Yes USMLE scores are important - but not everything for a Medical Residency in USA!
To be Pre-Informed is to be In Form :-)
Sharing Wisdom learned through application experience and mistakes - especially for IMGs / FMGs!
The other day I was reading about black-holes and how things never come out from them, including light - and somehow writing about waiving LORs reminds me of them ;-) - you will see why.
To 'waive' is to forgo, forfeit or give up or 'waving goodbye to'... While waiving your right to see those letters of recommendation has its merit of adding more authenticity to the document, there are some technical disadvantage it puts a candidate in, because, you do not get them back ...
Quoting ECFMG on this : "If you waive your right to view a Letter of Recommendation (LoR), that letter is not eligible to for return via the ECFMG Return of Document Service"
And here are the problems that you should scratch your head over, before deciding to waive your rights:
1. You won't get them back for the scramble - though you may apply to programs via ERAS and still be able to use those letters 2. You won't get them back and you will not be able to reuse them again for the next match season. Thus in case one does not match or does not succeed in the scramble either, a new letter of recommendation will have to be produced for the next match.
If you still wish to keep themn waived, a way around the problems above would be to have your writer write the LORs for you in 2 copies, if he or she is willing to give you sealed copies in addition to sending one to ECFMG-ERAS. So, in case you have to scramble, you can open the 2nd copy and use it for faxing, if needed. Also, you will have an option of using the same second copy for the next match in the 'un-waived' form.
Note that even for LORs that were not waived, the Return of Document service cannot guarantee giving you the documents back in time for the scramble - you must therefore make photocopies of all your documents (with unwaived rights to see of course) before submitting them to ECFMG-ERAS. This is because, as far as faxing is concerned - faxing an orginal is as good as faxing the photocopy, since its always a photocopy that is received at the other end.
[ (Whisper) I could not believe my ears when someone I know believed that the actual document itself was transmitted via fax instead of its copy....he he ;-)]
ECFMG Warns against Fradulent Letters of Recommendation (LORs)
It might just be too tempting to write tons and tons of self-praise on the Letters of Recommendation think
Quoting an email warning from ECFMG:
"In recent years, the ECFMG Medical Education Credentials Committee has made a determination of irregular behavior in 12 cases based upon the submission of either altered or wholly fabricated letters of recommendation. In 11 of these cases, the applicant's Standard ECFMG Certificate was revoked. Since these individuals are no longer certified by ECFMG, they are not eligible to participate in an accredited residency program in the United States and are not eligible to take USMLE Step 3."
So who does a confirmation check on your LORs ? IProgram directors do not routinely do a check on LORs for all applying candidates, but the chances could be higher for the following:
1. Candidates called for Interviews , especially candidates that the program like or are considering a prematch offer for
2. Candidates with extremely flowery and praising Letters of recommendation
3. LORs that clearly look fabricated by the candidate (not much specific substance, but general praise)
4. Letters without an official letterhead and an official seal of the insititution OR department OR the faculty
5. Unsigned letters - *Duh*
6. Letters signed in Black ink - yeah, coz' photocopied signatures look black
So avoid all these factors mentioned :-)
Hmmm...having said that - while its true that some professors would like the candidate to write the letter himself/herself and then sign it after approving the letter, residency applicants should be sure the faculty remembers them and the letter LOL! [Maybe a reminder phone call or email that they might receive a call from the US about the letter he/she signed for u ;-) ]
You definitely do not want to write and sign your own letters ! he he
What if you get that LOR AFTER Applying to Residency Programs ?
Sometimes good things in life come after the time you wanted them the most, which somehow takes the fizz out of them when they come to you, nevertheless they still might have some might remaining ;-)
Likewise, it is always possible that you finally get a new Letter (or letters) of Recommendation (LOR) AFTER you already applied - for example, if your observership term got over or the recommender was out of town. etc.
Oh a question first : Does ERAS accept new LORs after you already applied ? = Yes, they do ! But that will take time for the letter to reach them by post, to get scanned and available for download the programs and finally time for the programs to see the new document and download it. Lets say at least 7 to 10 days or more
1. In case your experience was ONGOING while you applied but got the LOR later, it may worth your time to send an email (or even better to call) all programs about the availability of the new letter of recommendation. Tell them that it will be available on ERAS shortly and also mention that if they wanted, you could fax it to them (since ERAS thingie takes time as I mentioned above). Now, to be able to fax the letter, two things are automatically implied:
a. Send the original LOR to ERAS as soon as you get it - BUT make a copy of that letter before you do so for faxing
b. Obviously this can happen if you DO NOT "waive" your right to look at the LOR (an analysis of waive or not to waive LORs will be posted soon)
Now, I understand that some recommenders might insist (especially US LORs) that they will send the LOR to ERAS directly - in that case you may not be able to fax it to the programs but you can always write an email to programs to applied along with providing them with the email address or phone number of your recommender
2. In case you land an a clinical experience or a research project AFTER you applied, you might wanna still send an email to all the programs you applied along with providing them with the email address or phone number of your potential recommender.
[ Note: At this point, I would also like to point out that getting an experience would make you eligible for some more programs that you have not applied to before - so consider applying to those programs after emailing them to find out if they would consider your application.]
Psst....You might begin to understand why its a good tip to have all email addresses of programs that you applied to, to be stored in a separate file on your computer with commas separating them. So when the time comes to update programs, you merely have to copy paste that list and put them onto the BCC section when you compose that email. Other way to do so is to store them on your online email address as a group and then all you have to do is compose an email to that group!
Also, do not forget that some physicians would not mind calling up some programs personally for recommending you (depends on how your rapport builds up during your experience). This can be pretty powerful interview-fetcher if you can manage it ;-)
Often, you may be asked to frame an LOR yourself by your attending or faculty and he or she will edit and endorse, if found appropriate. Here are some keywords that you could use to focus on various aspects that it must focus on - your personality, work habits and intellectual and clinical capability. Of course, I don't expect you to use ALL - just the one's that are appropriate to you :-)
Keywords for Residency LORs and Personal Statements
Work Traits and Intellectual Capability
Meticulous Neat Organized Good Clinical Acumen Ambitious Multi-tasking Assertive Focussed Intelligent Innovative Bright Technical Mindset Career-Driven Inquisitive Leadership Skills Team-Player Industrious Supportive Inspiring Likes to Collaborate analytical thinker 'Flair for assessing Clinical symptoms' 'Well versed with working clinical knowledge'
Personality Traits
Poised Pleasant Disposition Cheerful Balanced Good Communication Skills Good English Compassionate Spreads good energy Friendly Warm 'Get's along well with peers and faculty alike'
Well....mmm Hmmm....speaking of throwing modesty out of the window ;-)
Here's a Sample LOR I received from my friend over email - shall post more samples as they become available from contributors
Sample 1:
"Dear Program Director,
I am pleased to write this letter of recommendation for Dr. ABC, who was first introduced to me when when he came to XYZ hospital as an Extern, which he started in July 2006.
I found Dr. ABC to be a very hard working, warm, conscientious and delightful individual who showed much interest in learning. He took very good care of patients who were assigned to him and he made sure that all the work-up was done before the morning rounds, where he actively participated. His responsibilities included taking histories and physicals, SOAP notes, collecting lab reports from the previous day, writing transfer and discharge summaries and also participating in morning reports and noon conferences. He also did some excellent presentations. He has excellent clinical skills and displays them with mature mannerisms.
ABC is a very humble individual who gets along well with his peers and the entire medical team. It is therefore without reservations that I recommend him to you for any residency program that he may be seeking. I am sure he will be a valuable asset to your organization.
Please do not hesitate to contact me if you need further information.
Sincerely yours,
PQRST, MD XYZ medical Center"
[These links to samples below have been disabled - Will be back with more samples soon] " You might also wanna check out some LOR samples I found online:
"sample lor for residency" "sample recommendation letters for medical residency" "keywords recommendation letter residency" "sample recommendation letter usmle residency " "sample LOR internal medicine" "Sample LOR - Family Practice"
First of all, why do Program Directors need LORs at all? Because they carry a big responsiblity in choosing the right people to look after their patients safely for the next three years and are seeking assurance about the guys they are interested in! It's like - while choosing a good car dealer for buying a used car, we naturally ask information from friends we know and trust. Likewise, it is best if the LOR is from someone whom a Program Director can trust and believe. Hence, LORs from the MDs that are already established in the USA carry much more credibility and trust than those in other countries - unless they are big figures internationally. Some programs may even put forth a requirement of Recommedations from US Doctors as their criteria , for example check out the application criteria of the Quad Cities Genesis Family Practice Program.
That is not to mean that other LORs are utterly useless - but do get them from professors from your Medical school, which are more trustworthy than some friendly private practitioners.
Secondly, the practice of "You write the letter - I will sign it" by docs in our home countries is now known to most PDs here... :-) US Docs will hardly do that - which adds to their reliability !
Do all LORs need to be from MDs ?
Not really - but some programs may have special requirements. Like some family practice programs would want at least one recommendation from a family practice physician.
How many LORs are needed for ERAS / Match ?
Most programs wanna see a minimum of 3 Letters of recommendation - in addition, ERAS allows you to attach one more LOR allowed per program, bringing the total to a maximum of 4 LORs that you can allot to a single program.
Should LORs from people in the same specialty that you are interested in?
Not necessarily , but please have atleast one and the more the better. The practical disadvantage in having all from the same specialty could be that if could weaken your case if you were planning to apply for other specilaties as a backup with the same letters.
Should my LOR have an AAMC ID on it ?
Yes - its safer that way -why ? Coz then it ensures that ERAS scans and attaches the LOR image to only YOUR application and not someone else by mistake. In case the recommender forget to write the AAMC ID on the letter, you can write it yourself on the backside of the letter before you mail it to ERAS.
What formats should your LOR be in ?
There are no Universal formats per se, but its good to follow some practical tips :
1. Let the letter be addressed as "Dear Program Director"
2. Make the Letters 'specialty neutral' If you plan to use the same letter for different speciaties- what I mean by this is that don't let the letter specifically mention that you would be a great fit for 'pediatrics' or 'Internal medicine' - just let them say that you would be a great fit for 'your residency program'. Two reasons for this : a. The same letters can be used for multiple specialties and b. This also avoids a mistake by ERAS guys sending the wrong letter to the wrong specialty and embarrassing you ;-) Another reason this becomes important is that most people have the impression that they will be able to see the scanned LORs online after ERAS uploads them - Unfortunately NO , YOU CAN'T :-( You can only 'assign' the name of the person writing the letter to the programs you apply to and hope that ERAS sends the right letter to the programs..The new ERAS system now allows you to specify which specialty/specialties you would like the LOR to be sent to, to eliminate such errors.
3. Don't have it too short - atleast 3/4ths of a page or more
Click Here to view Sample Letter of recommendation (LOR) that a friend forwarded me over email ...
Read about the official Recommendation Requirements specified by ERAS Here.
Search Keywords to this Blog Post:
"letter of recommendation medical residency sample" "LOR+content+match+usmle" "sample letter of recommendation residency matching" "strong lor residency example"
The other day I was reading about black-holes and how things never come out from them, including light - and somehow writing about waiving LORs reminds me of them ;-) - you will see why.
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