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Letters of Recommendation and Feedback

by Mohammad Hajighasemi-Ossareh, MD, MBA
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    00:00 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.

    00:34 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.

    00:51 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.

    01:01 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.

    06:29 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.

    07:07 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.


    About the Lecture

    The lecture Letters of Recommendation and Feedback by Mohammad Hajighasemi-Ossareh, MD, MBA is from the course Med School Year 4. It contains the following chapters:

    • Letters of Recommendation and Feedback
    • The Importance of Letters of Recommendation
    • Who and how to Ask for a Letter?
    • Lecture Summary

    Author of lecture Letters of Recommendation and Feedback

     Mohammad Hajighasemi-Ossareh, MD, MBA

    Mohammad Hajighasemi-Ossareh, MD, MBA


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