Due to the sensitivity of the post, the author wished to publish the following piece anonymously. 

Dear potential Referee,

My name is Jane Doe, medical student and residency applicant. So nice to meet you. You are the 30th new staff that I have worked with in the past 15 months and among the over 100 physicians and residents who I’ve met and had to prove myself to across many disciplines and hospitals in our fair country.

So excited to be working with you, to learn from you and to incorporate some of the approaches and expertise that you have into my slowly forming future practice. Look at all that I know how to do! Please appreciate all the additional readings I have done. Did you notice that I’m wearing a perfectly professional outfit with properly groomed hair? I’m actually living out of a suitcase and couch surfing in a city I have never been to that I paid hundreds of dollars to come to just so that I could have the opportunity to spend the day with you today.

I am pleased to inform you that I will actually be working not 1 but 2 full days with you. This is a great opportunity for me as you may appreciate that as an elective student, I am trying to earn letters of recommendation for your specialty as I will be submitting my application over the coming weeks. This is a rare and fortunate opportunity as I will be able to show you so many sides of me and so much of my potential as you will see me not only perform in clinic but also in the operating room.

Clinic day has been busy and fun! Got to meet many patients and learn about many interesting pathologies. I presented cases and you reviewed my written notes, but none of my patient interactions were observed and few physical exam teaching points were refined as we jumped from one room to another and you reviewed with one student/resident after the other. I sure you hope you remember that you witnessed me perform that technical skill! I hope you heard the patient thank me as they left and say that they felt comfortable in my care. I sure hope you appreciated my efficiency as all my visits were within a reasonable time limit. Did you see all that?

Day 2 with you in the operating room. A new surgical procedure for me to witness. I stayed up late last night reading up on the patient, their presenting symptoms, their diagnosis and the expected outcome post-operatively. I read around the pathology and looked up the surgical technique and operation to anticipate any potential questions you could ask. Walk into the room: will you let me scrub? 1,2,3…5. We’re a team of 5. 1 fellow, 2 senior residents, 1 junior resident and myself. Oh, who is that? A shadowing medical student. I guess we’ll be six. Who will scrub – all of us. I sure hope I get an opportunity to show you the hours of suturing practice I have been doing alone at home and the 1000s of knots I’ve tied with both right and left hands.

Visibility is limited. Stepping stool kind of helps but time is shared between myself and the other medical student. Hour 3 of quietly watching and trying not to be annoying. You finally decide to ask us a few teaching questions. I am standing by reviewing in my head all of the material I read last night. You start with the shadowing student; she gets an easy one correct. I’m wishing that question was directed to me – argh. My turn, a more difficult one – I get it wrong. The questions stop. Back to silence and observation. Me in my head metaphorically kicking myself for having reviewed so much but not that particular anatomic feature. WHYYY?!

Hour 7 of operation and it’s time to close. Will this be my chance to throw a few stitches? Senior resident calls me over and hands me the scissors. “You can cut for us now,” he says politely. I feel like a superstar – I’m officially part of the action. I’m contributing, I’m in the mix! You see me cut a few sutures. I hope you thought I cut well! You look around at the team and announces that you will let us close and leave the room to dictate and catch up on some paperwork. Senior resident passes me the instruments just as the you exit and says, “Your turn to practice!” I’m so happy that I forget that there is no staff watching and go through the motions as I’ve practiced a hundred times. It feels different on human skin. The lighting needs to be ideal. My positioning matters. My hands are less steady. Many eyes are watching. But the resident coaches me and I can appreciate fully that I am slowly but surely improving my skillset.

My 2 days with you are ended. Now is my chance to find you, and ask for the letter. 1 day in clinic and 1 day in OR. I was told this was sufficient. I feel like I just met you; however, I truly need this letter. It feels silly to even ask but you are renowned in your field and on the program committee. Can’t miss this opportunity of course! Find you at the end of the day, and request a letter. You agree without showing much emotion. I’m reading your facial reaction to try to determine if it will be a strong letter or not.

Now comes the time to run after the confirmed letter. Email reminder 1. Email reminder 2. Email reminder 3. No response. Catastrophizing begins. Potential back up letters and contingency plans swirling in my head. Until finally, the letter is updated to ‘’submitted’’ status on the CaRMS website.

I can now sit tight and “relax.” Letter 1/5 ready to go for application to program 1/20.

Thank you for your support of my application to your specialty.


Surgical Specialty Gunner, MD CM Candidate 2020