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.