MedChatter Guide to Letters of Reference

Most schools require 2-3 letters of reference as part of their medical school application (e.g. OMSAS requires 3.  UofA,UBC, Memorial, Dalhousie, require 2).  As is the case with most of the other sections of the medical applications, here is variation between the format and medium of the reference letter between medical schools.  What is common is that there is usually a referee form with instructions for the referee to follow. Often the applicant is responsible for providing the referee with a copy of the form to use (such as with OMSAS, UofA). However in UofC’s case, each referee must provide an e-mail address and in turn, the reference form is directly e-mailed to the referee.  The referee then answers questions on an online form provided by UofC.

Often the application has a set of directives for the referee to follow when writing the reference letter. For example some schools ask the referee to answer specific questions (e.g. UofA, UofC), while other schools ask the referee to comment on certain characteristics (OMSAS).  In the case of OMSAS, the referee is asked to not only write a narrative reference letter, but to also fill out a one-page form ranking the referee in several categories.

Common among all schools is the restriction that friends/family are not chosen as your referee, and the recommendation that at least one reference letter is from an “academic” referee OR for other schools, that at least one letter is from a “non-academic” referee.  Usually academic refers to professors who have taught you courses, or supervisors in research work.  Non-academic referees are typically people you have meet through your extra-curricular or volunteer work.

What can be useful is having your referee emphasize the characteristics that medical schools look for.  Below we have a list of the qualities that some medical schools look for to help you:

Queens Characteristics that Referees can consider commenting on:

Academic Abilities

• commitment and achievement

• problem solving

• critical thinking

• self directed learning

• scientific reasoning

Personal Characteristics

• ability to function as a team player

• ability to communicate effectively

• sensitivity to the needs of others

• adaptability and ability to cope with stress

• creativity and extracurricular interests

UBC: Motivation, social concern and responsibility, creativity, scientific and intellectual curiosity, attitude toward continuing learning, maturity, integrity, and realistic self-appraisal

UofT - The status or profession of the letter writer is not relevant to the evaluation process.  What matters is what they say about you.  When selecting referees, think about how well and how long the writer has known you.  Can the Admissions Committee see them as an objective reference?  Referees who may not be objective (referees with family or friendship connections) should not be used - their evaluations will be given less weight than objective evaluators.  It is recommended that at least one of your letters be from a non-academic source.  It is also recommended that at least one letter (not necessarily the same one) be from a referee who can provide a comparative perspective on your character and strengths with a number of your peers, for example someone who has had occasion to interact with a number students interested in medicine.

The letters of reference is probably the aspect of the med school application that you have the least control in.  Thus when approaching the letters of reference, the goal is to eliminate as much variance as possible, and to take advantage of the control that you DO have.

So the first question is typically, “Who do I choose as my references?”.  Do not take this question lightly, because this is your first point of control.  There are several things to consider when choosing your references, but the most important one is what you believe that are willing to say about you.  It does not matter if you have a Nature-publishing doctor writing for you if that person only states a list of things you have done.  An effective reference letter is similar to an effective personal statement in that you need to STAND OUT and to MAKE A CONNECTION with the reader, in this case, the admissions committee.  So instead of a referee listing things you have done (which you already do in your application), you need that referee to put effort into conveying the impact your contributions have had to whatever you two were involved in.  Basically you want that personal touch.  Because at the end of the day, after the admissions committee has read hundreds of applications, they won’t remember the Nobel Prize winning referee, but the IMPRESSION that they had of you afterwards.  In any case, if a committee member can remember your referee better than aspects about you, then maybe your referee should be applying to medical school instead.  Don’t get me wrong. IF you can get a Nobel Prize winner writing you a very impassioned reference letter, then by all means go for it!

So once you have mentally chosen the referees who you believe will be willing to write you a personal letter that really conveys the kind of impact you have had, then the next step is to ASK them to write it.  Again, this is another point of control.  The way you approach your referee has a HUGE impact on the outcome of the letter.  When asking your referee, you want to do a couple of things. First, let them know that this letter is important for your application into medicine. It is NOT just a formality. Second, tell them because of the previous point, you want to know: “Can you write a STRONG reference letter for me?”.  You have to ask this because no matter how well intentioned your referee is, no matter how much they like you, life sometimes get in the way.  Your referee could be out of the country for the next 3 months, or they could have grants due soon and not have the time needed to put in the effort to make the letter good.  So make sure they have the time to write it.  The second reason for asking for a STRONG reference letter is that some referees may actually hold a lower opinion of you than you thought.  In this case, once they hear how important the letter is, and that you need a strong one, they will likely back out of writing it, especially if it will be more work for them to write it.  This saves you from blindly sending in a mediocre letter that was half-heartedly written.

Lastly, make the experience as easy as possible for your referee.  So provide them a printout of any and all forms they have to fill out, provide them with self-stamped and addressed envelopes for mailing the reference letters- basically provide them with everything they need.  Some referees might even ask you what kind of letter you want.  In that case, tell them the truth.  Tell them you want it to be a personal letter, where they provide examples of how your work has had a strong positive impact, blah blah. Make sure you have examples ready in case they ask you to “refresh” their memory.  If your referee feels lost, they are less likely to spend enough time on your letter, so make sure they don’t feel alone or lost in any way.

Kevin's opinion

Who to ask for LOR:

• Research supervisor - Do research. Summer projects work well.
• Professors from undergrad who know you well - Get to know your professors. Go to their office hours and speak to them.
• Volunteer supervisors - Preferably clinical volunteering.
• Physicians - A good letter from a physician says a lot more than letters from other non-medically related sources. Get to know physicians through clinical volunteering or research.
• Lay person who know you well (i.e. employer).

Asking for LOR:

LORs aren't hard get. Many people are willing to write them for you. If you ask a professor who only knows you as a person who asks a lot of questions in a class of 300 people, chances are he will still write one for you. But honestly, what kind of quality of LOR will you be getting? I've heard horror stories of two line LOR that goes something like, "so and so is a great student who expressed interest in organic chemistry. He achieved an A in my so and so class which demonstrates his strong work ethics." Obviously the referee has little to say about the applicant. This LOR not only will not add to your application, it will actually take away from it. A flop of a LOR such as this shows that you have no one who has nice things to say about you. Your aim here is QUALITY letters, so choose wisely.

• Approach your referee courteously and ask if the individual is willing to write a STRONG LOR for your medical school application. The key is to communicate to the referee your need of a QUALITY letter. Say to your referee, "its very important for the referee to be able to comment on my character, strengths, and also convey why I would be a good fit in medicine. Please let me know if you are comfortable with that. If you feel that you don't know me well enough to write a strong letter, feel free to say no. I will understand." This will serve as quality control and a screen for bad letters. It's better to have no letters than bad ones.

• Often it's nice to provide an format for the referee to follow. For example, I asked one of my referees (research supervisor to structure the letter as the following:

P1 - Explain how we've come to know each other and the degree of interaction.
P2 - Explain what I've accomplished in the lab and find examples that exemplifies my character/abilities.
P3 - Explain why I would make a great doctor with examples to support it.

This way, the referee found the letter much easier to write, and I had less to worry about the content.

• Give the referee ample time to write the letter (1 month should be sufficient). Remember, your referee has a life and your needs aren't on top of their priority list.
  
  
• When asking for LOR, provide your referee with your CV (serve as an extra source of information and a refresher on things that they may have forgotten about you. However, their letters shouldn't be based on your CV). If the referee will be mailing the letter directly, provide a stamped envelope with the address of the admissions office pre-written on the envelope. It's just the courteous thing to do. You can also retrieve the letter from the referee and mail it yourself.
  
  
• Ask the referee to keep an electronic version of the letter. In case a problem occurs, you will have a backup. Another efficient way to manage and deliver your LORs is  INTERFOLIO. It is an online system that manages documents. You can ask your referee to submit their letter electronically or via mail to their system. From their system, you can then submit your letter to which ever school you choose with a small fee per letter. However, due to the variability of the LOR system within Canadian Universities (i.e some require unique reference forms separate from the LOR), the use of this service may be limited. However, if you are applying to American schools, this service becomes VERY handy.
  
  
• Don't be afraid to remind your referees to submit your letters! Since your application is incomplete without the LORs, make sure your referees submit your letters before the deadline.

When it comes to LOR, be careful of bad ones. If you exercise poor judgement and chose someone with negative things to say about you, it can severely harm your application.  LORs will not get you into medical school, but it can be enough to make you not get in. At most schools, the weight of LORs is ~ 5 to 10%. However, this may be deceptive. If its a school that has a panel interview, the interviewers may have access to your LOR, and they may view them prior to your interview. If this is the case, the letters will contribute greatly to their pre-conceived image of you as a person. Since first-impressions influence you interview evaluation enormously, and knowing interviews are often weighted 40-50% of your application, these LOR can potentially play a big role in your application. That being said, most schools are under the MMI format where your LORs aren't accessible to your interviewers. Therefore, their 5-10% influence on your application are fairly minor.