Module 5: How to Obtain Stellar Letters of Recommendation (LOR)

Welcome to Module 5. As you know, this is going to be detailed on the letters of recommendation that make a difference for your application packet. I really want you to tell me how the program has been going for you so far, so do leave me a comment down below. In this module, you're going to focus on something that is a little bit out of your control, so to speak. You may but there are certain things that you can do that can influence your letter writer. And I'll teach you exactly what those are so that while you're rotating through whether it's your electives core rotations observerships, you're not waiting until the end of the rotation to request an LoR. I'll teach you how you can make your intention clear when you start your rotation, how you can ask the questions that you really need to be asking to ensure that your letter writer is going to write something that's going to work in your favor. In addition, I'll show you some sample How about that? I'll show you letters that I've written over the years and even letters from other sources. Just like in the personal statement module. We had several sample personal statements from prior I want you to know what's good and what's not so I will take you through some attending physicians psyche and what they're thinking and how you can ask for a letter out of them in a way that allows you to be able to influence what they put into Some attendings do ask you to write your own letters and we're just going to leave it at But I'll show you what you can provide your letter writer as information that should go in your personal statement. That makes their work easier. A lot of at the end of the day, they have the final say as to what they choose to include or exclude from your So I want to show you some specific components that make up a great A few more things that are coming through over the next few sections is I want you to stay tuned and I don't want you to stop now. Don't pause, keep Remember, you're going to have to sit through whether it's the USMLE. 6, 7 hours, you're going to have to put in a lot of time and tenacity. So it's okay to take short breaks here and there, but don't give up in this program because you've made it this far already. This is also an exercise in building patience and tenacity and in completing the work that you start. So I encourage you, if you're getting weary, don't stop now. We still have a lot to cover that's going to benefit you. And remember, it's all about accelerating your success. I hope you're feeling empowered, that you're learning new material and more importantly, that you're implementing this material so we can make you the next resident physician in the US. Thank you for joining me and I'll see you in the next section. That's coming up next.

Welcome to How to obtain a stellar LOR. LOR is an acronym for Letter of Recommendation. As always, I am your lecturer here, Dr. Nina Lum. I will walk you through a set of slides that will bring information and guidance to you about what you need to do in order to get a strong letter of recommendation that you will use as part of your residency application process.

Let us get right into that. In this section, I will teach you some specific things. I want to teach you why the letter of recommendation is important. I want to teach you about the parts of the letter and the components of the letter that should stand out and I will show you how to identify a potential letter writer. I will also tell you the information you need to give to your letter writers to improve their experience, and also to make sure that you get a good letter. We will also talk about the different things that you can do to influence the content of your letter because that above all things is what matters the content of your letter matters more than anything else.

Alright, we will move on to the next slide.  This slide tells us why the whole LOR process as part of application is very important. The national residency match program did a survey in 2018. They surveyed program directors from all specialties and they reviewed the percentage of importance that these program directors placed on certain elements. This was really to find out what factors influenced the program director's decision to invite students for interview. They asked them, “Hey, on a scale of 1 to 5, can you rate and tell us which one of these items in the application packet make you want to invite a student for an interview?” A 5 over 5 would be absolutely top of the line, you must have these things for me to invite you for interview, but one of the five means lower on the totem pole, not as important. When you compare these factors and there is a bucket list of them, I highlighted some five factors on this slide.

USMLE Step 1 was ranked at 4.5 over 5. It is a pretty high rating, meaning as in medicine, we never give anyone a five over five. We are always very stingy with our marks but a 4.1 over 5 means that stood a really high likelihood that you will be invited for interview. That means the programs rated that point as the most important thing or one of the most important things.

Next on that list were the letters of recommendations. It was not just any type of letter. It was a letter of recommendation from a person in the same specialty that you are applying into. That point alone ranked 4.2 over 5, just a little bit over Step 1. We know Step 1 maintains importance because Step 1 is a filter. They used that, most programs used that to say if someone is even eligible for applying. Once you get past that Step 1, the next thing they will be looking at is whether or not that you have a letter of recommendation from a person in that same specialty.

If you are applying to orthopedics, how many orthopedic surgeons have written a letter? If you are applying into neurology, how many neurologists have written you a letter? If you are applying into internal medicine, how many internists have written your letter? Does not have to be all your letters from the same specialty but a majority of them.

The next thing is the medical student performance evaluation and that is the Dean's letter. I know some people that graduate from foreign schools always find it really hard to get in contact with their Dean, but you really want to start now asking your Dean and prepare your Dean to be ready to write you an MSPE. There is a structure for an MSPE, I will find a sample and I will have that in the notes as well.

The next thing was the USMLE Step 2 CK and the personal statement. We will talk about the personal statement extensively in a separate module. The next thing we are going to touch on is some general topics regarding the letter of recommendation.

I will tell you exactly who your letter writer should be. You want to make sure that you choose your letter writer wisely. They should be a faculty member or an attending physician who has knowledge about you. Do not ask a random person that you just met for one day to write you a letter of recommendation. Because if they say yes, chances are they will write very generic letters.

US clinical experience is always better because if you get some US clinical experience, you can ask your preceptors to write you a letter. You may need to combine that with maybe a letter from your medical school professor that is in another country or the school that you went to in your hometown. You may want to ask them for a letter as well. You want to have a nice mix of letter writers. It is important to choose attending physicians, not residents, not other professionals who have a doctorate degree. It doesn't really matter if the person has a PhD in nutrition or if they have a doctor of nursing practice, they are not a medical professional. I should say they are not a medical doctor. They are medical professionals but not a medical doctor. You need to choose an attending physician that has preferably an idea of the US system so they can vouch for you in the proper way. If not, then you want to take notes so you can send it to them and tell them, “Hey, based on this course that I just took, I need and I have learned what you need to put in my letter and so here you go.”

The next point is that letters from program directors look good. Think of it this way, “If you are a manager of a firm somewhere and you have a problem, who do you go to? You do not go to your subordinates. You go to another manager.” So program directors value their perspectives and their own opinions, just like colleagues in the specialty value their own perspective.

It is important if you can get a letter from a program director that looks good automatically because it tells them, “If that program director wants to retain this person, I would want to retain them as well.”  That makes them a little bit more competitive for you. I actually have one student that I coached maybe a few years ago. She had a program director from a big school write her a letter. She came in as a student during medical school and ended a rotation there. During that rotation, she did something that I will tell you later on in this presentation as to how to make yourself more likable. By the time she came around to request for letters, he gave her an exceptional letter with the letterhead from his program. She had over 14 interviews and this is somebody who requires a visa. She was applying with a J1 or with the J1 requirement, and she was able to get that many interviews. Letters go a long way and the author really matters. You want to make sure that you are getting an author whose opinion counts to the residency program.

Another thing you want to do is you want to prioritize the letters from peers of the same specialty of interest. If I am an internist you want to or if I am looking to go into internal medicine, you want to make sure you are getting at least more than half of your letters from an internist because they understand what it takes to train in that specialty. If they are going, if anybody is going to recommend you into it, it has to be someone who has the experience. It is like taking an E-courses like this from somebody who has never been to medical school. How do you believe that person? To that same effect, you want to make sure that you are prioritizing letters from people that are considered peers in that specialty.

Last but not least, content over title. In the last few points I have mentioned how title can benefit you. I want you to remember that content matters more than anything. In order to have good content, you need to have a good relationship with that attending physician. You need to have spent time with them. They need to know you. They need to know your attributes. They need to know the things that you have done. I will tell you specifically in the upcoming slides what you should give your letter writer, so that they can have enough material to create a good content letter of recommendation for you.

This slide is a sample letter of recommendation that I wrote for a student of mine back in the day. I would just point out some things to show you because I have taught you about letters but I want to show you an example. The reason I am showing this slide on here is I know that there are some attendings out there that will ask the student to write the letter and give it back to them. They will tell the student to include what they want in the letter, and then they may rephrase it. Sometimes they may copy it verbatim even without rephrasing it. I really want to teach you, I want to show you what you should be wanting your letter writer to bring out in you.

This is Mr. Brinkman. He is a resident right now somewhere in Indiana I believe. This is the body of the letter and I wrote, “Mr. Brinkman, during the in-patient portion of his clerkship here at my hospital as a community based faculty at precept students from his school on a one-on-one basis.” What I did in that first line was I established relationship. I am showing the reader how I am related to Mr. Brinkman and why I have the authority to speak on his behalf into internal medicine. Now granted, I am board certified in family medicine but what I did here was I told him the setting in which I was in, which was not a clinic, it was not an out-patient practice. I worked with an internal medicine group, it was important that I set that precedent in my letter that he was rotating with me under the auspices of internal medicine, in an internal medicine environment. Then I cited that it was one-on-one,  meaning I had a lot of time to spend with him. It was not in a group. I was not distracted by other people. I spent a lot of time with him. Then second I go into saying he stood out but I did not just say he stood out and left it at that. I showed a reader how he stood out. I said, “He stood out with his breath of knowledge for his level as a fourth year.” Then I compare him with his peers and say, “He stood out in comparison to his peers.” That showcases his actual strength when I compare him with other people. Then I go back and I tell the reader exactly how his background helped him. His background was a teaching assistant. How was that helpful for him? His background in teaching was more apparent when we did journal article reviews or journal club. I have really done this in one paragraph. I have talked about this person highly. I started it off by telling them the setting in which I met the student, why I think the student is a strong candidate, and why I think he stood out compared to his peers. I affirmed my role in his training even though he is applying into internal medicine but I am a family medicine specialist. I affirmed my role in his training to reassure the reader that I am well aware that he wants this specialty. This is what he wants to do. If this was a family medicine letter which it looks like, this was actually a family medicine letter. In the last paragraph, he exhibited full commitment to his medical education and asked thoughtful questions that revealed his interest in family medicine. Again, if you flip that script which was a family medicine letter, but he was part of his internal medicine rotation, but it was written by a family medicine specialist. Either way whether it was a family medicine or internal medicine, that one word could be flipped over and it could be an interest in internal medicine. This letter will be just as good.

It is important that the person is showing personal attributes. Instead of saying this person is prompt and shows up to work and be enthusiastic. Guess what I did? I wrote that then I also showed how he was enthusiastic by citing an example. An example here really says that he was the only student that showed up to the hospital on July 4th which was not mandatory, that incense tells you that this person put in the effort to show up when he did not have to. That really speaks to his personal attributes. This is just an example.

I want you to take those samples that I have talked about, bringing out the attribute of the person. Actually, first of all, the letter writer should affirm the role in your life. They should start off by describing how they know you and for the duration of time that they have known you. Secondly, they need to talk about the setting in which they knew you. Then they need to go into your clinical knowledge, your clinical skills, what makes you a good student or physician. They need to go into some examples citing your character, your attributes, your traits, things that make you stand out from other people. They need to speak to the specialty that you are applying into like, “This person will make a good orthopedist because…” They should follow that format.

Some additional tips for the LOR process. Usually, I tell IMGs to waive their right to view the LOR. This is best because it keeps it blinded and unbiased. The programs are not worried that, “Oh, maybe this person wrote the letter themselves or something like that.”

There was actually an article that came out and I will link it down below. It is an article that speaks to IMGs having fraudulent portions of their application. They said we are making up stuff in some of their applications. If you can keep your application as pure as it can be, that is always best. But if you do not trust the letter writer, then you should reconsider not waiving your rights. If you are applying for more than one specialty and you plan to overlap, you want to know what is in it. Because the last thing you want to do is let the reader know that you are applying to a specialty that is not their specialty. That just looks bad. If you are applying into emergency medicine and your letter writer is writing about you applying into family medicine, then guess what, the emergency medicine person will not be impressed by that letter because it is clearly stating that you are applying into family medicine. You need to be cautious about what the content of your letter is saying on your behalf. There are people that have applied into residency and requested letters. The letter writer has written really horrible things about them. You do not want that. I know actually an IMG who I featured on my podcast for emergency medicine and she actually disclosed that she did not waive the right to her letter. She was glad she did. Because she was able to read one of the letters and reject it. She stopped it from moving forward because that person was not speaking to her best strengths. They were actually focused on her weaknesses. After working so hard, the last thing you need is someone painting a negative picture of you as a resident. That is why it is important to ask more than three to four people. If one persons’ letter is not as great, you can always bounce back to the next one. If you waive your rights then by all means you would not have to go through this but if you do not, make sure that you review the content then.

Here is a list of what you should give your letter writer. The letter writer, again, is the author of your letters of recommendation. You should give them a copy of your CV, so they can pull back from your past experiences into the current letter. You need to give them a copy of your personal statement so they have a general idea. If you feel like you do not have a final personal statement, you could give them a draft, give them something that they can use to speak to your attributes. This is particularly for somebody who maybe you worked with for a month and you do not know them for that long. Give them a copy even if it is a draft, it does not have to be perfect. You just need to submit something that has a little bit about you in it, so that they can also learn about you and then be able to put that into a letter for your document.

The next thing would be to specify the specialty that you want them to write it for. You want to make sure that you are very specific as to what specialty they are writing for and be open about what you need from them. This is a good place to ask them specifically what you need them to portray in your letter. 

One thing that I notice is sometimes students wait until the end of their rotation to ask for a letter when they could have asked for that letter earlier on. Please if you start a rotation, I want you to build that relationship early on so that you can demand or ask for a letter at the start of your rotation. What you can actually do is you can present yourself to a faculty member and say, “Hey, Doc, I am interested in specialty X, Y, Z. I will be applying into your specialty. I really would want you to write me a letter of recommendation around it with you for the last few days but I will be here for the next few weeks. If you do not mind, can you tell me things that I need to do in order to make sure that I can get a good letter.” That faculty member would tell you right off there if they are the person for you or not. More often than not, if they do not feel like they will have enough exposure, they may say no. Even if they do say no, you want to remember that it is not the end. You can ask somebody else but you are better off hearing that “No” in the beginning than waiting until the very end to ask for a letter of recommendation. 

If the person is outside of the US or if they are not familiar, maybe a community based preceptor, you want to inform them that they will need to renew their AAMC account information if they do not have one already.

In this section, I will teach you how to get a strong letter and really what this means is there are certain things that your letter writer must highlight about you. I want them to be very evident in your letter. They need to talk about your strengths. They need to talk about how you were a great student, your participation. They need to talk about your clinical acumen, your performance. They can compare and contrast you with a group of your peers. They need to write things that allow you to be distinguished, traits, virtues, moral character, your work ethic. Those are things that they can capitalize on.

It is important though guys, that you submit your letters on time. The only way to do that is to start early. Start now. Start thinking about people that you are going to be looping in as your letter writers, as you go through your clinicals. If you are in medical school right now, you need to be thinking, “Who is a professor that I can really build a relationship with over time, so that they can write a really good letter of recommendation for me.” The other thing too would be telling the professors exactly what they will need to know. Some key points that you need to know for those of us that are on the writing side, what we do or what we have to do in order to make sure your letters are well done. It has to be a PDF format document. They start off in a word document. You type it out. It has to be submitted in a PDF format. It must be on a professional letterhead because those letterheads do make a difference. Honestly, think about this, when you see a letterhead that says University of X, Y, Z, and then you get another letter without a letterhead, what happens? You lose that effect of value. A person that has a letter from a university program already brings out some value to it as opposed to a letter that just does not really have a letterhead. You should have a professional head letterhead. The limit on the size of the file that is uploaded on AAMC is a one MB, one megabyte limit. It is MB as I think it is a micro limit. It is a very small document. The document should be written on an 8.5x11 inches document. That is a usual regular A4 sheet of paper here in the US. Other countries print out a longer format paper. That is why that is important. 

Let us look at another example of a good letter. In this sample, I am showing you another letter and just pointing out those personal things that I wanted to highlight. This person in the second line is a bright, inquisitive, dedicated, and amicable individual who undoubtedly puts his heart and soul into his learning experience. That is because this person comes with an impressive resume and a dedicated mind to learn. I have no doubt that a candidate of such would do well in your program. This is not a student. This is already a physician who has practiced in another country, who has some research background, who is obtaining an additional Master of Public Health degree at the time at which they are applying for residency at a really good school. This person has a great resume. They have a great CV. They may almost look as if they will be a difficult learner or a difficult student because they may know too much. What is good about this is I brought out this person’s personal attributes that despite the fact that they have an impressive resume, they are actually still very inquisitive. They are still dedicated. They are amicable. They are approachable. They work with their heart and their soul and they are still a learner. That is what is important for someone that has already been in practice or who maybe even has subspecialty training in another country that is trying to come here is we still want to know that you are still going to learn from us because that is the whole point of residency. You may not feel like you need to learn anything more and you are just doing this for the paperwork, but it is important that your program feels different. I wrote about, “He was first introduced to me while doing that observership.” I usually put the hospital name on there. I got to observe him closely. Again, I am asserting my position of authority here, “How do I know this person? How long did I spend with him?” I get to watch him in an in-patient and out-patient setting. Then I also know about his work ethic, his commendable, and his clinical knowledge skills. He demonstrated his inquisitiveness by asking probing questions regarding the cases that we saw. I go further to say, “He is committed to the specialty.” I talk about how he showed commitment by teamwork. I showed not only saying he is a great team player because a lot of people want to just say that. I went further to explain that he was quick to integrate into our healthcare group. I talked about a specific instance. It is really important that your letter writer knows you, so they can write something that works in your favor. That is very important.

The big question remains, “Doc, how do I get a strong letter?” First of all, you have to identify your letter writers like we mentioned before. You have to find authors for your letter. That could be your medical school professor, your medical school Dean in the form of an MSPE. It could be any of your attending physicians. It could be someone that you rotated with either in an observership, an externship, or a research experience. Whatever that is, it could be that person. You can always ask friends and family to direct you to attendings that they know about but you do not want to ask friends and family to write a letter imposing as an attending. That is never good, never a great idea.

Once you get an observership, you always want to ask for letters early on. You do not want to wait until the end to make your intention known. Because guess what, they already know you are going to need a letter. You may as well just start prepping them early. But here is a trick. I do not want you to just go ahead and ask for a letter. I want you to go ahead and ask for advice as to how to get a good letter. Then in the course of that conversation, I want you to bring it up that you will be requesting from this particular person a letter of recommendation. You do not want to wait until the end of your rotation. You want to ask and ask early.

Some other key points, tell the letter writer what the letter will do for you. If you know that this letter could change your life literally because it would be of high esteem when you put it on your CV. Tell them that. People like to hear how they can help you or how they can be a benefit to you. Tell them what it would do for you and for your career. Tell them why you value the expertise in this process, “Why are you peeking me out? Tell me and it makes me want to write you a good letter.” Because then that means one, you recognize my position in your life as your preceptor or as your attending. I am by “me,” I am referring to whomever that attending physician is because of course, I can not write you a letter because you took a course with me but I can show you how you can approach other attendings about getting a good letter of recommendation.

I will give you some tips and these are more character development tips that you can use during your rotations and during encounters if you are networking at a conference. We will talk about networking in a separate video, in a separate module. I really want you to focus on just these few tips of ways that you can influence your letter writers into writing great things about you.

This is what I took from the How To Win Friends & Influence People, by Dale Carnegie. It is a great book. I think it is a book that really lists out principles that you can follow for the sake of your residency application experience and what really matters. I will walk you through some very general things. You want to be polite. You want to be courteous. You want to smile. You want to be very open and approachable. Those are just some beginner tips. We get right into it here.

According to that book that I just referred to, here are some principles that make people instantly like you. If you smile when you are in person, when you meet, their mirror cells pick up your smile. They pick up your chair. That is always a good thing. Be an intent listener, be a good learner, a good student. Become genuinely interested in that person. Develop a relationship with them. I have said this before multiple times, “Relationships go a long way. That is the basis of networking.” There is a patient-physician relationship. There is a physician-physician relationship. There is a physician-student relationship. The tenants of a successful relationship really evolve around communication. Becoming genuinely interested means you are engaging your letter writer in conversation.  You are engaging them to communicate with you. You are asking thoughtful questions during rounds. You are asking thoughtful, meaningful questions. You are talking in terms of the other person's interest. Guess what their biggest interest is, their specialty. If you ask them questions, “How did you get to where you are? Where did you go to medical school? Where did you train? How was your training? How did you make it in? What score do you think I should be going for?” You need to be asking that person questions based on their interest. You can always ask medical questions too. Professors like when students ask them questions. That is a great opportunity, a great place to do that.

The next thing is you want to make other people feel as important as you would want to feel but you want to do it sincerely. This is not a cue for you to be a brown noser or to try to please everybody. It is a place for you to respect people. It is a call for respect and honor, and doing it in a very sincere manner, in a manner that does not appear as if you are just trying to get something but that you are honestly interested in that person.

You can contact me at drlum@imgroadmap.com. You can also find me at www.drninalum.com and fill out the contact form or we can meet on the Facebook group is the IMG Roadmap Group on Facebook. Look for me in any one of those places and you are guaranteed to get a response. I will see you in the next module.

As we get to the end here, just some final words. It is important to be polite, courteous. We mentioned that before. Tell the attending what a good letter will do for you. Tell them why you value their expertise in this career choice. Ask for people to link you up with potentially good letter writers or people in the specialty that you can shadow, observe or rotate with.

Treat your attending like you would want to be treated if you were in a place of authority. I hope that these tips today would help you to understand what a strong letter of recommendation is because showing sometimes is better than telling. I will include some letters in the comment section right below this lecture video. You will have some downloadable letters that you can see and use as an example of what a strong letter is.

I hope that your preceptor does not ask for you to write a letter but if they do, I want you to use these as a showcase to say, “Hey, how do I mirror my thoughts along the same line?” Remember you really want to make yourself stand out very differently from a generic letter. Thank you so much for sitting through this lecture. If you have any questions or if you need anything in the meantime, you know where to find me.

Regarding your letter of recommendation, it is a very important part of your application. The letter can bring out valuable qualities that distinguish you from other applicants. The more up to date the letter is, the better it is. Programs preferred letters from their own specialty like I have said this before. If you are applying to family medicine, have at least two letters of family medicine doctors. Then another one could be a pediatrician. It could be an internist but you want to make sure that you have letters from the preferred specialty. You want to follow the rules for each program as to how many they want. Programs will tell you on their website exactly how many letters that they want. It is usually between three and four. I usually recommend that you ask over four people to write you a letter because if one person fails, you can substitute with the next person.

Refrain from submitting more than what is requested. Sometimes that may just appear as desperate or it may appear as if you are not following the rules, you want to stick with the rules. Rules are made for a reason there to be followed. You remember that you will need to generate a request from your AAMC account and your letter writer should be able to have access to that as well, so do not forget that is another really key component of this whole process.

In this section, I will be teaching you about some of the issues around letters of recommendation. This is just to answer some frequently asked questions about letters in general, obviously, I'm sure you've completed the prior module on what it takes to have a strong letter of recommendation and what that really means, but yes, let's go into some FAQs regarding this topic.

First off, I want to give you some tips on how to use the sample letters that are in this course. So you'll find out that in this module that you're watching right now, there are sample LORs written by physicians. Some of them by me and other physicians that you can use to really gain insight as to what a letter looks like for recommending a physician into residency, but do not copy those letters, do not plagiarize them.

I want you to use them as inspiration so that when you present yourself on the wards, you're exhibiting those character traits. You're showing up early, you're putting in the work, you're doing the scout work, you're taking notes. You are speaking with your patients, presenting your cases so that when the time comes for you to ask for a letter of recommendation, that doctor can write those things about you.

Sometimes, they may ask you to write some things about yourself and submit to them. But in order for that to be truthful, there needs to be some amount of your character that ties in what you proclaim to be. Those letters are there for your inspiration. Please peruse them, read them, you can print them out and make variations of them and present to your attending if they want you to submit a letter to them. 

Who can write me a letter of recommendation for residency? I get this question often and some people have asked me if a nurse practitioner, or if a PA can write a letter, if a PhD can write a letter, I strongly recommend that you stick with an MD, MBBS, or a DO. That should be a physician in medicine, in the discipline of medicine. It could be a surgeon, but their credentials do matter. You cannot get a letter of recommendation from a nurse practitioner or a physician assistant or a nurse or a doctor of nursing practice. They are not medical doctors. They are not physicians. So your letter must come from a physician.

Between physicians or amongst physicians, there are some preferences also. You'll notice that programs like letters that come from program directors or chairs of department. We'll get into that a little bit here. What kind of letter matters the most?

But how many letters do you need? Again, this is program specific. Some programs have on their website, three is the average. Some will take four, some will allow you to submit as many as possible, but I really do think that if you're applying to a particular specialty, you should bring at least two letters from that specialty and maybe a third from another.

So if you're applying into psychiatry, at least have two psych doctors write you a letter, and then one internal medicine or one family or one peds or one surgery. Whomever else you want to add as a third person is fine. What you're doing is you're showing that you have a preference for psych and thus by inference, you're bringing more letters because you've done your due diligence to get the work to be able to say, you're interested in psych or that you're a good student, or you make a good psychiatrist.

Can you get a LOR from your home country? This is another frequently asked question. Yes, you can. Your dean can write you a letter. Your medical school professor can write you a letter, but I just recommend that you do not only get a letter from your home country but that you mix and match.

What do I mean by that? I think you should get a letter from your home country, maybe your dean, and also from United States physicians so that you get a variety. And it's just not only about your home country, because you're not trying to train in your home country. You're trying to train here. So get letters that mesh both of those together. So one from your home country, two from the states, two from your home country, two from the states, I think that's a fair game. 

How many letter writers of each specialty do I need? Like I said, always have more from the specialty that you're applying into. So if you have an opportunity for three letters or the program is saying, give us three LORS, then you should get two from that specialty and one from another. If you want to get all three from the same specialty. Go for it. I'm all for it. But sometimes that's hard because maybe you've only done two rotations, so you can definitely get a letter, two letters from your specialty, and one from a third specialty. Let's get back into it here.

The next is what type of letter writers do programs like. Program directors love when other program directors write the letter. They love when a chair of department writes the letter. Why? Because those people are in the same position as they are. And it's a small niched academic sector. Program directors tend to know one another and you know what it means to get a recommendation from somebody that you know, somebody that's doing your job somewhere else, it usually carries a lot of weight. It carries credibility. 

It means that person would want to train you. And so it makes it easier for that program director to see you in the light that other program director sees you in. It's really good to get letters from other program directors and other chairs of department. Anybody that's the chair of the department of medicine, chair of the department of surgery, those people carry weight within their communities. They're well respected. They're well-known, well-liked, good leaders. They can pinpoint a good student, a good future doctor. So their opinion is highly respected. 

If you get a program you may ask, what about a letter from a community-based physician? You paid for a rotation and you're doing it with a community-based physician. That's fine. If that community-based physician is recognized in the specialty, it may be okay. And usually, it is okay. Most programs will take a letter from just about any physician because it takes a lot to become a physician anyways. So don't shy away from that, if that's your only option. 

What I'm saying is what program directors really respect is a letter from a program director and a letter from a chair of the department. You can also get a letter from any of your clinical preceptors. Any of the doctors that you work with, whether they're faculty members or non-faculty members, that is also acceptable.

Can I get a LOR from a paid rotation via an agency? Yes, you can. You can get a letter from any of the paid rotations that you do, and you can also use those attendings for your references and so on and so forth. But obviously, you need to come in with the mutual understanding that you are there to get an LOR also. They need to be aware, and what I usually caution you to do is at the start of your rotation, present your objectives of the rotation to the attending. Tell them what you are aspiring for, what you're going for, “My goal is to match into residency in peds.” “My goal is to match into residency in general surgery and I'm here because I believe you'll be a good person to recommend me and to also teach me about this specialty”, and somewhere halfway in your rotation, you should go back to them and ask for feedback. “How am I doing? How am I performing? Do you have any recommendations for me?” Then you take that and you implement any changes. 

At the end of the rotation, when you're about to leave, you can present them with your personal statement and say, “Here's my personal statement. Here is a copy of my CV. Can you please consider writing me a letter of recommendation?” You do that before you leave. Then, a couple of months later, you follow up again and ask for that letter, when ERAS opens, you submit them that request, and so on and so forth. 

Can you get a letter from a private practice physician? Yes, you can. In this case though, I'll caution you, the content of the letter matters more than the title. What that physician is saying about you matters a lot more than the fact that it is from a physician. If you're getting a letter from a private practice physician, just make sure they're writing you a strong letter.

It shouldn't be something generic. I know I've worked in private practice also. So I know some physicians have generic letters. They just keep in their shelves and when you ask, they just copy-paste. It's always important that you add some material, give them your personal statement, give them maybe a list of the activities that you did while you rotated with them so they can highlight that.

It is perfectly okay to include, “I did a poster presentation. I did this, I did that. I did that.” So that they can know what to put in your letter. They need to know your research work that you did in med school. They need to know that you've done more than one rotation in that specialty.

They need to know that you did a sub-I or an acting internship because that helped them speak to your advantage in that letter. You need somebody else basically, selling you to the program and you can use this private practice physician's authority by sharing with them your experiences so that they can put that in your letter. That makes you look good. It makes you look competitive. It makes you look serious. It makes you look desirable to teach in a residency program and thus makes them want to invite you for an interview. 

Where can you find samples of a strong LOR? In this course I have some, even on Google, if you just type in, “Sample letter recommendation for residency”, there are tons.

Please do not plagiarize. Please do not copy word for word, use them as inspiration. And I want you when you're reading a letter, look for the character traits that are being highlighted. Look for the work ethic that is being highlighted. Look for what are the things that they're saying about this person that makes them good and, “How can I replicate those in my life so that my attending can do the same for me?” 

You know how to find me, you know where to meet me. Send me an email. If you have any questions and I'll see you in the next module.

In this section, we will discuss crafting a robust LOR for edit and review by your attending physician. So this is important because sometimes when you work with a certain physician, they may end up putting the responsibility of you creating a draft letter of recommendation in your lab. And so I want you to consider these points before you start writing. Now, in this section, you'll also find in your next module that there is a demo where I actually put these recommendations in practice so you could see how I use what I teach you in real time. So let's get into now to start, guidelines for the letter writer. So this is, again, a section that we're reviewing because your LOR writer has requested that you send them a As a letter writer, the person that is recommending you into residency, at least in their opener, must confirm the position of authority that allows them to evaluate you as an applicant. So what does that mean? In their opener, they at least owe the reader an introduction, and that could. Be evident with the letterhead that they choose to use. For example, if they're a faculty member at an academic teaching program, the letter may come from the letterhead of the university or medical school or medical center. However, in the opening of the letter where they're writing, dear Program Director, I am writing in support of Nina Lum for the position of a PGY-1 intern in internal medicine at your residency program. I've known Nina Lum from spending four weeks with me on a teaching service here at University of XYZ. So being able for them to be. Able to position themselves as someone in a position of authority allows the reader to get a quick understanding in the opening of your letter about what type of person this is that is writing your LOR. Typically, they may be a supervising physician, an attending physician, an assistant professor, or a professor of medicine. Those are all examples of their position of authority, what that does for your reader. So the person who is reading your letter, the program director that's reviewing your letter, is they can grasp an understanding of this person has the expertise to be able to assess a resident. That is the key there. Now, in addition to that, the letter writer must also demonstrate skills through metrics like numbers and time What does that mean? So being able to describe that you have worked with the applicant over the preceding four months or six months is a metric because it gives a fixed time frame under which they had the time to supervise you. So again, in that opening paragraph, after writing their first liner about who they're writing to recommend they may follow with skills that they've noticed, or metrics such as numbers and time frames that describe how long they spent with how much time they had to supervise you. And it validates their position to be able to recommend you into that program. Now, another key part of this is the letter writer must be able to verify and add clarification to any level of expertise that you already possess as the applicant. So the way you're going to do. This is you're going to provide them with your CV. And this doesn't have to be the CV that you submit to residency application. It may just be a regular CV that you write and give to them so they have a perspective. Why is this important? So, as we've discussed the first paragraph, it's about introductions, validating their expertise, validating their position as to why they have the rights to recommend you or not recommend you into using time frames to speak about how long they've worked with you or during what setting that they knew you. So another thing that's important is that they must also give insight as to the setting in which they worked with you. And that setting could be it was a suburban community hospital serving 300 beds, or it could be a private practice clinic serving 20 patient encounters a day. Those are all back to the point of metrics numbers and time frames because that also validates the reader's understanding of the setting that you were in, how much time you put into this rotation with this person, and how they're able to give a recommendation for you so as far as your expertise and your verification of the work that you've done, providing your CV to your letter writer allows them to be able to extrapolate from there. What do I mean by that So you are on the process of applying into residency, and so you've done ancillary in other specialties over the course of your life and now you're applying to one specific specialty. However, your ancillary work can be used to emphasize a point For example, maybe you worked with the United Nations as a volunteer ten years ago, and now you're applying into residency and you have a strong attraction for global health or even just community wellness and education. Well, your letter writer can extrapolate from a past experience from your CV even though they did supervise you at that time. They can speak to your passion for global health in the present day, while extrapolating from your past expertise in working in global health or in a community setting or community service setting based on your prior experience. So they can utilize your past experience to make a point across in your current day letter. And what that does for you is twofold. It helps the programs to also see or get a better understanding of something that you've put in your CV. But then also it gives some additional verification that you are still a consistent physician individual who continues to apply these same principles that they've applied for ten years in their current day Are you tracking with now? Next thing to do, which is what we actually this just talks about achieving greater clarity. To achieve greater clarity, provide precise examples of clinical scenarios, avoiding generic descriptions. So being able to highlight from your past CV instances that validate the current recommendation that's being set forth for you is super important So, for example, you are a student, you're an MS four, and you're on rotation, and you're working with the physician. And you ask them for a letter of recommendation, and you're stumped at what to write, right? Maybe you choose to write about your punctuality. You showed up early to rotation. You were first to hop in on procedures, you were willing to learn, you were enthusiastic about patient care, you were a self starter, and you would seek out opportunities to create a research project. And so on and so forth. Now, those are all great things to. Write as clinical scenarios and precise examples. Of why I think you would be. A great internal medicine resident or a great pediatric resident or a great resident irrespective of specialty, right? So I can choose to include either one of those examples as precise examples of clinical scenarios. That's way better than saying this student was the best student on a rotation. They did really great. That is so vague and generic. So for better clarity, we can go down to the nitty gritty parts of what you actually did on your rotation. Now, demonstrate rather than simply stating their abilities. So this is, again, the letter writer must demonstrate rather than simply showing or stating what you're good at. Yes, she's a great student. That's very generic language. How can we tell or how can we show that she is a great student? Well, we cite an example. Compared to her peers, Nina Lum always showed up early. Nina Lum took the role of the leader in the student rotation. She created the schedule for her mates. She directed them or assigned cases. Each morning, she printed out the rounds list. She broke down the rounds list and assigned roles to her colleagues. Right? She was always the first to follow up and determine what we needed to do next as a team. She arranged the lecture order for all the students on the rotation. So those are specific things that say, wow, you were a great student, as opposed to just, Nina Lum was a great student or is a great student. So personalize your letter for relevant specialty. So, as the letter writer, the letter writer must personalize your letter for the relevant specialty. Now, obviously, some of you are going to get generic letters, which mean it could be applicable for any specialty. But if you're looking at a holistic application, you want to make sure that your letters are actually specifically saying your letters are actually specifically saying that you are interested in this specialty. Because your letter will be reviewed by a Program director of one specialty, it's unlikely that you'll be reviewed by a Program director who is also a Program Director of Psychiatry and also a Program Director of General Surgery. He'll just have maybe one specialty. If anything, he may have a subspecialization, which could be for a second. So when they are reading your letters against all the other your competitors and. All the other letters that are being submitted if your letter just states you'll be a great candidate for any residency program, it doesn't drive the point home as well as the letter that states that you would be a great candidate for their specific specialty. And then the traits that are unique for that specialty, for example, general surgery, they can extrapolate on that. Dexterity, time management, early punctuality, working late, hard worker, right. They want to be able to extrapolate and cite examples of how the traits that you have, the characteristics that you are relevant to the specialty. So it is important that you steer clear of just generic letters and you seek to get letters that speak to your specific specialty. And one way that you could do this is have several letter writers. So ask each person to write a. Letter for a specific specialty, if you Now, obviously, if you are in a scenario where you don't have several options, by all means you can therefore choose maybe the three letter writers you have, but you can always have a conversation with them and ask them, can you please write this letter specifically for internal medicine, and I'll make a variation for family medicine? Or can you make a variation for That way, when you're submitting your application, it's as specific to your specialty as possible. And another point which is very important in drafting this LOR, which we've discussed a little bit earlier on, is extrapolating from the applicant's CV in order to validate and reiterate skillset So I'll give you an example. I was applying for fellowship, and I reached out to my medical director to write a letter recommendation for me And she asked for my CV. And I gave her my CV. And she was able to write a letter. And go into my CV and pick out things that I did, even as a resident, that were not applicable to my current job and share about them in her letter. So how does she do that? She basically went through my CV and saw, "oh, wow, Nina volunteered in Haiti twice," right? During a PGY-2 and during her PGY-3 here And so she was able to speak to Nina has a passion for global health. She has a passion for reaching the underserved. And she's demonstrated this way back when she went to Haiti twice, but she continues to do that even with her current patient population. So that's a clear example of how you're taking a story from an applicant's past and using that to validate or reiterate a current skillset Remember, these are simple guidelines that your letter writer must incorporate. And if your letter writer is willing to listen to this lecture, please, by all means, share it with them. However, if delegating this responsibility to you to draft an LOR, consider these things when you start your draft. We also have some templates on here. We have some writing prompts, and we have a demo of how I put. these into practice in the next section.

All right, so this is an LOR that we're going to work on. So the opening is you know, they have a date. All right, so we'll correct that. Derek program director. And they put a reference of the person's name. And so that could be name and AMC id, which is fair. I think that's a. That's fine. So the opening is a one liner that says I'm pleased to write a letter of recommendation for. So again, in support of application for your residency program. So again, completed four weeks elective internal medicine rotation. And later I personally evaluated the clinical communication skills for the purpose of Pathway 6 and ECFM certification. So I like this validation here. What I would do is I would include what I mentioned in the prior video, which is I want to give a little bit more perspective about who I am and why I have the capability to recommend soin. Right? So I would say, you know, this part. I will bring it up here in my first paragraph introduction. So I would say I'm pleased to Or I would change that. I say this with great Joy to support Dr. But she's already graduated medical school. Or to support Dr. Sogin Tahiri. All right, Application into your. Then I would even include the specialty. Right. I'll even include a specialty to say into your internal medicine program. Now, if you were even going super, super specific and you were getting just one letter for one program, you can even put the name at. Right? But, you know we know that many of us are going to use the same letter for multiple programs, but at least we should use the one letter for one specialty. So it is with great joy that I write to support Dr. Sugar's application into your residency internal medicine residency program. Okay. As an attending physician, or you could even say as an ABIM board, you know, or we could just say as a board certified preceptor in internal medicine or whatever, you know, insert specialty. Now, this person is a different specialty from internal medicine. Then they can talk about their specialty, but they'll just speak as to why they can recommend you for the other specialty. Right? So as a board certified preceptor in internal specialty, I have or I evaluate residents, or you can even say I instruct, you know, teach, educate, evaluate students and residents in intern specialty. Or insert time frame. Right? So that gives the reader a little bit of perspective as to, you know, who are you to recommend this person and why should I listen? So as a program, as a board certified preceptor, and this could also be replaced with their job description. So, you know, it could be medical director, it could be chair of department, it could be practice owner. Right? And then obviously it gets fluid, right? The more changes you make, the more fluid it gets. But what I'm really showing you here is that you should be able to validate the expertise of the person that is recommending you. And so that person should be able to say, hey, here's some great work I've done. Right? It could be a researcher. They could be a physician researcher. Right? So it could be a physician researcher. As a physician researcher in the neurosciences. Right. Searcher in xxx. Right. So you're saying, hey it's with great joy I write to support Dr. So again to hear his application into your internal medicine program. And then you go quickly into validating your expertise in writing the letter. And those notes in the first part of the video included here, there's a board certified preceptor, job description, medical director, chair of department, practice owner, whatever in that specialty. I. And then, you know, what I'm doing here is I share the role, share current role and authority statement, right? So you put an authority statement that says, here's why I can tell you about the student because that gets the program director and the people evaluating that application. So to really see who you are and why we should listen. Right? So I evaluate students and residents in the specialty and. Or if you're writing in the past tense, I evaluated. Right. As an option for. And then you set time frame. Right. Or if you're speaking the present tense. I have been evaluating these students in or for the last five years. Okay. Six years, 10 years, 20 years, 30 years. Okay. All right, so for the last, we put a time frame. So now moving forward, then you go into using specific duration metrics, right? You're sharing metrics as to how so how much time you spend with. So how do you know. So again. Right, so. So again, completed a four week elective internal medicine rotation here at. Hopefully Another thing that should be up here is the letterhead of hospital office practice, whatever the case may be. So they want to put it on a professional letterhead. So, you know, that's the first thing that should be. Obviously that's a header. So it's a, it's a hidden part in the document. It doesn't have to be like free, it shouldn't be free texted. It should be that they have a template that they use when they're doing like their official billing, communications or official letters. So letterhead must be included. Okay, now, so we've talked about why we're who we are and why we're supporting slogan. And now we're going to share about our, our experience with soin. So Soan completed a four week elective here at elective in medicine, right? Or insert specialty and please forgive the punctuation here. I just started typing and I'm trying to not make this video 10 hours long. So insert medical specialty all right here at. And then you insert location and hopefully this is already evident on the letterhead. But if it isn't, that's an opportunity for that. And then you end with that. Right? Upon completion. So in Sogin's case it's unique because this is also someone that qualified her for pathway six. So upon completion of her rotation she continued to work with me which resulted in my personal and professional evaluation for ECFMG certification as required for pathway six. Okay. And then this person can even go into detail, right, to share things that they noticed about you during that Pathway six time frame. So she demonstrated exceptional communication skill and then they go into how. Right. Often putting patients at ease in her educational component of the office visit. Okay, now because I know from Soygentv that she's also done some work in in the healthcare space, caring for the elderly. Geriatrics is a branch of internal medicine, it's a branch of family medicine. And some people finish medicine and go into geriatrics. So I may utilize her CV experience invalidating this communication skill here by saying this is a trait that I know also serves her patients well within her, you know, whatever. Insert, insert patient care business that so again works in. Right? So she knows what she does and so she would be the one inputting the details of that because I don't have those details right now as I'm editing. But if I was writing this letter, then I'll go into a CV and say, okay, she says she has, you know, this business that she does where she cares for the elderly. And I can even put her elderly patient cohort well within her home based care delivery. Or it could be home health care delivery. Right? So these are all just options for how she could describe her business or a home, home health care delivery business or whatever that so again works in. So what I'm doing is because I assessed her for pathway six, I accept, I assessed her communication dedication and such. Exceptional professional. Okay. And another way even is not even opening with the straight. I could say I Can even start by saying she often put patients at ease in her. In her educational puts patients at ease in her educational component of the office visit. Okay, I noted this specifically, I noted this specific professional communication skill during this assessment during this time. Okay? So that's something. So this person is speaking from one perspective that they know. So again, right? So now the next paragraph, the person goes into. So, guys, highly motivated, enthusiastic, good team player, et cetera, interpersonal skills. I feel like those are good things about somebody, but everybody's writing the same thing. So this is where I think we write about specific examples, right? Of how should make a good fit. Because, yeah, you want a motivated applicant, you want an enthusiastic applicant, you want a team player. But there's something about being able to describe why you think that they are all these things. Okay? So she showed responsibility in considering her assignment to patients. She took great histories beside manner, strong clinical knowledge, ability to formulate. So this is a place where I may even compare. So again, right, Because I set up here that maybe I have. I'm a practice owner and I have three students or four students that come by my practice each year. Okay. So. So I could say, you know, here at. And then I insert location. Okay. And another thing too is if you were in, like, a multiple location, you can speak about your work and they can write about your work in the clinic. You work in the. Or you're working in the hospital as three separate instances. Right? So here at insert location. Or it could be while rounding on ICU care or on our ICU patients. All right. I don't know if this was an inpatient option experience, but it could be that or, you know, here at the clinic. Clinic, hospital, you know, whatever the case may be I off. I. Precept an average of 12 students a year. So one, one a month. Right. And or other metric. So it doesn't always have to be the precepting. It could be any other metric. And so again, then you compare sogin to her peers. Is in the top two. Right. Two or five or three or whatever. Or sometimes you can say the top person. But that's also if you are the top person, maybe you're not the top person. Maybe you're the top quarter. Right. So it could be two or three or quarter. Maybe this person precepts like dozens a year. Right. So the point here is to quantify or compare against people. Peers. Right. All right. So you're going to quantify or compare against peers. And then you can go into like how you came about the fact that she's a good team player. Right. So So the top teacher when compared to the students from the prior academic year. And then I would even now segue into she. I will remove all these lines about highly motivated. Yeah, that's great. But I would rather show than tell. So I'd rather that I show them that you are all these things than tell them. So that ends up looking like, let's make this larger. So that ends up looking like while writing, you know, here at insert clinic, hospital, ER or other. Right. Again, this is just a template. Okay. You know, this is just tempered and variation. So here at XYZ, while rounding on ICU patients, I precept an average of 12 students a year. Or, you know, insert other metric. Insert other true metric. You don't want to make stuff up. The true metric. And so again is in the top two, three, four, you know, when compared to students from the prior academic year. So you're not seeing all time because not all going to be great. Right. But at least comparing to the recent pass, we may be good enough. So let's put that on here. Gotta be realistic. Okay. Don't want to sound like you're blowing a horn. That's unrealistic. All right. Tooting your own horn kind of thing. But if you did, if your preceptor definitely gave you some certain verbal compliments, this would be a great place to add that as well. So I preset an average of 12 students a year. And so against the top two, three or quarter, you know, you put some numbers that quantify or compare against the peers when compared to those from the party here. And then I took out the line about she's hardworking. Da, da, da. Because I would rather show than tell. And by showing, I mean you're showing how she has those traits. Right? So I'd rather say, you know, she was sorrow because instead of saying she took good history taking skills. What are good history taking skills? She was thorough yet concise. Which is, which is kind of a hard balance, right? You want to get all the information, but you want to get the pertinent information. So she was thoroughly yet concise. Or she was. Or she pays attention to detail while simultaneously being concise in her presentation. In her presentation of patient work, patient care. Okay, so that also says. So again, has a great deal of responsibility considering her assigned patients. I'm showing them how slogan has this great responsibility by saying she pays attention to detail while being simultaneously concise in her presentation of patient care. All right. And that also now takes away these history taking skills. Right. And I could say during rounds, her bedside manners need a nursing and ancillary stuff talk highly of how she treated others around her. Okay, so bedside manner can be for the patients, but you've already talked a little bit about patients, so let's talk about how you relate to other people. I'm assuming this is an office based, right? So because it's an office based well, maybe it wouldn't be around during clinic visits. Oh, you did say bedside manor. So maybe it's round. So during rounds or bedside manner. All right, so it's a little bit hard for me to write this letter because I didn't work with. So again, and I don't have like perspective of who this doctor is that wrote the letter for her or, you know, whatever the case may be. So, but you know, kind of who you're working with in the setting. So you're going to put material that is pertinent to that setting because you don't want to say you're in ER and you talk about rounds. Right? Because we don't round in the er, but clinic you're not really rounding, but you could go from room to room. Or if you're in a hospital, then rounding becomes applicable or is the same. Talking about the or is different from talking about the er. And that's why it's so important that you have at least a general understanding of your specialty of interest. Because then how do you say these things? Right. So when compared to students from prior, she pays attention to detail while sometimes being concise in a presentation of patient histories. Right, so we can put that on here. During rounds of bedside, amount of made her nursing answers. I'll talk about how she treated others, how she treats others. You can even just say kindly, right. Of how she treats others. All right, so she has strong clinical knowledge. You know, for now, the thing is, you know, if she's a student, it's good to put, like, clinical knowledge sometimes positions. It can kind of be hit or miss. But instead of just saying clinical knowledge, I would say that her approach to formulating approach to formulating differential diagnoses, assessment and patient plans for the day, because you're maybe only working per day was picked up upon by her junior peers. So maybe seogun was a third year and there was a. The fourth year and there was a third year with her, and she was able to teach them how to get a differential and assessment plan. Right? Or was impressed upon, not picked upon. I'm sorry, impressed upon. Impress upon her junior peers. So what am I saying here? I'm saying so again, has leadership skill, but I'm not saying she's a great leader. I'm just saying I'm showing you how she has leadership skill. All right, so overall, then I come into those overall, you know, those traits. Right? She possesses leadership skill leadership and professional skill to learn efficiently in any practice environment. She also shows interest in procedures unique to the procedures often performed. Let's put this in hospital within the scope of internal medicine. And this is something that if I was writing for a non. Say I was writing for anesthesia or writing for somebody that in a specialty that I have no interest in, that's a line you can put to say that, hey, yeah, you know, even though I don't have that specialty understanding. But I did a rotation and in med school, and I know that it's heavy on procedure. So, you know, for the scope of that, she shows interest. Right. So then I finalized with so again, is witty and smart. Right. With impressive attitude and receptiveness for learning. That's a great one because I'm now summarizing why she will be a great fit. Right. Based on my assessment of her, I believe she would be a fantastic addition to any program. And it's even better if you can insert the specialty you're supporting, and if not, you can just put program. If you're writing a generic. As the prior chief resident myself, she is the type of intern you want to teach your consideration of her application. Now, if I know. So unless this token has 19 publications. Okay, this is a part where I can take from my CV and Even add some impressive stuff and say, your consideration of application would definitely result in publications to add to the academic RS of your program. Okay. And I can say, based on her interest in research, your consideration of application would definitely result in publications add to the academic progress of your program. And then I even like to add a line that says, please do not hesitate to contact me. Okay. Do not hesitate to contact me with any specific questions or to facilitate your decision about Dr. Tahiri @ your program recruiting. So, okay, so when I'm editing, right? Or when I'm writing again, and this goes, even for your personal statement, the first time you're writing, you're not there to correct the language, the grammar, just putting the ideas down. Okay. But I'm putting it as down based on the notes that I made here, which I shared with you in the first part of this video. Because sometimes when you're writing, you're just gonna write, write, write, and then you edit afterwards. So now, as an attending physician, what I do is I don't send this draft. I step away from it, and then I come back and I look at it again and I make some more changes. And then once I make those changes, then I now edit for grammar. So editing, writing at first is not about editing. You're just writing, writing, writing. And then you come back and you edit for grammar. And if you feel like. And the good thing with Google Docs is it gives you options to edit. And this is what I do even when I'm working on personal statements that I'm writing for students or editing for students, which is a separate paid service. But when I do that, this is what I do. We write it out, step away, think about some things, come back and work on it. And so this is just a perspective, a general overview. All right I'm going to leave this here, and I'll step away, and when I come back, I'll make more changes and make more changes, and then I have a final document. Usually edit about once or twice. I don't edit 10 times because you lose the concept of what you're trying to share. But. But sometimes you just write and you step away. All right? And you can even write like this and send to the attending and let them be the one to edit and move things away or take things out. But that's how you go from super generic to specific and sharing traits that make you look good. All right, so I'll stop here and I'll take any questions in the chat or when you watch this video, you can always reach out.

In today's lecture, we're going to go over the MSPE. The MSPE is a medical student performance evaluation. And this is a requirement for US Grads. So whoever told IMGs that this is optional, I'm not certain where you're getting your information from, but I strongly recommend that you have an MSPE ready so that you can be as competitive as the US applicant, but also so that you can show that you've made the effort of reaching out to your medical school even if you left there over ten years So most often the medical school would ask you to provide them a template. And this is a template that is from AAMC. It's on their website. Just type in on your Google screen MSPE AAMC reference, and they have this Word document on their website free of charge so that you can send it to your school as an example of what they should put in your MSPE. So the Medical Student Performance Evaluation, formerly known as the Dean's Letter, is a document that provides an overview of a medical student's academic and personal qualifications. It's a very important part of your residency application package, and they usually ask for certain things. All right, so the first thing is the identifying information, which is right here, and that is constant. Okay. Location of the medical school, your name and the year that you were in that school. Noteworthy characteristics. This is a part that they'll have to edit, so they would have to change this section and put in three characteristics that are noteworthy of who you So this is not a place where they're going to make up stuff, right? You know who you are. You know what characteristics that you had in school. Maybe you were consensuous, maybe you were punctual, maybe you were research driven. Maybe you were a giver. Maybe you volunteered a lot. Maybe you created something new. You started a new curriculum, right? You're innovative. You won a scholarship or an award. There are certain characteristics that it takes to win certain things or to be awarded certain distinction. So those are all useful here because you can therefore include those noteworthy characteristics in this spot in the IMG Roadmap course. I also share my MSPE as an inspiration, so you can see an example of what that looks like. That would be in the next video. So, academic history. Okay. This is like when you matriculated into medical school, the expected date of graduation. So if you're already a grad, a lot of this is in the past. So you know what day you started med school and what day you graduated med school. They usually ask for any extensions, leaves or gaps or things that they want to know a little bit more about why maybe your duration in medical school was longer than the average. And they're not asking that information to use against you. They're just trying to get an understanding of who you are. So don't be afraid to disclose the true reasons for why you have gaps or extensions or leaves They also want to know if the student was required to repeat or remediate any coursework during their medical education. And if yes, please explain. So this is where you fail a class, or you fail an exam, or you repeat a whole year or something like that. And again, it's not to single you out, but it's for your school to give their version of the story. So you want to make sure this is very professionally written, it's factual and to the point. Less emotion and facts. Okay? If there's nothing you get from this, the MSPE should just be factual, less emotional and factual. You have the opportunity to be emotional in your personal statement, meaning writing about what was going on in your psyche, your senses, and how you felt. That's for your personal statement. For the MSPE. It's factual. The student was awarded a leave of absence for one year, or granted a leave of absence for twelve months due to financial reasons, or due to financial difficulties, or due to health related concerns, and so on and so forth. Okay? Student had to repeat anatomy. That's it. Okay? I mean, there's no explanation for why anybody fails a class necessarily, right? That you not do well at that time So was the student a recipient of any adverse action? So were you dismissed? Were you under disciplinary action? That's where this falls. Academic progress. So they want the medical school to describe how the medical school defines professionalism, what it assesses. Whenever possible, areas of strengths and weakness should be This is again up to your medical school to define that each medical school. So for those who are in Caribbean medical schools, they already have a set definition for how they assess professionalism. Same thing with pre clinical coursework. If it's a pass fail system that's already set in place, or if it's a scored system, if there's a percentage or grades, or however that is done in your medical school. That is what they're asking for in Usually they're asking to know about your academic performance in general. That is the main purpose of the MSPE really has a few purposes, so let's just go over that before we continue in the doc. The first purpose is it should provide a summary of the student's academic performance, including grades, class ranking, any honors or awards received during medical Number two, it should highlight the student's performance during clinical rotations, including any comments on clinical skills, professionalism, and interaction with patients and colleagues. Number three, it must mention extracurricular activities such as leadership roles that you've been involved in, such as research, community service, or student organizations. And sometimes some schools would include that under the Noteworthy Characteristics section. Okay? Number four, it must include personal characteristics. So the student's personal characteristics and qualities such as your work ethic, your communication skill, your compassion and your level of reliability. So again, this could all be traits that are included under the Noteworthy Characteristics spot. Now, in addition to that professionalism, which includes things like being punctual, ethical behavior and adhering to professional standards. And some schools would extrapolate from your results, such as your clinical assessment or the comments that were made in clinical assessments. Some schools may use and then they also want excerpts, right, summaries from faculty members who have had the opportunity to grade you or who've worked closely with you. So my medical school, for example, includes one liners from all my evaluation. They included all of that in my MSPE. Again, like I mentioned, you'll see my MSPE in the next video. So just go ahead and review that and kind of learn from the example that's there, not necessarily copy but learn And we'll try to highlight or remove any identifiers before we put that so my information is not out there on the internet. But that's besides the point. So clerkships, they want one liners from people who have assessed you I think is a great way. Another way with the clerkship is if they give you a percentage on a shelf exam or a case write up or any kind of clinical experience work. So it's better that they write using numbers and metrics because it really informs the program directors on your performance. Whenever possible, areas of weaknesses and strengths should be addressed. So if you performed really low in a certain area, this is an opportunity for them to explain maybe how a remediation was done in that specific area. So collection evaluations are a crucial piece of information for program directors and they're considered by many to be the most important section of the MSPE in determine when they're looking for applicants for interview selection and the rank order list. So definitely you want to make sure that you are including that information as well. Now, graphs in this template are meant only as examples and so each school has its own grading system. This right here the graphs do not show. But as you can see in my own MSPE, there are specific graphs that are used to depict performance. Like this person falls. Mine I think is a bell chart where you have a mean in the center and they just kind of show what grade that you were and were you in the percentile, 25 percentile, 50th percentile, or average, right? And so by each specialty with months and dates is how that information is depicted on there. Also as well on the website, which we can navigate into really quickly. So you can see exactly what I am referring to. Let's go into AAMC MSPE template. So if you go into this site here and you scroll down, this is where you'll find the word template and it downloads as a Word document into your computer. So you'll then have to open that Word document and review But they also have MSPE FAQ section, which I think is very helpful as well for creating or submitting an MSPE, what should be included and what formats to use. So this is just a brief overview of the MSPE, but some key things that I want to add before I leave. You remember that unique experiences can also make it on the MSPE, such as highlighting any unique experiences or accomplishments that the student has accomplished in the past that would make them stand out. I think that that is a great thing that should be added to the MSPE. I also think that any kind of contextual information, so providing context about the medical school's curriculum, grading system, any challenges or opportunities that the student may have faced during their education should be included by the medical school in the MSPE. Overall education. So provide an overall evaluation of the student's performance and potential as a future physician. So at the end, they should give a summary, right? Relative to your peers, where do you fall? What categories make you stand out? Right? So they have to give a statement of evaluation of how you would perform as a physician. Signature. The MSPE should be signed by the medical school's dean or another authorized official. And usually that's where the signature comes down here. So it's important to note that the specific format or the content may vary between medical schools and that is fine, but I want you to remember that you have this free resource provided by the AAMC that you can use. Okay? And so for those of you for medical schools that are not familiar with writing MSPE's, this is an opportunity right here for them to do so. So I'll see you in the next section.

Letter writer, here is how it works. You log into your account. Once you're in the account, it gives you a summary of what is expected of your document. I notice that this becomes a bottleneck, especially the page dimensions, so being able to shrink that down before uploading really helps. The file name shouldn't have any special characters, and the letter must be signed by the LoR author, and it must include a date. Also should be on a professional letterhead. So at this point, I want to add a new LoR. So I go here, and this is the part where I go into my email to identify the ID that the AAMC sent to me. And this ID is generated by the applicant. And so I'm currently right now, looking for that ID because it is a unique ID, and I want to make sure that I find the right ID for my applicant. So if I'm writing 10 LoR's, I may get 10 different requests, which will require a unique ID each time. So I'm copying from my email the ID that was sent to me by the AAMC. And really all you need is your letter writer's email to submit a request. So I'm just verifying that that is correct and we'll continue. So here I have the student's name and I'm just verifying that this is not a SLOE and that this is for the right applicant. And then I'm going to upload. So this is the portion where I've already prepared a PDF. And so I'm just going to upload the PDF to this page. So I'm going to browse here. And I'm going to go to downloads. I think I just saved it on my desktop. I have so many files on my desktop here. It gets confusing. But you could probably see why it gets a little bit cumbersome for. Okay, there we go. LOR Dr. Nina. It can get cumbersome for your letter writer, but be patient with them and provide them this video as well with the step by steps to follow. All right, so, yep, we're in. And we'll finish. Okay. And it is uploaded. And that's it. That's the end. That's how you upload an LoR.