<p>I offer the following comments as one who writes many letters of recommendations and one who evaluates many letters of recommendations for medical school applicants.</p>
<p>The checked “top 1%” boxes are generally taken with a grain of salt. Some referees are overly generous with this classification-with 20% of their references being so checked, while other referees use this classification more accurately. What is more useful is the quality of the letter itself. Does it reinforce the general impression from the rest of the application? Does it reveal new aspects of the applicant not readily seen in other areas of the application? In general, is this letter specific for this specific student or is it a general “great student” letter with few specifics and thus little impact?
Lastly, letters of reference are only one portion of a complete application.</p>