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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.

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For Pre-Meds, What IS Solid Clinical Experience Anyway?

Getting into medical school has gotten so competitive that it’s increasingly important to have a strong candidacy with excellent grades and robust extracurricular activities starting early in your college career. As I’ve mentioned in previous blog entries, one mistake I see pre-meds make is that they are so focused on leadership and research they forget a critical component – clinical experience. To prove you want to be a doctor, it’s essential you obtain clinical experience for a significant period of time – not just a health fair or two. Good grades will not make up for a lack of clinical experience.

Working as an EMT, in a good clinical care extender program, or in a low-income clinic are just some ideas for obtaining excellent clinical exposure. (Although you might think free clinics would be thrilled to have a pre-med volunteer, many understandably require one-year commitments.) Shadowing is a mixed bag: Medical schools don’t know whether you’re second-assisting in the operating room or just standing in a corner being ignored. If you choose to shadow, make sure you strategically highlight your clinical experiences in your written materials. Other popular options include international clinical work (although it is usually short-lived) and working as a volunteer in a hospital (although it might be more clerical than clinical, depending on the position).

Do your research before accepting a “clinical” job so you ensure you’ll really get the experience you need to confirm to yourself that you’ve made the right career choice (very important) and to show admissions committees that you can handle the heat.

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Secondary Essays: Why Do You Want to Attend Our School?

Secondary essay prompts vary, but there are a few that are standard fare. “Why do you want to attend our school?” is a common topic pre-meds will encounter.

Med school admissions officers want to be assured that you know their institution, are seriously considering it, and will fit in well there. In approaching the “why-our-school” question, do your research on the institution and link something specific about you with the school’s philosophy, curriculum, surrounding patient population, and/or extracurricular programs.

For instance, if you were a teaching assistant for chemistry in college, you might link your use of the Socratic method with a school’s tutorial-based learning. In that way, you demonstrate knowledge of the school, show that you connect well with it, and showcase your accomplishment.

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The Medical School Wait List: Can Anything Be Done?

Just when you’ve completed your medical school interviews and feel that you can sit back and relax because – after all – the rest is out of your hands, you may be surprised by a wait list notification. What is the next step? What can you do?

First of all, realize that getting into medical school has become increasingly competitive year by year. Being wait listed is better than being rejected, and thus a positive, despite the anxiety is causes.

A few things you can do:
1. Send a letter of intent. Let the school know of your continued interest and your new accomplishments. Ensure the letter is well written, streamlined and brief. Be explicit about your enthusiasm, and if the school is your first choice, let the admissions committee know that.
2. Ask the school if you can set up a second look. A second visit indicates to the institution that you are serious, and it offers you more data in making your decision if you are later offered a spot.
3. Do not neglect your other options. Don’t focus all of your attention on this institution to the exclusion of others: Ensure you are well-prepared for upcoming interviews at other medical schools.
4. Plan for last minute notice. At some schools applicants are offered slots off the wait list throughout the summer. I’ve even heard of acceptances being offered the day before medical school was to begin. Would you be able to change your living situation, move your personal belongings and uproot if this were to happen?

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Taking the Fifth

medical school interview questionsIf there were one reason not to accept you, what would it be?

When a faculty member asks you this tough question in an interview, her motivation might be to determine whether there is a weakness in your application that she is missing. Or she may be assessing how you manage stressful situations by posing a question that is unpleasant.

While you need to be honest throughout the entire application process, you do not need to volunteer information that might harm you.

You can say, “While every candidacy has room to improve, I think I have a strong application.” Then you can use the question as an opportunity to mention the strengths of your candidacy.

Contact me for Mock Interviews. I still have January slots open as of this writing.

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to
stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital.
She was appointed to the Assistant Residency Director position for the Harvard Affiliated
Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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