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  • Advice on writing LOR

    I am academic-adjacent (community hospital with FM residency, med students rotate through). One of my students has asked me to write a LOR for fourth-year clerkships and for residency. I'm happy to do it - but I've never written a medical student LOR before.

    Would appreciate any suggestions from those of you who routinely write or read LORs. Do you use a template? Specifics you try to incorporate (context in which I precepted, # of patients etc)? Anything I should avoid?

    If you read a lot of LORs: what makes one stand out to you? anything you find helpful?

    Thank you in advance!

  • #2
    My general template:

    First paragraph: how I know/worked with the Med student, some info on the applicant’s background and interest in the field (taken from discussions with the student + their personal statement)

    Second (and sometimes third, for students who I worked with a lot and were truly impressive) paragraph: why I think they are a great candidate with fairly concrete examples, specific strengths i have noted. I make this as specific as possible so it’s clear this isn’t a generic thing I say about everyone.

    Last paragraph is generally something along the lines of “I highly recommend x for postgraduate training in x field. S/he is a pleasure to work with and is an excellent candidate for residency training in X. I look forward to having him/her as a colleague in the future”

    if I can’t say the above with complete honesty I politely decline the letter request and tell the Med student I have not worked with them enough to write a strong letter.

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    • #3
      to what specialty are they applying?

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      • #4
        The thing that makes them stand out is if they seem personal. It was typically a negative when I read applications for med school/residency that couldn't impress one person out of 3-4 to write a genuine comment about them. There is also some responsibility of the letter writer to put forth the effort, but if one can't write a decent LOR for a student, then they should decline to write it.

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        • #5
          Originally posted by Anne View Post
          My general template:

          First paragraph: how I know/worked with the Med student, some info on the applicant’s background and interest in the field (taken from discussions with the student + their personal statement)

          Second (and sometimes third, for students who I worked with a lot and were truly impressive) paragraph: why I think they are a great candidate with fairly concrete examples, specific strengths i have noted. I make this as specific as possible so it’s clear this isn’t a generic thing I say about everyone.

          Last paragraph is generally something along the lines of “I highly recommend x for postgraduate training in x field. S/he is a pleasure to work with and is an excellent candidate for residency training in X. I look forward to having him/her as a colleague in the future”

          if I can’t say the above with complete honesty I politely decline the letter request and tell the Med student I have not worked with them enough to write a strong letter.
          I've written dozens of LORs and generally followed this template, but then I heard (at least in Ortho) that residency and fellowship program directors have their own key phrases with understood meaning that are placed at the end of the letter to communicate with other directors their true level of recommendation (e.g., "qualified" vs "highly recommended" vs "best of the best" etc). I was never a program director so I don't know if this is true.

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          • #6
            APD for competitive specialty - "highly recommend" vs. "highest possible recommendation" vs. "top X med student I've ever worked with" is different. Everyone's say at least "highly recommend"

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            • #7
              Originally posted by CrockettsRiver View Post
              I am academic-adjacent (community hospital with FM residency, med students rotate through). One of my students has asked me to write a LOR for fourth-year clerkships and for residency. I'm happy to do it - but I've never written a medical student LOR before.

              Would appreciate any suggestions from those of you who routinely write or read LORs. Do you use a template? Specifics you try to incorporate (context in which I precepted, # of patients etc)? Anything I should avoid?

              If you read a lot of LORs: what makes one stand out to you? anything you find helpful?

              Thank you in advance!
              Here is an example of a standardized letter of recommendation used in a competitive specialty. It has pros and cons, but gives you an idea of what to write about.
              Attached Files

              Comment


              • #8
                Originally posted by BruinBones View Post

                I've written dozens of LORs and generally followed this template, but then I heard (at least in Ortho) that residency and fellowship program directors have their own key phrases with understood meaning that are placed at the end of the letter to communicate with other directors their true level of recommendation (e.g., "qualified" vs "highly recommended" vs "best of the best" etc). I was never a program director so I don't know if this is true.
                This sounds like a neurotic Med student rumor.

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                • #9
                  Originally posted by wa2106 View Post
                  APD for competitive specialty - "highly recommend" vs. "highest possible recommendation" vs. "top X med student I've ever worked with" is different. Everyone's say at least "highly recommend"
                  Yes to this!
                  ive only used “highest possible recommendation “ , still looking for the “top 5 medical student” lolol

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                  • #10
                    Originally posted by GastroMastro View Post

                    This sounds like a neurotic Med student rumor.
                    May sound that way but it's true. First and last paragraphs normally have code phrases. "I have been asked to write a letter for ____" is totally different from "it is my true pleasure to write this strong letter of recommendation for _____".

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                    • #11
                      Sort of related: it is my opinion that letter writers have the responsibility of being honest with students and telling them they cannot write them a good letter due to “x”...bc some medstudents may not know which attending is best to ask or may think they’ve impressed an attending but actually are only in the “highly recommend “ category....

                      case in point: here I am 3rd yr medstudent. Had met monthly for the previous 3 yrs with the chair of the Dept I was applying to who was also past president of that specialty board. He was a big deal, everyone knew him. Every medstudent who was applying to specialty wanted to rotate with him obviously so to make it fair there was a lottery, so I did not get one of the few spots. I ask him for a letter when the time comes as I thought he could speak to my character and interest in the field, he agrees. He even calls a few programs to personally recommend me. At one of my interviews, the interviewer leaves for a sec, I glance at his desk and see letter of rec from said writer literally right in front of me, so I read it. It stunk.
                      I still remember it ....
                      “__ asked me to write a letter and I agreed. I have not personally observed him during rotations but his evaluations state his procedural skills to be good to very good. He would make a fine addition to any program.”
                      There was more but this was the jist.
                      My 2 other letters were fantastic (I know bc the letter writers forwarded them to me).
                      My point is please don’t just write a letter out of obligation if it’s going to stink. Be honest with students.

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                      • #12
                        “My point is please don’t just write a letter out of obligation if it’s going to stink. Be honest with students.”
                        This.

                        Referencing Anne’s outline, the personalized paragraph(s) make a difference. Face it, attending interact more with fellows and residents. Take the time get the info to illustrate the story. Boilerplate gets a quick scan. A personal story gets read and makes the LOR standout.

                        The points about the wording are valid. Be honest but be willing to promote your product. You trained them. LOR for a med student is much harder than for a fellowship. You don’t know them as well. Get to know them and be honest. The LOR is required for them, not for you. You should be willing for them to review it and use someone else. Additionally, you should be willing to make a call if asked.

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                        • #13
                          Thanks so much for your responses - exactly what I needed!

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                          • #14
                            if you want to help the student (you think they are someone you would actually recommend) i would shoot for a narrative structure with a story about something the student did really well.

                            i'll be honest, letters written by people who don't write many letters are of very shaky value. this is one of the reasons why the EM standard letter requires the writer to indicate not only how many letters they wrote last year but also provide last year's grade distribution. if you write 1 letter a year and you always give honors, you are not really capable of providing a useful assessment of a student.

                            also if you are in a primary care specialty remember that FP/Peds are kind of notorious in the LOR space for describing every student as the best student they have ever worked with.

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                            • #15
                              Originally posted by PedsCCM View Post

                              May sound that way but it's true. First and last paragraphs normally have code phrases. "I have been asked to write a letter for ____" is totally different from "it is my true pleasure to write this strong letter of recommendation for _____".
                              Yes, I don’t doubt that the two examples you provided are vastly different and clearly show the letter writers interest or lack thereof. Completely agree.

                              I still don’t think it’s a ‘code phrase’ which implies pre-ordained coordination and agreement among program directors

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