Which LOR to use?

[lymphocyte]

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During my American rotations, I got formal evaluations from my attendings that will show up on my MPSE. These evaluations are detailed (2+ paragraphs) and quite good (advanced PGY-1/PGY-2 level, etc.). However, two of my current LORs are from Australian professors of psychiatry. They are happy to write in American hyperbole, and I've known them for years. Soo.... Do I go back and ask my American attendings (great but impersonal) or stick with the Australian ones (great and personal but foreign)? My third LOR is from an American neurology professor with whom I did a Sub-I. He offered the LOR unsolicited, so I assume it will be good.

I feel like the American ones will be mostly be rehashing what's already in the MPSE and might not be as strong. Will it even make that much of a difference? I'm aiming for less competitive university programs.

Otherwise my application is strong: 250+, honours in all clinicals, etc.

 

[clausewitz2]

During my American rotations, I got formal evaluations from my attendings that will show up on my MPSE. These evaluations are detailed (2+ paragraphs) and quite good (advanced PGY-1/PGY-2 level, etc.). However, two of my current LORs are from Australian professors of psychiatry. They are happy to write in American hyperbole, and I've known them for years. Soo.... Do I go back and ask my American attendings (great but impersonal) or stick with the Australian ones (great and personal but foreign)? My third LOR is from an American neurology professor with whom I did a Sub-I. He offered the LOR unsolicited, so I assume it will be good.

I feel like the American ones will be mostly be rehashing what's already in the MPSE and might not be as strong. Will it even make that much of a difference? I'm aiming for less competitive university programs.

Otherwise my application is strong: 250+, honours in all clinicals, etc.

In general unless your Australian preceptors are super famous or you suspect your American preceptors secretly hated you, go with the American LORs.

 

[lymphocyte]

In general unless your Australian preceptors are super famous or you suspect your American preceptors secretly hated you, go with the American LORs.

So the MPSE thing doesn't matter that much? If the two are basically going to say the same thing...

 

[clausewitz2]

So the MPSE thing doesn't matter that much? If the two are basically going to say the same thing...

The consensus that seems to have emerged among people in the know on this forum is that MSPE/LOR are basically box-checking at this point. They will hurt you if they are terrible, and if they are earthshakingly amazing it might be a fillip, but 95% of people it has no effect.

Problem is, the editorial voice of most med student letters/evals in the States can best be characterized as Garrison Keillor.

 

[OldPsychDoc]

The consensus that seems to have emerged among people in the know on this forum is that MSPE/LOR are basically box-checking at this point. They will hurt you if they are terrible, and if they are earthshakingly amazing it might be a fillip, but 95% of people it has no effect.

Problem is, the editorial voice of most med student letters/evals in the States can best be characterized as Garrison Keillor.

Not sure that our Aussie friend would get that reference, but...

From my perspective, when I'm scanning through LORs I'm looking for something in the opening or closing pragraph that indicates that the writer actually spent a decent amount of time with the applicant and has some sense on a personal level that they are going to be solid, pleasant, hard-working interns. US ones are definitely a plus, and pretty much a requirement if you're coming from a non-US school, but a country-of-origin one is also helpful if it indicates a solid pre-existing aptitude and ability in psychiatry. In short, if your Aussie profs know you well and have good things to say about you, I would include at least one LOR from them as well.

 

[Amygdarya]

the writer actually spent a decent amount of time with the applicant and has some sense on a personal level that they are going to be solid, pleasant, hard-working interns.

What is "a decent amount of time"? I understand the necessity of a "decent" amount of personal interaction for a strong letter, but my problem is, how do you get that (the decent amount)? I applied to medical school after graduate school and a few years of research, so people who wrote my medical school LORs - my thesis advisor, graduate school professors, research PI - had known me for *years*, so I had no doubt they would give me very personal and specific, strong LORs. Now I'm going through my clinical rotations and I've noticed that, unless you spend a significant amount of time doing research with an attending (and even then, letters have to address your abilities as a future clinician, not as a researcher), the most you get to spend with any given attending is 2 weeks. How does one get to know you in 2 weeks to write you a strong letter? (almost rhetorical)

 

[lymphocyte]

What is "a decent amount of time"? I understand the necessity of a "decent" amount of personal interaction for a strong letter, but my problem is, how do you get that (the decent amount)? I applied to medical school after graduate school and a few years of research, so people who wrote my medical school LORs - my thesis advisor, graduate school professors, research PI - had known me for *years*, so I had no doubt they would give me very personal and specific, strong LORs. Now I'm going through my clinical rotations and I've noticed that, unless you spend a significant amount of time doing research with an attending (and even then, letters have to address your abilities as a future clinician, not as a researcher), the most you get to spend with any given attending is 2 weeks. How does one get to know you in 2 weeks to write you a strong letter? (almost rhetorical)

From what I've read, everybody says they have "strong" LORs, but they don't. They have LORs that sound like everyone else's. And there's nothing wrong with that. In a way, a LOR is like a high sensitivity, low specificity screening tool. If you can't get one that's effusive and hyperbolic, something must be wrong....

I think what @OldPsychDoc is saying is that if a PD reads something that indicates the writer PERSONALLY knows you, then the specificity of the LOR goes up, and it becomes much more valuable than just a screening tool.

How do you get a personal letter from a clinical attending? In my experience, make it personal--form a RELATIONSHIP. That is, treat them like a PERSON. DON'T ask for a LOR at the end of the rotation. Take your amazing evals with grace and say, "I really want to keep in touch." And then keep in touch. Send them an email every six weeks or so. Maybe send a funny consult or something relevant to their research. Ask their opinion about something non-trivial. Invite them for a beer when you're visiting town. Why not? Of course, you have to be tactful, and make sure they like you, but attendings are generally pretty interesting people, and I've noticed that many are happy to be mentors to not-annoying students. (@OldPsychDoc, please feel free to slap me down on this last point.)

I'm not advocating being manipulative or false. I'm sure a psychiatrist's BS meter is very, very, very sensitive. But if you treat people like people, it's good for everyone. Find a receptive attending and cherish them like you would any friend. And if your attending isn't receptive, but you did a great job anyway, then what's the worst that could happen? He'll write you a "strong" LOR, like everyone else.