Friday, April 8, 2016

Dr. Thinker: Letter of Recommendation (LOR)

1.      How to get a good LOR?
-           It’s very simple.  The doctors in the USA are very friendly. They just expect you to know basic knowledge.
A.      Be on time – very important.
B.      Come to the hospital at the same time your resident or fellows come and leave along with them, even if they ask you to leave early.
C.      Read a topic, or something related to the cases you see and ask your resident or the attending some intelligent doubts in that topic. This way you are building up a rapport without sounding dumb when they talk about that topic.
D.     Volunteer to take a case or present a topic. Don’t wait for them to give you work.
E.      The way you talk to the patients is very important.
F.       If you find some interesting case, volunteer to write a case report. It’s the easiest thing you can get published in a short time.
G.     Attend all the seminars, grand rounds and morning reports. Don’t miss any.
H.     Find out if your resident or fellow is working on any paper and request to give you a role in it.
I.        Search about your attending on the program website and learn about his field of interest. You can talk to him about topics related to it in free time. Also, see if he is into research and then request for a position if you are interested.
J.        Don’t just talk about subject all the time. Talk about sports, movies or anything that your resident or attending is interested in. You should show your all round personality.

2.      How to get a good LOR from an Observership?
-          It’s a common misconception that one can’t get a good LOR for an obsie as its not hands on.
-          You can still get a very good letter by following all the points I said above except for taking cases.
-          You main focus here should be to be on time, attending all seminars, volunteering to present power point presentations or small talks pertaining to the cases whenever you get time.
-          Some attendings may even let you see a patient if you show sincere interest. However, they won’t be able to mention it in the Letter.

3.       My attending changes every one week or two weeks. How can I ask for a letter?
-          YOU ARE NOT ALONE in this aspect. Almost everyone faces this situation while doing a clerkship, and sometimes during observership.
-          So, make sure you utilize every minute of that 1 week or 2 weeks with your attending.
-          Your resident will be with you for the entire rotation depending on his schedule. So, your LOR author will take inputs from your resident or the other attending you would work with for the remaining duration.
-          DON’T HESITATE TO ASK FOR AN LOR. As this might be your only chance to get a letter or you might face the same situation during your next rotation.
-          THE ATTENDINGS TOTALLY REALIZE YOUR SITUATION. THEY KNOW WHY YOU ARE HERE AND WHAT YOU ARE EXPECTING. And as I said earlier, the doctors here are very friendly. So, more often than not they agree to write you a letter.
-          It could be a generic letter, but remember it also might be your only letter! Don’t miss it. You can later decide whether to use it or not if you get more letters.

4.      When to ask for an LOR?
-          There are mixed opinions about the timing of the request.
-          Some say ask during the start of your elective and some say ask at the end.
-          I feel the best time to mention is at least one or two weeks prior to your rotation end date. By this time you would have developed enough rapport with your attending and will also give enough time for the attending to assess you more personally.
-          If you are rotating with the doctor for only one week and you need his letter, then just ask on the last day.

5.      How to ask for an LOR?
-          Don’t rush into it during the rounds.
-          The best thing to start with is to ask him for an appointment at his office. You can tell him that you would like to discuss about your future plans. No attending would say no to this.
-          During the meet, you can start with the fact that you would be applying for residency in that specialty and that it would mean a lot to have a letter from him. Then, request him if it would be possible for him to write one.
-          Use this meeting to also talk about future opportunities like obsie or research.
-          If you couldn’t ask him in person for the appointment you can email or his assistant.
-          If setting up an appointment wouldn’t be possible because of the time constraints, then just ask him at the end of the day’s rounds.

6.      Waived vs Unwaived LOR?
-          Waived means you are giving away your right to see the letter. This will have more value since it is assumed that the author would write an unbiased letter as you won’t get to see it.
-          Unwaived means you have an access to the see the letter. This will have less value for the above mentioned reason. But, it’s not a waste letter.
-          I STRONGLY RECOMMEND TO TAKE A WAIVED LETTER, unless you have strong reasons(not just paranoid reasons) to believe that the author might mention something negative about you in the letter. Only in that case take an unwaived letter and see whether you can upload it or not.

7.      What constitutes a good LOR?
-          It should be written at a personal level.
-          Any letter would mention good words or praises about you. But, the most important thing that differentiates a good letter from a generic one is the specific examples for those praises. –Eg: It could be as simple as about how you dealt with some patient situation during your rotation.
-          It should describe you in whole. Not just subject related but your overall personality. Eg: Team player, easy to talk to, punctuality, other skills unrelated to medicine.
-          It can mention the presentations or the talks you made during the rotation. Also, if you took part in writing a case report or any research papers.
-          And, finally words like “I would take him into the program if I am the Program director”.

8.      I am doing the elective now, but I would be applying for the residency next year. So, when should I take the letter?
-          This is one of the common situations faced by many, especially with clerkships.
-          There is a chance for the attending to forget specific details about you and your work if you ask him write the letter one year later.
-          You have the following options.

a.      Take an ERAS token for that particular year, ask the attending to upload an LOR on to the ERAS. Next year when you are applying for the match, you will have to take a new ERAS token and forward the LORs from the previous one.
Advantages: This way you can have a waived letter which has all the specific details about you, as the memory of the author is fresh.

b.      Let the attending know that you would be applying next year, request him to write an LOR and save it on his desktop or with his assistant and that you would like him to upload it next year. Most often than not, they agree to this.
Advantages: Waived letter, includes specific details about you, when he uploads it next year he can put the current date of uploading on the letter.

c.       You can ask your attending to write the letter now and take it with you. You can upload it yourself whenever you are uploading it.
Advantages: The letter will have specific details about you and you don’t have to worry about his availability for uploading the letter as you can do it yourself.
Cons: Unwaived letter

d.      You can tell the attending that you would be applying next year and hence ask him to wite a letter next year during the application time.
Cons: There is a major risk that the attending won’t remember specific details about you. It will most probably be a generic letter.

9.      How important is to have a date closer to the applications season on the LOR?
a.      It’s good if you can have the most recent date.
b.      But, in many cases it may not be possible especially when you do electives an year before. So, it’s ok to have an old date since the programs would understand the gap.

c.       For observerships which you do after graduation, it’s better to have at least one LOR with a recent date. If you can’t, then don’t worry. 

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