1,233 U.S. medical residency program directors ranked letters of recommendation in specialty (4.2/5) more important than USMLE Step 1 or COMLEX Level 1 (4.1/5) when selecting applicants to interview.

2018 NRMP Program Director Survey Results. (2018). NRMP, 3-3. Retrieve here

Letters of Recommendation (LOR) in the specialty that you are applying to is the #2 factor (by percent citing factor) residency program directors consider when selecting who they should offer residency interviews (2018 NRMP PD Survey, pg 3), 2nd in popularity only to USMLE Step 1 scores, and more important and popular than MSPE and USMLE Step 2 CK or COMLEX Level 2 score! So it is no surprise that every year, nearly 500 candidates for U.S. medical residencies become members of AmeriClerkships to be mentored by experienced U.S. physicians, experience the U.S. healthcare system, become more confident, and improve their overall competitiveness by earning multiple U.S. letters of recommendation (LOR’s) for the annual Match.

Navigating the process of securing U.S. LOR’s can certainly be challenging, and new requirements are implemented each year, so we have compiled the following resources to make this process as pleasant and predictable as possible:

How many LORs will I need for the Match?

You will need at least 4 strong and recent (dated within last 12 months, and experience within last 18 months) U.S. letters of recommendation to be competitive for the Match. According to the 2018 NRMP Program Director Survey, ‘Letters of Recommendation from Specialty’ are the #2 most popular and important factor when Program Directors consider inviting candidates for interviews across all specialties. Your AmeriClerkships Membership provides you with 12 months of uninterrupted professional liability insurance coverage, and with clinicals as low as $250/week (Low Price Guarantee fee), there is no reason why you would have to use foreign LORs during the Match.

Should I use foreign LORs when applying to U.S. residencies?

Along with a few positives, foreign LORs send a negative messages to U.S. residencies that ‘you were unable to secure support from within the United States for your residency candidacy’ – so because of this, using foreign LORs is not a recommended path. Writers of foreign LORs typically have not completed a U.S. residency, and the experience portrayed in foreign LORs is not of U.S. healthcare system, so by nature, foreign LORs and their writers are typically a great mismatch when it comes to supporting your U.S. residency candidacy.  Your AmeriClerkships Membership provides you with 12 months of uninterrupted professional liability insurance coverage, and with clinicals as low as $270/week (Low Price Guarantee fee), there is no reason why you would have to use foreign LORs during the Match.

How long does it take to secure an LOR from a typical clinical block?

Each LOR is typically earned after a 4 week clinical block, however this doesn’t take into account the time it takes the writer to finalize that LOR. You also have to account for the time it takes to correct errors in or weak LORs, or those that lack objectivity and no relation to ACGME core competencies (read below). Also physicians are quite busy, so it is not unusual for it to take months before you receive your LOR (or never receive one if you ask for an LOR months or years after a rotation ended).

I have submitted my LORs to ERAS/ECFMG. How will I know they’re ready to be submitted to programs?

LORs that are submitted to ERAS will be marked as “being processed”, then converted to “uploaded”. You will receive a message that indicates that your LOR has been uploaded, meaning it is ready for use. You will not get a “being processed” message if submitted to ERAS @ ECFMG;  you will just receive a message in MyERAS message center that indicates it has been “uploaded”.  You will see the same “uploaded” indicator next to each LOR, under Documents > Letters of Recommendation when logged into MyERAS.

Is it okay for my MSPE or Dean’s Letter to recommend me to U.S. residency program?

Absolutely not! According to the AAMC’s 2017 Recommendations for Revising the Medical Student Performance Evaluation (MSPE), “The MSPE is a summary letter of evaluation, not a letter of recommendation. Information presented in the MSPE must be standardized, clear, and concise and presented in such a way that allows information to be easily located within the document.” Please click here to learn about MSPE, and its significance on U.S. medical residency applications.

More AmeriClerkships advice about LORs (click each to read more):

Can AmeriClerkships help me draft a personalized LOR?

Introducing the ‘Clinical Experience Assessment Draft’ writing service

Can AmeriClerkships help my Dean draft a strong Medical Student Performance Evaluation (MSPE)?

Introducing the ‘Medical School Performance Summary Draft’ writing service

Have a question about letters of recommendation that we did not answer? Fill out the form below for an answer from our Chief Clinical Officer (and a chance to post your question and answer on this page):

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