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Pre-Med Preparation: Getting Letters of Recommendation

Created April 26, 2008 by Christian Becker


In my last article for SDN, I addressed the importance of physician shadowing and clinical experience. This time, I want to focus on recommendation letters.

Recommendation letters are used by admission committees and are part of your application. To get good letters, participation in extracurricular activities and positive interactions with faculty and physicians are important.

Admissions committees see on the application what activities you have listed, but recommendation letters tell them how you interact with people, what type of person you are, and (hopefully) stress your good qualities and support your application to medical school.

For most schools, you’ll need 2-3 letters of recommendation.

Bad Letters

“He was dressed nice and followed me in my office for a week… …and I think he will be a great physician… …I strongly recommend this individual…”

This type of recommendation is pretty much worthless. Letters that merely state you were present in the office won’t do you any good. Neither will letters that don’t stress your personal strengths and qualities.

Great Letters

What will help you are descriptions that show what type of person you are. In a great letter, you should be able to find strong positive descriptions of your personal characteristics and your attitude towards medicine that will make you a great physician. You should see statements that explain to the admissions people why you would be a great addition to the medical community.

The letter writer has to support the recommendation with evidence, writing about your qualities rather than just stating that you will be a fine physician.

“He was punctual, eager to learn, very interested, asked questions, was very attentive, well-mannered and friendly, and interacted well with patients. I enjoyed discussing things with him. He eagerly watched surgeries and was very inquisitive, professional, and respectful. He interacted well with patients and responded well to them. He was enjoyable to work and interacted with…”

You get the idea.

The best letters are from people who have spent some time with you and gotten to know you well. That is why it is important to shadow physicians for more than just a few hours, or spend significant time with faculty, researchers or others who will be writing letters for you. For example, one physician really opened up to me after three days, and we developed a very good personal relationship. His letter on my behalf was great.

For faculty letters, make sure that the faculty member gets to know you by name and really knows you. If he or she cannot greet you by name in the hallway, you should find someone else to write a letter for you or do everything you can to get to know the faculty member.

You can do this by visiting his or her office to discuss prior assignments, for example:

  • “What can I do better?”
  • “Could you explain the details of this problem? I would have chosen a different way to solve it.”

Ask questions about homework, assignments, readings, or your progress in the course.

You need excuses to get to know your professor for a good letter, so use all opportunities. Go to your professor, and ask him or her about assignments or other readings — even if you understand everything and really don’t have any questions.

If you do this throughout the semester, the faculty member will get to know you personally, will see that you are engaged and interested in the material, that you are doing extra reading and that you are thinking about the course content. You may also have the opportunity to mention that you will be applying for medical school.

Faculty members with whom you have spent time doing research are also good sources of recommendation letters.

How to ask for a letter

Ask the physician or faculty member, “Would you be able to write me a positive letter of recommendation for my med school application?” or “do you have any reservations about writing a positive letter of recommendation for me?”

Be sure to ask if he or she can honestly give you a good letter. You have to be firm on this — don’t be shy! If he or she says no, thank the person and ask someone else. Most letter writers are not cruel enough to say they would write you a positive letter and then write a bad one. Usually, if you ask, they will be honest and tell you that they can give you a great recommendation or tell you that they will not be able to.

Often, the letter writer may request a resume or curriculum vitae, listing your major accomplishments, schooling, etc. You may be asked to provide some additional biographical information about yourself or why you are interested in medicine. Ideally, you should already have this information typed up, and you should be providing it to the letter writer right after the person accepts your request. This allows the letter writer to personalize your recommendation even more and include more personal information about you.

What to do with the letters

Some pre-med advising offices or student affairs offices at colleges and universities will give you a choice between having an open or a closed student file in which they collect all documents pertinent to your medical school application, including recommendation letters written on your behalf. You usually have to sign a statement and decide at the beginning, when your file is first created, if you want your file to be open or closed. If you ask medical schools which type of file is best to choose, some will tell you that they don’t care. Don’t believe them! Some medical schools will only consider recommendation letters that were kept in a closed file, and most schools prefer closed files to open files. What’s the difference?

With an open file, you have full access to all documents and can look at anything in your file at any time. Most faculty members and others writing recommendation letters for you want to know in advance if your file is open or closed. If it is open, they are less likely to write negatively about you. When it is closed, they have nothing to fear and write frankly. Therefore, medical schools prefer (and some require) that you have a closed file to ensure a more unbiased appraisal. In my opinion, you should have a closed file. That is why it is so important to ask letter writers frankly if they are able to write a very good letter without reservations.

Recommendation letters are sent directly to medical schools from either your undergrad pre-med office or from the letter writers. You will have to tell your pre-med office or committee (or the letter writer) which letters to send from your file and which schools to send them to. Typically, when you receive your secondary application materials from the medical school, they provide you with information about what kind of letters they want from you and where to send them.

Who you should ask

The following people should write letters of recommendation for you:

  • Physicians you spent time with.
  • Managers of places you volunteered/worked at in clinical settings.
  • Faculty who taught you.
  • Faculty/mentors you did research with.

No personal friends, family, co-workers or others should write letters for you!

You should be able to get a personal copy of the letter from everyone with the exception of faculty, since they may be hesitant and most likely familiar with the closed file. If you have more letters than medical schools require, you can then choose the best ones to send to them. Most medical schools specify what types of letters and how many they want (usually one to four). Don’t send additional letters — they just clutter your file and your best ones may not get read at all. I recommended no more than three or four.
Christian Becker is the creator and operator of and an SDN Contributor.

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