Dr. William James

By Samir P. Desai, M.D., and Rajani Katta, M.D.
Authors of The Successful Match: 200 Rules to Succeed in the Residency Match and
250 Biggest Mistakes 3rd Year Medical Students Make And How To Avoid Them

As the Paul Gross Professor and Vice Chair of the Department of Dermatology at the University of Pennsylvania, Dr. William James directs the dermatology residency program at the University of Pennsylvania, which recently was found to be the highest ranked academic dermatology department in the United States.¹

He is widely regarded as an outstanding clinician, teacher, and researcher, having received numerous honors and awards. He has published over 200 peer-reviewed publications, served as the editor-in-chief emeritus of the emedicine dermatology section, and been on a variety of national committees.  We recently had the opportunity to speak with him about the dermatology residency selection process.

In a recent survey of dermatology residency program directors, 87% of programs cited a letter of recommendation from the department chair as an important factor in selecting applicants to interview.²  How can students interact and work with the chair in such a way that the chair is able to write a productive and meaningful letter?

First of all, the Chair is certainly a great person to be able to work with and get a letter from. In many circumstances, though, that’s not going to be the person who is most involved with students, especially depending on the size of the program. Your letter doesn’t necessarily need to be from the Chair. It could be from one of the academic dermatologists in the program, either the Program Director or one of the faculty members.

It should be from someone with whom you’ve worked and who knows you in some meaningful way. That would usually mean at least working in a clinic with the letter-writer. Specifically, not just observing in clinic but actually interacting with patients and discussing diseases. It may involve rounding with the inpatient team and presenting patients in follow-up. It could be writing or participating in a project, such as a clinical project or a case report. There should be some meaningful interaction. There needs to be information about how the applicant works, what kind of ideas they have, and how they interact with patients and the team. That really is the key: being able to get to know your letter-writer long enough so that they can take examples and then detail how an applicant would be a good person to have in the residency program. For the people reading the letters, they’re going to be looking for some meaningful pieces of information that is based on personal observation.

Audition electives have been found to be very important in the dermatology residency selection process.³ What sets apart students who shine during these rotations from those that are average?

First of all, enthusiasm. There are students, believe it or not, who show up and look a little bored. I think enthusiasm for the work and the subject is very important. The way students interact with others is certainly a key. You can have all the brains in the world, but if you can’t get along with people, that doesn’t say much for your ability to work on a team or work with patients. Sometimes students can be a little too aggressive in their interactions, probably because they’re trying to either come across as enthusiastic or they’re trying to show off their smarts. There is a fine line regarding what is appropriate for the level of training. At the same time, I think faculty members do take into account that students are trying to make a good impression, so I think there is some leeway there.

Hopefully, there will be opportunities to demonstrate their knowledge base or get involved with a project. If you find that the dermatologists are getting excited about a case and saying “I haven’t seen this before” or “I don’t really know what is a good treatment for this condition; let’s go look it up”, this would a great opportunity for the student to follow up by reporting ”This is a case that I learned something from; I looked it up, I thought about it, and I’d like to pursue it a little further.”  

Dr. Miller, who is Vice Chair of Clinical and Educational Affairs in the department of dermatology at Penn State College of Medicine, has encouraged applicants to make their personal statement unique.⁴ Too often, he has read statements where an applicant writes about “being a visual person” or is drawn to the specialty because of the “ability to do procedures.” Having read thousands of statements, what advice can you offer for the dermatology applicant seeking to create a unique statement?

I think the main point is that this can’t be a recitation of what’s already in other parts of the application. I’ll get to the positive side, but one of the main things that bothers me with personal statements is reading about that first I did this, and then I did that, and I wrote this paper, and I did this research, and I published it in this journal, and I did this volunteer work. It’s all in the CV already and the whole statement becomes “I, I, I.”

But while the personal statement is just that – personal – if it’s all going to be about delineating accomplishments that are covered in other places, then that simply isn’t helpful. What is helpful is to draw a picture of yourself that can’t be obtained from anywhere else in the application. It should be personal – this is who you are, this is what makes you excited, these are your special interests. Sometimes it may be outside of medicine, sometimes it may be a volunteer experience that is expanded upon, or it could be a personal connection that stimulated the applicant to want to do something more, such as a specific part of Dermatology down the line. You might express your future goal, as that is something that wouldn’t be revealed in other parts of the application.  

It certainly has to be sincere. If everyone just says at the end of their statement “I want to be an academic dermatologist” and there’s nothing else in the application that tells a reason for this, it’s not believable. It would help if you can describe your personal background and bring in information about your life that isn’t available in other places, and then transfer that into a future plan.

Overall, your statement has got to be personal, sincere, and bring out information not available in other places.

Students recognize the importance of research in the dermatology residency selection process and hope to participate and, perhaps, become published in the field.  Although there are over 100 dermatology residency programs in the United States, some programs are more prolific than others in terms of scholarly activity. For example, between 2001 and 2004, your program produced 318 publications, placing it among the top dermatology programs in the country.¹ What recommendations do you have for students who wish to do research but are either at schools lacking a dermatology residency program or for those whose dermatology department focus is largely clinical?

I would expand the idea of research. If a student doesn’t have any background in laboratory-based basic science research, then they could work in a lab to see what it’s like. However, most of the time people that don’t have that type of background, and don’t have advanced degrees, are not going to end up in that situation.

Most of the time, students are going to be looking for more of a clinical-based project. Protocol-based projects and clinical research do require a fair amount of time in order to get things off the ground and move through the process. For the person that you’re describing, they could get involved with a review article, a case report, or a small case series. Other possibilities could be a review of charts or a review of pathologic specimens. With that type of background, these are the types of projects that such a student would be both capable of and interested in, and would make the most sense for their background.

There is a growing shortage of academic dermatologists with fewer residents pursuing a career in academics.⁵ Years ago, your program developed the unique Dermatology Fellowship for Academic Clinician-Teachers, with the goal being “to develop future leaders in dermatology who will attain positions such as residency program directors, professors in clinician-educator tracts, and departmental chairman.”⁶ As a lifelong academician, what are some misconceptions that students have about academic dermatology?

Students are, of course, being taught in an academic setting, and depending upon the people they’re exposed to, some may tend to see the bright side of things, while others will focus on a less attractive side. There are pluses for academic Dermatology and pluses for private practice, but there are also negatives for both. If someone is more negative they may assume that “since this is what academic medicine is about, private practice must be better.” However, they don’t have the knowledge base about what actually goes on in private practice, and they don’t know the negative aspects.  In other words, they think it’s greener on the other side of the fence, but they don’t really look on that other side to see what’s there.

I think that some of the misconceptions are that academicians don’t make such a good living – but I don’t really know any academic dermatologists that are living out of their car.  I think we make a better living than 99% of the citizenship in the United States, so I think that that’s underappreciated. 

I sometimes hear things like “there’s too much politics in academics” and I can’t say I don’t understand, but personally I think it’s an overstatement. In my opinion, it’s all about interactions with others, and if you have good interaction skills, then you’ll do fine.

Certainly there are concerns about independence and the size of organizations, or what some people might call bureaucracy. I think that you have to be able to operate in a larger setting. If you are someone who is an entrepreneur and wants to be in charge all the time, then you probably aren’t built to go into academics.  But if you are more able to accept some bureaucracy, then certainly in exchange for that you get a lot of infrastructure. You have a lot of the business side of medicine that you don’t have to deal with, and in return you can concentrate on patients.  In private practice, you’re responsible for hiring and firing, balancing the books, and complying with the regulatory requirements. Private practitioners are small business operators and good business sense is necessary.

You have to be self-aware of what kind of arena your personality would best operate in, and in the end that’s something you are going to have to figure out for yourself.

Dermatology residency programs routinely receive hundreds of applications for just a few positions. As the years have passed, the academic credentials of applicants have become more impressive. In the 2007 Match, 47% of U.S. seniors who matched were members of AOA and the mean USMLE Step 1 score was 238.⁷ While strong credentials are certainly important to secure interviews, it is the interview that ultimately makes the difference. What advice can you offer students as they prepare for interviews? 

One of the things I find is that people tend to want to downplay what they have done. If it’s done out of modesty, that’s fine, but I think there are people that have a pretty darn good record, and unfortunately they say things like “Well, my boards could have been better, but you know I had this happen in my personal life.” Basically, they’re apologizing. They may have gotten 80% honors grades and yet they’re apologizing for this one rotation that they didn’t honor, and trying to come up with a reason or excuse. That’s just not a good way to approach an interview.

The way to approach an interview is to be self-confident and to accentuate the positives. They’re clearly there, because if you’re interviewing for a program, you must have a lot of positives. We don’t just interview anybody. You’ve got a good record, so you want to go in and be self-confident about that. You want to look good, and you want to come in sharp and enthusiastic. 

You should also treat everybody well. Some applicants will bow down before the Chair and then are rude to the residency program coordinator. That’s just not a good practice. I also think there’s something to be said for a practice interview if you’re nervous.

Ultimately, you want to be honest and open during your interview.

In 2007, out of 407 U.S. seniors applying to dermatology, 158 failed to match (39% of U.S. senior applicants).⁷ Applicants who fail to match often wish to reapply the following year. What can these applicants do to strengthen their application?

There are certainly a number of dermatology fellowships out there. It’s been documented that applicants who complete these fellowships have a higher match rate the second time around. I think that’s probably because you get to know the director well, and since they know how you work and how you produce results, they can write you a better letter of recommendation. I’ve also seen some individuals plan to do degree-producing programs, such as a Masters of Public Health, or a program with a focus in biostatistics or epidemiology.

There are certain objective measures that can’t be changed. You can’t change the Dean’s letter, you can’t change your board scores, and you can’t be AOA the second time around. However, you can publish and get new letters of recommendation. These are ways to strengthen your application.

Some applicants who fail to match pursue a pre-residency dermatology fellowship. In a recent survey of fellowship directors, it was learned that 92% of past fellows (176/190) were able to match successfully following completion of the fellowship.⁸  How can applicants make the most of these fellowships?

Most of these fellowships are directed by individuals that are fairly well-known in their specialty. A letter of recommendation from a faculty member that spent months, or sometimes a year, with an applicant is a very valuable resource. That’s going to be more information than the prior application, and the letter writer is able to be very rich in their detail about what supports the positive things that they say about the applicant. We look very closely at that.

Many fellowships are directed by some very productive members of our specialty. If the director is known for publishing, putting abstracts in meetings, and making headway in addressing different questions, then it’s expected that the applicant will have participated in those results.

There may be interview questions such as “why do you think you didn’t match?” There are certainly applicants who don’t match who have fantastic records, and for some reason they just didn’t make it. There may be cases where you cannot say that’s the reason I didn’t get in. But if there were an item or items that weren’t so good, then you have to plan to address those. You can’t change those items, but another way to address prior performance is to demonstrate in a more current job that you can do the work, and you can do it well.

References

¹Wu JJ, Ramirez CC, Alonso CA, Berman B, Tyring SK. Ranking the dermatology programs based on measurements of academic achievement. Dermatol Online J 2007; 13(3): 3.

²Results of the 2008 NRMP Program Director Survey. Available at http://www.nrmp.org/data/programresultsbyspecialty.pdf.   Accessed June 12, 2009.

³Clarke JT, Miller JJ, Sceppa J, Goldsmith LA, Long E. Success in the dermatology resident match in 2003: perceptions and importance of home institutions and away rotations. Arch Dermatol 2006; 142(7): 930-2.

⁴Miller J, Miller OF 3^rd, Freedberg I. Dear dermatology applicant. Arch Dermatol 2004; 140(7): 884.

⁵Resneck, J Jr, Kimball AB. The dermatology workforce shortage. J Am Acad Dermatol 2004; 50: 50-4.

⁶Available at the University of Pennsylvania Department of Dermatology website (http://www.uphs.upenn.edu/dermatol/education/clinician-educator.html).  Accessed on June 12, 2009.

⁷Charting outcomes in the match: characteristics of applicants who matched to their preferred specialty in the 2007 National Resident Matching Program main residency match (2^nd edition). Available at http://www.nrmp.org/data/chartingoutcomes2007.pdf.  Accessed June 12, 2009.

⁸Wasong SH, Miller JJ, Zaenglein AL. Does a predermatology fellowship increase the chance to match in dermatology? J Am Acad Dermatol 2008; 59(3): 535-6.

The application puzzle can be a complex one, and letters of recommendation are just one piece. It doesn’t need to be the hardest piece though. Based on our experience with thousands of medical school applicants, and our relationships with many career centers and pre-health advising offices, we’ve identified some tips for making the process of collecting letters of recommendation as painless as possible. 

Put Time on Your Side: There’s nothing worse than pressuring a writer to get a letter done in time for a quickly approaching deadline. Give your writers plenty of time to pen their letter. Like most professionals, they are busy people and their attention is usually focused elsewhere. Give them as much time as possible to make sure they aren’t rushed and are able to compose a thoughtful evaluation of your character and credentials.

Choose Wisely: Make sure that you are well acquainted with your writer, whether that person was a former professor, advisor, or supervisor. The more that they know about you, the more compelling their letter can be. Don’t ask a professor from an introductory level class to write you a letter if you never went to office hours and didn’t stand out from the other 300 students. If you can, select someone well spoken, who will be able to write about you with conviction.

Inform Them: Your writers are on a need to know basis, and they need to know. Keep them aware of what you expect of them. Give them clear instructions and address information. Be explicit about the things they should be mentioning in their letter. If you are using a service like Interfolio, be certain to make sure they are clear on the process.

Also, give them the details that go beyond the confines of your relationship. Tell them about your relevant coursework, your summer jobs, and your motivation for applying to medical school in the first place. All this information will complement what they already know, better equipping them to write on your behalf.

Gentle Nudges: Without applying too much pressure, make sure that your writers have actually sent your letter. A gentle reminder is fine – most writers understand how important these letters are to you, but everyone forgets or procrastinates from time to time. You don’t want to realize that you’re short one letter as deadlines approach.

Thank Them!: Once they have written your letter, make sure to thank them. Stop by at office hours, write them an e-mail, or give them a call. Just make sure they know that you appreciated their time and (hopefully) kind words. They will certainly appreciate it!

—————

Using Interfolio’s online document management service can also help ease a lot of the stress. We offer one secure, constantly accessible place to collect and store their letters of recommendation, while also distributing these letters to your targeted medical schools. After you request a letter, your writer can choose to mail it to our office, or upload electronically using a free writer’s account. After letters have been added to your account, you receive e-mail notification and once they have been received you can start sending them out.

For more information about Interfolio, our services, and our pricing, please visit us online at http://www.interfolio.com.

For more advice on the application process make sure to talk with your advisor or check out the many informative posts here on the SDN forums.

A big thanks to the Health Career Evaluation Committee (HCEC) Office at Cornell University and the Health Professions Office at the University of Texas at Austin for their contributions to this story.

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 www.medschoolready.com and an SDN Contributor.

by Christian Becker

Physician shadowing, in my opinion, is one of the best extracurricular activities in which a pre-medical student can engage for several reasons:

1. It provides you with clinical exposure and stories to talk about in the admission interview.
2. Shadowing allows you to see what medicine and a physician’s life are like every day.
3. You will quickly discover if medicine is really for you.
4. It’s easy to set up and do.
5. It’s one of those “intangible” (and unofficial) requirements to get into medical school.

For purposes of this discussion, shadowing really boils down to one thing: clinical exposure. If you already have worked as a nurse or medical assistant with ample patient and physician contact and interaction, you really don’t need any shadowing, or at least not much. It’s an easy way to get that important clinical exposure that can make or break your application. 

In essence, if you have not spent some significant time with physicians and patients during your time as a pre-med, how do you really know you want to be a physician? How do you convince the admissions folks that you truly know what it is like to be a physician and involved in patient care? They want to see that you have immersed yourself in clinical settings with real patients.

From my own experience as an applicant just a few years ago, I can emphatically state that I knew that I wanted to be a physician due almost entirely to my shadowing experiences. In addition, I was asked about those experiences in admissions interviews and was able to easily answer the question “Why medicine?”. I was also able to share some of the things I had seen and experienced during my observation time with my interviewers and use them in my personal statement. In a nutshell, shadowing is what cemented my desire to be a physician.

As a student interviewer for my medical school, I cannot over-emphasize the need for clinical experiences and exposure. One of the most important predictors of whether or not someone is a strong, motivated applicant is the breadth of their clinical exposure. Minimal or a complete lack of experience may dash the hopes of gaining admission to medical school for an otherwise qualified applicant. I was getting ready to interview a candidate a few months ago who had very minimal clinical exposure listed on his application. He had spent some significant time in a research lab and had a fairly strong application with a good MCAT and GPA. In discussing this applicant with the faculty interviewer, we both agreed that they really had to convince us that they had an adequate understanding of and insight into medicine or he would be rejected, despite an otherwise decent application. It really came down to clinical exposure.

On a separate note, if you are still worried about answering “Why medicine?”, I would suggest doing some more shadowing. This will allow you to get to know the physician, their specialty, and medicine overall. You’ll meet that one patient that will affect you in some meaningful way. You will never forget them and will be able to talk about your experience for years (and in interviews). I had such an encounter with one of the surgeons I was shadowing. A little girl showed up with a dog bite to the face, brought into the office by her parents. It was just about time for all of us to go home and we ended up taking her into surgery that night. It was one of the most exciting experiences for me as an undergrad: it wasn’t just the actual surgery that was cool, but the whole experience with the patient and the drama surrounding the whole thing. It gave me a good story to help convey my passion for medicine.

I believe that if you only spend a few hours shadowing here and there, you really miss a large part of the experience. Be sure to spend enough hours shadowing the same physician. When I say “enough hours”, I would suggest that you may want to spend a few days or even a week with a physician in the office, the operating room, and/or maybe even taking some call. If you only go to see the “cool surgeries” and never go to clinic, you may miss out on some of the “real life” of a surgeon.

Other Clinical Exposure
Don’t forget that you can get clinical exposure in other ways as well. This includes any employment in clinics or volunteer work in an emergency department, for example. Just make sure it’s real exposure with patients and physicians.

Arranging Shadowing Experiences
Realize that you can set up your shadowing however you like. Some people like to shadow a few hours every week for several weeks or months, if that is what will fit in their schedules. As already mentioned, I personally preferred spending time with one physician for an entire week in one stretch, Monday through Friday, 8:00 a.m. to 5:00 p.m., to get a better idea of what it is really like. I did this with several different physicians in different specialties and followed one of them on call after hours. I scheduled my shadowing experiences during the summer when I was out of school for a few weeks during my undergrad, and would highly recommend it to anyone.

To schedule a shadowing experience, simply open the local Yellow Pages, pick the specialty you are interested in observing, and call any physician’s office. Tell the office person that you are a pre-med student at XYZ University planning on going to medical school next year. Ask them if Dr. Smith allows students to come into the office to shadow him or her. They very likely have done this before with other students. Tell them what dates you would prefer to shadow. Usually, the office staff will take down your phone number and then call you back after asking the physician or office manager. Many physicians are excited to have pre-meds in their offices.

While Shadowing
This may be obvious, but make sure you are dressed and groomed professionally when observing. If in doubt, overdress for the first day until you can get a feeling for what is acceptable in the office or the physician tells you it is okay to dress down. For men, that should be dress pants, shirt, and tie, and for women, dresses or professional business attire.

Most of the time, you mainly stand back and observe what the physician does without doing anything yourself. Try not to get in the way. After all, that is what shadowing is. Some physicians may involve you to some degree, may let you look in ears, for example, or be part of what they do in some fashion. If so, great, but don’t expect too much.

Actively ask questions between patients or when appropriate. The middle of a patient visit may be a bad time to quench your own thirst for knowledge. You want plenty of interaction with the physician so they can get to know you and see that you are interested in medicine, in patient care, etc. If you are interested in discussing controversial topics, do so with caution and professionalism instead of bias.

Recommendation Letters
At the conclusion of your experience, make sure you ask the physician for a strong letter of recommendation in support of your application to medical school. Don’t underestimate the letter and ask for it in the right way, because there is a right and a wrong way to ask for a letter. I’ll devote an entire column to recommendation letters in the near future, since they do play an important role, so stay tuned!

Christian Becker is the creator and operator of www.medschoolready.com and an SDN Contributor.

Historically, applying to health-professional schools was a paperwork nightmare.

As a student employee in the Georgetown University Career Center, Steve Goldenberg felt there had to be an easier way to manage the paperwork of applications, so he created Interfolio in 1999.

Interfolio users can create an electronic portfolio to manage important documents online, including confidential and non-confidential letters of recommendation, resumes or CVs, writing samples, dissertation abstracts, teaching certifications, student evaluations and more.

Currently, Interfolio is used by students and alumni at over 500 schools each year—primarily pre-health students applying to dental school, pharmacy school, medical school or other health-related programs. PhDs also use the service to send academic credentials to search committees.

Interfolio allows documents to be received and distributed electronically or on paper. For example, a letter writer can submit a hard copy or email version of a recommendation, which can then be sent electronically or on paper to jobs, academic programs, or other opportunities. Users can retain their documents, even after they have completed their application process, so they can use them again. And for students who have attended more than one institution of higher education, an account with Interfolio eliminates the need to have a separate credentials file at several different institutions.

Users can add new documents, check on the status of pending documents, and make requests for document delivery through the web or a toll-free number.

Interfolio maintains the confidentiality of all closed letters of recommendation their file holders store with them, and follows strict guidelines for receiving and mailing all closed letters of recommendation to ensure that confidential documents stay that way. Account holders are notified when letters of recommendation are received on their behalf, and users have the ability to include these letters in a mailing to a potential graduate school or employer. They do not, however, have the ability to view the document at any point in time.

There are a few types of Interfolio accounts that can be established. A one-year plan costs $15 and includes 5 MB of online storage (or about 100 documents) for one year. The five-year plan runs $45 and includes 5 MB of online storage (~100 documents) for five years, as well as three free first class mailings. A 10-year plan is $75 and includes 5 MB of online storage (~100 documents) for 10 years, as well as three free first class mailings. Additional fees apply for the electronic or paper delivery of stored documents.

According to Frank Fessenden, Interfolio’s Vice President of Business Development, “we save our customers the hassle of tracking, copying and mailing LORS, and they can access their account any time. It’s easier for recommendation writers too. 95 percent of our users say that Interfolio is worth the cost. And 98 percent said they were happy with our product and our customer service.”

Interfolio is available at http://www.interfolio.com

Disclosure: Interfolio uses Google AdWords for advertising. As such, their advertisements may intermittently appear on SDN; however we receive no direct advertising support from Interfolio. Interfolio did not provide any promotional consideration for this article.