So, there you are sitting in your first year biology class. At UVic, a university of about 15,000 full-time students, there are approximately 250 freshmen in each class. Of these, at least half of them (125 people), are toying with the idea of medicine as a career. Tough odds. In addition, while your professor may have been hired strictly as a teaching professor (there are certainly examples of this at UVic), it's far more likely that your teacher is a researcher, as most lecturers tend to have their doctorate PhD degrees. These researchers are hired by universities for their scientific expertise, but buried within their contracts is a stipulation to teach a certain number of undergraduate courses. Teaching isn't usually the reason these researchers come to a university. As such, your teacher's mind is often occupied with the latest technical glitches occurring in the lab, or in keeping up with the current research published by other authors working on similar projects. Therefore, teaching often becomes a lower priority.
So, among this sea of fellow competitors, and apathetic teachers, how are you going to obtain the three distinctive and unique reference letters you need to enter medical school?
The first trick, of course, is to use reference letters from other people. However, for people who have not done graduate work, it seems that most medical schools want at least one reference letter from a representative at your undergraduate university. As I didn't go to graduate school, I don't know what procedures are commonplace in that environment. Since your entry into medical school is utterly dependent on receiving a reference letter (you can't get in without it), you should devote a significant amount of energy into this endeavour.
This is my hard and fast rule on obtaining the elusive university reference:"Get your reference letter from the most senior person who knows you well "
In this scenario, the tenured professor who vaguely knows you as the hand-waving student in the front row, and writes a stale, boring letter consisting of: "This student displays tremendous aptitude in the field of Biochemistry, and receives my recommendation" has actually cost you. Why? Because using that reference letter has squandered the opportunity for you to hand in a glowing letter from the Teaching Assistant whom you've met by being interested and sincere in lab. That TA could have provided the range of positive insights and endorsements into your personality, which is what each admissions committee looks for in a reference letter.
I say again, medical admissions boards use reference letters as a judge of an applicant's personality. I hadn't considered the depth of this point until after I'd undergone all of my medical school interviews. My current impression of the interview is that afterwards, each interviewer must complete a form ranking the individual on a scale on personal and social characteristics. ie: "On a scale of 1 to 10, rank this individual's ability to perform competantly under stress." As my longest interview was a mere hour and fifteen minutes, with the shortest interview being exactly half an hour, where I only answered four questions, I expect that many interviewers will be unable to accurately complete their feedback forms.
As a result, many of these interviewers will turn to your reference letters as a guide to help them complete their interview sheets. After all, your interviewer has only known you for a short time, while your references have presumably had long periods of time and environments in which to familiarize themselves with your quirks and characteristics. Who knows you best? Therefore, while UBC pools the reference letters and MCAT scores together as a puny 10% total of your admissions criteria, good reference letters may inadvertantly boost your interview score, which at UBC is worth a whopping 50% of your application. If you're an honest and straightforward person, obtaining brilliant reference letters should be a piece of cake.
So, should I use a big-name professor as a reference even though he/she doesn't know me very well, or should I proceed with a lesser-placed individual who really knows me as a person?
For me, it's a dead-obvious choice to use a letter that is rich, and vivid in personal detail over one that has all the personality and warmth of a dead fish, despite the quantity, or lack thereof, of letters after the name of the author. What you want is a reference letter that relates past situations in which the author has witnessed you demonstrating your compassion, patience, and honesty. If you don't have those characteristics, my knee-jerk reaction is to question whether clinical medicine is the right choice for you.
Giving situational examples showing these characteristics is always better than just stating them outright. If you read one reference letter relating an incident where a premed selflessly raced into a burning house to rescue a baby, and then saw a second letter where the author simply states: "This candidate is genuinely heroic/unaware of danger", who would you believe?
As I've already mentioned in the undergraduate timeline in the first, second, and third years, your best bet for obtaining a great reference letter is to work closely with your teachers, and then to volunteer for entry-level positions in their laboratories. You can make these connections via communicating to their graduate students, who will often be your teaching assistants for your lab courses.
You can also facilitate obtaining these positions by researching your professors to find one who is studying in an area you find interesting. Then, approach him or her about the practicality of volunteering as a dishwasher or solution re-stocker under the understanding that you will receive advanced duties as your technical skills improve via your lab courses. If I've learned one thing about research at a Canadian university, it is that money is tight everywhere, and no lab has as many hands as it would like. What you have to convince them is that you're competent enough for them to entrust spending the time on your training. After that, since you'll work for nothing, they continuously collect the rewards on their investment.
If working for no money doesn't sound appealing, well, that's tough luck. In a competitive environment, the job goes to the lowest bidder. You can't go much lower than offering to work for free. However, if working for free is not an option due to student loans and such, don't forget about looking into undergraduate scholarships and grants from NSERC, MRC, and possibly SSHRC, the "Tri-Council" of granting agencies in Canada. These agencies may offer to supplement your income, allowing your professor to hire you extremely cheaply. Since the time I did my NSERC project and now (August 2001), there is apparently a new method of university funding, involving various "Institutes" of science. I don't know anything more about these, but perhaps they are the new avenues to investigate when searching for lab funding.
With the current "brain-drain" of Canadian researchers re-locating to the United States where money for wages and research capital is significantly more plentiful, the Canadian government is looking into ways to recruit undergraduates into the research field. Your professor may also be eligible to apply for work-study positions which similarly supplement your income. In British Columbia, there is a government-funded program known as Student Summer Works, where the government pays an employer to hire students during the summer months. Researchers are qualified to apply to this program, at least at UVic Biology. This can easily be a doorway into a lab position.
Finally, you should go talk to your professors during their office hours. Do this even if you have no intention of asking them for a reference letter in the future. Don't fall into the premed trap of "What's in it for me?" and only working towards polishing your application. Often, except during exam times, the professor spends a lonely, solitary hour with the office door open, playing Hearts or Freecell on his/her Win98 computer. These people are at the cutting edge of their respective field, taking decades to amass their knowledge. As a student, you get to talk to them for free. You'd have to pay big bucks to do the same at a conference. You're studying to learn about the real world aren't you?
I learned a great deal about Canadian politics through my first year Economics teacher. Strange eh? I'd originally gone to his door to ask about a difficult problem, and it turns out of the 300 students in his class, I was the only one to see him that day. After solving the problem, we talked for half an hour about the economic situation in healthcare (his wife is a nurse), and I learned about the slash in transfer payments from the federal government enacted in the mid-eighties. This drop in transfer payments to the individual provinces is at the heart of why healthcare in BC is a major issue, with healthcare workers burning out, and waiting lists burgeoning. This was useful information to know, and I found it from a most unlikely source. Talk to your professors.
For the other two reference letters, I recommend choosing people who know you well, and can comment strongly on your non-academic qualities. I would try to choose a physician, and a layperson with whom you have had a long and trusting relationship.
If you are lucky, your parents will already know a physician as a family friend. If this person knows you well enough to write you a long and glowing letter, nod a silent "thank you" to the admissions gods and proceed to your next letter. For most people, it will not be that easy. You may want to consider your family physician to determine if he/she knows you well enough to be a reference. If not, look towards a nearby hospital for possible volunteering and doctor-shadowing programs.
Here, you will have the opportunity to interact with a multitude of physicians. Of course, if the bureaucracy is anything like in my experience, these programs leave you performing menial tasks well insulated from the physicians and nurses. I folded several thousand cardboard vomit receivers, colloquially known as "puke trays", in my months volunteering in the Emergency Department. It is up to you to find and meet the professionals. Be sincere and honest in your intention to enter medical school, and ask them for advice. You'll only get out of a volunteering program what effort you put into it.
For that third, elusive reference letter, I suggest looking towards a layperson who has placed in you a significant level of trust. Naturally, you must have earned that trust and respect. Some suggestions would be the parents of a child you currently tutor, or perhaps used to babysit. If you happen to volunteer as a coach or assistant in a children's sports league, your experiences in organization and patience will go a long way towards an excellent reference letter.
Another excellent possibility is an old or current employer. I considered using the manager at a store where I had worked for four years as a reference. In my favour was that after working for such a long period of time, I was responsible for handling the store at either opening or closing, and so I had access to the free cash in the till. I also defused numerous arguments and complaints with irate customers in that time, to ensure their repeat business. Being entrusted with the keys to another man's livelihood is a great responsibility indeed.
In closing, here's my current perspective on reference letters. Pick people who know you well, and can relate easily-visualized situations demonstrating your personal qualities. Your transcript will relate your academic skills; this is not the place to brag about your marks. Try to form relationships with your professors for the mandatory letters, and health care professionals as they will be able to provide reference letters recognizing your suitability for a career in medicine.
You'll first have to gather a list of the names and addresses of each medical school. I recommend heading to the Canada Post post office and buying the 8.5" x 11" mailers for XPressPost. These mailers will each set you back approximately $5. So, at three letters per medical school, each school you apply to will cost you $15. Don't be stingy, and pay the extra amount requiring signed confirmation that the receiver has actually received your envelope. Do not, under any circumstances, go cheap here and send your materials by regular mail without a tracking number.
I used XPressPost because I had heard horror stories of application materials being lost, and with XPressPost, you automatically receive a tracking number. Wouldn't you know it, but both myself, and two friends of mine had application materials lost along the way. Good thing the receipt had a tracking number, proving I had sent the materials, or else the medical school would likely have cancelled my application altogether. Make sure you call the medical schools to ensure that your materials have been received; the tracking number can be used to determine the current location of the package. I should note here that I've received emails from a few different applicants who have had XPressPost lose their packages. If you have the cash, you might want to consider being completely paranoid, and sending through a courier such as Fed-Ex or Purolator. Either way, get a receipt and number for tracking purposes.
Now that I've expounded on the very useful tracking number, you should pre-address each mailer and give these to your references. That way, they can just drop each reference in the mailbox. They're already doing you a huge favour; make their time as painless as possible. Be sure to include the dates by which the letters are due, and approach them well in advance of this deadline, say a month at least. This gives them time to write a decent letter, and gives you the flexibility to approach another potential reference should they procrastinate or refuse outright.
I feel that including a curriculum vitae along with your request is very useful. It gives your referee additional ammunition to include in the letter, and may help to refresh events he/she may have forgotten. Needless to say, each individual medical school can receive duplicates of a single reference letter; it's unreasonable to ask your reference to craft a unique letter for each school. Make sure they save additional copies of this letter in case the first letter is lost in transit. Nothing is worse than discovering your letter did not arrive and you have a week to re-submit it, except that your professor must first write a new letter. This actually happened to me.
Consider including a stamped postcard in each mailer, for the medical school to mail back to you on receipt of that reference letter. You should write on the postcard something along the lines of: "Please mail this postcard back to Ian Wong upon receipt of a reference letter for Ian Wong by Dr. Smith for the UBC med school application." That way, when you get the postcard back in the mail, you know which of your referees sent the letter, and which school received it.
Finally, don't be afraid to remind your referees to write the letter, and by all means request that they notify you when the letter has been sent. While you really are totally reliant on your referees to complete the letter, know that it is, after all your future and not theirs, and being reliant does not mean acting meek and submissive. While this may be your top priority, it is likely not theirs, so make sure it gets done.
Afterwards, a thank you card, and perhaps a small gift would be appropriate. Your referees have done you a huge service, and you should definitely acknowledge your thanks. Of course, it goes without saying that you should keep them up to date with your progress through admissions. Yet another hurdle jumped, now it's time to wait for that interview notice.