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ACP offers a number of resources to help members make sense of the MOC requirements and earn points.
Understanding MOC Requirements
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by Patrick C. Alguire, MD, FACP
Director, Education and Career Development, ACP
Unless you are beginning a solo practice, most job opportunities
are associated with an evaluative component. Once again, you will
be the target of scrutiny. Typically, the evaluation of your
abilities is conducted in two ways: by personal interview and by
letters of recommendation. This section will deal with how to
solicit letters of recommendation that will be most helpful in your
quest for the best possible position.
The first decision is how many letters? Customarily, two is
sufficient, but occasionally the organization requesting letters
may want more or less than two. If that is so, they will make it
perfectly clear. Supply only what is requested. Failure to do so
sometimes sends an unwanted message that either you cannot follow
instructions or are over-compensating for some (yet to be
discovered) personal weakness. As a corollary, do not submit a
letter of recommendation until asked to do so; premature disclosure
of this resource will make you appear too anxious or desperate for
Next, you need to determine who will write the letters.
Informative letters are generally written by those who have
first-hand knowledge of your abilities and potential. For the most
part, this is limited to the faculty in your training program. This
does not necessarily mean that the Medicine Chair or Section Chief
will be the best authors of your letters, unless they posses
special knowledge of your qualifications. A five-sentence letter
from the Chair will not be as helpful as a one-page letter from an
associate professor or community-based teaching physician who
worked closely with you over a long period of time. Occasionally,
your potential employer will specifically request a letter from the
Medicine Chair or Section Chief, and this request should be
honored, but otherwise stick with the people who know you best.
Allow sufficient time for your advocates to write a good letter.
Make an appointment to discuss your letter: don't trust anything so
important to a causal hallway conversation. Do not request a
thoughtful letter that is needed by the end of the week. If
possible, give your letter writers at least three weeks notice, but
at the same time, make absolutely sure they are aware of your
deadline. It's usually a practical idea and considered good form to
follow up your request with a thank you card and a personal
reminder of where the letters should be sent and when they are
needed. This is appreciated by busy faculty and preceptors who
often have multiple other responsibilities.
How can you pick someone who will write a good letter? Happily,
there are several options. You can ask your program director to
review your evaluation file with you. Look to see who wrote the
most outstanding evaluations, paying particular attention to those
accompanied by supportive written comments. This faculty person is
likely to write a good reference letter. Occasionally, if faculty
know that you are interviewing for a position, they will
spontaneously offer to write a letter, and this ordinarily is a
very good indication of a supportive letter. If the signals remain
unclear, you can request a letter in such a way that it increases
your chances of getting a good letter. For example, consider this
method of soliciting a letter: "Dr. Brown, do you think you could
write a very supportive letter of recommendation for a practice
position I am considering for next year?" When requested in this
fashion, your needs are clear, and you have left the door open for
Dr. Brown to demur if a very supportive letter will not be
forthcoming. This is much preferable to: "Dr. Brown, will you write
me a letter of recommendation?" In this situation, Dr. Brown may
well agree to write a letter, but it may be mediocre, and then both
you and Dr. Brown are boxed in with no alternatives.
Can you influence what is in your letter? Not only can you, but
it is in your best interest to do so. There are three things you
can do to create a better letter, and all three will be appreciated
by the person writing the letter. First, provide the writer with a
copy of your CV or resume. This information can be used to add the
detail to the letter not otherwise evident from previous
interactions with you. Second, highlight on the CV or resume, or
include in a cover letter, special attributes or qualifications you
think might be emphasized in the recommendation. This might include
special training in a procedure, extra-languages, administrative
skills, or other competency that enhances your desirability as a
new employee or partner. Finally, it is perfectly legitimate to
meet with your program director and copy portions of your
evaluation file for your reference writers. Remember, very few
faculty have access to your evaluation file, and providing
information that confirms and strengthens their good opinion of you
will result in a stronger letter.
Your last obligation is to follow up with your letter writers
and let them know if their efforts in your behalf have been
successful. Keep them informed about the job and your plans. You
never know when you may need their help again.
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