Welcome to this week's edition of Dear Dr. Horton! Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through , and if your question is appropriate for the column, expect an answer within a few weeks!
Dear Dr. Horton,
With CaRMS applications open, the pressure is definitely piling on... yet no matter how much I tell myself I need to get started on preparing personal letters for the different programs I'm applying to, I just keep putting it off.
I know a great letter isn't going to pop into existence the night before applications are due, but I'm also at a loss in terms of where to even start... any advice would be much appreciated.
CaRMS is a perfect storm. It pits a few of life’s most fundamental questions and conflicts against one another. First, there’s the problem of identity — who you are vs. who you wish you were. Then, there’s the matter of what other people in your life want you to do. There’s also geography (where you want to be vs. where other people in your life expect you to be). And throw in a pinch of infectious mass hysteria… everyone around you is screaming, “Fire!” So something must be on fire, right?
That’s why the drive to procrastinate is so overpowering. You’re not just writing a letter; you’re making a statement about who you really are.
Here’s the good news: you can reframe the job ahead of you as an opportunity to work some of these things out. It can serve to remind you of who you were before you started medicine and how that person is connected to who you are right now.
Over the years, I’ve read hundreds of CaRMs letters, and I’ve learned what makes a fabulous letter and what earns a non-stop flight to the shredder. Here is my roadmap for the first steps to writing a letter that people will remember for all the right reasons:
1) Authenticity rings true. Don’t say anything you don’t mean, and you’ll always sound authentic. There are myriad ways to convey enthusiasm and avoid lying or committing to a statement that isn’t really true. For example, if you’re split between two specialties, you don’t have two write two sets of letters vowing your undying allegiance to each of them. Instead, you can say:
“While my CV reflects my competing interests in A and B, what I have never had any uncertainty about is my commitment to looking after the chronically ill. I believe this can be achieved in more than one environment, and it is clear that family medicine offers particular advantages for providing this care.”
What to do right now: Take five minutes to write a 1–3 line statement about why you are applying to each specialty you are applying to. The only thing you can’t write is, “This is my back-up plan.” But you can address why it’s your backup plan. Begin your draft by writing what’s true, not what you think others want to hear. That will give you more interesting, authentic, and heartfelt content to start with.
2) Control the narrative. Things go wrong in all of our lives, and there’s almost always a backstory. For better or for worse, people will make assumptions about your record, but they will always react more favourably if they hear about the problems from you directly. The bonus here is that you can give critical context to any bumps in the road before they jump to conclusions, and you can also use what I call “lessons learned” framing.
What to do right now: Take a few minutes to generate a list of what you believe are vulnerabilities in your application. Then, write down the worst thing you think a selection committee could say about them. Once you’ve done that, use the same list to write down how you think your best advocate or mentor would positively re-frame those weaknesses. For example: illness can lead to compassion, better skills around self-care, and insight into the patient experience; failure can teach you to improve time and stress management; anxiety can force you to learn critical coping skills for the stresses of medicine; and negative comments on your Dean’s letter could be moments of reckoning when you realized your knowledge of X was inadequate or you were too quiet, and you took some action that shows you are a person who responds to feedback. If I read that in a letter… I’m intrigued. People who reject constructive feedback don’t make good doctors. Use your CaRMs letter to help the committee understand that you are not one of those people.
3) Tell a story. We think and remember in narrative. If you start with a story that’s grounded in time and place, you’ll hook your letter-reader more quickly than any list of reasons why you like specialty X ever will. Everyone has interesting stories… sometimes, you just need help finding them.
What to do right now: Make a storyline. On the left side of a piece of paper, write, “my birth.” On the right side, write, “this moment.” Now, start filling in milestones. Kindergarten. Highschool graduation. The first day you started violin lessons. Getting into medicine. What happened in between? Maybe a family member was ill. Maybe your family relocated. Maybe you broke your leg and saw your first x-ray machine in the ER. Add all those highs and lows.
Now… add people. Write in the name of the grade ten teacher who made you feel like you could do anything and gave you the determination to pursue medicine. Write the name of your aunt who died of breast cancer, and how that loss lit a fire in you to pursue cancer research. Write the first time you read Atul Gawande in your mom’s New Yorker.
Somewhere in what you’ve just written, I can almost guarantee that there’s an opening for a great CaRMs letter.
If none of this works: try doing timed writing prompts for five minutes on additional questions. Some of my favourites: what case made you want to go into X? What’s the greatest act of humanity you’ve seen in medicine… or outside of medicine? What was your lowest point in clerkship and your highest? What did you learn from those moments?
And finally, Procrastinator, don’t try to do this alone. Pair up with a friend and go through these questions one night, soon, with a paper, a pen, a timer, and the confidence that you now have a roadmap.
Dr. Jillian Horton is a graduate of McMaster Medical School and completed her residency and fellowship in general internal medicine at the University of Toronto in 2004. She was the Associate Dean of Undergraduate Student Affairs at the University of Manitoba from 2014–2018 and now directs programs in wellness and medical humanities at the Max Rady College of Medicine. She has won awards for mentorship, professionalism, and teaching at the undergraduate level. She is also a mother, musician, and writer. As an Associate Dean, she cared so much about undergraduate students because she never forgot what it felt like to be one of them.