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

IMG
• Abbreviation for an International Medical Graduate.

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

Clerkships/ Core Clerkships

• 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.

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

Clinical Sub- Observership Externship

Observership
elective Internship

Hands on
No Patent
(Patient
Contact
contact) Hands on (Patient
No Patent Contact
contact)
 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.
 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!
 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!
 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
 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
 DECIDE well in advance what
Specialty Of

you want to do (residency)!!!
 Should be a specialty of your
Choice
choice. e.g. Internal Medicine,
Subspecialty
Pediatrics, Family Medicine or
General Surgery. Related
 Can be the subspecialties or specialty
related specialties.
e.g. For Internal Medicine the Any specialty
subspecialty would be Cardiology
and a related specialty would be
Family Medicine.
 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!!
 Hospitals that accept Students Hospitals that Require USMLE Step
from affiliated schools only or 1 score
require a sponsor

Hospitals that accept

International Students

Hospitals that Charge lots and lots Hospitals that do not need
or $$$ Affiliations, Step1 score or $$$
 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: [email protected], [email protected], +92-99215754-7 (Ext. 180)
 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
 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:
[email protected] 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
 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
 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 : [email protected]
in order to receive the application material
◦ TOEFL required but can be waived
◦ http://www.jefferson.edu/international_affairs/prospective/electives_clerkships_rotations.cfm
 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
 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 [email protected]
◦ $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
 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 [email protected]
e.g. Gregory House : [email protected]
◦ Once a sponsor agrees DONOT email Dianne Weiland, email Penny Hamilton at [email protected], 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 [email protected] 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/
 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 [email protected] 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
 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/
 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
 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.
 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.
 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)
 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.
 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!
 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.
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.
 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
 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.
 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.
 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!
 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.
 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
 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!
 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 LOR
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.
Waived Unwaived
 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 ERAS support
LWP MAIL
services
 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.
 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!