Today’s inane image of the day:
The last four months have been extraordinarily draining. I think the combination of being in the ICU in January [which is a bittersweet experience for me; on one hand, I love taking care of critically ill patients but on the other hand, the hours were long and the daylight hours were short], using all of my off days for either ACGME commitments, fellowship interviews, or AMWA103 planning made it difficult to stay balanced.
Cue the burnout.
Luckily, things started looking up the last few weeks. I won’t go into excruciating detail in this particular post about the struggles of the last few months [generally, I like to stick to the advertised entry title], but I will say that I’m feeling better about things overall.
Anyway, on to our topic for the day: letters of recommendation.
A little background
My first experience with asking for a letter of recommendation dates back to my Sophomore year of high school when I stumbled across an ad for the full-tuition scholarship program at Bard College at Simon’s Rock. I nervously prepared all of the recommendation materials [a generic form provided by the college and information on when I wanted my application to be complete] then waited until the end of class to approach my teachers. Things went well that time around – I was invited for an interview as a finalist for the scholarship program, then accepted the offer to drop out of high school and live in Great Barrington, MA [again, a great story for another time].
Since my scholarship only covered my first two years of college, I planned to transfer to another university. This meant – you guessed it – more requests for letters. I went through a similar process as two years prior and approached a few professors that I thought knew me well to write letters on my behalf.
Fast forward many application dollars later, despite a stellar GPA and test scores, I only received acceptances from a handful of schools I applied to. Luckily, one of those schools was the University of Michigan College of Engineering [which, by the way, did not require any letters of recommendation to process my transfer application].
I always knew I wanted to go to medical school, so I had mapped everything I needed to do in order to achieve this dream. I read the SDN forums religiously and based on advice from the forums, thought that it’d be important to include a letter from a basic science professor that I had taken multiple classes with while at Simon’s Rock [now having been on a medical school admissions committee, I find that there are no hard and fast rules about letters from specific people; it’s all about context]. In my request for a letter from this professor, I included a narrative about the activities I had been engaged in while at Michigan as well as the concluding statement asking for a strong letter of recommendation. That’s when I found out a toxic letter had been written for my transfer application.
I will never know whether or not the negative letter made a difference in my transfer admission decisions, but I hope none of you will ever have to experience the feelings of betrayal, frustration and overwhelming sadness that comes from the realization that someone you trusted was not forthcoming about their concerns for your candidacy. Ultimately, this professor wrote a strong letter on my behalf for medical school that led me to 3 acceptances, but it was still a lesson I had to learn the hard way.
So with that…
Tip 1: Always ask for a “strong” [or whatever your favorite grammatically appropriate synonym for strong is] letter
Based on my previous experience with a toxic letter, I highly recommend that you ask your letter writers outright for a positive letter. Most individuals will be honest if they do not feel that they know you well enough to write a strong letter. While it doesn’t guarantee that your letter will be fabulous, it’s at least one level of protection you can offer yourself.
Tip 2: Titles matter, but relationships matter more
Many individuals fall into the trap of finding the highest ranking person they have ever shared a small space with to ask for a letter of recommendation. In applications to residency, I’ve seen many letters from a Chair or Program Director of the specialty they intend to pursue. I’ve also seen that backfire when the applicant clearly had minimal interaction with these individuals on a clinical or research level. Unless there is a specific requirement [e.g. fellowships ask for a Program Director letter], it’s important to consider what your letter writer knows about you and whether they can speak to your qualities.
In anesthesia, it’s hard to figure out who to ask because you rarely work with the same person enough times to foster a relationship. On the flip side, it doesn’t take much time for someone to decide if they want to be stuck in an OR with you at 2am doing a hand case. Interpersonal skills matter a lot in our field and can go a long way when trying to make a good impression for a letter. I personally spent only a handful of days with an attending that ultimately called my current residency program on my behalf – interactions may be short, but they can mean a lot.
So when it comes time to select letters for any stage of the process, look for individuals who can speak to your strengths because they’ve actually had exposure to them.
Tip 3: Writing your own letter can be detrimental
Having now served on medical school, transitional year and residency admissions committees, I have read a wide variety of letters with numerous styles. Word choice can really matter in these letters; there’s often a lot of “read-between-the-lines” when committees review letters. Especially in a small specialty community [there may be a lot of anesthesiologists in this country, but it’s still a tiny field; everyone is connected to everyone, somehow], residency programs often receive letters from the same high-ranking individual for different applicants. Committees have learned how to read the implications of a letter. While one letter may conclude, “I recommend Jane Smith for a program in anesthesiology,” the next one may say, “I will be recruiting Jane Smith aggressively for our program in anesthesiology.” These statements mean very different things.
That all being said, there’s a hidden language to letter writing. Seasoned letter writers have learned the lingo and novice ones sometimes stick out like a sore thumb. Which is why when a letter writer asks you to draft your own letter of recommendation, it may seem like a great opportunity to highlight your extracurricular activities and research experience, but you’ll quickly realize how difficult it can be to write a letter on your own behalf. I mean, that’s why there’s a personal statement, right?
Tip 4: Be prepared with your CV, personal statement, submission instructions
Before you even ask for a letter of recommendation, make sure that your CV is updated, at least a draft personal statement is ready for review and you have specific instructions for the letter writer about how to upload the letter or where to send it. It saves everyone time if your letter writer does not have to ask you for specific things. Additionally, consider meeting with your letter writer one-on-one to discuss your application [e.g. applying broadly to medical schools, the specific reasons you’re interested in specific residency programs, some of the recent extracurricular activities you’ve engaged in, etc] and make an in-person request for the letter.
Tip 5: Set a deadline [but give ample time]
I don’t know about you, but I need a deadline to get things done. This has gotten progressively worse as I’ve advanced in my medical career. Think about how many requests your letter writers have received and everything else they may be juggling – clinical duties, career deadlines, family matters, personal issues. Realistically, your letter of recommendation will not be the top priority of the individuals you ask. Which is why it’s important to setup a concrete deadline for when you’d like your application complete. Don’t ask for a 2-day turnaround time – that can be seen as unprofessional and work against you – but give writers at least a few weeks. Something like, “I’m hoping to complete by application by April 31st, 2018. Do you think you’ll be able to submit my letter by then?” is a gentle way of asking if they’re up for your requested timeline.
Tip 6: Be professional
This should be a given, but it’s always good to have a reminder. Triple-check your CV, personal statement and emails for typos or grammatical errors. Be conservative in your tone. Think about how a stranger could misconstrue what you’ve written. Consider asking someone to proofread all of your materials before you send it out.
Tip 7: Follow-up with your progress
At minimum, a follow-up with where you received interviews or where you decided to go with a thank you included is common courtesy. Letter writers invest a lot of time and energy in you and often care about the outcome. Let them share in the excitement on your acceptances or match!
What other letter of recommendation tips do you have?