Prelim intern reapplying for match, how do you update an LOR from previous cycle from someone who saw you as a student and not a resident?

[Anon_1522]

I’m a medicine prelim intern reapplying for the match this cycle. I asked one of my mentors from med school to update/rewrite a letter, and she agreed! The thing is, she isn’t sure how to update the letter given that she worked with me as a student and not a resident.

Any tips or sources I can look into on how to do this?

I have also gotten an LOR from my current program, and plan to get another one plus a PD letter. Does the PD letter count toward the ERAS LOR limit, or is that separate?

Thanks for your help!

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[NotAProgDirector]

You haven't mentioned what field you're applying to, which matters quite a bit. And what field you applied to last year.

Yes, the PD letter counts as one of your LOR's.

Asking a LOR writer from medical school to update a letter is a mixed bag. If you did lots of research with them, then may be worth it. Else the only thing they can "update" is anything you did with them after they wrote the prior letter and before you graduated from medical school. Else you'll be getting the same letter.

If you're applying to Derm or Rads, then you'll want the PD letter, and then three letters for Derm or Rads. One should be from your research mentor, one or two from Rad/Derm in your residency program (hopefully you were able to get a rotation). One letter could be from your prior medical school.

If you're applying to IM, then what you really want is a PGY-2 spot. These often open during the recruitment season. You should be talking to your PD.

 

[Anon_1522]

You haven't mentioned what field you're applying to, which matters quite a bit. And what field you applied to last year.

Yes, the PD letter counts as one of your LOR's.

Asking a LOR writer from medical school to update a letter is a mixed bag. If you did lots of research with them, then may be worth it. Else the only thing they can "update" is anything you did with them after they wrote the prior letter and before you graduated from medical school. Else you'll be getting the same letter.

If you're applying to Derm or Rads, then you'll want the PD letter, and then three letters for Derm or Rads. One should be from your research mentor, one or two from Rad/Derm in your residency program (hopefully you were able to get a rotation). One letter could be from your prior medical school.

If you're applying to IM, then what you really want is a PGY-2 spot. These often open during the recruitment season. You should be talking to your PD.

Applied to anesthesia last year, dual applying IM and anesthesia this year. This LOR update would be from a IM-subspecialist, and I let her know I’m dual applying. No research, just someone I did a rotation with. I’ve been reading it’s ok to reuse a letter if the date is updated but I wanted to minimize this and use it as a supplement in addition to 3 new letters from my prelim year.

So far, from my program I have 1 new IM letter. I am doing anesthesia this month and am working on getting another letter from the anesthesiologist. I let the IM doc know I am dual applying, and plan is to talk to the PD soon (this would be the 3rd LOR assuming the anesthesiologist one works out).

I am applying broadly to IM and while it sucks to have to redo intern year, I’d rather match than take my chances. I’m hoping for anesthesia but given how competitive it’s getting I won’t hold out hope. I’ll shoot my shot but can also be happy with IM. Looking at other PGY-2 spots helps, but I’m also using this prelim year to gain valuable experience and hopefully match somewhere with a lot of opportunities.

 

[NotAProgDirector]

These details change all of my advice above.

Applying to anesthesia, you'll be in the match for R positions - anesthesia spots that start July 2023. You can also apply for advanced spots to start July 2024.

A letter from an IM subspecialist with whom you did a single rotation in medical school is useless.

You can submit different letters for your applications. For anesthesia, you should submit the PD LOR, 1 new anesthesia LOR from your internship, and 1 anesthesia LOR from medical school (especially if anesthesia has some sort of department / summary letter). The last letter could be either a new anesthesia letter (ideal) or a new IM letter.

For IM, you'll submit the PD letter, the department letter from medical school, and 2 new IM letters.

rematching into IM isn't as easy as you expect. Some programs may decline to consider you for another intern year - applicants often say they are happy to repeat their intern year, but it's very hard to do so with a good attitude. Intern year is (somewhat) fun the first time, repeating in the same field is painful.

 

[Anon_1522]

These details change all of my advice above.

Applying to anesthesia, you'll be in the match for R positions - anesthesia spots that start July 2023. You can also apply for advanced spots to start July 2024.

A letter from an IM subspecialist with whom you did a single rotation in medical school is useless.

You can submit different letters for your applications. For anesthesia, you should submit the PD LOR, 1 new anesthesia LOR from your internship, and 1 anesthesia LOR from medical school (especially if anesthesia has some sort of department / summary letter). The last letter could be either a new anesthesia letter (ideal) or a new IM letter.

For IM, you'll submit the PD letter, the department letter from medical school, and 2 new IM letters.

rematching into IM isn't as easy as you expect. Some programs may decline to consider you for another intern year - applicants often say they are happy to repeat their intern year, but it's very hard to do so with a good attitude. Intern year is (somewhat) fun the first time, repeating in the same field is painful.

So I went to a DO school without an official home program for anesthesia or IM. Last year, students needed a chair letter for IM, not so much anesthesia. Do I need to contact my school about this? They have a staff physician do this. I presume this is the closest thing to a department letter we have. I did get an anesthesia LOR as a student, but it’s quite old, and not a department of residency PD letter.

As for getting another IM letter, I’m running out of time. My coordinator isn’t able to get me something IM like for next month. I’ve talked to all my letter writers and told them I’m dual applying to help make letters more generalized. That, and I’m applying to a lot of IM program. I’m not gonna be too picky there.

 

[Anon_1522]

These details change all of my advice above.

Applying to anesthesia, you'll be in the match for R positions - anesthesia spots that start July 2023. You can also apply for advanced spots to start July 2024.

A letter from an IM subspecialist with whom you did a single rotation in medical school is useless.

You can submit different letters for your applications. For anesthesia, you should submit the PD LOR, 1 new anesthesia LOR from your internship, and 1 anesthesia LOR from medical school (especially if anesthesia has some sort of department / summary letter). The last letter could be either a new anesthesia letter (ideal) or a new IM letter.

For IM, you'll submit the PD letter, the department letter from medical school, and 2 new IM letters.

rematching into IM isn't as easy as you expect. Some programs may decline to consider you for another intern year - applicants often say they are happy to repeat their intern year, but it's very hard to do so with a good attitude. Intern year is (somewhat) fun the first time, repeating in the same field is painful.

Sorry for the double post. I did have one more question regarding reapplying. I was thinking about reaching out to programs where I interviewed at last cycle for feedback and what I can do to improve. If I do this, should I contact the PD, or someone on the committee that I know, and how would you go about doing it?

 

[NotAProgDirector]

Asking "how to improve" at this point is pointless. First, its unlikely they remember your app. Second, there's no time left to improve.

In general, DO "Department" or "Chair" letters are not very helpful.

How many anesthesia interviews did you get last year? And you might as well just post your COMLEX/USMLE scores, and grades from your Anesthesia rotations as a medical student. I assume if your school doesn't have a home IM program, they don't have a home Anesthesia program either -- did you do aways and if so how many?

And did you do any more anesthesia work after the match last year?

 

[NotAProgDirector]

One of the most important things you can do is go talk to your home rads PD. It's great that they are going to write you a "strong" letter. But the fact remains that they did not match you. Something made them put you lower on their list. You want to know what that is. It's a hard conversation to have (for them), but you need to ask them to be honest, not worry about hurting your feelings. You might want to start the conversation that you don't expect to match there next year -- you're not asking "what can I do to match here", you're asking "what happened that I didn't match anywhere". The answer to that question is the main thing to focus on now. If it was interviewing, you need honest feedback about what the problem was.

Otherwise, you've laid out a decent plan. You need to do whatever you can right now to get more rad experience -- whether that's more rotations, research, whatever. Ask people for letters before you leave -- it's much easier to write a letter and hold onto it when memories are fresh (unless your research will be ongoing / remote). You'll get a letter from your IM prelim PD, but they will need to write that in August so it;'s likely to say @Striatum14 is doing fine as a new prelim intern and not much more than that. With no rads residency program, a letter from rads there will be of much lower value. You'll apply to both A and R programs (an A match would have a 1 year gap, an R match would start immediately after your prelim).

You should also consider a backup specialty, and consider applying for it. Or, if your backup will be IM, then be ready to hunt for a PGY-2 position immediately after the match if it does not go well.

 

[NotAProgDirector]

LORs and interview skills can be fixed. If you already have good research, not clear that more case reports will add much but I do think it's important to show that you're "doing things". What to put into your PS is a personal decision, I don't think there's any need to specifically talk about why you didn't match.