Letters of recommendation are required by every medical or dental school (that I'm aware of). Although they play a much smaller role in the selection process than other elements, for many, collecting letters is often one of the most stressful parts of the application process. Many students feel as though they haven't developed a strong enough relationship with their faculty, especially with online courses or very large lectures to ask someone to vouch for them. I hope this guide helps to break this process down for you, but if you still have questions, please ask!
First, let's address the "relationship" part of the request process. I believe many expect that you should have an extremely personal connection to your faculty in order to ask for letter. That is simply not the case for most applicants. At many large universities, it's pretty difficult to get that close to faculty with TA's teaching most of the time. All you need the faculty letter to do is comment on one or two of the 15 Core Competencies. The most common competencies that faculty could mention based on limited experiences are Science Competency (if you did well), Capacity for Improvement, Resilience, and Critical Thinking. If there were a presentation or a paper, perhaps they could also write about your Oral and Written Communication. What the faculty letter does NOT need to be is a story of your life. You DO NOT need to meet with your faculty in advance to "get to know you". It is your responsibility to tell the faculty what you hope they can say about you in your cover letter. Here is a sample of a letter request:
REQUIREMENTS
Every school is going to set their own requirements. The type of letters most often asked for include:
Science Faculty (anything out of biology, chemistry, physics, physio, anatomy, etc). Psychology (yes, even neuropsych or cognitive psych) are oftentimes not counted as science. Nutrition also may not count. Advisors are not the judge for whether a letter counts. The only entity who can answer that for you is the school itself. If you like to play it safe, make sure you have at least two faculty (or TAs) from a physical or natural science that you can ask.
Health Professionals, especially one from the field you intend to join, are required for some professions, such as osteopathic medicine, dentistry and veterinary medicine. Allopathic medical schools do not usually require a letter from a physician. Most DO schools will accept an MD or DO letter, but there are still some schools that want to see a DO letter (those a fewer these days).
Non-Science Faculty, such as those from the humanities, psychology, nutrition, and any other field, can be a requirement. Two allopathic schools require a non-science letter.
Non-Academic letter writers are those not associated with your courses. This can be a PI, a health professional, a job supervisor, or clergy. It should not be family or friends.
Major Faculty is less common, but if they want to see a letter from someone in one of your major classes, it would most likely be an upper div course.
Basic Science Faculty is a thing. That means they want to see a letter from one of the following: Biology, Chemistry, Organic Chemistry or Physics. These are often hard to get because you took them so long ago.
What if a school has a requirement and I cannot get that letter?
Choose a different school. Of course, you can spend money and try to take a course just to get a letter OR you can ask the school for an exception (frowned upon), but if you simply don't meet their requirements, you should not apply.
WHAT GOES INTO A LOR?
Letters of rec are supposed to highlight the competencies needed to be successful in their school. What makes a good student? Science competency, Capacity for Improvement, Communication Skills (oral and written) and Resiliency and Persistence. Your letter writer should know what competencies you want them to highlight and speak to how he/she has witnessed those competencies in you. They will tie that to how they predict you will perform in your professional school. For example, "Based on the effort that Johnny undertook in my physio course, I am convinced that he would persist and thrive in a rigorous medical school course."
Letters should start with a simple statement: "I am writing this letter to strongly recommend Jeetu to your dental school." Each paragraph should highlight something about Jeetu with evidence. The conclusion would end with, "Without any hesitation, I strongly recommend Jeetu to your school." The whole thing should be within one page.
VERY IMPORTANT: All letters of recommendation need to be signed and on official letterhead. If not, the schools will often contact you during the screening process and ask you to have the person re-upload the letter. This may delay your screen.
WHEN TO ASK
Technically you can ask for a letter of recommendation anytime. The issue is if they say yes, they aren't going to do anything with that letter until you're ready to apply, which may be three years later. Sometimes you have such a great experience with a professor and you want to ask right then because you aren't sure you will have that person again in class. If that's the case, definitely ask, but when you do, you'll let them know that you aren't applying until 2025 (for example). They will know to write some notes about you, but the responsibility is yours to stay in touch with them. There is no legal obligation for them to write that letter three years later, so if you don't stay in touch, they could very well forget about you and then ghost you when you go to ask. Ideally, if you really like someone, you'd find other classes they teach, or join their research lab, or ask them how else you can get involved in something they do. These types of relationships need to be natural and reciprocal. You cannot force someone to take an interest in you. You cannot simply ask to meet so they can get to know you for the purpose of writing a letter. That is unnatural and forced. Making connections with people should be a skillset that you learn to develop over time. Maybe this doesn't happen your first year, but if you are aware that you struggle to chit chat with faculty or you have a hard time looking people in the eye and asking questions, you need to work on that over your second and third year so you can get better at it. You cannot simply say to a medical school, "I am not good at talking to my faculty, so I don't have any letters." People all across the country have to do this very same thing at all types of universities. You HAVE to learn to do this. I believe this is why LOR are still required. Not because they add any value to an application, but because being able to connect with just two faculty over the course of four years in college is a necessity to demonstrate your ability to connect with patients. I don't know that for sure. That's just my guess.
To summarize, you can ask anytime, but make sure you ask no later than March of the year you are applying.
CREATING A LETTER PACKET
I've always recommended that applicants create a Letter Request Packet to email to those they are asking. This makes you appear organized and professional, increasing the odds of them saying yes. Here are some documents to include in your packet:
Cover Letter (the body of your email)
Resume
Draft of Personal Statement
Transcripts
AAMC Letter Request Form with Core Competencies
If you're concerned about your grades, do not have to include your transcript. Most schools would prefer that letter writers NOT reference your grades or test scores because it creates bias in blind interviewers.
Make one PDF with all of these documents and name it as your name.
HOW TO COLLECT
You have two options to collect letters of rec. First, you can use the application system (AMCAS, AACOMAS, or AADSAS). The cost of this service is already included in your application fee. This is good if you are applying to only one system. You would add your letter writers into your app once it opens for your cycle in May.
The second option is good for those taking multiple gap years and those applying to both MD and DO. Interfolio is a paid service that stores your letters for you. You can add letter writers into their system at any point, and Interfolio emails them to remind them to upload. Once the letters are in that system, you connect them to your application by adding your letter writer's name in the application, but instead of using the letter writer's email, you use the email Interfolio gives you, and they upload the letter for you. It is a fairly seamless process.
Tips
You can email the professor to ask. Meeting in person is not necessary.
You can ask a TA to write the letter, but always inquire if they think the faculty would co-sign the LOR.
Rather than asking for a "Strong" letter, ask if they can support your application to medical school.
Give them at least 30 days notice.
Do not act aggressive when you follow up. Always thank them for their time.
Letters for MD schools do not need to be submitted until mid-July before it begins to affect anything.
Good luck with asking for letters of rec!