Letters of recommendation are an important aspect of any IMG application. The task for any applicant is to secure not just good LORs but strong letters which vouch for the applicant. If you are going to work in a hospital or a clinic make sure you are clear about what you want out of it at the end. This is true especially is you are involved in patient care.
Hospital based USCE is valuableThe most sought after letters are from clinical faculty at university or university affiliated hospitals. A LOR on a university letter head is going to be viewed positively. To secure a USCE or observer-ship spot in a reputed hospital is tough but you have to do a lot of networking and develop connections. Read about USCE and observer-ships here.
Place for clinic based USCELetters from physicians in private practice also have a place especially if they are a large community practice and the applicant is interested in applying to family medicine.For clinical sciences like internal medicine or family medicine, it is good to have some clinic and hospital based experience. This way you can have a broad range of referees who can write letters for you.
Buzz words create a stirSometimes, faculty will let you review their recommendation before mailing it in. Though this is not publicized much, it still happens and will be very much in favor of the applicant. This way, the applicant has some input and is able to ask the letter writer to mention specific 'buzz' words that are key to a strong application.
Provide input for your letterIf you are directly involved in history taking, talking to patients and physical exam, outlining a plan of care, make sure this is mentioned in the letter. This shows that the referee had an opportunity to observe your interactions with the patient
To waive or not to waive.Most applicant will be faced with a referee who chooses to send in your letter with no input from the applicant, since they waived the right to see the letter. According to ERAS, such letters are given more weight by program directors and faculty as they are supposed to represent an unbiased view of the applicant.
State your need for strong letter in begining.The key is to ask the attending upfront if they would consider writing a strong LOR for you, so that they know what YOU want out of this. It is not good enough to write just a recommendation letter, it should be an impressive one. You should ask for a strong, solid recommendation. It is better to clear that up in the beginning, rather than assuming that they will, and end up getting a generic letter that does not look impressive at all.
How to ask for LOR1. Be specific in asking for a letter of recommendation, do not beat around the bush or be indirect. Doing so the referee will know for sure they have a letter to write
2. If they have no time or are busy, ask if you can draft a preliminary letter which they can revise and sign as needed
3. If you are having issues with getting in touch with them via email, there is no problem in calling their office on the phone and reminding them of the time sensitive nature of the task.
4. refrain from haggling them too much but if they are still not responding, ask if they can still do it, if not, you can spend that time looking for a new referee.
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