Reference letters are a critical component of medical school applications because they provide the selection committee with an external impression of your personality. Using the personal profiles, essays and questions of the core application, you are given the opportunity to create a polished idealization of yourself. In the essays and personal statements are your opportunities to accentuate your strengths and downplay your weaknesses; to shape your personality, skills and desires into a form that epitomizes your essence and fits in with the medical school’s requirements. Unfortunately, we tend to be biased when we look at ourselves, and in our often hyper-competitive pre-med mentalities can manipulate our accomplishments to seem more impressive than they truly are. The selection committee knows this very well. The reference letter is their sole of way of viewing you through the perspective of others. Your reference letters can make or break you. They can highlight your illustrations, or bring light to the irregularities of the brush strokes. For this reason, it is imperative to choose your reference letters with care. Here are some guidelines for attaining solid reference letters.  

 Nurture Relationships

 Obtaining good references takes advanced planning. If you are planning to apply to medical school at the end of university, you should be building relationships with potential references by the end of your freshman year or the start of your sophomore year. This is not to say that you should use professors, physicians and other potential-references with the sole intention of obtaining a reference letter. While most people can sense manipulation, those who work with pre-meds are especially sensitive in detecting insincerity. By nurturing your academic relationships, I don’t suggest befriending professors with a smarmy attitude, instead I believe that professional and academic relationships must be based on genuine intentions and true respect for your potential reference.

 In the course of your university career, you are going to inevitably find interests in certain courses and fields or research. You may need help with course material. You may want to discuss a case study or the ethics behind a procedure. For this, you may turn to your professor. In shyness, students may be afraid to ask questions in-person during office hours or after class. Others may not wish to invest their time in seeing a professor in person. Many students settle for the alternative of sending an impersonal email to their profs to get a query addressed. However, this does not foster any sort of relationship. Instead of doing this, make an effort to get to know your profs. Go to office hours or ask questions after class. Introduce yourself and tie in how your interest with the course relates to your future academic goals.

 From these academic interactions, you will find that while professors can appear intimidating, many are open to students who truly want to learn. Don’t force yourself to start a relationship with a potential reference because you think their high rank or impressive sounding course will reflect well in a letter. Develop academic relationships with people who you are genuinely interested in talking to. A mutual interest for the material will forge a strong connection. If you make your name and face known, and are able to convey a genuine interest in the academic material, then you are on your way to obtaining a good reference letter. While I make the reference letter seem like the endpoint, make no mistake, it is only because the focus of this article is the reference letter. The endpoint of these interactions is actually to increase your knowledge in subject in which you are interested. The attainment of a reference is a useful but ancillary benefit.

 Diversify your selections

 Well-roundedness is a key criterion in gaining the selection committees attention. Try to show your well-roundedness in the people you choose to be your references. While requirements may vary from school to school, you will typically be asked to provide three letters. One of the most important references to have is a physician. This will show that you are interested enough in the profession to explore it with someone who knows the ins and outs of the career. While not a mandatory requirement, having a physician vouch for you will make you seem like a more serious candidate. After all, who can testify to your qualifications better than someone who knows the job well and can judge whether you really have what it takes to do it?

 Having a professor write your second letter is often impressive. This will emphasize your ability to learn, your love for academia and your desire to expand your knowledge. Choose a professor for a course that you loved and got a lot out of. Your interest in the course will definitely shine through in the letter and your prof will be far more likely to write fondly about you.

 I like to call the third letter the wildcard letter. Pick someone that meant a great deal to you. If your passion is research, pick a research supervisor you have worked with. If you love volunteering, ask your organization or a member you have particularly influenced to write a letter for you. While the first two letters can be very standard, let your creativity show through on your third. While a completely unconventional letter—such as one from the Prime Minister, or from a little child you volunteer with through Scouts—may help you stand out, it can also increase skepticism of your seriousness. The reaction really depends on who is looking at your applications. You can take a risk with your letters and you would be surprised at how often risky ideas are paired with committee members who relish the freshness. However, a risk is still a risk—especially in a field like this with limited calculations to base your decisions on. In the end, it is important to choose someone who knows you well and will write honestly about you. It is important that in their honesty, they can find nothing but good words.

 Formatting

 Keep your letters to 1-2 pages. One page is most preferable. After reading piles of applications, succinct letters start to look more and more appealing. Give your reference an approximate page limit. Always try to get letters on letterhead. If you choose to be creative—as with the example of the child—ask the organization and his/her parents for permission. Along with the child’s letter you may want to enclose—in the same envelope—a letter from the parent or organization briefly explaining your connection to the child and a general overview of your importance to the organization. Reference letters not written on overhead appear unprofessional and may give the impression that a family member or close friend wrote a letter for you. This makes you appear less like a serious candidate and raises questions about your lack of relationships in the professional world.

Content

 Well-roundness can also be expressed through content. There is nothing more flattering than having your academic reference also talk about what a kind and generous person you are, as well as a tremendous student. Likewise, there is much credence in your volunteer supervisor knowing that you are also a varsity athlete and that it takes time, commitment and excellent time management skills to ensure that between homework and practices, you can make it to the soup kitchen. One way to ensure this scope of knowledge is through opening up to your references and telling them about your personal life. This is part of the fostering relationships step (See the first guideline). However, try as you may, it is not always possible to convey the extent of your commitments to your references without sounding self-centered.

 After asking someone to write a letter for you, you can provide them with a curriculum vitae of all of activities and ask them if could incorporate the idea of well-roundedness into their letter. Some students are shy to ask their references what to write about but sometimes references just don’t know what to say. Even professors and physicians ingrained in the academic world may not realize how much the application process has changed from their time. Non-medicine related references probably won’t have a clear concept of what medical schools are looking for. Do not be afraid to provide your reference with an outline.

 Provide them with a very general overview of what you would like them to touch upon. Make sure you plan an in-person meeting to have this discussion, so they can understand how important this letter is to you, and so they realize that you are trying to be helpful and not impertinent. A sense of appreciativeness during this speech, and a respectful and suggestive—instead of overbearing—tone will help you through the process.

 While it is up to you to gage the content you wish to include, don’t forget to highlight two important points: well-roundness and your ability to be a physician. Make sure all of your references know that this is a letter for medical school and that in the letter they should address the skills and qualities you have that would make you a good physician. Ask them to address how your interaction with them has helped them see specific characteristics in you, and how these traits will make you suited to medicine.

 While a glowing reference letter is flattering, broad phrases like “He was great volunteer in our organization”; or “She loves to learn”; or “He is very smart and loves to help people”, may show aspects of your personality, they don’t clarify why you want to go into medicine. Without clarifying thought, none of these phrases alone showcase your desire to study medicine; they do not convey a sense of the hard work and dedication you’ve put in specifically in medicine. Instead, ask your references to specifically make comments about why you would make a good doctor. This will help the selection committee know that your “love for helping people” is also tied in with skills specific to medicine, instead of making you a prime candidate for social work.

 Editing

 When you first approach your reference letter, ask in advance not only if you can discuss content with them, but also if you can read it over before they submit it. Some references will not be comfortable in doing this, but your polite asking will not usually sway their opinion of you, especially if you have developed a good rapport (and you should only be asking those individuals with whom you have a good relationship!). However, the ability to read over the letter will allow you to shape your letter. If a reference does not feel comfortable in changing parts of their letter or you do not feel like they know you well enough in some aspects of your life to comment on particularly important qualities, you will be able to try to fill these gaps in your other reference letters. Remember, the point of being about to read your letters is not so you can force a reference into creating a duplicate of your essays and personal statements. When the voice of a letter eerily resembles the voice of your personal statements, the committee is more likely to see you as overbearing and manipulative, or may believe you impersonated a reference in a self-written letter. The point of gaining access to letters before they are sent is to get an overview of what your complete application will look like. You can also emphasize points missed by your references in your personal written statements.

 Timeliness

 Give your references ample time to write their letters. Nothing reads worse than a rushed letter. Not only will the letter lack the elegance that only time and multiple refinements can bring, they will also reflect your reference's frustration with the time-pressure. However, if you give your references a long period of time to write a letter, make sure you follow up on the writing process.  

 Appreciation and Maintenance of relationships

 Do not discard your relationship as soon as the letter is polished and sent away. This makes your reference feel used and will cause them to harbor resentment for you, resulting in a loss of friendship. After your reference has written you a letter, make sure you give your thanks, not only verbally, but at least through a thank you card. A small token of appreciation, such as a box of chocolates are inexpensive, but showcase your gratitude. Continue to treat them with same dignity, respect and value that you always did. While this may appear to be common sense, many people—in the excitement of finishing applications—begin to neglect their professional relationships. However, it is important to maintain these relationships because you never know when you will need more reference letters in the future.