Letters of Recommendation

The requirements for letters of recommendations vary from school to school. Generally, students should prepare:

• 2 science letters
• 1 non-science letters
• 1 clinical letter
• For MD-PhD, the letters from Principal Investigators
• Additional letters might be needed based on how long you were out of school, your activities list, etc. Check with each school’s requirements.

For activities, it is a safe practice that unless it is a student organization without a faculty mentor, you should be able to ask for a letter from the faculty mentor (or supervisor) for each of the significant activity that you have on your AMCAS application. We will discuss the application in another section, but among the 15 slots for activities, you can designate up to 3 as your “most significant” activities.

Of course, there can be overlapping between the letters. For example:

• My PI wrote me a science + research (i.e., significant activity #1) letter
• My Math professor wrote me a science + teaching (i.e., significant activity #2) letter
• My supervisor at a clinical volunteer program wrote me a clinical + leadership (i.e., significant activity #3) letter

It is important that these MUST be STRONG letters. In other words, when you ask a person to write a letter for you, you have to be explicit: “Can you write me a strong letter of recommendation for medical schools.” If you get a letter from a person who does not know you too well, it can negatively impact your application because they cannot vouch for you as much – which is not anybody’s fault because you two did not know each other well in the first place.

For medical school, science disciplines include Biology, Chemistry, Physics, and related fields (e.g., molecular biology, microbiology, etc.). Schools often count “Mathematics” as a science, but a few do not (and I do not understand why so just be careful when you submit letters to each school).

This letter can come from a professor in a field that is not regarded as a “Science” discipline. Examples include Economics, English, Literature, Music, etc.

Not necessarily. If you know your professor really well, it doesn’t matter if it’s an upper- or lower-division course.

There are obvious benefits to obtain letters from professors whom you had upper division courses with. The classes tend to be smaller, and instructors tend to like their topics better than with lower-division courses. As a result, you get more opportunities to build a relationship with these instructors. Plus, you get to showcase your strengths in a more advanced setting (given that you do well in the class, of course).

With that being said, the opportunities are not always there. English-major students are less likely to take upper-division Biology courses, and Physics-major students are less likely to take upper-division Sociology classes. As a result, make the best use of what you have. For an English-major student, that may mean 2 lower-division science letters + 1 upper-division English letter. And for a Physics-major student, that may mean 2 upper-division Physics letters + 1 lower-division Sociology letter. You can try to take extra upper-division courses if you want (and there is a potential that you can get a good letter out of it), but just remember that your schedule is limited, so weigh the risks and benefits. AT THE END OF THE DAY, HOW WELL YOU KNOW AND YOUR INSTRUCTOR KNOW EACH OTHER MATTERS MORE THAN IF IT’S AN UPPER- OR LOWER-DIVISION CLASS.

For students with a science major, many of them end up submitting a letter from a professor whom they had a GE class with. If you are in this situation (i.e., having a science major), you need to realize that your GE courses are very important, and it is crucial that you pick those that you are genuinely interested in, so you can put more time and efforts in to not only learn about the discipline but also know the instructors.

Ideally, the letters should come from faculty, and not teaching assistants. This is NOT to say that teaching assistants cannot write strong letters. The distinction exists here because when someone writes “Person A is among my top 5 students,” that statement has more weight from a faculty who has seen 500+ students, compared to a teaching assistant who only taught like maybe 50 students.

I was told that co-sign between faculty and teaching assistants is strongly discouraged. To some, this can be an indication that the writers are not too confident about their knowledge of you that they need to a co-signer on the letter.

However, if you are out of options, make the best of what you have. For example, if your option for the non-science letter is between (1) a professor of a Psychology class (300+ students) which you happen to get an A in without knowing them at all, and (2) the teaching assistant of your Writing class (~10 students) whom you had a great relationship with (and you obviously did well in the class), maybe consider the teaching assistant. Get it co-signed if that is what it takes.

It obviously takes a lot of time and efforts, but some basic things that you can attempt:

• Come to office hours at least once a week (there is absolutely no necessity to go to every single one)
• Ask questions and/or discuss your particular interests related to their field during their office hours (but please, don’t try too hard to impress or show off)
• When the class is over, thank them in person
• If opportunities to work with them are present, take them if your schedule permits (e.g., serving as a Teaching Assistant, Learning Assistant, etc.)
• Try to stop by their office just to say hi every once in a while, maybe once a quarter, once a year (even though you should approach this carefully during this time of COVID)

The answer is it depends.

The conventional practice is that you ask when it comes closer to your time to apply to medical schools. I chose this route because:

• I worked with many of my letter writers for many years, and at the time of applications, I was still working with the majority of them. They know me (and vice versa) very well.
• For one of the writers, I took his class very recently (~6 months from the time of applications), and I was sure that I made a strong enough impression on him that he would not forget who I was.

There is also a safe-ish practice that might work well for instructors whom you took classes with but would never work with (because of no overlapping in work interest). Examples include lower-division classes. What you can do in this case is:

1. After you finish the class, ask them to write you a STRONG letter.
2. Ask them to submit the letter to Interfolio – this is what most people use for medical school letters anyway.
3. It is free to keep the letters on the cloud. The year that you are applying, you only have to spend $50 to get that option to send to AMCAS.
4. Maintain a good relationship with the instructors throughout.
5. When it comes to the time to apply to medical schools, ask them to revise their letter (or at least update the date written on the letter) and resubmit it to Interfolio.

• Via this safe-ish practice route, they will write the letter when their memories of you are still fresh. You can ask them to write the letter and save it on their local hard drive. However, you are running the risk of them changing computers and wiping their hard drives (along with their letters for you). This happened to me with one of the writers (who also wrote a letter for my M.S. application). Thankfully, they know me well enough to rewrite from scratch. Also, you also do NOT get to see their letter anyway because Interfolio will not let you, so confidentiality is not an issue.

Medicine is a long and hard journey that not only requires an incredible amount of skills and emotional intelligence but also asks for a lot of patience and perseverance. Due to this long and difficult training process, medical school needs to know that once they admit you, you will not quit on them halfway and leave a spot vacant that could have gone to someone else. After all, physicians are treasured resources that our society always needs more of.

As a result, it is incredibly beneficial to have someone – who knows you in a clinical setting – to vouch for both your capability as a future clinician and your dedication to the field.

It is highly recommended that you obtain this letter from a physician, such as an M.D. or a D.O. In fact, many D.O. schools will ask that you submit a D.O. letter.

However, it is NOT required that you have a letter from a physician. For example, I submitted a letter from my supervisor from my clinical volunteer activity.

As mentioned, it will be wise to obtain a letter from each of the faculty mentor or supervisor for each of your “most meaningful activities” – specifically those that you designated as “most meaningful” on the AMCAS application. This rule obviously does not apply to the student organizations that do not have any faculty mentor. And obviously, just because you asked for a letter doesn’t mean that you have to submit it to the school (in fact, you can specify which letters to be sent to which medical school that you are applying to). More on that in the AAMC Application section. Some examples include:

• The supervisor of your part-time scribing job
• The supervisor of your part-time teaching job
• The supervisor of the social justice advocacy group that you are active in
• The coach of your intercollegiate sports team
• The director of your music group
• Etc.

Obviously, there can be overlaps with other letters. In my case:

• My PI wrote me a science + research (i.e., significant activity #1) letter
• My Math professor wrote me a science + teaching (i.e., significant activity #2) letter
• My supervisor at a clinical volunteer program wrote me a clinical + leadership (i.e., significant activity #3) letter

Depending on your plan after college, you might feel the need/will be asked to submit additional letters. For example:

• A letter from the supervisor of your full-time job after college
• A letter from the advisor of your graduate study
• Etc.

The requirements vary from school to school, so make sure that you check for EACH school that you are applying to.

I will recommend that you should ask at least 1 month in advance, if not a lot more. Generally, letters are not due until the submission of secondaries. However, to be safe, it is strongly advised that you have all of the letters ready by the time you submit your primary application. Some letter writers are aware of this nuance, so for them, please do not try to argue with them about the deadlines. For most others, I recommend that you ask them at the beginning of March for a letter and then have all of those letters ready by June 01 of the cycle that you are applying.

You might even ask as early as early January. Some faculty members do get a lot of requests (e.g., I heard one who got 70 requests by the end of February). As a result, you could just ask your letter writers early. Then, if they tell you to come back with the request at a later (specific) time, you can follow exactly what they said.

Usually, I just asked for a letter, then the writer has the freedom over the content.

However, if you want, you can have a discussion with the writer about what you think the letter should focus on. AAMC published a List of 15 Competencies that are expected of entering medical students:

• Interpersonal:
  • Service Orientation
  • Social Skills
  • Cultural Competence
  • Teamwork
  • Oral Communication
• Intrapersonal:
  • Ethical Responsibility to Self and Others
  • Reliability and Dependability
  • Resilience and Adaptability
  • Capacity for Improvement
• Thinking and Reasoning:
  • Critical Thinking
  • Quantitative Reasoning
  • Scientific Inquiry
  • Written Communication
• Science:
  • Living Systems
  • Human Behavior

For example, you can ask:

• Your PI to write about the “Intrapersonal” and “Thinking and Reasoning” part
• Your Clinical Volunteer Supervisor to write about the “Interpersonal” part
• Your Biology Professor to write about the “Living Systems” part
• And your Ethics Professor to write about the “Human Behavior” part

You might be able to suggest topics, but the final decision is up to the letter writer. For some writers, you might find it helpful to send them a printable copy of this AAMC Guidelines for Writing a Letter of Evaluation for a Medical School Applicant.

For myself, as mentioned, I chose to respect the writers’ freedom to choose whatever they want to write about.