Applied late to fourth-year IM sub-internships

[boyington!]

New MS-4 here. I am hoping for a mid-tier academic IM residency and was told by my residency advisor to try super hard to get a LoR from a medicine department chair at an academic residency. I already have secured 3 letters from IM preceptors at my home site, each from a different sphere of IM (hospitalist, outpatient, specialty).

Unfortunately, I applied for 4th year rotations late due to taking step 1 really late in the year, and it was hard to find general medicine sub-I's that fit the pre-ERAS timeframe. So far I have a sub-I in pulm/CC at a large academic hospital scheduled in a few weeks, and a few dozen more rotation applications still pending. Couple questions..

1. How important is this chairman letter as a DO applying to academic IM? I get that most of my MD counterparts will probably have one from their attached medical centers, but I'm wondering how much programs actually care about that. Is a letter from my future pulm/CC preceptor good enough?

2. Assuming all of my other apps fall through, will only doing pulm/ICU sub-I's before interview season look bad?

3. How would I even logistically go about asking a chairman for a LoR as a lowly visiting med student?

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[boyington!]

let's hope bumping threads isn't frowned upon here...

 

[calivianya]

Is your school not doing IM department chair letters? I am not doing, and have never done, an IM rotation at my school or within 1000 miles of my school and I have never met the IM department chair, but I am getting a chair letter.

It’s a standardized thing kind of like the MSPE where you write part of it yourself - at least, it is at my school. You should ask.

 

[FutureDoctor5000]

Is your school not doing IM department chair letters? I am not doing, and have never done, an IM rotation at my school or within 1000 miles of my school and I have never met the IM department chair, but I am getting a chair letter.

It’s a standardized thing kind of like the MSPE where you write part of it yourself - at least, it is at my school. You should ask.

How did you never do an IM rotation at your school? Like not even in your 3rd year?? But yea a chairman letter needs to be from your school not a visiting school, so your school should have someone designated as the chair of medicine who you should ask for this letter.

 

[boyington!]

Is your school not doing IM department chair letters? I am not doing, and have never done, an IM rotation at my school or within 1000 miles of my school and I have never met the IM department chair, but I am getting a chair letter.

It’s a standardized thing kind of like the MSPE where you write part of it yourself - at least, it is at my school. You should ask.

That's kinda why I'm confused. We have an IM clerkship director that writes us a "department letter" that from my understanding is basically an IM-specific MSPE. However, my advisor specifically told me that if I'm interested in academic IM, I should rotate at an academic center with an IM residency and get a letter from the medicine chairman before ERAS opens.

 

[calivianya]

That's kinda why I'm confused. We have an IM clerkship director that writes us a "department letter" that from my understanding is basically an IM-specific MSPE. However, my advisor specifically told me that if I'm interested in academic IM, I should rotate at an academic center with an IM residency and get a letter from the medicine chairman before ERAS opens.

From what I understand, the department letter plus whatever letters you’ve gotten should be good enough. I wasn’t planning on getting anything besides preceptor letters and the department letter.

This may be app-dependent, though. If you have borderline or weak scores and an otherwise weak app, getting a letter from a chairman would help you. But I can’t imagine if you have great scores and an otherwise well-put-together app someone’s going to pass you over just because you don’t have a chair letter from an academic center.

How did you never do an IM rotation at your school? Like not even in your 3rd year?? But yea a chairman letter needs to be from your school not a visiting school, so your school should have someone designated as the chair of medicine who you should ask for this letter.

I wasn’t clear at all - my bad. I did two IM rotations in third year, one with a residency program and one with a preceptorship. They were just 1000 miles from my actual school and I’ve never met anyone who’s officially in the IM department at my school is what I meant. It’s hard to think that anyone actually at my school knows me at all. Still getting a letter from them, though.

 

[FutureDoctor5000]

The wording of it is kinda weird though, it states that it has to be a chair letter from YOUR school, so getting one from an academic center that is not YOUR school wouldn’t meet that requirement,(also it would be really weird to ask that from a chair of another school, I would think lol and be difficult because the chair of medicine isn’t always around) now getting a PD /another attending letter from a academic center who you worked with on your rotation would help for academic IM if your app is otherwise borderline or weak..

 

[boyington!]

The wording of it is kinda weird though, it states that it has to be a chair letter from YOUR school, so getting one from an academic center that is not YOUR school wouldn’t meet that requirement,(also it would be really weird to ask that from a chair of another school, I would think lol and be difficult because the chair of medicine isn’t always around) now getting a PD /another attending letter from a academic center who you worked with on your rotation would help for academic IM if your app is otherwise borderline or weak..

Okay that honestly clears things up and makes me feel a lot better. I think maybe I had a bit of a miscommunication with my advisor and now feel pretty dumb lol. Thank you!

 

[thegoodfella321]

so are Sub-I's necessary with this new SLOE? i wasnt aware there is a section on sub-i's on the SLOE form.

 

[FutureDoctor5000]

so are Sub-I's necessary with this new SLOE? i wasnt aware there is a section on sub-i's on the SLOE form.

No department letters need to come from your school.

 

[thegoodfella321]

No department letters need to come from your school.

there is a blank section on the form that the department chair talks about SubI, from what I see on the website.

 

[FutureDoctor5000]

there is a blank section on the form that the department chair talks about SubI, from what I see on the website.

What form?

 

[boyington!]

What form?

There's a new supplemental application specific for IM, my school sent it to us like a month ago. The IM SEL

 

[thegoodfella321]

The new Internal Medicine Structured Evaluative Letter for Residency Program (IM SEL) form for department letter, introduced in last cycle.

 

[thegoodfella321]

There's a new supplemental application specific for IM, my school sent it to us like a month ago. The IM SEL

lol just found out last week. Before that, I always assumed they were optional and was recommended to be wary of completing one from peers, if you're good on paper.

 

[FutureDoctor5000]

lol just found out last week. Before that, I always assumed they were optional and was recommended to be wary of completing one from peers, if you're good on paper.

Is this form required?? I believe it’s simmilar the DOM/chair letter??

 

[BellaWriterChic]

There's a new supplemental application specific for IM, my school sent it to us like a month ago. The IM SEL

Can you elaborate on this form? I am just learning about this new form this week and I'm having trouble learning about it.

 

[boyington!]

Can you elaborate on this form? I am just learning about this new form this week and I'm having trouble learning about it.

I took a look at it a few days ago. It's basically just a form that kinda sums up your IM clinical rotations in a way. There's a section for whether your shelf score, for your eval score (honors, pass, etc.) And kind of a breakdown of your clinical experiences on those rotations i.e. did you do outpatient, did you do ICU work, did you do procedures, did you write notes, etc.

There's a special section for a sub-I with the same kind of assessment, more or less. The whole thing is basically designed to give a more holistic view of your IM ability besides board scores. Again, everything I've read says that programs aren't taking it particularly seriously this year and will be lenient with how much of it is filled out. Fairly certain that it is required though, otherwise it wouldn't be standardized which seems to be the whole point...right?

 

[FutureDoctor5000]

I took a look at it a few days ago. It's basically just a form that kinda sums up your IM clinical rotations in a way. There's a section for whether your shelf score, for your eval score (honors, pass, etc.) And kind of a breakdown of your clinical experiences on those rotations i.e. did you do outpatient, did you do ICU work, did you do procedures, did you write notes, etc.

There's a special section for a sub-I with the same kind of assessment, more or less. The whole thing is basically designed to give a more holistic view of your IM ability besides board scores. Again, everything I've read says that programs aren't taking it particularly seriously this year and will be lenient with how much of it is filled out. Fairly certain that it is required though, otherwise it wouldn't be standardized which seems to be the whole point...right?

I don’t believe it’s required, some programs do require a chair/ DOM letter though, but no where does it say that it has to be this specific SLOE form…

 

[NotAProgDirector]

Some programs request a Chair / Department letter. It is rarely actually written by the chair -- rather it is usually written by the clerkship director or a committee. It's supposed to summarize your performance in IM -- clerkship, SubI, Outpatient (if separate from the clerkship), and any electives. It's much like a mini - MSPE focused on IM only. Some MD programs have done this really well -- explaining your performance, how your grade(s) were determined, lots of comment from evaluators, etc. Other programs are much more opaque, and the whole letter can be useless. This standardized format was an attempt to get all IM programs to have a single format -- mainly to encourage those programs with vague letters to be more structured. There's no requirement -- this is up to each school to decide how they are going to write their letters. Either they will use this format, or not. I expect those that have written good letters in the past will switch to the template, and those that have not will continue to do as they see fit.

For DO or IMG candidates, I'd recommend completely ignoring this. Department or Chair letters from DO or IMG schools are usually completely useless. I guess if you could convince your DO school to use this template, then that might add value. IMG chair letters are completely useless in most cases. My favorite is the SGU chair letter. It's completely identical for every student -- I'm the chair of SGU medicine, this is a student at SGU, I'm sure they will be great. Something like that. It's word-for-word identical for every single student. A complete waste.

 

[FutureDoctor5000]

Some programs request a Chair / Department letter. It is rarely actually written by the chair -- rather it is usually written by the clerkship director or a committee. It's supposed to summarize your performance in IM -- clerkship, SubI, Outpatient (if separate from the clerkship), and any electives. It's much like a mini - MSPE focused on IM only. Some MD programs have done this really well -- explaining your performance, how your grade(s) were determined, lots of comment from evaluators, etc. Other programs are much more opaque, and the whole letter can be useless. This standardized format was an attempt to get all IM programs to have a single format -- mainly to encourage those programs with vague letters to be more structured. There's no requirement -- this is up to each school to decide how they are going to write their letters. Either they will use this format, or not. I expect those that have written good letters in the past will switch to the template, and those that have not will continue to do as they see fit.

For DO or IMG candidates, I'd recommend completely ignoring this. Department or Chair letters from DO or IMG schools are usually completely useless. I guess if you could convince your DO school to use this template, then that might add value. IMG chair letters are completely useless in most cases. My favorite is the SGU chair letter. It's completely identical for every student -- I'm the chair of SGU medicine, this is a student at SGU, I'm sure they will be great. Something like that. It's word-for-word identical for every single student. A complete waste.

I believe DO schools have finally realized to use a template for the chair/DOM letter and I think there is value in getting it anyway cause you don’t want to risk getting screened out for not having that letter…

 

[BorntobeDO?]

let's hope bumping threads isn't frowned upon here...

Don't think it will matter unless that letter is awesome from a outside chair. If you did community rotations during third year, it likely will not be. The sub-i will be more important for networking for you, I would ask for opprotunities to help with case reports as that is something that will benefit you for years to come. As far as the new SLOE for IM, you usually get a chair letter from your school. The language also gets confusing on fourth year rotations. Multiple Univerisities I rotated at would call me a sub-i, but then state that officially I was just doing an away and then tell me could only do an official sub-i at my home program.

 

[FutureDoctor5000]

Don't think it will matter unless that letter is awesome from a outside chair. If you did community rotations during third year, it likely will not be. The sub-i will be more important for networking for you, I would ask for opprotunities to help with case reports as that is something that will benefit you for years to come. As far as the new SLOE for IM, you usually get a chair letter from your school. The language also gets confusing on fourth year rotations. Multiple Univerisities I rotated at would call me a sub-i, but then state that officially I was just doing an away and then tell me could only do an official sub-i at my home program.

Wouldn’t it still show up in your medical school transcript and deans letter as a SUBI? Isn’t that what matters lol?

 

[BorntobeDO?]

Wouldn’t it still show up in your medical school transcript and deans letter as a SUBI? Isn’t that what matters lol?

That’s also a thing, it’s what your school calls it as well. Heck a community rotation with an attending can be a ‘subi’ if your school says so. OTH they could be like my school and call every away an ‘elective rotation’ even when they were supposed to be subi’s

 

[FutureDoctor5000]

That’s also a thing, it’s what your school calls it as well. Heck a community rotation with an attending can be a ‘subi’ if your school says so. OTH they could be like my school and call every away an ‘elective rotation’ even when they were supposed to be subi’s

Lol what?? They call community rotations as audition/SubI? I have never heard of that

 

[BorntobeDO?]

Lol what?? They call community rotations as audition/SubI? I have never heard of that

If you have to have a mandatory subi for a specialty and you school doesn’t have a residency(I.e. majority of DO schools now) they have to call something a subi.

 

[FutureDoctor5000]

If you have to have a mandatory subi for a specialty and you school doesn’t have a residency(I.e. majority of DO schools now) they have to call something a subi.

I mean yeah many DO schools don’t have a residency per say but mine has several in its core sites, these are essentially our “home programs “ I don’t think there’s a DO school that doesn’t have a residency atleast in a few specialties at their core sites.