Tuesday 10 April 2012

10 ways to improve residency chances through letters of recommendation (LOR)

  1. Target each LoR to the specific specialty you are applying to. For this you will have to meet with the referee to explain the nature of the LOR and its purpose.
  2. According to American Medical Association (AMA), LORs from overseas schools are not very helpful since international medical school standards vary and often are not comparable to those in the U.S.
  3. Get some experience working in a U.S. health care system before applying for residency so that you can get a US LOR
  4. Teaching programs are better than private offices of physicians in US for point number three
  5. Opportunities for USCE/observerships/externships are hard to come by but if you work hard enough, you will get a good break
  6. Letter, which extols your clinical abilities in addition to other niceties, is received very well by programs.
  7. Work with your letter writer to produce a well composed, personalized attestation of your capabilities as a physician and portray you as an asset.
  8. Deans letter is not that important unless there are delinquencies and discrepancies in your medical education.
  9. Since at least 2007, increasing weight is being given to LORs from US teaching hospitals. In same line of thought, LORs from faculty in hospitals without ACGME accreditation will be carry less importance.
  10. Order of importance of LOR
    1. US LOR from ACGME accredited university hospital
    2. US LOR from ACGME accredited community hospital
    3. US LOR from non ACGME accredited hospital
    4. US LORS from university based research program
    5. US LOR from non hospital based community physician
    6. Non US LOR from US affiliated university hospital
    7. Non US LOR from university hospital
    8. Non US LOR from non teaching hospital
    9. Non US LOR from private physician
    10. Non US LOR from non physician


  1. Hey,
    Thank you for the above mentioned information..
    I have a quick question.. I have done about 6 months of USCE in private offices..
    How much weight do these carry.
    Your Candour as always is much appreciated.
    Thank You.

    1. not as much weight as you might think. see point 10 in the above article as to where they might lie. It may also help if you ask your referees to call in some programs for you.

  2. ALso I have received 4 Strong LoR's from the Physicians I have worked with during my USCE.
    How much of a role do these play, as I have just about mediocre scores, in securing interviews????.

    1. letters are good after score criteria have been met unless there are strong contacts between the referee or applicant and program. if you have poor scores or attempts, you may be filtered out of the PDWS system and your letters may not be of any use.

  3. I have got a fellowship in Illinois( i got luvky I got selected for fellowship with out residency in US). Will LORS from the prgram director help? Its a teaching hospital.

    1. absolutely. do you plan to move backwards professionally and do a residency after your fellowship is done? in any case, the LORs from OD will certainly help

  4. Thanks for the information you give us. It is very helpful. I have a question. I am an IMG, I did an observership in Neurology in a accredited university hospital 2 years ago when I was still a 4th year medical student. I think I can get a strong LoR from that experience, but the problem now is that I am going for Peds. Do u think that still works or it's a waste of time considering I am not applying for Neurology

    1. I think it will still be okay, especially of it is going to be a high value LOR (high recommendation and only US LOR etc). You could ask the referee to comment on your work ethic, moral and commitment to being a physician. Also not making it very neuro specific may also be a good thing


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