Letters of Recommendation and Dean's Letter Information for IMGs

What’s in a Letter?

A letter of recommendation is a key piece of information for any NRMP Match applicant, but especially important for the IMG. Letters of recommendation for US applicants often are partly just to make sure that a candidate that looks “good on paper” isn’t crazy, or doesn’t have any hidden flaws that have not been mentioned elsewhere in the application. US faculty members are well trained at reading applications from medical schools for which they are already familiar with, and reading thru exam scores for the USMLE. They are also very familiar with the curriculum and general training of US medical students.

If you are an international student, chances are high that your evaluator knows nothing about your medical school, your curriculum, your years of training, or your clinical competency. For the IMG, the letter of recommendation becomes even more crucial.

The purpose of the IMG letter of recommendation includes making sure you are well trained and ready for residency in the United States. Ideally this letter will describe you from a clinical perspective, including your familiarity with the US hospital system, your ability to make diagnostic decisions based on clinical and laboratory data, your ability to work as a team, and your ability to communicate with patients. The best letters will also make direct or indirect comparisons to US equivalents and perhaps even rate you as above a comparable US medical student/resident.

Who Should Write Your Letters?

First of all, the best letters will be from US faculty members. Letters from back home will only be helpful if your professor happens to be a world authority on a subject and is well known around the world as “the man” in your field. Otherwise, be sure your letter comes from a US faculty member.

This is for several reasons. First, residency admissions committee members always look first for the letterhead of the stationery the letter of recommendation is written on. They look to see if your letter came from Big Name University, USA, or Small Town Hospital Doc. There is going to be a level of trust when it comes to reading a letter, so if the reader does not personally know the letter writer (true in most cases) they will weigh the letters comments more heavily if it is from a big name institution. So you’ll want the most well known person to be writing your letters.

US faculty members are also more likely to be better letter writers. They will know what residency committee readers are looking for in a candidate and be able to write a more relevant letter for you. This will include information on your clinical competency as a member of a US medical team.

Letters written from professors at home are less desirable for a number of reasons. First, they are unfamiliar with the structure, function, and purpose of a residency letter of recommendation. Also, US readers will probably not know who your letter writer is, or even the university or hospital they are coming from. As explained above, they will not know how reliable your letter is coming form an unknown entity. Also, the tone of the letters is important, and culturally, letters written from US writers will probably be stronger, more direct, and more positive (hopefully) then more “polite” letter writers from back home.

Try to be sure to get letters from faculty, and the higher the better. Full professors will be more impressive when residency committees review your letter, and chief residents the least impressive. If you’re really in a pinch, a chief resident’s letter will suffice if you use that letter primarily to apply to the same institution for that same institution.

If you must have a letter written for you from your home country, make sure that it is relevant, explaining your clinical abilities, and that it is up to date. Don’t submit a letter that is several years old, or one where you have not worked with the letter writer in many years. Additionally, it should compare your abilities and training with the training expected of residents in the US and explain your qualifications to be a resident in the US. Ideally this letter will originate from a country with similar training and clinical practice as the US.