Letters of Recommendation: Advice for Faculty

It’s the time of year when fourth year medical students have decided on their specialty and are working on their applications to enter the NRMP match.   It’s also the season that faculty are asked to write letters of recommendations. With approximately 17,000 medical school seniors applying, there will be around 100,000 letters of recommendation written this year!


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If you have had the benefit of sitting on a residency committee to evaluate and rank applicants, you’ve read these letters – and you know that they matter.   If you haven’t had that experience, it will be important to seek advice on how to write these important letters.  Seek help from other faculty with more experience or review the great advice posted by the University of California- San Francisco and the University of Illinois Urbana-Champaign.

A few other points that may help:

  1. This year, for the first time, faculty will have to upload these letters themselves. You can have a “designee” (your assistant, for example) do this for you – but it cannot be someone in the Office of Student Affairs. Make sure you get started early so it doesn’t become an issue as deadlines approach! The help desk at the AAMC is wonderful, but it’s going to be a problem if you wait until the last minute!
  1. Proofread. Twice. This is the first year that the Deans in your school won’t be able to look at your letters.   No one means to make mistakes…. but in years past, I’ve found letters with the wrong names, the wrong gender and grammar that only sort of made sense.   Needless to say, for the Program Directors it raises a question about whether your letter is legitimate.
  1. Instead of having the students worry (think back…. you worried, too), let them know when you plan to upload their letter. Regardless – make sure they are uploaded by September 1st.


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On behalf of all the students you are helping, and all the departments who rely on your letters to help match students to their programs – thank you!!


Resilience, Grief, and Remarkable Wisdom

My heart breaks for Sheryl Sandberg’s loss of her husband … and I am so grateful for her honesty, her wisdom and for the effort it took to share her journey. As I read her post on Facebook today, I realized that all of us in medicine could benefit from her thoughts as she ends sheloshim, the Jewish 30 days of mourning for the loss of a spouse.

One of the things that is so hard to teach in medical school (and all other health professions) is to honor the resilience of those we accompany on their journey through times of struggle and loss.  It is so hard to let go and realize there is nothing to “fix” in these situations. Far more important than trying to convince our patients, their families or our friends that it will be “better” or that there is “hope”… we need to commit to just being there with them, and walking with them on this very human… but incredibly hard journey.

“I have learned that I never really knew what to say to others in need. I think I got this all wrong before; I tried to assure people that it would be okay, thinking that hope was the most comforting thing I could offer. A friend of mine with late-stage cancer told me that the worst thing people could say to him was “It is going to be okay.” That voice in his head would scream, How do you know it is going to be okay? Do you not understand that I might die? I learned this past month what he was trying to teach me. Real empathy is sometimes not insisting that it will be okay but acknowledging that it is not. When people say to me, “You and your children will find happiness again,” my heart tells me, Yes, I believe that, but I know I will never feel pure joy again. Those who have said, “You will find a new normal, but it will never be as good” comfort me more because they know and speak the truth.”

Thank you for your wisdom, Sheryl.   We will hold you in the light.

Rabbi David Wolpe: What Sheryl Sandberg’s Post Teaches Us


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“We are all just walking each other home.”  Ram Dass

Fast, Easy Healthy – A Couple Cooks

One of the keys to wellness for medical students, residents and physicians is to cook. Sorry, but it’s the truth. Eating nothing but fast food, pizzas at conferences and “free” food in the hospital is just not good for you!

I developed the “pizza rule” years ago for myself and my trainees. It’s important to cook food at home … but who really has the time? I realized that we had to find recipes that took less time to cook than it takes to order a pizza.

This week I discovered A Couple Cooks– a great website by Sonja and Alex, a couple who taught themselves to cook together and now share their recipes and ideas for others.


Enchilada skillet


Tropical Mango Salad with Creamy Cilantro Dressing and Grilled Shrimp


Lasagna Stuffed Zucchini

Top 10 Holiday Gifts for Physicians and Physicians in Training

The holiday season is rapidly approaching.   Here’s my top ten gifts for medical students, residents and physicians…. or any busy friend!

  1. Mark Bittman’s new book How To Cook Everything Fast.

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This is an amazing cookbook and it is perfect for busy people. The recipes are interesting, delicious and healthy. The instructions are easy for a novice without being simplistic and the layout of the book in innovative and makes it really easy to use.


  1. An electric pressure cooker.

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Slow cookers are often suggested for medical students and residents but I don’t think they are as good as a pressure cooker.   You have to be there when slow cookers are (slowly) cooking, which is usually your rare day off. Also, it’s hard to cook vegetables in a slow cooker. Pressure cookers on the other hand cook broccoli in 2 minutes (perfectly!).  I’ve been told that the electric pressure cookers take a little longer to come up to pressure, but it seems a small downside for a device that also lets you slow cook, steam, sauté, and cook rice.


  1. Coffee or Tea

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There are several options to consider if they are a serious coffee or tea drinker. A Starbucks or Teavana gift card in a cute “medical” coffee mug? A Starbucks Verismo coffee brewer? Nespresso? Keurig?


  1. A FitBit

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Anyone in medicine loves gadgets and loves data. The fitbit has become a socially acceptable piece of “jewelry” in the hospital and it unquestionably changes behavior to increase activity. Having washed three of the “clip on” Fitbits with my scrubs, I would recommend one of the wristband Fitbits!


  1. A maid or housecleaning service

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Doing housework has to be on everyone’s lowest list of fun things to do on your day off, but it’s especially true for people who are studying extensively or taking call in the hospital. My parents helped finance someone to come occasionally to help clean my apartment when I was an intern. It was without a doubt the best present I’ve ever received.


  1. Anything that helps make it easy to get more exercise

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Another great gift is anything that will promote more exercise… a bicycle to commute to school or work? Yoga classes? Spin classes? A gift certificate for new running shoes? Resistance bands for the call room? A membership to a YMCA or a gym close to where they live? Certificates for post workout massages?


  1. “Date night” packages

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Whether they are single or have a significant other, being able to socialize is an important part of stress reduction for busy people.   Create combinations of gift cards to movie theaters and restaurants to support “date nights”. If they love art, music, or sports think of season tickets (or ticket packages) to museums, music venues or professional sport teams.


  1. An “over the top” alarm clock

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It’s not easy getting up at “dark thirty” to make it to rounds, but being on time is important.   The snooze button is not a good idea… but it’s so easy to hit. This alarm clock is my personal favorite to make sure you get out of bed. After a few hits of the snooze button, it rolls off the table and around the room until you turn it off!


  1. Great books by, for and about doctors.  

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If they are a serious reader, think about a Kindle (or other eReader). The Kindle paperwhite is small, lightweight, back lit and has a great battery life – which makes it great for the occasional times on call that you can find 30 minutes to escape into a good book. You can also read it outside in bright sunlight (unlike tablets like the iPad) On my list of great reads for doctors (in no particular order)…

Cutting for Stone by Abrahan Verghese

How Doctors Think by Jerome Groopman

House of God by Samuel Shem

The Immortal Life of Henrietta Lacks by Rebecca Skloot

The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukheries

Being Mortal: Medicine and What Matters in the End by Atul Guwande

William Osler: A Life in Medicine by Michael Bliss

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman


  1. The always appropriate gift of money

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If you are going to give gift certificates or money,  “package” it with some humor (in a pill bottle with a “prescription”) or a context (this is to help you buy good food for times you are too busy).

Please let me know (comment or email) anything else to add to this list!  Happy Holidays to all!



Ebola, Personal Risk and Our Trainees

Around the world, Ebola and other infectious diseases take the lives of mothers, fathers, sons and daughters … and place at risk those who care for them. This risk is known to all who choose medicine as their career.  It is part of caring for the ill, and always has been.


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 A healthcare provider has an ethical and professional duty to address a patient’s needs, as long as the patient’s diagnosis – or when the patient’s initial complaint, on the face of it – falls within the provider’s scope of practice. Refusing to do so is not consistent with the ethical principle of beneficence. “ Twardowski, et. al. RI Med Jl October, 2014

Around the world, physicians, nurses, and all healthcare workers willingly fulfill their duty to care for patients who are or might be ill with Ebola and other dangerous diseases, reflecting the altruism and compassion of those who choose medicine for their career.

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Emory Nurse ‘Could Not Be More Proud’ of Those Treating Ebola

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Ebola doctors sacrifice all to bring hope.

However, the duty to care for these patients does not automatically extend to those who are learning medicine.  Without the experience, context and well developed skills of established providers, trainees are potentially at greater personal risk.

When I operate on patients with HIV, Hepatitis, or any blood-borne pathogen, I take every precaution possible for myself and the staff who are scrubbed. I also take advantage of the “teachable moment” to discuss ethics and universal precautions with my trainees…. but I don’t allow medical students or junior residents to directly participate in the case. Likewise, I am sure that learners will not be allowed to provide direct care for patients known to be infected with Ebola or other dangerous diseases… or to travel to West Africa for clinical experiences while the epidemic is still present.


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All of us in medicine honor those who provide care to the ill despite the risk …and we thank you for the example you are setting for those learning to heal.  We hold our colleagues in Dallas, Atlanta, Africa and around the world in our thoughts as they work tirelessly to heal the sick and contain this terrible disease.

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Here’s a list of aid groups working on the Ebola crisis — and how to donate

Fast, Easy Recipes: Naturally Ella

I’m always looking for websites with great recipes that meet the “pizza rule” for medical students, residents and busy docs. (Food that takes take less time to prepare than it does to order a pizza).

Naturally Ella is a website by Erin, who “grew up on fast food” but, along with her family, made significant changes when her father had a heart attack at age 45. Her blog has healthy vegetarian recipes that are easy to prepare and make great #callfood*. Even if you aren’t a vegetarian, these recipes will convince you to join the Meatless Monday movement!


Avocado Chickpea Salad

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Hummus and Grilled Cheese Sandwich


Sweet Potato Sriracha Noodle Soup


*Search for #callfood on Twitter for other “pizza rule” recipes that are great to take to the hospital for call!

Words of Welcome and Advice to New Medical Students: The DeBakey Scholar Convocation Address

Convocation1-2 copy“Whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is gracious, if there is any excellence and if there is anything worthy of praise, think about these things.”

It’s so good to be here with you—what an exciting day.  I was asked to share some thoughts that might be relevant to you all as you get started on this incredible ride.  I’ll get back to the Paul in a moment—just to say here that, from a purely literary sense, there’s something to admire in his lists, their cadence and directionality.  Most of the rest of what I’ll have to say is from Greek pagans but they just can’t compete with this poetry, so I put it first.

I remember sitting where you are now on my first day.  The woman who is now my wife was halfway across the country; I was in a new city, sweating profusely, with a slowly dawning perception that I didn’t actually know what I was getting myself into.  Over time I found a place, some solid friends, some good study habits.  We all helped one another through.  I’m sure you will do the same.

What I wanted to share with you today, though, is something that I think is pretty important you know up front.  Here it is: You are all about to devote a tremendous amount of time and energy over the next four to…fourteen years…on something that is not enough.  I’ll say it again: a tremendous amount of time and energy will go to something that isn’t enough.  Medicine—the science, the practice—won’t get you through.  It can’t sustain you on its own, through all through the hard days, the specter of burnout, nor can it sustain the lives we will cultivate with others while we are here in school.  There’s a temptation sometimes to think it will, or at least to slip into the illusion that the whole world is just a somewhat distracting corner of medicine, instead of remembering that medicine is really just a small part of the world.  But we can’t forget that—and our patients, if we listen to them, won’t let us.

For us, medicine is (or will soon be) a way of life.  We’ll eat and sleep in the hospitals—and sometimes, we won’t eat or sleep, but we’ll still be in the hospitals.  But for the patients we serve, their days are anything but normal.  They—often regardless of how sick they are—are in extremis.  This day that you just walked into represents to them disorientation, rupture, interruption of their story and sense of self, reckoning with an unseen, threatening force.  We would do well not to forget that.

Narrative theorist Arthur Frank writes of what he terms ‘spaceship ethics,’ named after a physician’s anecdote of leaving his home and imagining his car a spaceship, carrying him to a distant world where “terrible things happen,” all the while refusing to acknowledge that his planet and the planet of the hospital are one in the same.  The problem here is that the physician is isolated—from his patients, his role, and even from himself.  What Frank proposes instead is to invest deeply in stories–essentially, being willing to be open to the ways that stories are the first inroads to a more personal and specific way of being-toward-the-other. Others have picked up his argument to strongly argue that we as clinicians need also to look outside of medicine, and toward things like living traditions, authentic relationships, good art, the natural world–not just to relate to our patients better or to help ourselves recharge but also to help us do the work that, ideally, we’re trying to do.  Medicine—the science—pushes us to efficiency, effectiveness, near-perfection.  There is a lot of power in that.  But healing—I hesitate to call it an art because it is more than that, more than artifice and closer perhaps to a way of being—healing sometimes requires inefficiency.  Hesitation.  Our wounded nature encountering another wounded nature, and stopping long enough to witness their suffering and, even if we cannot take it away, being willing to be changed by it.  How?

I promised you pagans.  Aristotle said, “the virtue of a man…will be the state of character which makes a man good and which makes him do his own work well.”  There is a sense, in his writing, that virtues—from virtus, excellence, worth, developed through habit—are the raw materials for a well-favored life in which work is integrated into a greater and more important pursuit of being a good human being.   Philosopher Craig Irvine at Columbia wrote, “I must care for my hands, if I am to lift the fallen; my heart, if I am to love the stranger; my mind, if I am to cure the ill; my eyes, if I am to find the lost, and my soul, if I am to guide them home.” I would challenge you to find a few ways to sustain yourselves that are not simply disconnected from medicine, and to avoid the slow gravity toward “spaceship ethics”—but instead to look to each other to begin to cultivate those strengths—humility, courage, charity, patience—that can sustain us as we remain human in the face of the suffering we will inevitably see.

Baylor has given me a tremendous education.  Now in my fourth year I can almost feel the first little shoots of competence poking up over the vast freshly-fertilized fields of my inexperience.  Thomas Merton said, “The world is made up of people who are fully alive in it: that is, of the people who can be themselves in it and can enter into a living and fruitful relationship with each other in it.”  Education, then, should be one of the ways that we learn who we are, what we have to offer, and how to make that offering valid to the contemporary world.  Baylor has provided that type of space for me while laying a solid foundation, and I have confidence that the faculty here will do the same for you.

As I look ahead, there’s one particular virtue that I would personally like to cultivate, that seems especially fitting especially after this last month at Texas Children’s Hospital with patients and families who are uprooted from home.  Here’s a long quote from Henri Nouwen from his book called “The Wounded Healer,” and then I’ll wrap up.

“Hospitality is the virtue that allows us to break through the narrowness of our own fears and to open our houses to the stranger, with the intuition that salvation comes to us in the form of a tired traveler…Paradoxically, by withdrawing into ourselves, not out of self-pity but out of humility, we create the space for others to be themselves and to come to us on their own terms…But human withdrawal is a very painful and lonely process, because it forces us to directly face our own condition in all its misery as well as all its beauty…[W]hen we have finally found the anchor place for our lives within our own center we can be free to let others enter into the space created for them, and allow them to dance their own dance, sing their own song, and speak their own language without fear.  Then our presence is no longer threatening and demanding, but inviting and liberating.”

Enjoy this time—it is fun.  Study hard, and try to do it for someone else.  Be good to one another, to your patients, to yourselves.  I wish you all the best.

The address given by the Mark Kissler, MS4, the 2014 Debakey Scholar of Baylor College of Medicine on July 30, 2014 at convocation for the class of 2018.