COMMENTARY

Personal Letters for Residency Match: 5 Tips to Stand Out

Jillian Horton, MD

Disclosures

September 16, 2020

Given COVID-related pivots in application processes and impending changes to the licensing exam scores used for candidate screening, personal letters for the residency match are more important than ever. If that strikes fear into your heart, you're not alone.

As a former associate dean of undergraduate student affairs, I've easily read hundreds of these documents. I've also spent years coaching medical students on how to write letters that will distinguish them from the pack. Full disclosure: My approach is different from most. I have also been trained as a writer and have a master's degree in English. It is this training that has allowed me to see the act of writing those personal letters as an opportunity to explore your motivations and goals in a way that is surprisingly meaningful.

Although you will inevitably — and understandably — be focused on the outcome of these letters, the process of writing them is actually about more than just completing your residency application. The experience can be an opportunity for you to consider everything you've overcome, everything you've accomplished, and everything you really want to do in the future.

I know that these essays feel like an exercise in futility: Aren't everyone's letters essentially the same? Not yours — that is, if you follow these five tips to help you write something that will get you noticed for the right reasons.

Tip 1: Don't Be Boring; Start With a Story

Mediocre letters often begin with a list of a student's favorite attributes about a specialty. That's boring. An internist reading your letter already knows what's great about being an internist. What they don't know is why you want to be an internist. This is where you can hook them with a great story.

Our brains work best with a chronological narrative. The best letters start with stories grounded in a specific time and place. Those stories are vivid, they are personal, and — when chosen carefully — can endear you to a reader.

Many students have told me, "Nothing in my life makes for a great story." Untrue. A great story is just an authentic experience shared with a dose of humanity. Did someone in your family have a health struggle that motivated you to go into medicine? Did a passionate university teacher introduce you to the concept of the social determinants of health? Did the inexplicable thrill you felt when you dissected a frog in high school make you want to become a surgeon? With just a little work, a story like this can lay the groundwork for a standout letter.

For those of you who still think you have no such story, here's an exercise. On the left side of a piece of paper, write "My Birth." On the right side, write "This Moment." Next, fill in the usual milestones — things like your first day of school and your graduation. Now take a moment to add the significant events that have occurred between those goalposts, the highs and lows. What connections can you draw between those moments and this moment in your life?

During this exercise, you'll be surprised at what you recall and link together. You may find yourself thinking about how witnessing a car accident led to your interest in emergency medicine or how a sibling's peanut allergy made you want to learn about the workings of the immune system. Some of my favorite letters have started with anecdotes like these.

If you don't have any "blockbuster" moments or memories, that's okay too. Some great letters that have stuck with me started with quieter stories. They were as simple as students moved by images of suffering in magazines or books that sparked their interest in medicine. You have one of these stories in you. I promise.

Tip 2: Never Tell a Lie

Everything you write, from that initial story to your final conclusions, must be genuine. Nothing is more off-putting than when a student submits a letter that sounds inauthentic.

This is often a particular struggle for candidates applying to several programs at once, as so many of us have. If you've done several electives in surgery but are using family medicine as a "backup," anyone reviewing your application can tell that from your elective choices. You need to help us understand your motivations. Now, how do you do that without lying?

I guarantee you that there are ways to honestly convey your enthusiasm for a specialty that your transcript shows is not your first choice. For example, if you are split between two specialties, your letter could have a section that looks something like this:

You will notice that my elective choices reflect an interest in both internal medicine and psychiatry. These interests have been complementary. I am committed to looking after marginalized and oppressed populations who face chronic health challenges. Although both specialties offer unique ways to provide this care, psychiatry offers me the best opportunity to tend to the trauma that is often associated with the lives of these patients.

I'm always impressed when I read these types of statements in a letter because they show discernment. It is clear that these students have done significant reflection, and they automatically seem more thoughtful. This is so much better than yet another letter from a student telling me what they think I want to hear but actually leaving me trying to figure out their true motivation.

How can you come up with an authentic explanation for your interest in several specialties? Here's an exercise you can try. List each specialty you are applying to, in order of preference. Next to each one, write a few lines about what that specialty has in common with your top choice, and focus on those factors as you write your "backup" letters. Your motivations will sound more plausible and natural, and your application will be less discordant as a result.

Many programs get a massive number of letters from applicants who won't be ranking their specialty first. They know that just as well as you do. So give them — and yourself — a window into why you will be motivated to do something other than switch programs if this is where you match. And tell the truth while doing that.

Tip 3: Prevent Red Flags by Controlling the Narrative

Most of us have not had a linear path to where we are today. We've faced illness, we've dealt with the death of someone we love, or we've failed at something that was important to us. All of these things can, and often do, affect performance or create a disruption in medical training. If any of this is true for you and you're worried about how it may impact your residency application, you must control the narrative.

This tip isn't just about being savvy; it's also about how we all like to be treated. If your partner breaks something that's special to you, would you rather hear about it from them or find the shards by accident when you open the trash can? We all like to be given a heads-up about problems rather than discover them on our own. Don't let those reviewing your application wonder what happened and come to their own conclusions. When you have a chance, address the issue directly.

If you're struggling with this, take a few minutes to generate a list of what you think are the greatest vulnerabilities in your record and application. Next, write down the worst thing you think a committee member could say about them. Now, think of how your best advocate or mentor would respond to those comments. That is how you need to respond on your own behalf.

Our failures make us who we are, especially if we approach them with a growth mindset. What have you learned during your illness and leave, your failure, or your initially unsuccessful application to the match? Did your struggle with exam anxiety prompt you to learn new coping skills? Did your failures introduce you to the concept of self-compassion and lead you to a role as a mentor for more junior students?

When I read letters that take me on these little journeys, I see the writer's challenges in a new light. People who can't learn from failure, or don't label it as such, don't make good doctors. If you've responded to early failures with strength and grace, we are actually interested in learning more about you.

That's the big, heavy stuff. I'll leave you with these two quick tips.

Tip 4: Lean on Prompts

You'll notice that I've provided a few exercises to help you along. Prompts are not a crutch; they're useful tools. If you're not used to narrative writing and tend to dread it, try using 5-minute narrative prompts to get you used to writing. Reflective prompts can be a good place to start. Books like Dr Alan Peterkin's Portfolio to Go can help you work with questions that can turn into content for letters.

Here are some prompts that I like to use with learners who are gearing up for the match:

  • What case made you want to go into your chosen specialty? 

  • What's the greatest act of humanity you've seen inside or outside of medicine, and how did it inspire you?

  • What was your lowest point in clerkship? What was your highest?

  • What is it about you as a person that has made your success in medicine possible?

If you're still feeling demoralized, I have one more, simple tip.

Tip 5: Buddy Up

Most of us have had times when our relationships carried us through. Personal letters for the residency match will feel particularly burdensome this year. Everyone's cognitive load is at an all-time high.

If you are procrastinating and feel too disheartened to get started, buddy up. Reach out right now to a friend going through the same process and ask them if they want to make a contract for accountability. You can do the exercises I've suggested together over Zoom, with a timer, in as little as 5 minutes. Then you can "pitch" each other your answers and provide real-time feedback.

This will give you a little boost of near-human contact while allowing you to avoid more procrastination. Even at this stage in my career, when an important article or manuscript is due, I often lean on a friend or colleague for motivation and accountability

If you're applying this year, the clock is ticking. If your letters aren't underway, start them today — with a friend, a laptop, and the confidence that you can do this. If you follow these tips, not only will your letters stand out from the pack, but you also may even learn something about yourself in the process.

Jillian Horton, MD, is associate head of the Department of Internal Medicine, director of the Alan Klass Program in Health Humanities, and a former associate dean of undergraduate student affairs at the University of Manitoba in Winnipeg, Canada. She was recently named the recipient of the 2020 Gold Humanism Award from the Gold Foundation Canada and the Association of Faculties of Medicine Canada. Her memoir about medicine and medical education will be released by Harper Collins Canada in February 2021.

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