Reviewed and written by Jessica Freedman, M.D., former medical school admissions committee member at the Icahn School of Medicine at Mount Sinai.

As a faculty physician who served on the admissions committee at Mount Sinai, I personally read and evaluated thousands of letters of recommendation. I know which ones moved an application forward and which ones hurt a candidacy without the applicant ever knowing.

Before we answer some basic questions you likely have about medical school letters of recommendation, let's review the history and purpose of letters in medical school admissions.

Like everything about the med school admissions process, the letter of recommendation (LOR) has evolved from a fairly basic "stamp of approval" by a few teachers to currently, a letter of evaluation (LOE) that is more expansive.

The transition to the letter of recommendation to the letter of evaluation was deliberate and followed the "holistic review" trend. Medical schools have been thinking about admissions in terms of whether a candidate has demonstrated the competencies that are desirable in a medical student candidate — competencies that are required to be successful in medical school and residency. Increasingly, medical education has been thought of on a continuum from undergraduate (medical school years) to graduate (residency years) and beyond to fellowship training.

Keep in mind that many people use the terms letter of reference and letter of evaluation interchangeably.

Medical schools have slightly different requirements, but, generally speaking, you will need to have a minimum of three school recommendation letters which must include two science letters. Most medical school applicants send in four to five letters of evaluation. AMCAS allows students to send in a maximum of ten letters of reference. However, most medical schools have limits on the number of letters you can submit with the most prestigious medical schools allowing you to send up to six letters. MedEdits' nontraditional or very highly accomplished students routinely submit up to six letters of evaluation when allowed.

How many letters of recommendation do I need for medical school?

You need a minimum of three letters for most medical schools, and at least two of those should come from science professors. Most applicants submit four to five letters of evaluation, and the maximum varies by system.

The maximum number of letters you can submit, and how you submit them, depends on your application system:

Keep in mind that most schools accept fewer than the maximum, and the most prestigious programs typically allow up to six. MedEdits' nontraditional or very highly accomplished students routinely submit up to six letters of evaluation when allowed.

What are medical school admissions committees looking for in letters of recommendation?

Admissions committees want your letters to demonstrate the professional, thinking, and science competencies the AAMC has defined, everything from your critical thinking and scientific reasoning to your empathy, reliability, and teamwork. They are looking for evidence of who you are beyond your grades and scores, and they value writers who can compare you to other students they have taught or supervised.

Professional Competencies

• Commitment to Learning and Growth
• Empathy and Compassion
• Ethical Responsibility to Self and Others
• Interpersonal Skills
• Oral Communication Skills
• Reliability and Dependability
• Resilience and Adaptability
• Self Awareness
• Service Orientation
• Teamwork and Collaboration
• Understanding Others

Thinking and Reasoning Competencies

• Critical Thinking
• Quantitative Reasoning
• Scientific Inquiry
• Written Communication

Science Competencies

• Human Behavior
• Living Systems

Admissions committees also value comparison information highly. What does this mean? They want to know how you compare to other students or co-workers within context.

Who should write my medical school letters of recommendation?

Your ideal portfolio is four to six letters: two from science or math professors, one research letter from a principal investigator if you have done significant research, one from a non-science professor, and one clinical letter, ideally from a physician. The two science or math letters are the most important in your portfolio. (Keep in mind that TMDSAS allows a letter packet or a maximum of four letters.)
Two letters from science or math teachers or professors, meaning any letter from a biology, chemistry, physics, or mathematics teacher or professor. These two letters are the most important letters in your portfolio.

• One research letter from a principal investigator. A research letter can be as important as your science and math letters if you have done significant research.

   

• One non-science or math teacher or professor. Many medical schools require a non-science letter.

   

• One clinical letter, ideally from a physician. For osteopathic applicants, this clinical letter should be from an osteopathic physician. Unless your letter is from an academic physician, keep in mind that this letter won't have a huge impact but can serve more as a character reference.

  If you majored in something other than science or math, we suggest that your non-science letter be from a teacher or professor within your major. If you attend a large university and know your teaching assistants better than your professors, you can ask the TA to write the letter and have the professor cosign it.

  By the same token, if you did your research primarily with a lab assistant or postdoc and had little contact with the principal investigator, ask the person you worked with most closely to write the letter and have the PI cosign it. Additional letters from extracurricular mentors mainly serve as character references, and while they don't hurt your candidacy, they won't be overly influential.

  Keep in mind that individual medical schools may have specific requirements, so be sure to check each school individually.

What does it mean to waive my right to see my letters?

Waiving your right means you agree not to read what your writers say about you, and you should always waive it. Writers give more honest and more valuable evaluations when they know the letter is confidential, and committees trust waived letters far more. Then keep the rest, and this is one of the three answers where your committee-member sentence will go.

Do I need a medical school committee letter?

Yes. If your school offers a premed committee letter, you should qualify for it and submit it, because its absence is a red flag to admissions committees. Then keep your guidance on following the committee's process and treating that office professionally.

How do I ensure I have the best letter profile?

The strongest profile covers you from several angles, so that together your writers can speak to you as a learner, a researcher, an employee, and above all as the kind of person your future patients will meet. Then keep the point that letters should add what a transcript and activity list cannot.

Do professors ever write negative letters of reference?

Rarely. A professor would only write a negative letter in the unusual case that they genuinely believed you were unfit for medicine, and most writers who cannot support you will simply say so when you ask. Then keep the rest as is.

Should I get a letter from a "big name?"

Unless you have had direct contact with the "BIG NAME" in a work, academic, scholarly or extracurricular setting, and he or she can write about your distinguishing qualities and characteristics, a letter of this type can actually hurt your candidacy and be seen as disingenuous. As an admissions officer at Icahn, when I say a letter from a "big name" but it was clear the writer hadn't actually worked with the applicant, I saw this as a red flag. Applicants should not get letters from someone with whom they haven't worked or does not know them well. Medical school admissions committee members want to read letters from people who can truthfully discuss your accomplishments, characteristics, and attributes.

Which letters of recommendation are most useful?

The most useful letters come from advisors and from writers who know you well enough to compare you meaningfully to others, which is exactly what the AAMC's own analysis found. Then keep your recommendation to use the AAMC guidelines with your writers, and this is the third spot for your committee-member sentence.

When should I ask for my letters of recommendation?

Ask as early as you reasonably can, and ideally request all of your letters by April of your application year. The more lead time you give a writer, the more thoughtful and timely the letter. Then keep your example about asking a fall professor as soon as the course ends.

How do I ask for letters of recommendation?

How you ask depends on your relationship with the writer and their style, but the essential step is the same: ask directly whether they can write you a strong letter, then offer your CV, personal statement, and the AAMC guidelines to make it easy. Then keep your in-person versus email guidance and the sample email.

SUBJECT: [YOUR NAME]: Letter of evaluation
Dear Professor X,
I hope you are doing well. I am applying to medical school this summer and I was hoping you would be willing to write me a strong letter of evaluation. I really enjoyed your course in genetics and feel it gave me a firm foundation that will help me in medical school. I would be happy to meet with you and can send you my CV, personal statement, transcript, the AMCAS letter guidelines or anything else that might be useful. Thank you for your time and consideration. I look forward to hearing from you.

Sincerely,
[YOUR NAME]
[YOUR PHONE NUMBER]

How do I nudge my letter writer?

If your letter has not reached AMCAS about two weeks after you submitted, and you gave the writer at least two weeks of notice, send a gentle, polite email reminder. 

Consider sending an email like this:

Dear Professor X,
I hope you are enjoying the start of summer. I am happy to report that I sent in my medical school application two weeks ago. I know how busy you are, so I wanted to make sure you are still able to write me a strong letter of evaluation in support of my candidacy. Please let me know if there is anything I can do or if you need any further information.
Thank you for your consideration and time.
Sincerely,
[YOUR NAME]
[YOUR PHONE NUMBER]

How do I thank and follow up with my letter writer?

Once your letter is received, send a brief thank-you and keep the writer updated through the application season. Here is a sample:

Dear Professor X,
I wanted to thank you for taking the time to write my letter of evaluation for medical school. I value your endorsement of my candidacy. I will be sure to keep you posted as the medical school application season progresses.
Enjoy your summer.
With gratitude,
[YOUR NAME]

Then, be sure you keep in touch with your letter writer throughout the application season!

What if I am asked to write my own letter of recommendation?

If a writer asks you to draft your own letter, which is increasingly common because professors are stretched for time, write it using the AAMC letter guidelines as your framework If you need further guidance on how to write a stellar letter of evaluation, contact us.

By what date should my letters be sent?

Ideally, you want your letters of evaluation to be received when your secondary applications are sent in or earlier. Since medical schools won't review your application until the secondary application is received, you don't need to stress if your letters haven't been sent in by the time you submit AMCAS. That said, do not let this delay requesting your letters of reference since it takes some letter writers quite a long time to compose letters. In the ideal world, your letters should be sent in when you submit your medical school application.

How are my letters of recommendation stored and sent to medical schools?

Your letters reach medical schools one of three ways: through your college's committee or prehealth office as a packet, uploaded directly to AMCAS through the AMCAS Letter Writer application, or through a dossier service such as Interfolio or VirtualEvals. 

Does AMCAS need to have all of my letters for my application to be verified?

No. AMCAS will process and verify your application even if your letters have not yet arrived, and your letters are then forwarded to schools on a rolling basis as they come in.

If I am a reapplicant, do I need to resubmit my letters?

Yes. AMCAS does not store letters between cycles, so reapplicants must have their letters resubmitted.

What are the most common medical school letter of recommendation mistakes?

The most common letter mistakes are letters that are bland or generic, and letters from writers who clearly don't know the applicant well. Both quietly weaken a candidacy, and I saw them constantly when I read applications on the admissions committee.

The biggest mistake I would see was the bland or lukewarm letter, the kind that simply listed a student's responsibilities or recited the specifics of a class and a grade. These letters hurt applicants, because they offer no compelling evidence that the student is unusual or exceptional in any way. A committee reads dozens of letters in a sitting, and one that only confirms what the transcript already shows adds nothing and can signal that the writer had little genuine enthusiasm.

The other big mistake was the letter from someone who obviously did not know the applicant at all. These letters read as generic, often clearly a template the writer had used for many students, and they say nothing distinctive. A letter like this is a missed opportunity at best and a red flag at worst, because it suggests the applicant could not find someone willing to advocate for them personally.

Another poor decision I saw often was the letter that simply repeated what was already in the student's application or personal statement and told me nothing new about the applicant. A letter is valuable precisely because it offers a perspective the rest of the application cannot, so when a writer only echoes the personal statement, it wastes that opportunity and makes clear the writer did not put much effort into the letter.

A final consideration, looking ahead, is the growing use of AI to generate letters of recommendation. As more writers lean on AI to draft letters, I expect many of these letters to read as generic, and a generic letter, however polished, is far less likely to move the needle than one written from genuine, first-hand knowledge of the applicant. If a writer offers to use AI or asks you to provide a draft, do everything you can to give them specific, personal material to work from, so the final letter reflects who you actually are rather than a template.

Can I read a sample medical school letter of recommendation?

Yes! See below for a sample medical school letter of recommendation.

Dear Admissions Committee Members,

I am writing this letter on behalf of Sarah Smith who is an applicant for medical school. I have known Sarah for two years. I have directly supervised Sarah as she has worked as a medical assistant in my internal medicine office and has shadowed me as I evaluate patients. During the summers Sarah worked full time, and during the school year, she worked on Saturday and one evening per week.

Sarah's primary responsibilities in my office were to greet patients, use our electronic medical record to document visits, and help patients check out. Once Sarah became EMS certified six months ago, she started helping our clinical assistants and nurses take initial vital signs during patient visits. As a shadow student, Sarah observed me as I cared for patients when they were willing to have an observer.

Sarah has many qualities that I believe will make her an outstanding medical student and physician. First of all, she is intellectually curious and independent reading about patient diagnoses on her own. She would also ask questions that demonstrated insight and an ability to quickly synthesize information. From time to time Sarah and I would also discuss what she was studying in college, and, even though I was rusty on everything she was discussing, the conversations were engaging and showed her commitment to her studies.

Sarah also has the compassion and empathy that all physicians should possess. Patients would often comment that she was kind, understanding, and listened attentively. At holiday time, Sarah received many gifts from grateful patients. She is the only young student I have worked with to be acknowledged in this way. I also saw that she had a unique ability to connect with patients because she was open, authentic, honest, and treated everyone respectfully.

Finally, Sarah's interpersonal skills were extraordinary. She worked with my diverse staff wonderfully, respecting everyone in my office and contributed to the positive work environment. She was a great team player always aware of when someone needed help or was having a bad day. Her maturity and consideration of others is something I have never observed in someone her age.

I give Sarah my absolute highest recommendation. Since I work near the University, I have had close to 100 students work in my office and shadow over the years. Sarah is, by far, the smartest, most mature, and best suited for a career in medicine of all the students with whom I have worked. I congratulate the medical school that is lucky enough to recruit her. Please reach out with any questions.

Sincerely,
Sarah's Boss, MD

Why does this sample letter work?

When I read a letter like this on the committee, a few things stand out, and they are exactly what separates a strong letter from a forgettable one. First, the writer clearly knows Sarah well, having supervised her directly for two years, so the praise carries weight rather than reading as a favor. Second, the letter offers specific evidence instead of empty adjectives: Sarah became EMS certified and began taking vital signs, patients brought her gifts, and she read about diagnoses on her own. Concrete examples like these are far more convincing to a committee than simply being told that someone is hardworking or compassionate with nothing to support it.

Third, and most important, the writer compares Sarah to others, noting she is the best of nearly a hundred students who have worked in the office over the years. Admissions committees value that kind of comparison enormously, because it tells us where an applicant stands relative to a real peer group. Finally, the letter speaks to character and interpersonal skills, how Sarah treats patients and colleagues, and not just her competence, which is what a committee most wants to understand about a future physician.