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Laurie Ward, MD
Chief, Division of General Medicine
Nassau University Medical Center
Assistant Professor of Medicine
SUNY-HSC at Stony Brook
Letters of recommendation are a very important part of your application for residency training programs. Programs will tell you how many letters they require. Do not submit more letters than are requested. The maximum number that can be submitted through ERAS (Electronic Residency Application Service) is 4. You must also submit a Dean's Letter requested from the medical school from which you graduated, if this is available. This does not count as one of your letters of recommendation. If your medical school does not provide Dean's Letters, you can indicate that on your application.
Since many of the deans of international medical schools might not know the kind of information that has to be provided in the Dean's Letter, it is advisable that you provide them with a template of the type of information that is generally expected. These components are: personal background information, statement regarding academic evaluations and research experience, extracurricular activities, interpersonal skills, communication skills and personality descriptions.
If the Dean's letter is not in English, submit a translated version to ERAS. It is not necessary to provide a copy of the document in the original language. However you made be asked to provide your original documents if program directors ask for them.
When requesting letters, it is best to ask "Would you feel comfortable writing me a strong letter of recommendation?" rather than "Will you write me a letter of recommendation?" The first approach may allow you to eliminate people who do not feel they can write a letter that will help you. It is considered to be better, though not necessary, to waive your rights to see the letter of recommendation. These letters are considered to be a more honest reflection of the authors' opinions of you and, therefore, carry more weight.
If you have done a rotation in an American institution and have interacted with someone who you feel can write you a good letter, ask them to do so. Don't wait until it is time to apply, as letters written in close proximity to the clinical experience tend to be more detailed and personal. Such letters are especially helpful if they come from the institution to which you are applying.
The best people to ask for letters are the most senior faculty who has worked with you enough to comment on your abilities. It is especially helpful if this person is from the institution to which you are applying. Do not ask for letters from residents or fellows. Although they may know you the best, these are not considered to be adequate letters of recommendation.
It is best to request a letter from a faculty member/physician who has directly supervised you in a clinical experience so that he/she can comment on your abilities from a personal point of view. In general, letters that can comment on your work ethic, motivation, dedication, and communication skills will be at least as useful as those about your medical knowledge or test scores, if not more so.
In order to assist the physician in writing your letter, provide them with a copy of your CV and personal statement.
For ERAS programs, one letter is submitted addressed to "Dear Program Director." Information about submission of letters can be obtained from the ECFMG website. All documents should be identified by identification stickers sent with an instruction manual. If you do not have stickers, identify each document with 1) your name 2) your USMLE number and 3) what the document is (Dean's letter? Letter of recommendation? etc.). For non-ERAS programs, provide the letter-writer with the names and addresses of the programs to which you are applying as well as address labels whenever possible.
Allow sufficient time for the letters to be written and submitted. Generally 4-6 weeks in advance is sufficient. Do follow up with the faculty members to ensure that the letters have been submitted. Reminders may be necessary, but don't be a pest
Educational Commission for Foreign Medical Graduates: www.ecfmg.org
Laurie Ward is a graduate of the University of Pittsburgh Medical School. She trained in Internal Medicine and Nephrology. She was the director of primary care at Nassau County Medical Center and is now Chief of the Division of General Medicine at Nassau University Medical Center.
This article was prepared for the ACP IMG Web site in 2000.