2. Weighty academic titles
3. Well known in their field
4. Spent significant time with you
5. Experienced letter-writers
6. Explicitly state they will write you a strong LOR

Of course all of these qualifications are not possible for all letter-writers. But the more of these you can garner the better. With regard to #1-3, 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.

With regard to #6, 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 May 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. You now have the advantage of substituting a stronger LOR written by someone who loves you.

Remember that your letters have a big impact on your application, and a mediocre letter can bomb your candidacy. In a follow up blog entry I’ll review how to influence the content of your letter by making the job of letter-writing easy.

Inaccuracies in Medical Student Grades Translate into Residency Application Strategy

Here's an interesting article by Dr. Pauline Chen on medical student grades. In reading the article, residency applicants should reflect on how important the content of their letters of recommendation is, especially in the setting of medical school grades that may be inflated or simply inaccurate. The 2016 NRMP Program Director Survey 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.

Writing Your Own Residency or Medical School Letter of Recommendation: Is it Ethical?

It's not infrequent that an applicant tells me that a letter of recommendation (LOR) writer has asked the candidate to draft his/her own letter because the writer is "too busy." I notice that medical school and residency applicants are a bit sheepish as they tell me about this arrangement. Have no fear: You are not doing anything unethical. (Here is an old piece by the New York Times ethicist Ariel Kaminer regarding this exact topic.)

If a faculty member asks you to write your own letter, not only should you do it, but you should do it with zeal. Make sure you showcase the accomplishments that distinguish you from other candidates and highlight traits that are important for your future career path. Use honest - but bold - adjectives to describe your best qualities.

Remember that the letter writer has final say, so even a busy faculty member might modify the letter. Keeping this fact in mind might alleviate your (unnecessary) guilt and should encourage you to write the strongest letter you can. (It's harder to go from outstanding to mediocre than from outstanding to excellent.)

Get a Better Letter

After over a decade of reading medical school and residency letters of recommendation (LOR), I can tell you that the biggest error I see in the LOR process occurs when applicants settle for mediocre letters. In other words, they know that a supervisor/faculty member/attending isn't going to write them a strong letter, but they fill the LOR slot with the middling endorsement anyway.

Please take a look at my most recent Student Doctor Network article, "Get a Better Letter" for concrete ideas on how to approach the letter of recommendation process.

An Offer You Can't Refuse

I speak to a few lucky medical school and residency applicants who are asked to write their own letters of recommendation. If you have this opportunity, first, realize that it is not unethical to write your own letter if you're asked. If you'd like to explore the scruples of this issue, take a look at this New York Times ethicist column about this exact topic.

The mistake I see candidates make in these situations is that they feel awkward about showcasing their accomplishments fully in their letters. If you have this opportunity, write a glowing letter. Be effusive and full-throated in your compliments to yourself. After all, the letter writer can always tone it down if s/he doesn't agree. But if s/he does, you have bolstered your candidacy tremendously.

Letters of Recommendation

It's time to start securing your residency letters of recommendation (LOR) if you haven't already. Remember that your letters have a big impact on your application, and even a mediocre letter can bomb your candidacy.

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 getting a wimpy letter will be much thornier. If the faculty member says no, hesitates, or tells you in May 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 now have the advantage of substituting a stronger LOR written by someone who likes your clinical work.

Getting Strong Medical School and Residency Letters of Recommendation, Continued

This is my second blog entry  regarding actions you can take immediately to help you obtain strong letters of recommendation (LORs). The first entry describes two initial strategies for improving your medical school letter of recommendation process. (Much of the guidance in both blog entries is critical for residency applicants as well, so feel free to read on if you are a medical student.)  Today I’ll pursue the LOR topic further, specifically advising you how to positively influence the content of your LORs.

As a Harvard Assistant Residency Director, I bore witness to how weak – or even mediocre – LORs had the potential to bomb an otherwise competitive candidacy. Once you’ve followed directions and asked the right people (see my previous entry), it’s time to influence the content of your letters by making the job of letter writing easy.

 Let's Give Them Something to Talk About -Bonnie Raitt 

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, 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 in one page. The point of the cover letter is to supplement a letter writer’s knowledge of your candidacy and offer flattering content for inclusion. A professor may know that you made the only A in an organic chemistry class, but her LOR 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 or an incomplete 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 your receive. This is not a court of law, so the savvy applicant can take subtle advantage of her ability to "lead the witness."

Signed, Sealed, Delivered - I'm Yours - Stevie Wonder

In addition to making your writer’s life easier with a LOR packet, you can improve your writer’s attitude and speed by making the process of submitting your letter easy: Ensure that you don’t leave your letter writer to figure out where to send the completed LOR.

Your medical school recommenders have several options for submitting their letters to the American Medical College Application Service (AMCAS). You want to make the process as convenient as possible for the writers, and different faculty members may have different preferences, so offer each writer all feasible alternatives. If your letter writer plans to send the letter by postal service, provide her with a pre-addressed, stamped envelope. There is no worse party foul than asking someone to pick up the tab for the letter she is writing you as a favor.

Below are the options. Note that your AAMC ID and AMCAS Letter ID (found on your Letter Request Form) are required, regardless of the means of submission:

1. AMCAS Letter Writer Application: This site enables letter writers to upload documents to AMCAS securely.

2. Interfolio: AMCAS can receive letters sent to Interfolio if the applicant is an Interfolio user or if the faculty member’s institution/organization uses the program.

3. Traditional post (i.e. snail mail):
AMCAS, attn: AMCAS Letters
AAMC Medical School Application Services
P.O. Box 18958
Washington, DC 20036

4. VirtualEvals (VE): VE is available to members of the National Association of Advisors for the Health Professions (NAAHP).

A savvy applicant recognizes that even the way in which one asks for a LOR has the potential to leave a favorable impression on the writer if performed tactfully. The candidate who submits organized materials, provides supplementary information about her extracurriculars ("I knew she was a star in my chemistry class; I had no idea she also captained the tennis team and coordinated medical interpreters at the community clinic, too!"), and demonstrates the foresight to provide a stamped, pre-addressed envelope or explicit directions on how to submit a letter online can turn even the most overburdened professor into an enthusiastic supporter.

Getting the Best Letters of Recommendation Part 2

Check out part two of my Varsity Tutors guest blog on getting the best letters of recommendation to strengthen your candidacy.


Check me out at www.InsiderMedicalAdmissions.com

How to Get Outstanding Letters of Recommendation

Click here to read my guest entry on the Varsity Tutors blog explaining how to obtain the best letters of recommendation possible to bolster your candidacy. The article focuses on medical school applicants, but contains very useful information for residency, fellowship, post-bacc, and dental applicants as well.

Check me out at www.InsiderMedicalAdmsissions.com

Medical School Letters of Recommendation: You Get More Bees with Honey

Making the process of letter of recommendation (LOR) writing and submission smooth for your faculty recommenders will likely improve the content and turnaround time of your LORs. Your medical school LOR writers have several options for submitting to AMCAS. Because you want to make the process as convenient as possible, and because different faculty members may have varying preferences, you should offer each writer all feasible alternatives.

Below are the options. Note that your AAMC ID and AMCAS Letter ID (found on your Letter Request Form) are required, regardless of the means of submission:

1. AMCAS Letter Writer Application: This site enables letter writers to upload documents to AMCAS securely.

2. Interfolio: AMCAS can receive letters sent to Interfolio if the applicant is an Interfolio user or if the faculty member’s institution/organization uses the program.

3. Snail mail:
AMCAS, attn: AMCAS Letters
AAMC Medical School Application Services
P.O. Box 18958
Washington, DC 20036

(If your recommender plans to send the letter by snail mail, be courteous and provide him/her with a self-addressed, stamped envelope.)

4. VirtualEvals (VE): VE is available to members of the National Association of Advisors for the Health Professions (NAAHP).

Check me out at www.InsiderMedicalAdmissions.com

Writing Your Own Residency or Medical School Letter of Recommendation: Is it Ethical?

It's not infrequent that an applicant tells me that a letter of recommendation (LOR) writer has asked the candidate to draft his/her own letter because the writer is "too busy." I notice that medical school and residency applicants are a bit sheepish as they tell me about this arrangement. Have no fear: You are not doing anything unethical. (Here is a piece by the New York Times ethicist Ariel Kaminer regarding this exact topic.)

If a faculty member asks you to write your own letter, not only should you do it, but you should do it with zeal. Make sure you showcase the accomplishments that distinguish you from other candidates and highlight traits that are important for your future career path. Use honest - but bold - adjectives to describe your best qualities.

Remember that the letter writer has final say, so even a busy faculty member might modify the letter. Keeping this fact in mind might alleviate your (unnecessary) guilt and should encourage you to write the strongest letter you can. (It's harder to go from outstanding to mediocre than from outstanding to excellent.)

Contact me for Strategy Sessions and Complete Packages. The latter are very popular this season.

Check me out at www.InsiderMedicalAdmissions.com

Inaccuracies in Medical Student Grades Translate into Residency Application Strategy

Here's an interesting article by Dr. Pauline Chen on medical student grades. In reading the article, residency applicants should reflect on how important the content of their letters of recommendation is, especially in the setting of medical school grades that may be inflated or simply inaccurate. The 2012 NRMP Program Director Survey (yes, I do mention that document a lot because it's so helpful) 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.

Check me out at www.InsiderMedicalAdmissions.com

Medical School Applicants: Avoid Missteps in the Admissions Process

Check out my recent, featured interview on the Varsity Tutor blog. Note some of the biggest mistakes candidates make in applying to medical school, the single most important thing medical school applicants should focus on, and why mediocre letters of recommendation are actually bad ones.



Check me out at www.insidermedicaladmissions.com

Expert (Goofy) Writing Tips

This entertaining list of writing don'ts offers a comic break for applicants who are working feverishly on their medical school personal statements. The rules are based on the wit and wisdom of the late New York Times' William Safire and the copywriter Frank LaPosta Visco. Enjoy!

1. A writer must not shift your point of view.
2. Always pick on the correct idiom.
3. Analogies in writing are like feathers on a snake.
4. Always be sure to finish what
5. Avoid alliteration. Always.
6. Avoid archaeic spellings.
7. Avoid clichés like the plague. (They're old hat.)
8. Avoid trendy locutions that sound flaky.
9. Be more or less specific.
10. Comparisons are as bad as clichés.
11. Contractions aren't necessary.
12. Do not use hyperbole; not one in a million can do it effectively.
13. Don't indulge in sesquipedalian lexicological constructions.
14. Don't never use no double negatives.
15. Don't overuse exclamation marks!!
16. Don't repeat yourself, or say again what you have said before.
17. Don't use commas, that, are not, necessary.
18. Don't be redundant; don't use more words than necessary; it's highly superfluous.
19. Eliminate quotations. As Ralph Waldo Emerson once said, "I hate quotations. Tell me what you know."
20. Employ the vernacular.
21. Eschew ampersands & abbreviations, etc.
22. Eschew obfuscation.
23. Even if a mixed metaphor sings, it should be derailed.
24. Everyone should be careful to use a singular pronoun with singular nouns in their writing.
25. Exaggeration is a billion times worse than understatement.
26. Foreign words and phrases are not apropos.
27. Go around the barn at high noon to avoid colloquialisms.
28. Hopefully, you will use words correctly, irregardless of how others use them.
29. If any word is improper at the end of a sentence, a linking verb is.
30. If you reread your work, you can find on rereading a great deal of repetition can be avoided by rereading and editing.
31. It behooves you to avoid archaic expressions.
32. It is wrong to ever split an infinitive.
33. Never use a big word when a diminutive alternative would suffice.
34. No sentence fragments.
35. One should never generalize.
36. One-word sentences? Eliminate.
37. Parenthetical remarks (however relevant) are unnecessary.
38. Parenthetical words however must be enclosed in commas.
39. Place pronouns as close as possible, especially in long sentences, as of ten or more words, to their antecedents.
40. Placing a comma between subject and predicate, is not correct.
41. Proofread carefully to see if you any words out.
42. Prepositions are not words to end sentences with.
43. Profanity sucks.
44. Subject and verb always has to agree.
45. Take the bull by the hand and avoid mixing metaphors.
46. The adverb always follows the verb.
47. The passive voice is to be avoided.
48. Understatement is always best.
49. Use the apostrophe in it's proper place and omit it when its not needed.
50. Use youre spell chekker to avoid mispeling and to catch typograhpical errers.
51. Who needs rhetorical questions?
52. Writing carefully, dangling participles must be avoided.

Please check me out at InsiderMedicalAdmissions.com.

I Wish I Had Known...

I was recently speaking to a colleague who graduated with his MD from UCSF and his MPH from Harvard. He's a successful, practicing physician, and we were discussing some advice he had offered an undergraduate acquaintance who is pursuing medicine.

My colleague had advised the college student to ensure she gets to know faculty: During his undergraduate years at Stanford, my colleague had gotten acquainted with a few professors by inviting them to lunch. He had to call one or two several times before they met with him! But once they did, my colleague's opportunities really expanded. One of the professors in particular realized my colleague's potential and good nature and offered him a position on an honor committee and a strong medical school recommendation.

I wish someone had advised me early to get to know faculty. It turned out okay for me but not without having to do some hard thinking about whom I was going to ask for faculty recommendations. Acquainting yourself with faculty early in your academic career can afford you research and leadership opportunities. Of course, it can also help you with those much-needed letters of recommendation.

Applying in Two Specialties

Here are some clarifications about what ERAS offers that will help you apply in two specialties:

1) Different personal statements can be assigned to different programs. This means you can assign your ob/gyn essay to ob/gyn programs and your internal medicine statement to internal medicine residencies.
2) Different letters of recommendation (LORs) can be assigned to different residency programs as well. (A maximum of four letters may be assigned to each program.)
3) You will have only one MyEras application. It will go to all of your programs.

Thus, when you select a program to apply to, you will be able to choose which documents (personal statement, LORs) you would like send to that program. ERAS, in this way, allows you to keep your options open.

Is It Kosher?

My advisees often have questions about the ethics of letters of recommendation (LOR).

First, some applicants tell me they feel guilty because - although they waived their right to see their LORs - their writers gave them their letters to read. If your letter writer crafts your LOR understanding that s/he has no obligation to let you read it yet chooses to offer you a copy, you have done nothing unethical. That decision is the letter writer's.

Furthermore, I've had applicants tell me they feel uncomfortable because faculty have told them to write their own recommendation letters after which the letter "writers" will edit and sign. Again, totally kosher. This topic was recently addressed here by the ethicist in the New York Times.

Remember to start early in asking faculty to write your recommendations. LORs almost always take longer than you think.

New "Getting Into Residency" CD-ROM Available

I don't usually refer readers of this blog to my other blog, but with the launch of my new "Getting Into Residency" CD-ROM, I thought that might be easier. Here is the information. The CD includes video, audio, printable slides and a transcript.

Getting to Know Faculty

When I conduct Strategy Sessions with medical and dental school applicants, I notice a recurring problem: It's hard to get very strong academic letters of recommendation, especially at colleges with large classes.

So I'm here to offer a piece of advice to those just starting their university studies: Get to know your profs. In addition to keeping your grades up from the beginning of your college career, acquainting yourself well with your teachers is one of the most important pieces of advice I can give to the new pre-med. Go to office hours, send an email invite for a lunch meeting or approach the faculty member about working in his or her laboratory.

In addition to being strategic, these relationships can fill a mentorship role that is invaluable.