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Pre-Med Preparation: Getting Letters of Recommendation

Created April 26, 2008 by Christian Becker
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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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  1. Ella says:

    Thanks! :)

  2. good article, but could use more detail about standard requirements for who writes the letters- years ago when I applied to med school, most required at least 2 letters from faculty, with at least 1 of those being a science faculty member. Most med schools required 3 letters, with at most 1 being from a non-faculty member.

  3. Oscar Meyer says:

    Definitely an informative article. I would like to comment that you do suggest keeping letters “confidential” however, give many pointers on what a good a letter has. Just seems a little conflicting/confusing because if you waive your right to see the letters you won’t know if they are good (strong) or bad (weak). Nevertheless, thanks for the insight.

  4. EW says:

    “Great” letters of recommendation are unfortunately a dime a dozen. In the most likely scenario they do little to help your application although they are a necessity! The exception to this would be a recommendation from someone at the particular school or a leader in the field. For the majority of us who don’t have this going for them, go through the motions, but don’t count on “great” letters to get you any acceptances.

  5. Anonymous says:

    I think it is terrible advice to tell pre-meds to “make excuses” to go to office hours and pretend to have questions just to try and get in good with a faculty member in order to get a LOR. This is so disingenuous. It’s something I hated as a pre-med (thus I never did it). And now as an admissions committee member, I can tell when this is how a person has gotten their letters, and I take that into account.

    I really find it ridiculous when a PhD who has done basic science research for his/her whole life presumes to tell me, on the basis of some interactions in a lecture hall and an office, that “I know this student has everything it takes to be an outstanding physician” blah blah blah. That letter-writer has never been a physician, not for one second. He/she has never had to stay cool under pressure and act effectively when the guy with multiple gunshot wounds to the chest is wheeled into the ER and loses vital signs. He/she has never had to sit across from a person and tell them they have HIV, or multiple sclerosis, or their prostate cancer is back and now it’s in their brain. AND furthermore that letter-writer has never seen the applicant in a clinical setting. For that reason, I tend to feel that while the letters from basic science professors and research mentors is pretty much standard required fare, I don’t put a whole lot of stock into most of them.

    1. Shelly Gill says:

      That may be true; however, people still need letters of recommendation, and faculty members have many students… and some of these letters have to be written by faculty members, and if you want the faculty member to get to know you… well, you get the picture… However, they still insist that some of these letters need to be written by Professors… I think that a letter of recommendation from a Professor could be very insightful… a Professors who knows you will know if you are responsible, punctual, intelligent, and they will know how well you perform under pressure (excluding the “ER”, of course, so they probably should refrain from making statements such as “So and so has what it takes to be a good physician ,” because after all, what do they know about that? They should stick to the facts and not give in to the temptation of inferencing and predicting how good a doctor they think the person would be; rather stick to naming the qualities that make the person a great student/friend/helper/neighbor/scholar, etc.
      I agree with you, except on one point. Not putting a lot of stock into most letters of recommendation, unless they are written by a physician. That, I disagree with.

  6. Simone says:

    Informative article. However, what about the non-traditionals who have been out of school for sometime?

  7. Marissa says:

    I agree with Simone. What about someone who has been out of school for 4 years, but has been working and volunteering?

  8. Sam says:

    When is a good time to ask for letters? Right before we apply to Med School or right after the course or internship (even though it may be 2 years prior to applying to med schools)?

  9. Britt says:

    Are there advantages (or disadvantages) to going through a letter writing service like interfolio instead of the letter writing committee at one’s school? I ask this because my school is charging $175 to keep my letters of recommendation in a file, but they no longer write an additional letter for the student. This seems like a $15 interfolio account would be better. What do you think?

  10. Sammy says:

    Great article! Glad I found this site! Does anyone have advice for nontraditional applicants? Been out of school for a bit and it would be extremely hard to go back to my old professors for a LOR, you just lose touch with academics after you leave.

  11. Anonymous says:

    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.

  12. Anonymous says:

    “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.”

    I hate students that suck up to professors just to get recommendation letters. they waste their own time by pointlessly asking questions they know the answers to and more importantly, the time of other students who actually need to go to office hours!

  13. Anonymous says:

    Extremely helpful

  14. ANONymous says:

    Yes, I would love to see an article on what to do if you’ve been out of school and aren’t working through the pre-med advisement office. how should the letters be collected/stored and is there another way to get the copies of letters needed to apply to multiple schools without asking the letter writer to make copies?….

  15. S says:

    Can you ask a recommendation from a physician whom you shadowed for only a day? What is the best time to ask them? right after or formally through email?


  16. Matt says:

    This article was very informative, thank you so much for the time and effort you put into these.

    I have one question in regard to this article however.

    What if a family member, in this case, my uncle, is an ER doctor. And as such, have shadowed him multiple times. He undoubtedly would know me better than all of these other scenarios and because he is my uncle he would easily write a letter with the highest opinions of my character present.

    Would that not be an acceptable recommendation letter for med school? Or can this be one of those rare exceptions?

  17. kat says:

    I can tell you my personal experience of getting letters and now am asked to write letters for students and students asking to shadow me for letters.
    I was an A student but only because I worked hard for it, I had to ask my professor occasionally to reexplain a few pieces of the lecture during the semester. He knew I didnt go in just so he would write me a letter (which he did), I loved the material and wanted to understand it so I would do well in med school.
    Now I only write letters for students if I really believe in them, other wise I tell them that they would be better off having someone that knows them better write their letters. My other letter came from a Dr that I worked with when I volunteered at a medical clinic for the homeless. She actually asked ME if she could write my letter of reccomendation, she knew how much I wanted to learn about medicine and how I interacted with the patients.
    Remember at some schools reading the letters is one of the ways to get to know the students and may be the reason why do get or dont get an interview. All the students are qualified, the people writing the letters can portray to the readers much information about the applicant by their enthusiasm or lack of enthusiasm.
    I would never write a letter for someone that shadowed me for one day. Also remember to give the person writing your letter your resume and a personal letter about yourself, an abbreiviated personal statement.
    If you have been out of school for a while, make an attempt to find your past professor and reconnect or if possible take another class to show admissions you are still a good student. There are many places to volunteer to get a great reference letter or your current supervisor. The key is to have all your ducks in a row without being arrogant. Know what you have to offer the school and your future patients

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