US electivesMuhammad Arsalan Siddiqui

Research elective : Henry Ford – Infectious Diseases

Clinical Elective : Henry Ford – Infectious Diseases

Clinical Elective : Henry Ford – Nephrology and Hypertension

Clinical Elective : University of Wisconsin(Madison) – Pulmonology and Critical Care

Clinical Elective : University of Wisconsin(Madison) – Gastroenterology and Hepatology

• Medical schools in US usually span 4 years, so by 4th year medical student they refer to final year(5th) from Pakistan.

4th year Medical Student

• Abbreviation for an International Medical Graduate.

IMG

• Any type of clinical experience in US, observer ships are not usually considered USCE, unless they are Hands on.

USCE

• These are the compulsory ward rotations that American students usually do in their 3rd year of medical school. These include all the basic compulsory ward rotations of general specialties like Medicine, Surgery, Gynae-Obs, Paeds.

Clerkships/ Core Clerkships

• Internship in US is what you do after medical school, not during medical school. In short, the first year of residency is called Internship.

Internship:

Key Terms

Undergraduate

Clinical elective

Sub-Internship Observership

Hands on (Patient contact)

No Patent Contact

Graduate

Observership

Hands on (Patient contact) No Patent Contact

Externship

Different kinds of USCE

A clinical elective is an optional away rotation that a medical student can do outside the hospital of his/her parent institute to gain Clinical Experience.

Usually during final year of medical school in Pakistan. These include subspecialty rotations like radiology, cardiac

surgery, Pulmonology, that are not compulsory. Electives are most frequently 4 weeks in duration- can be shorter

or longer. Not all places accept international students and quiet a few

require passing USMLE step 1. There are only a BASIC set of skills that are expected from a

medical student. A good chance to impress the attendings and get good LORs.

UndergraduateClinical Elective

Its the same as an elective except that the level of responsibility is more(complete patient management).

The learning opportunity is immense at the level of a medical student.

Maximum possible opportunity to spend more and more time with your team/attending.

Being evaluated on more responsibilities and living upto the expectations, almost guarantees a residency in the program or at least guarantees OUTSTANDING LORs.

You should always prefer electives that have in their description 'student functions as an intern' or is titled sub-internship per se.

It is the most superior form of USCE that an applicant can have. A very rare opportunity. If you find one, SEIZE IT!

Subinternship

Gives you a direct exposure to how medicine is practiced in the US.

Experience a cultural change and helps you develop communication skills in a different setting altogether.

USCE is ranked by many as the 2nd most important filter for a potential Residency IV call, from within or outside the same hospital.

Contacts..Contacts…Contacts!!! As it helps the Med School faculty to know and evaluate you.

LORs…preferably 3 needed from US attendings. Great LORs will take you places. Cant stress enough!

Why do them?

https://www.aamc.org/students/medstudents/electives/ http://www.electives.us/ www.pakmeds.com http://umartariq.com/node/40 www.usmletomd.com/ http://www.eamtar.com/Electives.html

Where to start?

Usually final year but rarely some may accept students during their 4th year of Med School in Pakistan.

For Dow Students: End of 8th, 9th or 10th semester. Best time end of 9th semester(though NOC difficult to get) and end of

10th semester. Reason being: Better knowledge. Closer to the Match.

Places are limited so plan ahead and apply a.s.a.p (at least 8-10 months in advance)

Some do not accept earlier than 6 months so make sure you apply the first day of the 6 months period!

From my experience I feel that Jan-Feb-Mar-Apr-May months are easier to get into. The reason being US seniors(final year US students) usually prefer Jun-Jul-Aug-Sep-Oct-

Nov months to do away rotations or visiting electives to get an idea about that residency program

When?

DECIDE well in advance what you want to do (residency)!!!

Should be a specialty of your choice. e.g. Internal Medicine, Pediatrics, Family Medicine or General Surgery.

Can be the subspecialties or related specialties.

e.g. For Internal Medicine the subspecialty would be Cardiology and a related specialty would be Family Medicine.

Specialty Of Choice

Subspecialty

Related specialty

Any specialty

Where?Which speciality?

Hospitals where you have contacts. Places where you have relatives, as it minimizes the cost of

accommodation. IMG friendly hospitals, as it increases your chances of

matching in that residency program. But DO NOT restrict yourself, as doing so wont make your

life any easier!!

Which Hospitals?Based on personal preference

So you think you can choose, Eh?

Based on eligibility requirements

Hospitals that accept

Students from affiliated

schools only or require a

sponsor

Hospitals that Require USMLE Step 1 score

Hospitals that Charge lots and lots or $$$

Hospitals that do not need Affiliations, Step1 score

or $$$

Hospitals that accept International Students

University of Illinois Chicago (Chicago)◦ TOEFL not required◦ Must submit a pre-screening application first◦ $1000 application fee ◦ 20 students selected◦ http://www.medicine.uic.edu/international_affairs/undergrad/iva/

University of Louisville (Kentucky)◦ TOEFL required( I negotiated a waiver when I applied)◦ No application fee◦ 3 students selected◦ https://medicalstudentaffairs.louisville.edu/visiting-student-clerkships/foreign-medical-student-requirements.html

University of Massachusetts◦ TOEFL required◦ $500 application fee◦ http://hsc.unm.edu/som/oss/Visiting_Students.shtml

PS: Dow charges a $50 processing fee

Students shortlisted on the basis of GPA

Guaranteed placement for all those shortlisted

Dr.Usmani, Director QEC, handles all affairs

Contact info: a.wahid@duhs.edu.pk,   qec@duhs.edu.pk, +92-99215754-7 (Ext. 180)

Universities affiliated with Dow

Cleaveland Clinic, Ohio◦ TOEFL required◦ No application fee◦ Provides free accommodation◦ Very very competitive so apply at least a year in advance!◦ Offers Sub-Internships◦ http://www.clevelandclinic.org/education/mse/requirements.asp

Mayo Clinic(Minnesota/Florida/Arizona)◦ TOEFL required◦ Selection is based on medical school transcript grades, USMLE Step 1 score◦  Application fee of $350◦ Provides Malpractice insurance free of cost◦ Application not processed prior to deadline dates(usually 3-5 months prior to proposed elective date)◦ Also offers Sub-Internships◦ http://www.mayo.edu/msgme/visiting-medical-student-clerkships/elective-descriptions

Memorial Solan Kettering Cancer center (New York)◦ TOEFL not required◦ Selection is based on medical school transcript grades, USMLE Step 1 score◦ Application fee of $100◦ Application is not processed 6 months prior to proposed dates and deadline is 4 months prior to

proposed dates◦ Also offers Sub-Internships◦ http://www.mskcc.org/education/students/elective-online-application

Hospitals that Require USMLE Step 1 Score

Case Western Reserve University (CWRU)(Ohio)◦ TOEFL not required◦ $120 application fee◦ Also offers Sub-Internship

◦ http://casemed.case.edu/registrar/visitingstudents/

Wayne State University School of Medicine (Michigan)◦ Not sure if still accepting international students◦ Contact Guest student coordinator Mrs. Kaaym Gudger at: kgudger@med.wyne.edu or +1-313-5771470 before applying◦ http://www.med.wayne.edu/student_affairs/records_registration/electives/gueststu.asp

University of Texas Medical school at Houston (UT-HSC)(texas)◦ TOEFL not required◦ $250 application fee◦ malpractice insurance coverage available thru UT-HSC for a small fee◦ F1 Visa required

University of Texas Health Science Center San Antonio (UTHSCSA) (Texas)◦ A letter stating Proficiency in English works◦ $25 application fee◦ Also offers Sub-Internship◦ http://som.uthscsa.edu/srselect/vsguidelines.asp#anchor 1

Hospitals that Require USMLE Step 1 Score

East Carolina University Brody School of medicine (North Carolina)◦ TOEFL not required

◦ No elective fee◦ Also offers sub internships◦ http://www.ecu.edu/cs-dhs/bsomstudentaffairs/BSOM_Visiting-Students.cfm

State University New York (SUNY) Downstate (New York)◦ Only a few Departments accept international students as listed on the website◦ $175 application fee◦ http://sls.downstate.edu/registrar/visiting/international/index.html

Virginia Commonwealth University School of Medicine (Virginia)◦ Never heard anyone applying or getting accepted◦ Easy application though and no application fee◦ http://www.medschool.vcu.edu/md/m4_electives/international_students.html

University of Cincinnati College of Medicine UCCOM (Ohio)◦ Try requesting for a waiver◦ $250 application fee◦ http://med.uc.edu/StudentServices/Registrar/VisitingStudents.aspx

Hospitals that Require USMLE Step 1 Score

Northwestern University Feinberg School of Medicine (Illinois)◦ Some what reasonable $125 application fee + $1200 elective fee + $225

Health insurance plan◦ Requires TOEFL◦ Application not accepted earlier than 6 months prior to proposed elective

date◦ Plastic Surgery, Trauma sugery, CT surgery, transplant surgery relatively

easier to get into◦ http://www.feinberg.northwestern.edu/AWOME/visiting-students/documents/2012-2013-documents/2012-13-International-Application.pdf

Weil Medical College, Cornell (New York)◦ $200 application fee + $2000 elective fee◦ Application should be received at least 6 months in advance◦ Accepted Dow students in Rheumatology, Neurosurgery, BMT, Heme-Onc(PD) ◦ http://med.cornell.edu/international/for_int_stu/index.html?name1=Guidelines&type1=2Active

Thomas Jefferson University (Pennsylvania)(PA)◦ $75 application fee plus $750 elective fee as of last year◦ Prospective students must email the registrar at :

University.Registrar@jefferson.edu in order to receive the application material◦ TOEFL required but can be waived◦ http://www.jefferson.edu/international_affairs/prospective/electives_clerkships_rotations.cfm

Hospitals that Charge lots and lots of

University of Rochester Medical Center (New York)◦ $100 application + $1500 elective fee◦ TOEFL required◦ Only accepts F1 Visa

Emory University School of medicine (Georgia)◦ Used to be one of the affordable places; starting this year $500 application fee + $3000 elective

fee◦ A student on a full tuition scholarship at their home school may request a waiver of the

application fee by attaching a letter from his/her Dean confirming scholarship status.◦ TOEFL required from this year◦ Step 1 required but can be waived◦ http://med.emory.edu/main/education/admissions/md/visiting_medical_students.html

Yale school of Medicine (CT)(Connecticut)◦ No application fee + $3100(housing/elective fee)

◦ Requires TOEFL

◦ http://medicine.yale.edu/globalhealth/international/about/application.aspx

Harvard School of Medicine (MA)(massachusets)◦ $100 application fee+ $3900 and above tuition fee◦ http://ecommons.med.harvard.edu/ec_vqp.asp?name_GUID=%7B5EF2B84A-9537-467C-A7C9-4E81476E0AAB%7D

Hospitals that Charge lots and lots of

Mount Sinai (New york)◦ $1000 application fee + $2000 Elective fee + $100 Student health fee◦ TOEFL required◦ USMLE-Step 1 can be waived◦ Requires F1 visa◦ http://www.mssm.edu/education/student-resources/registrar/electives/foreign-visiting-students

Brown Alpert Medical School, Rhode Island◦ Accepts international students from approved list of schools, contact clerkship coordinator at 

VIMS@Brown.edu◦ $150 application fee + $3700/3800 elective fee◦ TOEFL required◦ http://brown.edu/academics/medical/education/vims/application-clinical-elective-visiting-international-students

Tufts University (Massachusetts)◦ $75 application fee + $2500 elective fee◦ TOEFL required but can be waived ◦ http://medicine.tufts.edu/Who-We-Are/Administrative-Offices/Office-of-International-Affairs/Medical-School-Clinical-Electives

Duke University School of Medicine(North Carolina)◦ Accepts students from affiliated school ONLY, agreement in process with DOW◦ $50 application fee + $6000 elective fee◦ USMLE step 1 required

Hospitals that Charge lots and lots of

Hospitals that do not require Affiliations, Step1 score or Elective fee

University of Wisconsin, Madison◦ $125 application fee

◦ Requires TOEFL but can be waived

◦ Proof of prior USCE (evaluation from a US attending)

◦ Medicine closed from this year, can apply in anesthesiology and all departments of surgery

◦ Dept. of Surgery needs a sponsor preferably but the elective coordinator can help you find one

◦ Selection is first come first serve, Neuro Surgery and Plastic surgery accepted Dowites last year

◦ http://www.med.wisc.edu/education/visiting-students/eligibility-requirements-international/379

Henry Ford Hospital (Michigan)◦ No application fee

◦ USMLE step 1 required but can be easily waived

◦ Requires a sponsor first

◦ Email address formula: 1st letter of 1st name, followed by first 6 letters of last name, followed by 1@hfhs.org

e.g. Gregory House : ghouse1@hfhs.org

◦ Once a sponsor agrees DONOT email Dianne Weiland, email Penny Hamilton at PHAMILT2@hfhs.org, rather

◦ Departments of Neuro Surgery, Infectious Diseases , Hemeonc, Nephrology accept international students ◦ http://www.henryford.com/body_program.cfm?id=37384

University of West Virginia at Morgan Town◦ $300 application fee

◦ Call the elective coordinator first to confirm availability at btaylor@hsc.wvu.edu or (304)293-2323, she will also send the application package

◦ Emergency Medicine, Pediatrics, Psychiatry, Urology, Pathology, Otolaryngology, Neurosurgery, Trauma & General Surgery accept international students, do ask for the rest

◦ https://sole.hsc.wvu.edu/ms4catalog/

Hospitals that do not require Affiliations, Step1 score or Elective fee

North Shore Long Island Jewish Hospital (New York)◦ NeuroSurgery and Neurology were the only 2 departments that used to accept international students

◦ Change of Policy last year, do confirm again before applying

◦ http://www.northshorelij.com/NSLIJ/NSLIJ+Elective+Clerkship+Application

National Institute of Health (Baltimore)◦ No application fee

◦ Online application with an LOR from the Dean; give principal’s email address p.dmc@duhs.edu.pk and contact Shahab

◦ TOEFL required

◦ Very Very competitive, considers TOEFL score, cGPA, and early application

◦ http://www.cc.nih.gov/training/students/clinical_electives.html

Louisiana State University at Shreveport◦ $250 application fee

◦ Selection is first come first serve

◦ Only Med-Paeds, Gastroenterology, Hemeonc & Nephrology accept international students

University of Texas at San Antonio ◦ Visiting International Students in San Antonio (VISSA) Program

◦ Only for Surgery and ONLY for international students

◦ Very competitive; 2 from Pakistan in the last 4 years

◦ TOEFL required◦ http://surgery.uthscsa.edu/vissa/program.asp

Hospitals that do not require Affiliations, Step1 score or Elective fee

University of California San Diego◦ $250 fee charged after acceptance

◦ Very competitive… so apply early!

◦ http://meded.ucsd.edu/ugme/visiting_students/foreign_schools/basic_information/

New York University◦ Require you to submit application request form prior to submission of a formal Application form 

◦ $100 application fee

◦ Rarely accept international medical students

◦ Restricted during certain parts of the year only (typically April-May)◦ http://www.med.nyu.edu/registrar/electives/requirements_non_lcme.html

Kansas University Medical Center◦ $400 application fee

◦ Requires TOEFL

◦ Application accepted minimum 9 months in advance

◦ http://www.kumc.edu/international/electives.html

University of Connecticut◦ No application fee

◦ Opens around March/April every year and closes after a few days

◦ Never heard any one apply

◦ http://medicine.uchc.edu/prospective/visiting/

Hospitals that do not require Affiliations, Step1 score or Elective fee

University of Wisconsin, Madison: 6 Henry Ford Hospital: 2 Emory University: 3 North Western University: 5 Weil Medical College, Cornell: 3 UIC: 7 University of Louisville: 3 Mayo Clinic, Rochester: 2 (Step 1) MSKCC: 1 (Step 1) University of West Virginia: 3 University of Chicago: 2 UIC (Urbana Champaign): 1 Louisiana State University: 1 University of New Mexico: 1 Mount Sinai: 7 NSLIJ: 6

Places where Dowites got accepted last year

Getting the University application form signed◦ Write an application to the principal attach it with the the filled university application form.◦ Get a fee voucher of Rs500 from admission cell, 3rd floor, Admin block.◦ Submit it to Samee ground floor, admin block.

Other documents you might need from the university (Mehmood 1st floor, outside VPs office, Admin

block)◦ Consolidated marks transcript◦ Clinical grades transcript◦ Deans Letter (paper)◦ Deans letter (online)◦ Letter of good standing◦ English proficiency letter◦ USMLE waiver letter◦ Bonafide certificate◦ Visa letter

LORs from faculty◦ You can get them from any professor you have rotated with.◦ They will usually ask you to write it yourself and will sign it.◦ Samples can be found online.

How to apply (Documentation)

Malpractice Insurance◦ Usually $1million/$3 million required◦ Academicins ($234 per month)

Get a quote by filling the online form at http://www.academicins.com/

◦ Proliability ($40 per year) but for Physician Assistants Steps mentioned at http://umartariq.com/node/16 US address needed For physician assistants

Health Insurance◦ Around Rs 1800 per month

IGI NJI EFU

Immunization◦ Can get all done from AKUH.◦ Give at least a month before ordering titers.◦ Titers all from Rahila lab including Montoux.

Some other documents

HIPPA & OSHA◦ Sometime universities have their own free courses

Johns Hopkins : https://secure.lwservers.net/

US Davis : http://www.ucdmc.ucdavis.edu/compliance/Quiz/PrivacySecurity/player.html

◦ Other courses on websites usually $15-$100 http://myhipaatraining.com/ ($25) http://mymedcerts.com/bbp.cfm ($15)

TOEFL◦ Test of English as a Foreign Language◦ Needed by many universities now◦ Fee of $160

Not a bad deal as many universities require it

◦ Many have a cut off value of 100 and 24-25 specifically for the speaking section◦ All the prep is done from Barron's CD of practice tests.◦ Some of the useful data available online for free is as follows:

TOEFL iBT Tour TOEFL iBT Tips TOEFL Practice Online Tour TOEFL iBT Sample Questions TOEFL iBT Sampler (you get it, once you register for TOEFL from the below mentioned link)

Some other documents

You  can   contact  the  faculty  members  by  the  emails. Email  addresses of the faculty can be found on the website. Send a cover letter and a CV. You  should  send  emails to  a  number  of  faculty  members,  because  only  a 

few  are going  to  reply  you  back. Don't  start  with madam/sir. You  can  always  start  with  words  like  Dear Dr.

House Followed by an introduction. Then stating your purpose and desire to do electives in the hospital. Make the cover letter personalized refer to his/her clinical and research work.

Application for Sponsorship

International◦ Do compare the air fares directly at the websites of individual airlines. You need a credit card

which depending on the airlines policy at times need to be your personal one.◦ Do check with travel agents who my sometimes get you a better deal.◦ Do check American express, usually cheaper than most other travel agents.◦ If you book early Turkish Airways is the cheapest followed by Qatar airways.

Inter City◦ Book early and book online.◦ Most of the times traveling by buses is cheaper

Megabus (Most destinations) Greyhound (Most destinations) Bolt bus (Some destinations) Peterpan (Some destinations)

◦ You may find air travel cheaper at times Southwest by far the cheapest airlines and offers 2 FREE check ins. Check Kayak.com for rest of the airlines, gives you links to the cheapest fares possible.

Intra City◦ Get a monthly bus/subway pass made◦ Rent a bike or WALK◦ Will have to rely a lot on Google maps and STAR BUCKS!

Managing expensesTraveling

Food◦ Can be between $150-$250, depending on how you spend◦ If you don’t know of any Halal stores, go to a local mosque and ask someone.

That’s how a discovered one in Madison.◦ You can always find frozen Vegetarian food at Wall Mart and Trader Joes.◦ Some people take canned food from Pakistan (NOT ADVISABLE!)

Accommodation◦ Student accommodation can vary from $400-$1200, usually utilities included.◦ On Campus student accommodation.◦ Craigslist, beds4meds, sublets.com.◦ APPNA house in that area.◦ Ask a relative, friend or a Dowite in that area to help you find something cheap

and close to the hospital.

Managing expenses

How to Shine during your elective

Professionalism!!!

Attire◦ Knowing what to wear is a combination of common sense, courtesy, and comfort. ◦ Basically, unless you are wearing scrubs, you should dress professionally.◦ Wear a short white coat as it identifies you to the medical staff as a medical student.

Appropriate Salutations◦ You should always introduce yourself when meeting a patient or new “team.◦ Give your full name and state that you are an international medical student from Dow Medical

College, Karachi.◦ Generally refer to attending by title: Dr. “Whoever”.◦ Residents/Fellows/Interns: Start with Dr., but most will tell you to call them by their first names.◦ Always refer to patients by proper name: Mr. or Mrs. or Miss or Ms.◦ unless the patient says it is okay to call them by their first name.

Relationships◦ You have to be “professional” at all times. It is expected that you will be attentive and respond to

questions.◦ Not getting what you want or you do not understand, the expectation is that you will ask.◦ Be interactive with everyone in the team and NEVER engage in political discussions.

Get your basics right

Medical records & gathering information◦ As a medical student, you will most likely need to complete full history and physicals (H &Ps).◦ Collect All the information, and have it available in case you are asked about it.◦ As time goes on, you will get a better sense of what is relevant.◦ Some attendings want you to have all details memorized (except for nit-picky lab data).◦ If you are on the consult service contact the admitting/primary team regarding details about the

patient and read their notes.◦ Nurses can be very helpful in providing some vital information.

Admission Note (The complete history and physical)◦ History of Present Illness (HPI), Past Medical History, Family History, Social History , Review of Systems, Physical

Exam

◦ Assessment : One run-on sentence summary of who the patient is, why he is here, what has been done since

admission into the Emergency Department or the doctors office followed by Differential diagnosis and

rationale on how to proceed to make the diagnosis

◦ Plan : What are you going to order, what studies are being done, who is being consulted) either by system or

by problem followed by a brief discussion on the management and possible therapies for the patient.

A good approach is running through neurologic, cardiovascular, pulmonary, renal, GI, heme,

musculoskeletal, infectious disease, etc. and describing any problems if it exists or does not exist

Gathering information and writing notes (before rounds)

SOAP Note (A daily progress note on the patient)

◦ S = Subjective Usually includes a brief chief complaint, brief history of present illness. May include pertinent past medical, surgical, family, and social history.

◦ O = Objective : Objective information-What you find on the vital signs, physical exam, labs,

tests

◦ A = Assessment Briefly recap the clinical situation in a few lines(usually one line).

◦ P = Plan What we are going to do about each and every issue. Can be organized system wise or problem wise.

Gathering information and writing notes ( before rounds)

Presentations!◦ Present as written in your note.◦ Complete H & P and A & P for a new patient.◦ SOAP format for the follow-up patient.◦ Discuss it with the residents and fellows in the team.◦ Give references to evidence based medicine during your A & P.◦ Start off with presenting one new patient every day and follow-up of

that. patient along with another new one the subsequent day.◦ Taking less patients doesn’t hurt, to start with, as far as you are

thorough in your presentation.◦ Once you think your presentations are thorough start presenting more.◦ Give focused presentations, mentioning the relevant details only!◦ Volunteer to give a presentation to the team on any interesting paper

which you have come across.

Presentations the CORE of your elective (During rounds)

Do your Homework!◦ Before starting your elective read up on the Anatomy, Physio, Pharma, Patho and

Medicine/Surgical guidelines on that domain!◦ If short of time at least read a pocket guide of medicine/surgery!◦ Do a clinical elective at Aga Khan if you manage to get one. Almost the same is

expected, as mentioned above, from students rotating there .

Dedication!◦ Never be LATE! In fact be the first one to arrive!◦ Never ask “Can I leave now?”◦ Always Volunteer to stay longer and you should rather ask “Is there anything else I

can do?”◦ Do Calls as it gives you more time to interact with your attending and shows your

dedication!◦ Always keep your self busy!

Some additional tips…

Read Up!◦ You will get time to read about your patients during the day, If the rounds start in

the morning, come even earlier and give yourself enough time to READ UP! Uptodate.com is an excellent resource, so use it as much as you can Read up on recent literature on the problem and give references during your presentation.

Case Reports and Research!◦ Be in the hunt for atypical cases and if you come across one do your literature

search and talk to your attending about a possible case report, I have seen quiet a few students do that and you WILL come across such cases.

◦ Ask them if they have projects in which you can volunteer as their research assistant.

Some additional tips…

Not your right! You have to earn it!◦ Few students try to take things for granted and expect LOR as their right at the end of

elective. It never happens like this and the attending physician/surgeon may dislike this behavior.

◦ Be careful and appropriate about everything during your elective. Every little thing may count.

Etiquettes for requesting a LOR◦ A week before leaving tell them about your future goals (about persuing residency in US)◦ Ask them for feed-back on how you performed and more importantly how you could

improve.◦ NOW is the right time to ask for your letter!◦ You can get more than one letter from your department. ◦ Usually those with whom you have worked more can evaluate you better. But ask

everyone whom you have worked with very humbly.◦ A specialty-specific LOR is one that expresses to the program director that you are

focused on pursuing a particular medical specialty.◦ It is not advisable to use that LOR to apply for positions in other specialties. If you are

submitting the LoR to more than one specialty, request your letter writer to provide a general letter applicable to all specialties

Getting good LORs; The prime objective!

Waiving your right to view the letter!◦ When you “waive your rights” to view a LOR, it means that you permanently give up your right

to read the letter.◦ It sends a message to the program that the letter writer was free to speak openly, honestly, and

without influence. ◦ These letters need to be submitted by the letter writer to ECFMG by themselves.◦ Some attending agree to show you the letter and submit it directly to ECFMG.◦ If the you don’t get to see your letter make sure to get a written evaluation from that attending

and only ask him to send the letter if he gives you a good evaluation.

Documents to submit to the letter writer◦ Letter about career objectives will help your letter writer to sculpt a more complete image.◦ A copy of your CV will help to familiarize the letter writer with your background and past

experiences◦ A copy of your personal statement will provide your letter writer with insight into your passion

for pursuing medical education in the United States and your future goals.

Maintain good ties with their secretaries◦ Talk to their secretaries before leaving and be very polite to them.◦ In future direct all your queries and emails to them as attendings don’t get enough time to

respond◦ Thank them and don’t take them for granted as they are doing you a favour!

Getting good LORs; The prime objective!

How to submit your letterProvide your letter writer with detailed instructions on how the LOR should be submitted to ERAS Support Services at ECFMG.

LOR

Waived

LWP MAIL

Unwaived

ERAS support services

ECFMG’s Letter Writer Portal (LWP)◦ Send an electronic request to the letter writer

using ECFMG’s On-line Applicant Status and Information System (OASIS). 

◦ Once you submit your request in OASIS, your letter writer will be sent an e-mail with a link to access LWP and instructions on how to send a letter in support of your application.

◦ If you and your letter writer agree to this method of submission, let him/her know to expect this e-mail from ECFMG.

LOR being sent by mail◦ Provide the letter writer with a completed

Document Submission Form (DSF)

◦ Also provide the letter writer with the Letter Request Form, previously called the Request for Letter of Recommendation Cover Sheet

Sending LORs yourself◦ You can send the letter yourself using the ERAS

Support Services section of your OASIS account.

◦ OASIS allows you to send the letter directly to ECFMG via the Web.

Remember to stop every once in a while to help others!

…..And you will always find others who are willing to do the same for you!

I would like to thank all my seniors for their support and guidance.

Also the OT complex administration and Medinbytes as without their cooperation this seminar would not be possible!

Acknowledgements!