‘Tis the season…

…for residency applications.  Somehow this process keeps moving forward in a recurrent fashion even when I’m certain I’m not any older than I was when I first started as faculty 10 years ago.  Of course, I’ll do things every once in a while (see “run half marathon”) that remind me I am indeed 10 years older now, mostly because I’m slower and more sore the next day.

For those who are working on their residency applications, this time last year I provided some tips about writing personal statements.  That guidance all still applies.  I also left “have as many people as possible read your personal statement” off of the list, and that is also true.

However, there are other important pieces of the application packet, letters of recommendation being the one that often serves as the greatest differentiator between the many excellent applicants.

For students, here are things to think about when selecting your letter writers:

  • They will ideally be faculty who have worked with you closely in a clinical setting and can therefore speak to your clinical knowledge and skills.  When I am reviewing applications, I always slow down when someone can tell me that they directly worked with a student, particularly if they had fairly extensive contact in the clinical arena.
  •  A letter from a less-known junior faculty member who has worked with you extensively and can speak to that will usually hold more weight than a letter from a very famous senior faculty member who damns you with faint praise because they don’t actually know who you are.  There are some senior surgeons whose letters I almost uniformly ignore because they write the SAME LETTER for every student from their institution.  I scan to make sure it’s the same letter again (I have yet to be disappointed by this) then move on to the next letter.
  • You have a responsibility to ask someone if they can write you a “strong” letter of recommendation. If you were clinically mediocre and ask me if I will write you a letter of recommendation without clarifying that point, I may agree but you may not get the letter you would want.
  • Things to have ready when you want someone to write you a letter:  Your CV.  Your personal statement.  And I now always ask, “What do you want me to highlight in your letter about our time working together?”  That insures that I won’t miss the mark of how you are “marketing” yourself for residency.
  • Please give us plenty of lead time.  While I almost invariably get letters turned around within a week, I assure you that is rare!

Faculty members, don’t think you’re getting away without some advice as well.  Thoughts for you, from someone who reads many letters every year:

  • Please be very specific about how long and in what capacity you worked with the student in the clinical arena.  It helps if I know that they worked one-on-one with you every day for three weeks and that they had the opportunity to first assist with you in the OR; that letter provides me with far more meaningful information than one about a student who came to your clinic for two afternoons.
  • A comparator can be helpful.  Is this the best student you worked with this year?  In the last 5 years?  In the last 10 years?  Having a benchmark like this, recognizing that it is something you have constructed, can still be very helpful.
  • Is this student someone who you want as a resident?  If yes, say so!  If no, navigate this wisely (“I anticipate that Bob will excel in surgical residency and have a great career in academic surgery.” tells me that you think Bob is a great guy who will succeed, but he’s not necessarily the guy you always want on your team).
  • Don’t lie to try to “help” your student in the process.  When you do that and we get a resident who can’t perform anything like the student you described to us, you lose credibility.  In other words, don’t help the one at the expense of all of the future ones.  There are individuals whose letters I skip completely based upon historical experiences with people they recommended.  This also means that when you see me three weeks after Match Day, I do not want to hear, “Sally may struggle with you all…” after you wrote her a glowing, flawless letter.  Again, credibility.
  • If your student really is a superstar and has a blemish on his or her record, your letter can help me get your perspective on why we shouldn’t be worried about it as a long-term issue for them.  I don’t expect you to violate confidentiality, but it’s one way you can support a student who may have had a personal or professional rough spell and subsequently pulled it together to excel.

If you have other tips about LORs, I hope you’ll share them in the comments (or, of course, on Twitter!).