I will be covering most of the questions that has been asked from me till now, by many other USMLE aspirants during my journey. By the end of this article, all of your doubts will be cleared about LORs hopefully.

LETTER OF RECOMMENDATION FROM HOME COUNTRY

Most of us underestimate the LORs that we get from our own medical college; they have their own importance and should be used at an appropriate time.
• When you are applying for electives: When you apply for electives anywhere in USA, one of their requirement is to get an LOR from your own medical school. This LOR should be from the most influential person in your department. In terms of international publications, current position (preferably from head of the department), number of years spent in that specialty, some professors do have international fellowship experience or any membership in one of the USA programs. Make a good search about people in your department, and start impressing them during your rotations in that department. Ask a letter of recommendation from them, by the end of your rotation.
• When you are applying for match: Some of the programs, e.g. the ones in Florida require one of the LOR from your own medical school. Keep in touch with them after getting the LOR from your professor, so that later (after getting your token number on 1st July every year) you can ask them again to give you an updated LOR with a recent date which you can upload on LOR portal. (How to upload LOR will be discussed in a separate article).

NUMBER OF LETTERS OF RECOMMENDATION FROM USA

This is always a pet question by many USMLE aspirants; the correct answer is you can send a maximum of four LORs with your resume, but you can upload as many LORs as you want in the LOR portal online. Hence, get as many LORs as you can get and decide later on which one you want to finalize, for a particular program. You can send different LORs to different programs. If you think that some professor is going to write you a bad LOR, never say no to an LOR that would be considered rude, just take the LOR and don’t assign it to any program.

WAIVED OR UNWAIVED

The waived LOR is the one, in which you are waiving your right to see that letter before it gets uploaded in your LOR portal. This is considered as the best letter and more authentic, but not at all the times, you will be able to get a waived one. Take the unwaived one and try getting a waived from a different professor or a different institute. In the final assignment, upload only the waived ones.
Tip: Sometimes, professors give you an unwaived LOR in hand and they are ready to upload for you as waived later on. You need to stay in touch with those professors and remind them to upload a waived LOR for you, once you buy your token and have access to LOR portal by emailing them your unwaived LOR as an attachment.

Do note the best iOS app for USMLE preparation – Dailyrounds.

WHOM TO ASK FOR LETTER OF RECOMMENDATION

The best way is to get yourself familiarized, with the names of people you are going to work with, is by searching about them online. The information that should be gathered including their post (chair > program director > professor > associate professor > fellow), international publications, involvement in resident selection, popularity, IMG friendliness, ways of writing a letter of recommendation (any previous LOR) and their availability.
Tip: You should always ask for a letter from a doctor with whom you worked the most, e.g., a good letter from a professor is better than a general letter from a program director.

HOW TO ASK FOR A LETTER OF RECOMMENDATION

This is the most confusing, most mistakes are made in this part.
• If you are going to work with a doctor for 4 weeks, the Wednesday of the last week is the right day for asking about the letter. But, let them know that you are going to apply for residency in their program during the beginning of your electives.
• Don’t just ask for a letter, say: “Could you please write a strong letter of recommendation for my match application in the coming year”. If he/she was going to write you a general letter, he/she will simply say NO. Trust me, that’s good for you, a general letter is considered as negative in these competitive match years.
• Don’t be desperate for a letter. I have seen people who start discussing about the LOR on their very first day, don’t ever show them that you are working their only for a letter. If you work hard enough, you will get a good one, but don’t show them that you are there only because of the letter.
• Don’t take it for granted, some people think that if they have worked with a professor for a long time, then LOR becomes their right. If you go with this attitude, it will be easily seen in your work and will be considered rude. Try to be polite all the time, even if you are refused for a letter by a professor

THE IDEAL LETTER OF RECOMMENDATION

• Waived
• Specifically written for program directors, instead of TO WHOM IT MAY CONCERN, try getting TO THE PROGRAM DIRECTOR
• A good LOR is a very specific one, always read a line and if you can fit someone else’s name in that line, then that line is not specific. It’s very hard to get a specific LOR
• Lengthier the LOR, the better
• LOR with personal things mentioned, e.g., about the coffee or dinner you had with that person one day, about the game you guys watched together, about your personal hobbies. It shows that you can easily fit in the American culture, and is considered a strong LOR.

Also read,

Six things you can do in college before USMLE step 1 preparation

USMLE WORLD: Ideal strategy and don’ts for your USMLE preparation

USMLE preparation: Everything you need to know about B1 visa

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