Weakness, Hardship, Disability in a Med School Letter
When a medical school letter should mention a weakness, hardship or disability, how to ask the applicant first, and wording that stays fair.
Weakness, Hardship, Disability in a Med School Letter
Mention a weakness only as something you watched the applicant work on. Mention a hardship only as context for what you observed. Mention a disability only when the applicant asks you to, in words the two of you agreed, and never a diagnosis they have not chosen to share.
Letter writers get stuck here because two instructions seem to collide: be candid, and protect the applicant. They do not collide. Candor is about what you observed. Privacy is about facts the applicant owns. This page separates the two, gives the published rules that apply, and shows constructed paragraphs for each case. For the letter's overall structure, see how to write a letter of recommendation for medical school.
Every TMDSAS, Liaison, university and EEOC page quoted below was checked on November 7, 2026. The AAMC's letter-writer guidelines page returned HTTP 403 to our checks that day, so this page does not quote it.
The rules that decide it
| Source | What it says | What it means for your letter |
|---|---|---|
| TMDSAS evaluator support | Committees want "candid, honest insight into the applicant's strengths and weaknesses" and "an accurate assessment … rather than advocate for the applicant" | A weakness may appear. A plea may not |
| TMDSAS evaluation form, metrics box | "Describe any factors that have had an impact on an applicant's academic performance." | Context for a record is invited, not just tolerated |
| TMDSAS evaluation form, experiences box | "Which factors that have had an impact on an applicant's experiences?" | Hardship can be described as a factor, tied to what you saw |
| RIT Disability Services | "If a student voluntarily discloses their disability to a faculty member, they should not disclose it to others." | A disability you learned about stays out unless the student decides otherwise |
| Pitt-Johnstown, information for faculty | "Remember that it is the student's decision whether or not to disclose a disability." | The applicant decides; you ask |
| EEOC guidance on the ADA | The ADA requires employers to treat "any medical information voluntarily disclosed by an employee, as a confidential medical record." | If the applicant is your employee, what they told you about their health is a confidential record |
| CASPA evaluations help | If the applicant waives access, "you will not be able to see the content of the evaluation." | The applicant may never read your letter, so consent has to come before you write |
The two university pages are those institutions' own rules for their faculty. Your own institution's disability office sets yours; the principle in both is the same. The same EEOC paragraph says employers "may share such information only in limited circumstances with supervisors, managers, first aid and safety personnel, and government officials investigating compliance with the ADA." An admissions committee is not on that list.
A weakness the applicant fixed
TMDSAS asks for weaknesses, and a letter with none can read as advocacy. The risk runs the other way too: in the one-school study of 437 letters described on the phrases page (DeZee et al., 2014), nonpositive comments were associated with graduating at the bottom of the class. A weakness named as an open problem is a nonpositive comment. A weakness named as something the applicant noticed and fixed is evidence of capacity for improvement, which TMDSAS lists as a competency.
Our view: name at most one weakness, in the past tense, with the fix you watched and the result. The countercase: if the weakness is current and you saw no change, such as missed shifts that never stopped, do not write it into a letter you are framing as positive. Tell the applicant you cannot write the letter they need, as in how to decline writing a recommendation letter.
Two constructed examples, written by us, not real recommendation letters:
Weak: "Although Felix sometimes struggled with time management, he is a hard worker and I am confident he will improve."
Strong: "In his first month in my lab, Felix missed two sample-processing deadlines. He asked me how I plan a bench week, built a shared calendar for the three projects he was on, and did not miss a deadline in the eight months that followed."
The weak version leaves the problem open and asks the reader to trust your confidence. The strong version closes it with an observation.
Hardship: context, not a plea
Hardship belongs in a letter when it explains something the reader will see elsewhere in the file and you observed how the applicant handled it. It does not belong as a request for sympathy. TMDSAS asks for "an accurate assessment … rather than advocate," and a plea is advocacy.
Two constructed examples, written by us, not real recommendation letters:
Plea: "Amelie has been through so much. Her family has struggled financially, and she deserves a chance to become a doctor."
Context: "Amelie worked 25 hours a week at a pharmacy counter during both semesters she took my physiology course. She never asked for an extension, and her lab reports were among the four best of the 30 I graded that spring."
Before you write even the context version, ask. Family finances, a parent's illness, immigration status or a death in the family are the applicant's facts. The applicant may already cover them in their own essays, in their own words, and may not want a second account.
Disability: ask, then write only what was agreed
The default is silence. Your letter is about what you observed, and you can describe excellent work without naming why the applicant needed extra exam time or a quieter room. A disability, a diagnosis or an accommodation enters the letter only through this procedure:
- Did the applicant raise it and ask you to include it? If not, it stays out. Do not raise it yourself: Pitt-Johnstown's office says "Disability Services does not recommend that faculty directly ask students if they have a disability …"
- Agree the purpose. One reason an applicant asks is to explain a part of the record, such as a semester before accommodations started.
- Agree the exact words. Send the applicant the sentence you plan to use and get a written yes. Name the condition only if they ask you to name it.
- Write the observation, not the condition. The sentence describes what you saw the applicant do. The disability, if it appears at all, is one clause of context.
- Keep the record. Save the applicant's written yes with your copy of the letter.
Constructed example, written by us, not a real email:
Subject: One sentence for your letter
Hi Thiago, you asked me to explain your spring 2024 grades in my letter. Here is the sentence I plan to use: "Thiago's spring 2024 grades came before the accommodations he later arranged through our disability office; in the three semesters since, he earned the top lab practical score in my course twice." Reply "yes" if I can use it as written, or tell me what to change or remove. If you would rather I leave it out, I will.
Dr. Bose
The email asks about one sentence, gives the applicant the words, and offers a clean way out. It does not name a diagnosis because Thiago did not ask for one.
Comparing to peers without overclaiming
When context explains a weak stretch, the comparison that helps most is on what you observed after it. "Among the 30 students in that course" is a group a reader can weigh; "one of the most resilient students I have known" is not. Name the group, its size and your basis, as in the phrases page for medical school letters. If the applicant's grades need explaining, the guide to explaining grades and rank in a letter and the letter for a student with low grades cover the sentence patterns.
Check before you upload
- Every weakness is past tense, with a fix you observed and a result.
- Every hardship sentence is tied to something you watched the applicant do.
- No sentence asks the reader for sympathy.
- No disability, diagnosis, medication or accommodation appears unless the applicant asked for it and approved the words in writing.
- You did not name a condition the applicant did not name.
- The closing endorsement does not mention the weakness or the hardship.
Questions about sensitive topics in medical school letters
Should I mention a student's weakness in a medical school recommendation letter?
You can. TMDSAS asks for "strengths and weaknesses." Name one, in the past tense, with what the applicant did about it. If it is still a problem, decline the letter.
Can I mention a student's disability in a recommendation letter?
Only if the student asks you to and approves the wording. RIT tells its faculty that a student's voluntary disclosure should not be passed on to others, and Pitt-Johnstown says disclosure is "the student's decision." Without that request, leave it out.
What if the applicant asks me to explain a bad semester?
Ask what they want said and agree the sentence. TMDSAS's form asks writers to "Describe any factors that have had an impact on an applicant's academic performance", so a short, agreed explanation fits.
Will the applicant see what I wrote?
Not if they waived access. CASPA, AACOMAS and ADEA AADSAS each require the applicant to choose "Prior to requesting any evaluations," so the choice is made before you are contacted. That is why the consent step happens before you write. If the applicant asks to read the letter anyway, see what to do when an applicant asks to read your letter.
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Get a free Quick Review of the letter against GradPilot's medical school letter of evaluation rubric. It checks whether your letter gives a measured assessment rather than a plea, whether each quality is backed by an incident, and whether hedged phrasing undercuts your closing endorsement. A letter for a PA, dental or pharmacy applicant goes through the health professions evaluation letter rubric.
More guides for medical school letter writers:
- Med school rec letter phrases, strong vs weak: tier words, faint praise and gendered wording.
- Writing a LOR for a student with low grades: concede the record, then give the evidence.
- All medical school essay and letter guides.
Sources
Retrieved November 7, 2026, except where noted.
- TMDSAS, Evaluator Support (no cycle year stated): "candid, honest insight," "rather than advocate," evaluation-form metrics and experiences boxes, Capacity for Improvement.
- Rochester Institute of Technology Disability Services, Confidentiality (institution policy, no date stated): faculty should not pass on a voluntary disclosure.
- University of Pittsburgh at Johnstown, Disability Information for Faculty (institution guidance, no date stated): disclosure is the student's decision.
- U.S. Equal Employment Opportunity Commission, Enforcement Guidance: Disability-Related Inquiries and Medical Examinations of Employees Under the ADA: employer confidentiality of voluntarily disclosed medical information.
- Liaison International, CASPA Evaluations: effect of the FERPA waiver.
- DeZee KJ et al., What aspects of letters of recommendation predict performance in medical school?, Academic Medicine 2014;89(10):1408-15 (one institution, classes of 2007 to 2009; "bottom of the class" means the 27 students per class with the lowest cumulative GPA): nonpositive comments and bottom-of-class status. Abstract read through the NCBI PubMed record.
- Not retrieved: AAMC, Guidelines for Writing a Letter of Evaluation, HTTP 403 on November 7, 2026. Not quoted.
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