Medical School Recommendation Letters are as important as the MCAT.
This website is all about the MCAT, but sometimes we forget the MCAT is a means to an end: a road to a destination. I have met people so burned out by the MCAT, they never asked the right people at the right time for recommendation letters. Come application cycle, they fizzled. Let’s put an end to this. Med school letters of rec not only take time, they take relationships. Building solid relations – especially during the new era of COVID-19 social distancing – needs to be accomplished, at the very least, a year before applying to Medical School: about the same time you are studying for the MCAT. This may seem nearly impossible, but asking for a killer Medical School Letter of Recommendation is remarkably more doable now than before the pandemic. All it takes is the right COVID-19 email strategy. Even if it seems too late, you can quickly turn things around. Find out how below…

[This article features exclusive advice from Tasheema Prince of PreMedLife]

1. What do Medical Schools look for in an Evaluation Letter?
2. Who do I ask to write my Med School Rec Letter?
3. What do I give this person to recommend about me that Medical Schools will actually like?
4. When is the best time to ask for Medical School Letters of Recommendation?
5. What do I need to get done before I ask my evaluator?
6. How do I write the perfect email asking for a Med School Recommendation Letter?
7. What should I do if my med school recommender doesn’t respond?
8. What should I do after my recommendation is sent?

Who are you?

This is the question Medical School Admission Committees want to know. If you were about to invest $1.1 million and 30 years to train the right person for the job, you would probably ask the same question.

The problem is, they don’t trust you.

Don’t take it personally. It’s a societal issue. People have become masters of presentation: high GPAs and MCAT scores don’t always translate into a person willing to face the harsh longevity of medicine. That is where medical school letters of recommendation – or letters of evaluation, as the Association of American Medical Colleges (AAMC) names them – fit into your application.

Evaluation letters either make or break an application by marrying actions with words. Alongside interviews, the main question asked here is, “You claim to be the best candidate for the job. Is there truth to these claims? Have witnesses recognized anything to back up said claims?” This sounds like a courtroom case.

Essentially, med school rec letters are evidence. What they capture will be extrapolated into rigorous coursework, long residency hours, high-stress competence, and patient interactions. In a nutshell, the AAMC wants to reduce risk on their $1.1 million dollar investment – and recommendation letters are the best way to ease their worries.

This is what people fail to see. Letters of Evaluation add a level of accountability evaluating your candidacy on a higher objective moral standard. They are not regurgitations of facts, they moreover say, “Jane Doe was the one undergraduate I could count on: she showed up on time for every lab meeting – and always respectfully communicated her honest, novel insight on the direction of our research. I have rarely been so challenged and invigorated by dedication towards human life.”

Actions speak louder than words.
Yet – somehow – through words (and a socially distanced interview), Medical Schools are supposed to predict our actions.

In a post-pandemic, socially distant world – how do we go about choosing the right person to write such a letter?

If you had to choose between a US Senator you met once, or a community college professor who has known you for two years…who would you choose to write your medical school recommendation letters?

By the end of this section, you should be able to answer this question by the AAMC’s standards. In the official AAMC Medical School Evaluation Letter Guidelines, the following eight prompts are stipulated:

To translate this into actionable terms, you need to look for someone who can:

1. Explainably Picture You as a Doctor
2. Honestly Recall Multiple Interactions for a Sizable Duration
3.  Size You Up and Give New Insights About You to the AAMC
4. Reference More About You than Grades
5. Give a Behavioral Snapshot (Story)
6. Be Comfortable Corresponding with You
7. Cite and Extrapolate on Your Solutions
8. Compare or Contrast You with Students or Peers

As you can see, this relationship goes deeper than “Hi Prof. Loved your class. Going to Med School. Wanna rec me?” Be assured, the aforementioned professor will wreck you.

Don’t famous people have power? Of course, field influencers would draw more attention than other letters – but if, and only if, they meet the above stipulations. Even Stanford’s undergraduate resources offer similar advice.

The easiest way to think about the letter is from the perspective of the Medical School Admissions Committee (AdCom). “Does John Doe really know the King of Wakanda?” “Wow, I guess he really does! Impressive!”  Without the latter statement, your medical school application loses gravitas – and you end up looking like a fan with a selfie stick.

A physician is sleep-deprived, overworked, over-caffeinated, and battle-scarred. What keeps one going is genuine human interaction. If you aren’t in the habit of reaching out and providing said human interaction – now is the time to start.

The heuristic that got me killer medical school recommendation letters comes from God’s mouth:

Therefore all things whatsoever ye would
that men should do to you:

do ye even so to them:
for this is the law and the prophets.

(Matthew 7:12)

This Golden Rule is often misinterpreted. Most people cite “Do to others what you would have them do to you.” This not only misquotes the basis for all positive human interaction, it places said basis on what you desire from people. No. Treat people the way they should treat you – not the way you want them to treat you.

Let’s apply this to your evaluators. These are busy people. Say one person is a physician you shadow, and another is a Principal Investigator. The former has an enormous to-do list they are slowing down for you to learn about, and the latter needs to get papers out to gain tenure, satisfy grants, or maintain a reputable research presence.

Applying the basis of modern ethics – Matthew 7:12 – allows you to forget about yourself, and help both potential evaluators reach their goals. For example, you can shift from shadowing to volunteering for the physician. Researchers always have data sets to analyze, so you could offer to tediously perform quality data analysis.

First, you observe what should be helped. Then, you help.

But – Mike – what about COVID-19?
You bring up a valid point.
COVID-19’s social distancing is actually a blessing in disguise. Why? Email. Email is enormously underused in universities. Aside from offering Amazon Prime and Adobe Creative Cloud discounts, your “.edu” email gives you access to a database of potential evaluators. Write your email as respectfully and candidly as you can, and always ensure more than 2/3rds of the email addresses the recipient rather than yourself.

Below is an example of an email relationship built over time.

The above collection of hypothetical emails not only follow the Golden Rule – they set up a win/win situation for your relationship.

The emails avoid talking too much about yourself, respect the recipient and their time, can be referenced months in advance, frame your specific skills to a future in medicine, and primarily aim to benefit the recipient. Even if rejected – you can at least thank the person for responding, or address the reason for rejection. If you have already humbled yourself, they cannot harm you with rejection. The “meanest professors” I have encountered have given the strongest commendations purely commenting on my ability to accept and respond well to harsh criticism. Be teachable, and no one can hurt you.

You are human, therefore valuable.
It’s never the other way around.

Don’t expect people to help you. Expect yourself to help people.

This is how you can choose both the senator and community college professor to pen Letters of Recommendation for Medical School.

One final note: ensure the people you choose are competent writers and the net result of all your letter are different perspectives of you in various environments.

This directly ties into what – exactly – medical schools value in an applicant… 

What – specifically – are Medical Schools looking for?

The AAMC – again – gives the answer in the aforementioned official Medical School Evaluation Letter Guidelines. In fact, said document references three Medical School Recommendation competencies: thinking and reasoning, science, and pre-professional.

Thinking and reasoning competencies – in a nutshell – ask:
“Can this candidate communicate? Also, can they wield numbers and science to solve problems? Are they able to base feelings on facts rather than facts of feelings: applying reason to discern truth? If they have a unique perspective, do they even voice this?”

Communication is absolutely imperative. It likely the reason CARS was created – and the very reason most abhor it. Ergo, I strongly recommend you take a day to read and apply a life-changing book that will fundamentally change your view on the English language.

One way to build all of the above competencies is the marriage of passions: mix the most disparate of interests. Love video games? Apply what is so enticing about your favorite game to pedagogical medicine. Love slam poetry? Make some crazy medical mnemonic. Truth is universal – meaning patterns repeat themselves in other mediums. Mixing art and science yielded this very website. Try “translating” research journals to younger siblings. Gain deep-seated conceptual mastery of a subject. Start a newsletter. Publish a blog. Write.

Not only are you mixing your God-given skillsets to paint who you are for medical school AdComs, you are creating backup careers in case you do get a rejection from Medical Schools.

Notice a pattern? This is – essentially – real-world MCAT!

Science competencies ask if you are solving real-world problems in living or social systems. While the best medical school recommenders in this area are likely physicians or principal investigators – it is imperative to note said problems infect every aspect of society.

In fact, this website’s very mission statement is to equip future physicians to fight the forces of death (why our logo is a sword through a serpent of death). If you are volunteering for an organization or entity, read the mission statement. Better yet – if you created an organization – write your mission statement. The antagonist of said statement is very likely a biological or behavioral issue.

Learn to ask “why” at the macro level regarding your work under an evaluator. 

You are devoting your days to fight for life. Have you shown what it means to love life? Do you have a passion for living beings, not merely a superficial fascination with their form?

Can you genuinely answer the question – why do you want to be a doctor? If you can’t answer this, than your evaluators certainly won’t be able to when writing your medical school letters of recommendation.

Do your actions demonstrate the following?

• Run towards fires and gather groups to put them out.
• Handle horrors with hopes, setbacks with opportunities, anger with joy, and chaos with peace.
• Act with class.
• Never trash talk nor back talk, nor defile your reputation with complaints and ingratitude.
• Compete with yourself before competing with others, and never compare people.
• Human life is immaculately valuable, respect its sanctity without fail – with words and actions.
• Honor your word and promises.
• Respect people’s time and space.
• Put your head in the heavens, not the heavens in your head.
• Be teachable. Have no pride in yourself. Have confidence in your worth.
• Place facts above feelings: be reliable, consistent, and sound.
• Be still.
• Disagree honestly and respectfully.

The beauty of the above is the capacity for improvement. No one is perfect – all fall short of God’s impeccability. There is everlasting joy in growth. You are not God. Ergo, you can do better!

To summarize all of the above competencies, medical school recommendation letters need to address if you walk the MCAT talk.

Are you: empathetic enough to identify and care about a problem, communicative enough to coordinate a response, scientific enough to reason and strategize a quantifiable solution, and human enough to repeat the process with failure’s understanding?

If you have demonstrated this, time to ask… 

People are forgetful.
Ergo, the right time to ask for medical school letters of recommendation are the moments experiences conclude.  Don’t let a memory fade or rot away. If it has been a while, send a refresher email to remind this person of the experience, first, than ask for the letter.  Even more than with the MCAT: time is of essence.

When, exactly, is the “conclusion” of an experience? This question is important to ask – because a letter should reflect the most amount of time a person has known you. If you have reached the end of a course, or position – and see no foreseeable, imminent future with the evaluator – ask now. If this person was truly impactful, consider creating a future with them. Ask them if they wouldn’t mind mentoring you during office hours – or introduce them to other professors to discuss research. I was able to construct a senior thesis and entirely new study by introducing two of my favorite professors together.

Moving through the medical school admissions process during the COVID-19 crisis presents several unique challenges for both the applicant and everyone else involved, including those who will be providing letters of evaluation. One simple, but very important, tip would be to reach out to your potential letter writer early to give them more than enough time to provide a quality evaluation. We all are adjusting to new modes of operation so any advance notice would alleviate any unnecessary stress during an already stressful time. It’s simple but it’s key.

Be sure to read more from Tasheema and PreMedLife on their incredible website here.

It is also helpful to know how – exactly – your application logs medical school letters of evaluation to determine the correct timeline.

If you have not yet made an AAMC account. Stop, now. Go make one and come back. It’s easy.

With your AAMC account – you not only have access to MCAT scores and scheduling – but also the American Medical College Application Service® (AMCAS).

Login here, click on the application cycle year you are apply for (the year you intend to go to medical school – 1), and in the bottom right – you should see a list of application item links to access.

After navigating to the Letters of Evaluation page, you should notice an option to add a new letter.

Clicking on this option, you encounter there are not only one – but three types of letters Medical Schools accept:

1.  Committee Letter
2. Letter Packet
3. Individual Letter

A committee letter is a collection of letters with an “official university evaluation” slapped on by an appointed pre-health committee. These are typically the same people who hold seminars (or COVID-19 webinars) about scary Pre-Med weed-out rates. These people scare undergraduates because their job is to have the best represent the university. Get to know these people! They are the face of the university – and can send a specialized letter package communicating what your university thinks of you. This typically takes months of planning, so it is important to make an appointment with these people often. However – the payoff is not only multiple letters for the price of one – it is also a group of lobbyists that want to push you forward as their next successful doctor.

A letter packet – like a committee letter – can contain multiple letters; but – unlike a committee letter – is arranged by career services or professional service that has not been appointed to create an institutional evaluation on your candidacy as a doctor. In other words – your university doesn’t judge you, but clusters letters together in an online platform. If you don’t have a Pre-Health committee, or are somehow their arch-nemesis – then contact your university’s career services to see if they offer a service like Interfolio: an online rec letter platform accepted by both AAMC and Texas Medical & Dental Schools Application Service (TMDSAS).

Both of the above cluster letters together and should be used, if possible. However – sometimes a letter is added later, or outside the “jurisdiction” of either Career Services or your Pre-Health department. This is where an individual letter comes in.

While the AAMC system supports up to 10 uploads – which you cannot delete – most medical schools accept three letters. A letter packet or committee letter count as a single letter, and letters in said packet should not also be sent as individual letters. AAMC information is always adapting, so be sure to download the latest application guide on their website.

Please note that Texas Medical Schools operate on a separate platform (the Texas Medical & Dental Schools Application Service – TMDSAS). Please also familiarize yourself with this portal now, if Texas Medical Schools are even an inkling of a thought in your mind.

When should you ask for your medical school recommendation letter? The short answer is – as soon as an experience ends. The long answer is dependent on how you want to process said letter: be it in the form of a committee letter, a letter packet, or an individual entry on the AMCAS.

Before you ask, you need to do some homework….

Imagine you just finished your final lecture – teaching undergraduates for hours, have a stack of finals due by midnight next week, and need to push out your paper at the month’s end. Finally, you are about to go home to your family!

Then, a student pops out from the bushes and asks, “Can you write me a letter of recommendation?!”

Even the nicest professors would understandably collapse with this pressure. In the era of COVID-19, there is a better way to ask.

Letters of recommendation are confidential – meaning you can’t read them. But what if you wrote your own medical school letters of recommendation? While this is illegal and not encouraged, there is a perfectly legal – and even respectable – way to go about doing this.

Collect all materials your evaluator needs to write the letter for you, make it as short and accessible as possible, and have it ready the moment you ask them for a letter.

Create a Google Drive folder with all the relevant materials they will ever need.

This folder’s link will go into an email you send said professor.

What should you include in this folder?

Check out the PDF below…

The above PDF gives a perfect indicator of what you need to prepare before you email your medical school recommender. Moreover, if you intend to have the evaluation be a part of a committee letter of letter packet – ensure you include your university’s committee letter forms and clear, succinct instructions for uploading the medical school letters of recommendation.

This MCAT Adventure journey – intended for CARS preparation – also addresses writing a stellar personal statement. 

In summary: imagine you are the evaluator.
With minimal back-and-forth, would you have everything you need to write a dream recommendation for yourself? If not, there’s some prep work to be done before asking this person. Just don’t take too much time.

Mike, we’re in a pandemic.
So….how, exactly, do I ask my evaluator? 

“Students are becoming insufferably rude.” 

I won’t name her – but this is precisely what my former Statistics professor said during a data analysis as she received another email asking for a letter of recommendation.

One of the AAMC evaluator guidelines is for evaluators to compare or contrast your candidacy with other students. This might actually be an advantageous wake-up call to how you would go about emailing your Medical School recommender in the post-COVID-19 era.

Imagine you are a professor. Which of the below emails would you rather receive?

Notice the difference?

The key to a great email and great medical school recommendation letters – in general – is respect. I’m not just speaking of politeness nor kindness: I’m talking about having absolutely zero demands nor expectations of a person who owes you nothing.

This requires a level of vulnerability.
But, there is no rejection here. The worst case scenario is a replied “No” or silence.  If “No” move onto the next person in your list.
If you hear crickets, time for a backup plan….

The busiest people tend to be the worst at replying to emails – especially physicians. Don’t take it personally!

It is important to have a follow-up strategy that allows the evaluator to reply without feeling bombarded. Examine the below two follow-up emails:

The first email is your typical reminder message. Honestly, it’s rude. Yes – you may think its brevity is respectful of the person’s time – but that is what a subject title (i.e. “Recommendation Reminder”) accomplishes.

The second email strategically introduces three new aspects: accountability, sincere persistence, and closure.

By citing the real possibility of your initial message going to spam, you communicate understanding for the recommender’s delay. This also opens up an opportunity to hold this person accountable to a third party – where they feel more obliged to get back to you.

Moreover, instead of pestering the person, you rationalize sincere persistence: meaning you truly want their evaluation because of their impact on you and in the industry. Your relation with and opinion of this person is not conditional on their letter concerning you. While this may seem counter-intuitive, it is precisely the reply that should incite a response.

Finally, you address the real possibility they might never reply – sealing a relation with closure.

This not only is a strategy to ensure stellar medical school letters of recommendation: but the seeds of professionalism.

If – indeed – a person willingly takes the time to recommend/evaluate you. There is one final step you absolutely must take.

A person – with little to no personal benefit – took time to pen a letter boosting your career. If you don’t take the time to demonstrate gratitude….I’m sorry, you are a monster.

 To communicate that your relation was not contingent on your evaluation – meaning they weren’t a “means to an end” for your medical school letters of recommendation – invest in a gift.

While there are certainly many ways to show gratitude, including a hand-written thank you note if you are on a budget, it is rare to see a professional researcher, professor, or physician without a trusty cup of coffee or tea.

That’s why we designed the mug I wished I had to give back when my professors recommended me. Given the application process is expensive, we tried to make it as affordable as possible.