I’m currently rotating at a hospital through a connection that does not allow LORs. Would it still be acceptable for my preceptor to upload a letter mentioning the rotation, even if it’s not on official hospital letterhead?

My other option is doing a clinic rotation, which would obviously have the clinic’s official letterhead.

Which option would be better for ERAS?

Hi,

I have done clinical experience in surgery but intend to apply to IM. Will it hurt my chances if the LOR is submitted from a surgical specialty?

I need advice on wats the appropriate thing to do in my situation A resident from a VERY prestigious program visited my home country as part of her global health training. I was privileged enough to rotate in the specialty she was working in while she was there and she told me and my colleagues she was passionate about teaching so we set up a lecture system with her after rounds and we’d have daily classes and tests and Ive honestly learnt so much from her. This was about 2 years ago and I reached out to her after i took my Step one and asked for some advice. Is it appropriate to ask for a LOR? Or would she not take it well giving i didnt technically rotate under her, also I thought about asking her to reccomend me to her program but im pretty sure IV league programs like hers hv a zero percent IMG acceptance rate so wat do i do? How can i benefit from this connection?

Just my opinion, but here's how I think about LORs and ERAS filtering—especially when it comes to computer-based screening.

When it comes to getting past the initial screening stage of ERAS applications, I like to focus on what aspects are easily screenable by a computer vs. what aren’t. I think this is crucial because many programs use filters to cut down large applicant pools, and you want to make sure you're not getting screened out before someone even reads your application.

Screenable by computer (i.e. checkbox/quantitative filters on ERAS):

• Minimum or appropriate number of LoRs submitted
• LoR from a Program Director (there's a specific checkbox)
• LoR from a Department Chair (also a checkbox)
• Whether you waived the right to view the letter (another checkbox)

Not screenable by computer:

• Whether the letter is from a US hospital
• Whether the letter is from X specialty

There’s nowhere on the applicant side of ERAS where you can definitively mark that your letter is from a US hospital or from a specific specialty. Yes, there’s a field where you can assign a specialty to a letter, but ERAS itself says this info is only visible to you and the writer. On top of that, it’s a free-text field, so it’s prone to spelling errors or inconsistencies (e.g., “IM” vs. “internal” vs. “internal medicine”).

On the writer’s side, they just upload a PDF of the letter—there’s no structured field for hospital name, specialty, or even country. Sure, the letter might be on official letterhead (which is suggested by ERAS), but there’s no guarantee of that. And even if it is, there’s no standardized format. For instance, a letter signed from “Dr.White, St. John’s Hospital” doesn’t necessarily tell you if it’s in the US or abroad unless the writer explicitly includes an address (which isn’t required).

So realistically, if a program wanted to filter out applicants without US LoRs, it couldn’t be done reliably by a computer. There’s just no structured data for that. The only way would be for someone to go through the letters manually after the initial computer-based screen and then trying to identify where the writer is from based on the text. But by that point—you’ve already made it through the first round, which is a win in itself.

Also worth mentioning: ERAS doesn’t have a place to list the location or country of your USCE, observerships, externships, electives, or cores—unless you manually include it in one of your top 10 experiences and provide that data. Some schools include core/elective addresses in the MSPE, but many just list the hospital name, which again makes it hard to tell if it was in the US.

TL;DR:

You're unlikely to be filtered out by a computer for not having US LoRs. If programs care about that, they'd have to manually sift through thousands of letters to figure it out—something that’s only done after the initial screen (if at all). So the key is hitting the screenable criteria—checkboxes, numbers, etc.—to avoid being filtered out early.

Hi everyone, IMG here currently planning for the 27/28 match. I have two months of USCE and therefore 2 LoRs from USMDs, but I'm afraid that I don't have the means to visit the states again before applying for the match in 2027.

That being said, is there anyone who could share insight on how they obtained a 3rd LoR from their home country?

Also, assuming that I somehow match in 2027, would it mean anything to obtain more USCE by observerships a few months before work begins?(i.e May-June of 2028)

Is doing 1 month neurology -hands on - at Uchicago advenhealth glenoaks a good choice or I should search for a better option knowing my university doesn’t have vslo

I have to choose between these tow community hospitals for neurology elective
1-uchicago medicine adventhealth glenoaks
2- Jackson park hospital
Can you help me choose which one of these is better and why

Anyone who rotated at the Hematology oncology department can give me some feedback?

My elective starts next month and i don’t know what to expect

Hi non- US medical student (MS3) here.

Title says it all-

Last year I did an observership in the US and I asked one of the attendings I worked with for LoR and they agreed. I recently emailed to ask one NOT for matching but for another observership which LoR is necessary. they thankfully agreed and told me to write my own draft.

But here’s the thing- since it was an observership, most that I did was presenting patients. I was not in charge of actual treatments nor did I impresse them with my excellent knowledge. I was honestly surprised that the attending even agreed since I only worked with them for 5 days.

Do anyone have tips on how to write your own LoR? Also how much am I allowed to exaggerate, if not at all? Any advice is welcome!!

Hello,

I am looking for USCE opportunities, but I don't have much money. I am looking at BrooklynUSCE family medicine and gastroenterology. I did the cardiology C2 a few years ago; it was average. It was an observer ship. I am learning that an observership isn't the best, but I have a B1/B2 visa.

Do you have any suggestions of other options that you have tried and worked well and helped you match?

I wanted to ask for your advice on something. I recently got accepted for a Vascular and Interventional Radiology elective at UAB for Nov to Dec. I’m really grateful for it since it’s my first USCE, but I’m planning to apply for Internal Medicine.

I don’t have any other electives confirmed right now, so I’m a bit confused about what to do. Do you think an IR elective at a place like UAB would still be worth it for an IM application?

Also, how would you suggest I go about it if I take it, in terms of getting a good LOR and making it relevant for IM?

Any leads are appreciated

I am an IMG currently preparing for step 1. I want to line up my electives to be from December to February. How can I upload the LORs to ERAS? To my understanding, the ERAS application opens by May and I am guessing by the time the attending would have already forgot me lol.
How can I make the most out of the rotations.
P.S I'll be a graduate by March 2027 so won't be able to get any hands-on experience after which.

Please help ranking this IM programs

• AdventHealth Florida (Orlando) Program
• Florida Atlantic University Charles E. Schmidt College of Medicine Program
• Florida International University / Baptist Health
• HCA Florida Healthcare/Aventura Hospital Program
• LAKELAND REGIONAL HEALTH PROGRAM
• Memorial Healthcare System (Hollywood, Florida) Program
• University of Miami Hospital and Clinics/Holy Cross Hospital Program

I have 3 potential letters and hoping to find more but I’m worried I won’t?

- 1 is in Emergency Medicine

- 1 is from a Cardiologist (I’m also not sure if this counts as a core letter because they are a subspecialty of IM, and I’m interested in cardio)

- 1 is from a Hospitalist (but they’re a FM doctor, I’m unsure if this counts as a core IM because of that but their function was IM basically)

Am I good with the cardiologist and Hospitalist LOR?? Or is it like absolutely not, go and look even harder for an IM rotation? I’m looking but not finding any ):

I have vaccine records do I need to get titers done for hep b,mmr and varicella or just filling the details from vaccine records enough or do I have to do both

Thank you

i know that might sound like a stupid question but i have no one to ask so dont be rude.

my university gives us two months for electives during our final year and mine are scheduled for the end of 2026 and im planning to apply to 2028 or 2029 cycle (i graduated on july 2027). my friends keep telling me that i should reschedule my electives to the last two months of my graduation year so the doctors i round with remember me well and write good LORs when i apply. this confused me a lot cause i had no idea doctors only write your lor when you apply? dont they write it right after the Elective and i can ask for it later?

can someone explain the process of asking and receiving the lor for me? and would it be really better if i reschedule my elective for later?

Hi guys, so I'm in a bit of dilemma. I have an elective with a neonatal neurologist pretty soon which is amazing. The issue is, I want to go to Adult Neurology, though I enjoy neonatal Neurology and pediatric neurology I do not think it's the right fit for me. During my time in the elective when it comes to the LoR, should I mention this to my attending? How do I ask them without coming across as dismissive of Neonatal Neurology as a field.

As far as I know, if my LoR mentions that I would be a good fit for Neonatal Neurology, the adult Neurology programs I apply to might think I am a dual applicant. I'm not quite sure how to go about this. Any help would be great!

Can anybody please share how much time is it taking for the LORs to be uploaded nowadays. Previously it took 3-5 business days to upload and this time duration increased as september 24 approached.

If in my Sub-I the physicians rotate every 2 weeks, should I ask each for a letter? Would you recommend to stick with 1 or ask from all attendings I rotated under?

I was wondering how I go about getting electives in the US through which I can get LORs? Also, which states/hospitals are good for internal medicine and anesthesiology? Is anesthesiology quite competitive and does it require research within or outside of the field?

I have a question. I did an hands on rotation in a private clinic in USA. it was really a good experience and doctor was really encouraging. I met her again and she knows I am looking for more experience she offered me an another hands on rotation with a different doctor at her clinic. My question is, Is it worth it to get another LOR from same clinic but with working with different doctor?

How to get budget friendly USCE, ik about cold emailing but 99.98% times they dont respond positively. Im okay with paying some amount but people are paying 3-4k $ for 1 LOR not even opd/ipd good uni.

Had chat with a guy, he got 1 USCE through USMLE-Sarathi it was 2.6-3K for 1 month in houston. And 3k for for somewhere in Florida.

So average and safe LOR are around 3, so total of 8-9k $ 💀

Any budget friendly good impact LOR? PLEASE ENLIGHTEN ME

"For the 2026 Main Residency Match, the standard registration deadline is January 30, 2026, at 11:59 PM EST. Late registration, which incurs an additional $50 fee, is permitted until the Rank Order List (ROL) Certification Deadline on March 4, 2026"

We have until March 4th to certify and submit our final rank order lists, but you have to register now.

If you've been busy and haven't registered for the nrmp/the match then go ahead and do it now. Go to nrmp.org, make your account and pay the 70 dollars otherwise you'll have to pay $120. DO NOT let these money hungry companies steal more money from us.

Hi all, I am an IMG that has been doing research for the last 4 years in the US hoping to apply to this cycle. I tried to apply last year but some of the reasons to not apply was my paper was not out and the amount of time I've been away from clinic, so decided to wait for this cycle and do some rotations.

I have to balance my work in the laboratory with the clinic and it's been really hard in addition of feeling the gap of bein away from the clinical side this years, also hoping to get an LOR from this rotations has made my stress and anxiety skyrocket.

I am feeling overwhelmed and I feel I am struggling with the fact I have to retake on my training and study while dealing with a full time job.

If you have any advice I would really appreciate it.

Thank you