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Welcome back to the 4th Year of Medical School lecture series. In today's lecture, we're going
to discuss how to ask for letters of recommendation during your sub-internship. We're going to
discuss how to prepare for asking for a letter and thinking about who to pick when asking for a
letter. We're also going to talk about the importance of speaking with residents and attendings
during your sub-internship and asking for feedback. We'll also talk about the importance of having
a sense of timing when asking about letters in this whole process. Now, letters of recommendation.
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Why are they important? Well, when applying to residency programs, residency programs require
that you fill out a residency application and the contents of the application are actually
quite simple. They contain the academic record that just means your grades and USMLE scores.
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They ask for your activities and that means well what have you been doing during your time in
medical school, they'll ask for a personal statement and lastly they'll ask for letters of recommendation.
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So of the 4 parts of the application, one whole part is letters of recommendation. Now, arguably,
the academic record and the letters of recommendation are the 2 absolute most important parts
of your residency application. People really care about board scores and people really care
about what do attendings in the field of your interest think about you. As we discussed in
earlier lectures, the purpose of the sub-internship is to work hard and earn a strong letter of
recommendation that will support your residency application. In the world of medicine, we are
a very small group. Who you know actually matters and if someone within the field that you are
interested in is writing you a strong letter of recommendation for your residency application,
this is going to go extremely far and benefit you into the residency application process. So that
bags the question "Who and how do you ask for a letter?" Well, when it comes to "Who do you
ask for a letter, the general rule is to ask the most senior attending that you have extended
exposure with. You can ask a senior attending or the senior most person you can get your hands
on. The more prestigious the person who writes the letter, the better, and by prestige we mean
title. So chair, it will be more prestigious than associate professor. The next component you
need to think about when thinking about who to write it is "Has that person actually has had
some degree of clinical exposure when working with you? Do they think of you as a doctor? Have
they seen you being a doctor?" The more you work with someone, then more they know about your
skills, your strengths, your weaknesses, and the better and more detailed letter that they can
write. Now, when you're thinking about who to ask for a letter, make sure to speak with the
residents on your service and ask them "Hey, which attendings do you know that are more friendly
towards medical students and have a history of writing strong letters for people?" They will
provide you with this kind of strong insight. Now, once you figure out who you want to ask for
a letter, the question becomes well, "How do you do it?" and this is a bit more complex. With
respect to the actual timelines, it's best to ask for a letter of recommendation during the last
week of your sub-internship. Now, the key to having someone write you a good letter is that
you need to show improvement. If you show improvement and even if you were horrible but you
improved that looks great and if you were already great and you even got better, great. Improvement
is the key. What you can do is that in the middle of your rotation you should make sure to ask
both the residents and the attendings for feedback. This is very important. If you weren't
listening, listen now. You need to ask residents and attendings in the middle of your rotation
for feedback and this is expected. Asking for feedback shows that you're interested in growth
and also allows you to learn and grow. This is better for your self. From the date in the middle
of your rotation that you ask for the feedback, make sure that you actually make and implement
the changes they gave you the feedback for so that when you come to ask for a letter at the
last week of the rotation they can say "Hey, he met with me in the middle of the rotation, I told
him to do a few things and now it's the end when he actually did them. He's grown. He's shown
improvement." That's the key. When someone emotionally or subconsciously feels that you grown
and they feel like they have helped you grow because they gave you the recommendation and you
did it, that's a good feeling for them and subconsciously they're going to write you a stronger
letter. So, during the last week of your sub-internship on whatever day you choose at the last
week, have a sense of timing for this. Ask the attending after rounds if they have time to give
you end-of-rotation feedback. Now, since you ask for feedback in the middle of the rotation and
you're asking again now at the end, they will see that you are interested in growing and
self-development. When they are giving you feedback at the end of the rotation, at some point,
ask your attending, thank them for their feedback and ask them "Excuse me can you write me a
strong letter of recommendation." Now, I didn’t just randomly say the word strong, I want you
to really use that wording. Don't say "Hey, if you don't mind can I have a letter?" No, that's
ridiculous. Ask for a strong letter, say "You know what, it's really been an honor working with
you. I really enjoyed how much you teach, you spend some time with me. Can I ask you for a
strong letter of recommendation to support my residency application?" Now don't come off too
aggressive but you need to use that wording because saying you want a strong letter sets it
in their mind that this guy has expectations. He wants me to write something good, I got to do
that for them. Now, make sure you mention kind of like how I gave the example that you would
be honored to have them write you a letter and support your application and that's the key. If
an attending is taking the time to support your application and residency, they're really putting
their name on the line for you and that's something that's very respected and honored. It's a
time-honored tradition. Now, make sure you have a sense of timing when it comes to this. Use
common sense. People these days are saying common sense isn't so common. I disagree. In the
medical school world, you guys are great. You have a great amount of common sense and you have
skill and I already know you have a sense of timing but let's just review for clarity's sake. When
you're on rounds with your attending and you want to ask for a letter, always think about timing.
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See when they are more available or when they sit down and talk with students. Think about
other times you seen students, round with them, say "Hey after rounds does he usually run off
and go somewhere else to the clinic or does he kind of hang around a bit?" Have a sense of when
is a good time that you can get the attending to sit down with you, talk, and have an unrushed
session. This is what you're looking for, that's the best time to ask for feedback and then ask
for a letter. Now let's summarize what we've talked about. Letters of recommendation are absolute
vital components to your residency application and they're absolutely looked at by committees.
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Speak with your team, the residents, the interns to ask and say "Hey, who would be the best
and most senior person to write me a letter? Who has written good letters in the past and likes
medical students?" Ask for a feedback midway through your rotation and again at the end but
make sure you implement the changes they actually recommend. Ask for a letter from an attending
who has spend some time with you and has gotten to know you and is impressed by your hard work
and knowledge base and make sure to have a sense of timing when you ask. You wanted to be unrushed
where you can get good feedback and ask for a letter. Best of luck. Thank you.