Does Love Letter to Program Director Work?

Does a love letter work? If the question exists, it means "yes" is a possibility, so just try!

I sent mine in sealed envelopes, thinking that the traditional, sincere way of conveying my message would bring my application to attention. Out of the ~20 envelopes I sent, I received a reply from the University of Maryland Prince George Hospital. So, if you only want to send one letter, send it there: 3001 Hospital Drive, Cheverly, MD 20785. (kidding.)

The letter should be specific to that particular hospital, and I tried to express my own values in line with theirs.

Here is an example:

Dear Dr. ABC,

I am writing this letter to express my interest in the Internal Medicine Residency at Cayuga Medical Center (CMC). I am from Malaysia, which is a multi-ethnic country where Malays, Indians, Chinese, Sikhs, and other minorities live together. During my clinical years in medical school, I did my rotations in a northern state where I witnessed the stark contrast in healthcare scenes between the rural area and my hometown, Kuala Lumpur. Due to the low level of education and poverty, many patients delayed timely treatment and presented to the hospital with medical complications. Cases such as diabetic foot amputation on the first admission saddened me because the patient could have saved their limb if they had the knowledge and financial resources. Simple advice such as "checking your foot daily" could make a huge impact on the patient's quality of life.

I knew I found the right fit when I came across your residency program, which addresses the inequality of healthcare and provides means to mend the problem. I am particularly attracted to CMC because of its location in a Health Professional Shortage Area and its collaboration with Weill Cornell in improving healthcare services in the Ithaca community. This resonates deeply with my principles in medicine: bettering lives, upholding human rights, and preserving dignity.

Cayuga's IM program further fascinates me with its strong community partnerships, including Foodnet Meals on Wheels, Ithaca Free Clinic, and The REACH Project Inc. I hope to devote my time to such activities and contribute to the community's well-being apart from my clinical work in the hospital.

I believe that the training offered by your program will help me become a competent and compassionate IM physician, and I want to start my journey within the Ithaca community. I wish to learn from both CMC and Weill Cornell in delivering top-notch patient care in various social contexts. After completing the IM residency, my goal is to pursue a fellowship in Nephrology. I am passionate about chronic medical diseases, and I seek to immerse myself in high-quality, community-focused research in the future.

I foresee that with three years of superb training at your institution, I will be well-prepared to take on future challenges and serve my patients. If you have any questions or concerns, please do not hesitate to contact me. I look forward to speaking with you regarding my application. Thank you for considering my candidacy for your residency program.

Sincerely,

Tan

Jia Wei Tan

USMLE/ECFMG ID

And here's another one, although futile, at least I tried.

Dear Dr. QRS,

Good day, I am Jia Wei, and I am writing to express my strong interest in the Internal Medicine (IM) program offered at Massachusetts General Hospital (MGH). I am a 3rd generation Malaysian Chinese, and I graduated from a 5-year Doctor in Medicine (MD) program in Kuala Lumpur, Malaysia. During my first year of medical school, I came to know about the research collaboration with Dr. Gordon H. Williams from the BWH Endocrinology department. Knowing that opportunity does not knock twice, I worked hard and applied for the competitive research program. Thankfully, I was selected to be the new intern at Longwood Clinical Research Center (CRC). I will always remember the day I held the one-way ticket to Logan International Airport, Boston. It marked the turning point of my life.

When I was in the Longwood medical area, I was constantly amazed and inspired by the people around me. I love the robust academic environment where scientists, MDs, and professionals from across the globe gather. I am very motivated by my mentor, Dr. Williams, who would go over my research findings and relentlessly help me achieve my potential. When I have a preliminary finding that I am excited to share, I head to the laboratory to find my scientist colleagues and get their ideas onboard. They taught me a great deal about molecular biology, and we cultivated a strong friendship along with scientific discoveries.

At Harvard, I can always channel my passions into learning something new. I would check the Harvard calendar every day and take every opportunity to join symposiums, classes, and grand rounds. These excellent educational experiences have broadened my horizons, and I really enjoy improving myself every day. Taking the red line subway towards MGH, I wonder where I would be if I were given the chance to continue learning at this exciting place. I would be unbelievably fortunate and extremely grateful if I could join the PGY-1 MGH IM program. I would be thrilled to represent your esteemed institution at the Boston marathon too. I foresee myself serving the diverse population in the Boston area and building a strong foundation in clinical medicine. I am also eager to continue solving the puzzle of cardiovascular diseases through translational research and to contribute to ushering in the era of precision medicine together with the fantastic research team at MGH.

"Circumstances do not make the man, they reveal him." I made up my mind that no matter what the future holds, I will always give my 101% to realizing my dream of being a competent and compassionate physician. It means a lot to me if you can kindly consider my ERAS residency application. Please let me know if you have any questions, and I am looking forward to hearing from you. Thank you.

Yours sincerely,

Jia Wei Tan, MD

I hope these examples help if you are thinking about how to write a love letter. Good luck!

Pre-Match US Residency

You're embarking on an exciting journey with pre-match programs, and while there may be some stigma surrounding them, it's important to remember the power lies within you. Let's break it down and boost your spirits!

First off, let's toss those pros and cons of pre-match versus match out the window. Why? Because you are unique and exceptional, and those generic statements just don't apply to you. One claim floating around is that pre-match candidates are less likely to secure fellowship positions. But hold on a second! Where's the systematic review or consensus from the experts to back that up? It's nowhere to be found. So, let's brush that aside and focus on what truly matters.

You, my friend, have a wealth of talent and knowledge. Your impressive achievements in ABIM/Step 3 and those strong Letters of Recommendation from your PD and attending physicians speak volumes about your credibility. You don't need the name of an institution or hospital to validate your worth. You're a kickass individual standing tall on your own merits! Remember, prestige is like the icing on a cake—it's delightful when it's there, but even without it, you're still amazing and capable of achieving great things. You've got your own back, and that's what truly counts.

Now, let's address the competition you encountered during your interview trails. You met incredible candidates, and the stakes were high. But guess what? As long as you have the willingness to learn and grow, you can thrive in any place you find yourself. Your adaptability and determination will be your secret weapons. So, embrace the stiff competition as an opportunity for personal growth and a chance to push your limits. You're up for the challenge!

When I was at NIH in Maryland, where I had a candid conversation with an attending physician. I asked about the odds of getting into prestigious institutions. He was very direct in answering and I appreciate it till this day.

The most important step for IMGs is to get your foot in the door. The rest will follow. 

Directness is a rare gem, indeed! So, my friend, take that honesty to heart. It's a reminder to be realistic but also to believe in your abilities and dreams. Keep pushing forward with determination, and you'll make your mark wherever you go.

In conclusion, let go of the stigma surrounding pre-match programs and embrace your unique journey. Your incredible skills, accomplishments, and determination are what truly matter. The sky's the limit for you, and no matter where you end up, you have the power to make a significant impact. Believe in yourself, keep that indomitable spirit burning bright, and remember that you're destined for greatness. Best of luck on your residency adventure, my motivated and unstoppable friend!

Sense & Sensibility 

Take a look at your rank list. Rank them now, even if you haven't visited the hospital. Try to consider the pre-match program and see where it falls in the rankings.

Numbers 1, 2, and 3 are like Olympic winners standing on the stage. You're already on the stage, so does the height of the standing stool really matter in the context of residency matching? No, it doesn't. Lump your number 1, 2, and 3 into one box, and number 4 into another box. If the pre-match program falls into either of those boxes, go for it!

But what if you rank it as 5 or 6?

Well, that depends on how much you desire to be in the top 4. What motivates you to aim for numbers 1-4? Will choosing number 5 cause daily heartache in your life, especially if it means being away from your family? Are you willing to take the risks involved? Consider what is at stake—your time, your finances, or even your mental health (as un-matching can take a toll on it). This brings us to the final point in this post.

P.S.: If you rank the pre-match program in your last 3, you already know what to do. :)

Addressing Your Fears:

For me, when I received the offer from Bronx, I was 25 years old, single, and burdened with student debt and no income. I was afraid of having to invest another five-figure sum in the matching process. Personally, I didn't believe I had the strength to go through it all over again. However, I am incredibly fortunate to have my mother's unwavering support. She summed it up beautifully:

"You can spend the year earning whatever money you need for the match cycle, work elsewhere, and your problem will be solved. If money is the issue, there are means available for you to overcome it. Use that year to grow and improve yourself. You already have the experience of interviews, and you can plan things much better than the year before. The whole process will actually be smoother and less stressful than the first time. Odds are, you will perform better and match in your desired place."

Now, if your fear doesn't revolve around money and time, are you willing to let go of your ego? Are you willing to experience failure once? Keep in mind that a few weeks after the results are out, no one will care whether you matched or unmatched. Your friends and acquaintances will move on with their lives and forget about this incident. The only person holding you back from moving forward is yourself. There are only two outcomes for you: either you match and feel happy or you unmatch, learn from it, and match successfully the next time.

Either way, your time won't be wasted. When you look at it in the long term, a difference of one or two years doesn't really matter, especially now that life expectancy is reaching into the 80s.

In conclusion:

General statements don't always apply to individuals, so take the notion of "no chance for fellowship" with a grain of salt.

If the pre-match program falls into Pandora's Box 1 or 2, take the deal. The decision you won't regret is the one made without the shadow of your own fears.

Timeframe for USMLE pathway

Time is the most precious commodity one has, and doing the right thing at the right time is crucial. "Failed to plan = plan to fail." Here, I am going to share my USMLE IMG time frame as a former medical student, just so you can get an idea of how to plan ahead:

2013: Enrolled in medical school.

2013-2014: Started learning bench research in university.

2014-2015: Studied my ass off as a second-year med student.

2015-2016: Undertook clinical research at Brigham Endocrinology.

March-June 2016: Prepared for Step 1.

June 2016: Took Step 1.

2016-2017: Came back to Malaysia, resumed as a third-year med student.

December 2017: Took Step 2 CK.

2017-2018: Crazy busy fourth-year med student, spammed Freida website, emailed coordinators for USCE positions.

April 2018: Rotated in a Michigan community hospital.

May 2018: Took the chance to get Step 2 CS done (saved flight money).

August-September 2018: Volunteered at Kathmandu Children Hospital, Nepal.

2018-2019: Spammed coordinators again for USCE.

July 2019: GRADUATED!

August 2019: NIH Cardiology internship.

September 2019: Audition rotation in the same Michigan Hospital.

October 2019: Interview trail started.

February 2020: Interviews ended, submitted RoL.

End of February 2020: WHO Internship in Geneva.

March 2020: Matched!!!

June 2020: WHO internship ended.

End of June 2020: PGY-1 commences.

Remember, this is just one example of a time frame for USMLE preparation and the matching process for an IMG. It's essential to customize your plan based on your circumstances and goals.

 I suggest clearing off the USMLE steps as soon as you can by practicing UWorld and Kaplan for 3-4 months and studying well during medical school.

The USMLE pathway is time-sensitive, and you can make your life much easier by taking it during your medical school years when you have extra time after school to prepare for these additional tests. You can also do it during Housemanship, but it won't be any easier, so why not take it now?

When you apply for USCE, it's beneficial to have Step 1 and, even better, Step 2 scores ready. When I applied for the Michigan USCE, the coordinator asked for my Step 2 score if it was available. Although not a requirement, it is a plus factor.

Plan your medical school elective, especially the away rotation, well. If your school does not offer it, use the end of the semester break or year-end break to go to the US for your rotation. During the same trip, take Step 2 CS.

Once you have your Step 2 CS, consider applying for the NIH visiting student elective. NIH requires either TOEFL scores of 29/30 or Step 2 CS. I tried TOEFL, but I did not get a near-perfect score, so I used Step 2 CS instead.

If you have completed all the steps mentioned above, engage in volunteer activities or pursue other internship opportunities. I found out about my WHO intern position in December 2019. Later, during my residency interviews, I mentioned this experience and expressed my interest in Public Health, among other topics.

What you do after medical school is super important. Remember that your CV does not end the moment you click "send" on the ERAS application. New work experiences, internships, publications, and even additional USCEs can provide you with ideal reasons to email programs, update them on your professional achievements, and express your interest.

If you don't have the mentioned experiences above, don't worry. What matters is how you spend your time, whether it was wisely spent, and how it contributes to your personal growth.

Touch wood, but if you don't match for that year, at least you have already started planning ahead for the next even better and stronger Match cycle with your new experiences.

Matched! as a Malaysian IMG

If you stumbled upon this blog, you're probably searching for information about the matching process for International Medical Graduates (IMGs), and here's my story.

I started studying at a medical school in Kuala Lumpur, Malaysia when I was 19. I have always been a planner and disliked uncertainties. As soon as I enrolled in medical school, I began thinking about the pathways to become a specialist after graduation. Due to personal reasons and the possibility of taking the USMLE during medical school, I set my mind on pursuing this route. If I didn't match, I would explore other post-graduate pathways, such as MRCP.

When did I become determined to take the USMLE pathway? It was during my second year. And with that decision came a wave of uncertainties. The most important lesson I learned from this journey from IMG to the USA is how to remain calm amidst unknowns. I relied heavily on faith and stoicism, but that's a topic for another day.

#1 USMLE score is crucial.

Take a moment to let that sink in. Unlike MRCP, where it's a pass/fail exam (although it recently changed), every percentage matters in the USMLE. Even with a score that falls within +2 standard deviations, it doesn't grant you the title of "Internal Medicine" MD like MRCP does. It's a bet that requires significant financial and personal commitment.

#2 Build the right CV

Applying for universities can feel like high school all over again. The right CV should include:

• Publications
• Impactful volunteer work
• Relevant work experiences
• US Clinical Experience (USCE)

Regarding volunteer activities, I didn't get asked about them much during my interviews. I had participated in campaigns, volunteered at clinics, and engaged in medical student association activities. However, these experiences weren't significant enough to make my CV stand out. Think about other aspects that showcase the impact or novelty of your activities. It's not about the number of hours you list on your ERAS profile, but rather the value of your contributions.

Next, let's talk about publications. I can't speak for other countries, but in Malaysia, publishing a paper during medical school is extremely challenging. I made efforts, but it wasn't enough for me to proudly say, "I did it." If you're currently in medical school, always be on the lookout for opportunities. There must be something out there, so don't lose hope.

In my case, I dedicated a gap year to research on the genotype-phenotype of hypertension at Brigham Endocrinology. While I was in Boston, I met another IMG who was a fellow, and he emphasized the importance of publications. Even if you spend an entire year abroad, if you don't have a publication as a first author, how do you differentiate yourself from a casual tourist?

I worked tirelessly that year and continued to do so until I graduated from medical school. During my residency interviews, many questions were directed at the research work I had done. I suspect that because it delved deep into internal medicine, the interviewer, who was also an internal medicine specialist, became interested and engaged in the conversation. My point is, find a research topic you're passionate about and become an expert on the paper you published.

On Publications:

Allocate sufficient time: At least 6 months (you won't get a paper out in 3 months; if you're investing your time, invest wisely and invest more).

Maintain strong connections: The best way to do this is by staying involved in the work. If you're still part of the team, even remotely, your supervisor won't forget you.

#3 USCE (US Clinical Experience)

This is the burning coal. It's a pain in the neck, but it's incredibly important. USCE serves as the source for your letters of recommendation. In recent years, many US universities and hospitals charge fees for USCE and require affiliation with your medical school. If you have access to VSAS, great, as it will be easier for you to secure USCE. If you don't have access, make every effort to search on Google, and FREIDA provides the email addresses of program coordinators whom you can reach out to and inquire about the possibility of being accepted as a visiting medical student.

Personally, I found a community hospital in Michigan through Google and completed a rotation there two years ago. Unfortunately, they now only accept students from affiliated medical schools. So, you'll need to explore other options. In 2019, I obtained a place in Cardiology at NIH, and they didn't charge any fees (thankfully). You might want to search for NIH and submit an application.

During my interviews, almost everyone I met had USCE. Many hospital websites may state that USCE is not a requirement, but if everyone has it, what's the point of saying it's not required? I know many people believe it's all about connections, but if you don't have them, keep searching online. Now you can see the uncertainties. Even after acing the USMLE, investing countless hours into research papers, and worrying about possible rejection from journal reviewers, you still have this vital chess piece called USCE.

I understand that it's hard to relax and trust that everything will turn out fine. You're still estimating your chances of matching and counting the odds each day. If you go through this entire process, you will undoubtedly experience personal growth and maturity. These qualities will become a part of your identity, and regardless of the match outcome, they can never be taken away from you.

My match journey began in 2016 and finally concluded in 2020. Looking back, I'm grateful that I discovered myself along the way. It's a daily blessing to know who you are, what you want, and who you can become. If you truly understand yourself, hold onto it tightly, like the last bit of ash on a cigarette butt. And if you emerge on the other side as a PGY1 resident, you'll be the happiest and brightest-smiling resident because you won't waste a single breath being miserable after everything you've been through to reach that point.