How essential is it to get a LoR from a US doc?

[jpimg]

Hey all, apologies if this is in the wrong place. UK med student looking to do FM in the US. We're planning our electives now and there's not long enough between now and then to do USMLE Step1,2ck and cs which means opportunities for sub-Is are limited. This leaves me with the options of
1) Do a US observership so that I can still solicit a LoR from a US doctor.
2) Do an elective in the UK, which means no LoR from a US doctor.
3) Potential third option where I try and get a sub-internship after graduating from med school in the UK which may not even be possible?

Which option is better, and is a LoR from a US doctor necessary for FM?

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[Ironheme]

At least 1 US LoR is required for some programs. I would try to do a rotation rather than an observership. You still have time to plan for the summer. And trying to do Step 1, 2 CK and CS all within the summer seems pretty rough. Having only UK letters is not ideal.

I would try to be realistic on your scores for Step 1, 2 CK and CS. If you're scoring high on the mock exams from Uworld that's one thing. If you haven't started studying for any of those that's another thing.

You need to do well on your step exams. That will open many more doors for you than doing poorly and getting a US letter. I would rather see a candidate with very good step scores and no US letters than the above. Your best bet is: above average Step scores + 1 US letter/doing a rotation - doesn't have to be sub-I in an FM program you'd want to match at.

You may also want to consider spreading out those exams - rotating at 2-3 places this summer working as Sub-I and making good connections + getting excellent letters, and then applying next year.