Abstract: This article provides advice on writing effective letters of recommendation for a scholarship awardee, a research assistant, a prospective employee/volunteer, or an entering graduate/professional student. The author suggests a process for establishing meaningful rapport with the candidate to glean useful insights for reference or evaluation letters.

Do you remember the first time a student asked you to write a strong letter of recommendation? I remember the student who asked 10 days after I had already committed to writing 15 other letters. The student bargained further in the hope that I would make an exception, but the other 15 requests had similar deadlines. Medical school application season was nigh, and everyone wanted their letters submitted before June 1, right after the registrar’s deadline to submit my final semester grades.

I hardly knew these students, aside from their midterm and final grades in my 200-person lecture class. Everyone earned A’s or B’s, so they felt they were doing well enough to avoid asking for my help during office hours. Each one sent me a customized email with an upload link.

I planned to begin writing during finals week, but my follow-up emails to these students went unanswered (which I attributed to their focus on their exams). But when finals week was over, I emailed each student to ask for more information so I could better highlight their strengths and fit for their desired graduate school opportunities.

All the medical school applicants sent me a link to the Guidelines for Writing a Letter of Evaluation for a Medical School Applicant.¹ However, I often could not recall information about each candidate; some of us use an online filing system to organize documents, while others hope our search function will find the candidate’s emails.

While we expect our lecturers to effectively manage introductory courses with hundreds of students, we rarely teach new faculty how to write a meaningful letter that helps a medical, veterinary, or dental school applicant, including those who need support letters for summer research opportunities. This guide is designed to help you write effective letters of recommendation help your students achieve their dreams.

Do not ask the candidate to write their own reference letter.

Admissions committees cannot condone the practice of having candidates write reference letters that the reference signs off on. For professor letters, the practice violates the principle that a student waives rights to review the letter under the Family Educational Rights and Privacy Act (FERPA), as discussed below. Instead, admissions committees expect references to maintain their professional responsibilities to deliver a supportive letter of recommendation.

This practice also invites candidates to use generative AI tools to ghost-write letters of recommendation. Admissions committees are highly concerned about references written predominantly by generative AI, and many schools may draft guidelines for writers about appropriate AI use.

Using templates and GenAI can produce less effective letters of recommendation, and admissions committees can tell.

Experienced admissions committee members develop preferences about the elements of an effective letter of recommendation because they often read letters from the same references over many application cycles. Many letters are effective because the writers organize information about an applicant’s academic performance, personal growth, professional demeanor, and communication skills in ways that would be valuable to the future professional community. The most effective letters reaffirm the applicants’ purpose and goals as future professionals and add to the application essays and interview responses.

Recently, admissions officers have boldly expressed concerns about the growing prevalence of generative-AI recommendation letters. Many commented on this topic from the 2026 conference of the National Association for Advisors of the Health Professions:

When a recommendation reads like ChatGPT, admissions committees stop asking, “Is this student exceptional?” and start asking, “Is this letter even real?”

The danger of AI-generated letters isn’t that they’re bad; it’s that they’re bland. They erase the quirks, content, and conviction that make advocacy believable.

AI can help a recommender organize their thoughts, but the moment it starts inventing them, the letter’s ethical foundation collapses.

AI can generate adjectives; it cannot generate accountability. A recommender still owns every word, whether they typed it or not.

In an era of AI-written letters, specific, verifiable stories about a student are the new currency of trust.

Admissions committees expect references to use genAI tools appropriately when outlining content, correcting grammar or spelling errors, auditing/reducing inappropriate bias, or adjusting for professional clarity. Generative AI tools should not be used to create generic reference letters, invent encounters with the applicant, or wordsmith to express a stronger endorsement when the evidence is lacking. Higher education institutions are also concerned about the use of genAI when faculty members are using tools that may not properly protect student information from larger public language models.

References should be informed that health professions programs have adopted different policies on using genAI in letters of recommendation.² They may be required to attest to the use of genAI (2026-27 CASPA policy).³ Similar policies are being considered in graduate medical education for letters supporting residency applicants.⁴

Set conditions for letters of recommendation for current students.

Writing letters for students is an uncompensated faculty responsibility. Faculty are not promoted based on the number or quality of reference letters they write for students. While your letter authenticates your official capacity representing your department, school, or university, most faculty letters do not require approval from the chair, dean, or university counsel.

In your syllabus or when making your first announcements to your class, tell your students when you are accepting requests to write letters, the circumstances for requesting your help, and the requirements for a strong letter. I needed at least 2 months to respond to each letter request.

Because many students may ask for letters from those who previously took your class, meetings with these students should be scheduled separately from your designated class office hours. Some evaluators ask students to meet at a nearby cafe or coffee shop for a more casual conversation; I know of another university whose student government underwrites vouchers that let students take a professor to lunch or dinner on the government’s tab (no alcohol or unnecessary indulgences). Otherwise, meetings can be done over a webcam or a leisurely walk around campus.

Ask for talking points and documentation

I find it helpful to get the online description of a scholarship, internship, or research opportunity, so students should provide this information before meeting with the reference. The meeting should go over why the student wants the professor to write the recommendation and specific “talking points” that put the student in a strong position.

As someone who reviews letters of recommendation, I want to know the following:

• How do you know the applicant (in what role)?
• How long have you known the applicant?
• How well do you know the applicant (to observe and evaluate their successful attributes)?

As a reference, if you know your answers will likely not support the applicant, you should decline by saying you are unable to write a “strong” letter of recommendation.

For me, my best letters come after at least two meetings over six months with the student that discuss their personal journey, their inspiration to pursue a health professional career, and whether they have leveraged the university’s resources (prehealth advising, career services, learning support, multicultural or interfaith centers). An actual packet with a resume, a biosketch, a photo for the application process, and a shortlist of desired programs, especially a printed copy, helps me craft a highly individualized letter of support.

One-on-one meetings also give me insight into how the students will perform in conversational interviews. What stories about their successes and failures can they comfortably share or discuss? How do they talk about their study habits and time management?

Code phrases and rubrics

Many faculty peers who engage in the admissions process often ask for “code words” that signal some comparative value: for example, what is the difference between “highly recommended” and “strongly recommended”? I have developed a working rubric with appropriate phrases to explain my summary recommendations, highlighting how the candidate has earned that assessment based on what I know about the candidate’s performance and connection with students in my course. Sometimes I share this rubric with the candidates in advance.

However, some evaluation portals ask you to complete their own rubric. The most recent ADEA AADSAS evaluation portal (2026-2027 cycle FAQ⁵) asks us to provide a Likert score for 10 attributes about an applicant.

• Critical thinking
• Didactic knowledge
• Integrity
• Interpersonal skills
• Maturity
• Motivation (to pursue dentistry)
• Organizational skills
• Professional demeanor
• Reaction to criticism
• Self-awareness

Likert Levels:

• Not observed
• Not ready at this time
• Meets expectation
• Exceeds expectation

Even if the applicant is not interested in dental school, I insist on meeting with each student to go over this rubric (or my own) and identify areas where I can offer insight and comment. I know most students would not ask me as a reference if they thought they were not ready in any one of these competencies; more likely, I have been asked because they feel I can articulate how the student exceeds expectations in all ten. But if the student is in my large lecture class, I couldn’t assess them as “exceeding expectations” in integrity. If the student has worked in my lab, I feel more comfortable rating them on their academic competencies. My expertise as a professor gives me greater insight.

Understanding FERPA (for professors)

As a professor, I should be familiar with the Family Educational Rights and Privacy Act of 1974 (FERPA).⁷ Faculty guidance is likely available at your institution (see FERPA Release for Letters of Recommendation & References at Towson University).⁸

Transparency and Trust

Because students waive their right to review my recommendation letters, I have always sought transparency in my work with students. Over the years, I have shared an outline of my recommendations. The length of the letter varies with the depth of my mentoring relationship with students, but I keep the length of my letters to within two pages as follows:

1. The opening focuses on the purpose of the reference letter and introduces the candidate. I strongly recommend [candidate’s name, application ID if available] as [professor/supervisor]… as a participant in your summer enrichment program.
2. I may briefly add more context about the size of the lecture class or any additional opportunities to mentor the candidate.
3. Summary recommendation with two or three specific accomplishments that show the candidate’s growth, maturity, and trustworthiness. I will specify skills, techniques, or projects that support my observations.
4. Envision the candidate’s success with a future opportunity. I present a closing statement commending the candidate as an appropriate fit for a scholarship, internship, or job opportunity, based on the information the student provided.

Even if I know they have waived their FERPA rights, I share a draft of my recommendation with the student to ensure I haven’t made any mistakes (such as improper naming or gender-appropriate language/pronouns). Those detail errors are noticed by application reviewers and can undermine the candidate’s standing. The student is also assured that their journey to the profession is accurately documented.

The Office of Medical Education at the University of California San Francisco provides guidance for clinical faculty when documenting student performance, including examples of strong recommendations.⁹

Letterhead and signature policies

In the past, many students asked former professors to write letters of recommendation, but the schools contacted the students because those letters were not submitted on officially branded letterhead. At my institution, letterhead is restricted to official business for current employees. For those leaving the institution, I advise my peers on our letterhead policy.

Many graduate programs are more accustomed to “digital signatures” that we affix to our letters. A few of us still keep a copy of our signature or have created an artistic “signature logo” to paste into our letters. The rest just type /* their name */ (within slashes and asterisks). At any rate, admissions professionals want to see a signature, and it doesn’t take much effort to satisfy this expectation.

Final takeaways

I love learning about these students and their dreams through this process. I am reminded how inspirational these students are in the way they speak about their futures, even as I have to set aside about two to three hours per letter. I hope this guide gives you an opportunity to see how you have guided them towards their dream professions.

Checklist for Recommenders (and Reviewers)

I make sure all of these items are fulfilled when I write a reference letter.

Logistics (Recommenders only)

Timeline/Deadline

• Allow one month for scholarship/summer programs. Requests begin after fall/winter exams with deadlines in February/March.
• Allow two months for professional school applications. Requests may begin after spring midterms. Writing letters should occur after spring finals (May/June).

Conferencing Times

• Meet at least twice during your month(s) of preparation.
• FERPA waiver (signed document required from registrar and/or application service/graduate program form)
• Technology (instructions to upload, add more time for unfamiliar portals)
• Confirm that the student has set up letter receipt into the application portal.

In your letter, show your credentials

• Explain any letterhead preferences/policies
• Apply a signature

State how you know the student (drop-down questions in AADSAS)

• Role (I am the student’s professor.)
• Length (I have taught the student for Organic 1 and 2.)
• Relationship (We have not met outside of class before.)

Who needs the recommendation (i.e., Who is the Audience)?

• “Dear Selection Committee” is a typical greeting.
• Refer to the internship, scholarship, or job description.
• Leverage insights from the application drafts the student gave you.

My observations about the student (refer to the rubric)

• What stories highlight the candidate’s excellence?
• What context has the student provided that shapes your impressions?
• Which responsibilities do you trust the candidate with?
• How does the candidate stand out among other students you have taught, supervised, or advised?
• How will this candidate inspire the audience/community? How will the program help the candidate?

Checklist: Using AI Responsibly in Letters of Recommendation

Here are suggestions for maintaining your voice as an author and recommender without allowing genAI tools to dilute your evaluation or support.

• I formed my own independent evaluation of the student.
• AI was used only for organization/clarity/polish, not to invent or exaggerate content.
• I protected student confidentiality and followed institutional policy.
• The letter includes specific examples I can personally attest to.
• The voice and judgments in the letter are truly mine, and I stand by every word.

Acknowledgments

This article was peer-reviewed by and includes suggestions by Nancy Lorenzon, Teaching Professor, Department of Biological Sciences, Director of Pre-Health Education and Advising, University of Denver.

Heather Brod’s Writing Effective External Evaluation Letters inspired this article.¹⁰

Conflict of interest disclosure

No conflict of interest reported.

AI use

Generative AI tools were used to support this manuscript in the following ways:

• Documenting and summarizing private conference notes and proceedings from the 2026 Conference of the National Association for Advisors of the Health Professions (Otter.ai).
• Drafting and suggesting checklists to aid authors of letters of recommendation (Otter.ai, Gemini in-browser).
• Spelling, grammar, punctuation, and wordsmithing (Grammarly and Microsoft Copilot).
• Implementing the standard formatting for publication (ChatGPT).

References

1. Guidelines for Writing a Letter of Evaluation for a Medical School Applicant, Students & Residents, AAMC website. This longstanding resource provides some tools to help authors write effective evaluation letters for applicants to medical school and residency.
2. Thacker, N. (2026, revised June 19). Can You Use ChatGPT for Your Medical School Application? AMCAS, AACOMAS, CASPA, and TMDSAS Policies Compared. GradPilot. https://gradpilot.com/news/can-you-use-chatgpt-medical-school-application-policies. Accessed June 30, 2026.
3. Thacker, N. (2026, April 13). PA program AI policies — 10 programs with real rules. GradPilot. https://gradpilot.com/news/pa-program-ai-policies-aggregator-2026. Accessed June 30, 2026.
4. Coraor Fried, J., Johnson, N.R., Pelletier, A., Landman, A., Bartz, D. (2025). Using Generative Artificial Intelligence When Writing Letters of Recommendation, Academic Medicine 100 (7): 769–775. https://doi.org/10.1097/ACM.0000000000006047. Accessed June 30, 2026.
5. AADSAS Letters of Evaluation FAQs (2026-2027 changes), ADEA. Also, “Preparing for ADEA AADSAS 2026” webinar, ADEA, April 21, 2026. It describes the additional characteristics questions that evaluators are asked to address.
6. Chuck, E.T. How to Assess Your Academic Competencies, Student Doctor Network Review. This includes an example academic competency rubric following AAMC definitions.
7. FERPA, Protecting Student Privacy, US Department of Education.
8. FERPA Release for Letters of Recommendation & References at Towson University. This guidance helps faculty navigate requests for letters of recommendation.
9. Writing High-Quality Evaluations of Student Performance:: Best Practices and Examples (PDF), Office of Medical Education, University of California San Francisco. Guidance for clinical faculty when documenting student performance for clerkship evaluations. It includes examples of strong recommendations.
10. Brod, H. Writing Effective External Evaluation Letters, LinkedIn (2021). The inspiration for this article.

“Joy Kwon, a third-year medical student trainee with a photographic memory and a scathing eye roll, clocks out at the end of her 12-hour shift,” Gupta’s story says. “Before she steps away, one of her supervisors, Dr. Frank Langdon, tries to pressure her to stay. But she doubles down, reminding him that she has finished her shift and that she isn’t being paid.”

Before she leaves, Kwon tells Langdon, “Maybe all you lunatics need to learn how to set some boundaries.”

As the father of two doctors and given my former roles as President and CEO of a medical school whose graduates have been matched to residencies at America’s premier hospitals, I understand the overwhelming physical and mental pressures that students and new doctors face. While frequently invigorating, medical training and residencies can also be exhausting, soul-crushing, and relentless. The decision that Joy Kwon made to put a discrete end to her shift at Pittsburgh Trauma Medical Center made sense.

However, while Joy prioritized her physical and mental wellness by adhering to the end time of her schedule, she potentially impacted her career trajectory, both short-term and long-term.

Short-Term Cost: Diminished Team Trust

Midway through the latest season of “The Pitt”, the hospital’s computer infrastructure went down due to a massive ransomware cyberattack. This caused the entire hospital to immediately switch to paper charts and work without access to digital patient histories or records.

Prior to the attack, Kwon, thanks to her innate gift, memorized the hundreds of specific details on the ER’s digital patient screen and then reproduced them on a whiteboard with a Sharpie after everything went offline.

Once the hack was resolved, the fatigued staff realized they needed to devote extra off-the-clock hours to updating their previously offline digital patient records, which were now back online. None of the doctors or residents were happy about this, and the drain on everyone’s brains and bodies was immense.

Kwon had the same grueling grunt work to finish as her fellow doctors, but when the hours of her shift came to a close, she was out the door, likely leaving the extra tasks of transferring her patient records to someone on the remaining day shift or incoming night shift to handle.

If this is how the action played out, it isn’t hard to imagine the annoyance and sense of betrayal that the residents and physicians felt toward her for exiting when everyone else was putting in extra (and unpaid) hours to repair the damage of the cyberattack, in addition to migrating the handwritten information of her patients’ paper records to the hospital’s computer system. I imagine that the ill will would have been massive. 

Kwon’s actions, while understandable given her desire for a healthy work-life balance, prevented a memorable and enduring bonding experience with her suffering co-workers. It also potentially created simmering mistrust among them at being left to complete her tasks. Such resentment, especially among a tight team in a period of crisis, is not easily forgotten or forgiven.

The Long-Term Cost: Setting Boundaries in Residency Narrows Your Specialty Options

If you are interested in being an ER doctor or pursuing another high-acuity specialty, boundary-setting of this kind is not realistic or achievable. As shown in “The Pitt”, ER docs must function and focus in situations of extreme chaos. In fact, some – like Dr. Jack Abbot, a character on the show who’s also a U.S. Army veteran and volunteers as a TEMS provider for the Pittsburgh SWAT team in his off-duty hours – seem to crave the mayhem.

Kwon is intent on maintaining professional-personal equilibrium in her life, and explicitly said on the show that she is not interested in an ER residency. She has chosen accordingly, deciding to pursue pathology by the end of the season. Other non-urgent, lifestyle-friendly areas include dermatology and psychiatry, though both of those commonly require ER rotations during internship year. 

For students who aspire to work in internal medicine, family medicine, pediatrics, or general surgery, ER rotations are non-negotiable. You’ll either need to adjust your work-life balance ambitions to fit the needs of your patients and fellow doctors or accept that upward mobility is limited: any aspirations to become a Chief Attending Physician (Dr. Robby’s title) or a similarly higher-ranking supervisory position within the ER department would be unattainable.

Professionals in all industries dream of finding improved steadiness between the demands of their day jobs and the pleasures of their personal lives. Finding that symmetry keeps us sane, well-rounded, and fulfilled. But doing so at the expense of your patients and co-workers (fellow ER staff) will impede your success in your work journey.

Conflict of interest disclosure

The author is a medical school executive and has held senior leadership roles at institutions that train students entering residency. He reports no financial interest in the subject matter of this article.

AI use

No AI use was disclosed by the author.

Image: Photograph by Warrick Page/HBO Max

Abstract: Health professions education is a growing specialty in many different fields of health care. Educators create unique careers from different mixtures of clinical care, direct teaching (bedside teaching, classroom lectures, small group facilitation), curriculum development, program administration, and educational research and scholarship. As part of a qualitative study of physician medical educators, participants were asked about their advice to others interested in this specialty. They suggested focusing inward, to examine one’s own interests and goals, and looking outward, to build support, community, and opportunities to share knowledge.

Many health care providers teach to some extent, but more and more people are recognizing the importance of this growing specialty, which focuses on the process of education and offers opportunities to impact the way we teach and learn. Beyond providing clinical care, health professions educators can improve the knowledge and practice of generations of students and providers. What advice do today’s educators give to others interested in this rapidly evolving field?

As part of my thesis work for a master’s in medical education, I did a qualitative study of medical educators. I interviewed 22 physician educators across the United States to learn more about their work and how they got started as educators.^1,2 Some started as educators very early in their careers, while others began to focus on education after many years of working. I asked them what advice they would give to others interested in health care education. They suggested focusing inward, to understand one’s own interests and goals, and looking outward, for support, community, and opportunities to share knowledge. Their advice fell into four main categories.

Explore what it means to be an educator

Several participants recommended trying out different areas of health care education, through work, volunteer positions, or educational programs, to learn about the many aspects of health care education and figure out what fascinates you most. They described different elements and entry points into the world of health professions education, and many different ways to integrate clinical and educational work. What do they say to people interested in health care education?

“You could do education administration, you could do education research, or you could just be an amazing teacher. I say it just depends on what you want to do, and you don’t have to know now…”

“…just dive in and do things and get involved […] encourage people not to get intimidated with lack of formal training…”

“…reading a couple of those books to just get their minds thinking about things in a different way. Then probably taking something like the [educator course] early would be helpful.”

“…early on, volunteer for everything that you find interesting, being on a committee, reviewing somebody’s paper for them before they submit it, whatever. And don’t just look for things that are going to protect time because there just aren’t enough of those. And then there will be payback, hopefully, after you get a foot in the door and you make yourself indispensable initially on a volunteer basis.”

Focus on your goals

Educators described the importance of figuring out what is most important to you and communicating those goals to others. Being able to communicate your interests and passions can give you a competitive edge, and staying focused on what you want helps you advocate for what you need as your career progresses. It’s also important to recognize that you may need to look in a variety of places to find exactly what you are looking for.

“…get a sense of what you’re good at, what you like, and probably make some of the decisions based on those two things. […] trying to get a sense of what to do with your career and understand that that changes.”

“I go into any meeting with someone who’s responsible for my career saying, ‘Hey, this is what I want to do. This is what I expect over the next couple of years,’ […] to allow for those things to happen and to communicate my vision to them.”

“I do advise people to value their own time and to advocate for getting protected time to do things. It’s just really hard to find the revenue stream to do it.”

“Take the promotion criteria of whatever pathway you’re in, read it, create your to-do list and let’s start moving forward.”

“If you are really looking to be in something very specific and you know that, then you might have to be willing to go to another place to actually achieve that.”

Find support and build community

The importance of support in a variety of forms came up in multiple interviews. Educators talked about encouragement, emotional support, and opportunities offered by coworkers, supervisors, individual mentors and sponsors, hospital and professional groups, as well as educator networks and programs.

“My first piece of advice is to find a mentor who can help you understand medical education and academics because it’s not self-explanatory by any means.”

“Find good mentors. Figure out what you like and don’t…I always like to remind people that they don’t have to know. They don’t have to know what they’re going to end up doing. So just do what feels good in the beginning and learn, learn from the people around you.”

“I also really encourage people to find an academic home […] And for me finding a mentor actually means finding a network of mentors, you’re not going to put all your eggs in one basket.”

Share your knowledge

The importance of educational research and scholarship in different forms was stressed by several participants as a way to share one’s experience, teach others, develop a strong reputation, and advance the field. Also consider structured formal educational programs to push you to the next level and help you progress.

“I think scholarship becomes super important, and that’s not just necessarily papers, but I think it’s being able to present it at national meetings. Especially within medicine, there’s so many different specialties, and each specialty has at least one, if not two, national organizations. I think each of those organizations are now creating better avenues for folks to learn about teaching.”

“…my biggest piece of advice is that even though it’s medical education research, it can and should be done in a scientific manner. And that just makes it all the stronger and all the more meaningful.”

“…if you want to do education research, you’re going to need a master’s degree. It’s just very difficult otherwise to get the level of training and rigor going without it.”

Building from inside and out

Through their own experiences and advice, the educators in this study described important ways that people at any stage of their career can learn more and develop their skills as educators: through exploration, goal setting, community development and support, and shared knowledge and experience. Especially for people with an interest in education, considering health care education as a specialty is one way to expand your skills, develop an area of expertise, and build a challenging and meaningful career.

Conflict of interest disclosure

This article summarizes findings from a qualitative study of medical educators, conducted as thesis work for a master’s degree in medical education. First-person references throughout refer to Cynthia Stein, who conducted the interviews. Both references cited are the authors’ own prior publications in Cureus and BMC Medical Education. No funding supported the underlying study, and the research protocol was reviewed by the Harvard University Institutional Review Board and determined to be exempt. Cynthia Stein is affiliated with Boston Children’s Hospital and Harvard Medical School; Jennifer Kesselheim is affiliated with the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School. Both authors are practicing physicians and medical educators, and both report no financial conflicts of interest.

AI use

No AI use was disclosed by the authors.

References

1. Stein CJ, Luff D, Gold JM, Schwartzstein RM, Kesselheim JC. A volunteer passion: a qualitative look at how we measure and reward the work of medical educators. Cureus. 2024;16(7):e65849. https://doi.org/10.7759/cureus.65849 (opens in new tab)
2. Stein CJ, Luff DF, Gold J, Schwartzstein RM, Kesselheim JC. Serendipity, support and equity: a qualitative study examining career initiation in medical education. BMC Med Educ. 2025;25(1):1764. https://doi.org/10.1186/s12909-025-08014-9 (opens in new tab)