Why AMGs have better LORs & MSPEs than IMGs

This article is written as a supplement to my blog "Things to think and consider about before taking the USMLE". Please read that article first before reading this one so that this post will make more sense.

*Disclaimer: This blog is written based on my own personal experience and observations. Not all IMGs have the same experiences and all people will have different experiences from what I will discuss below. Please weigh the risks and the benefits when applying the events of this blog to your own situation.

We now all know that one of the reasons why US residency programs prefer AMGs is because most of them don't need a visa to stay and work legally in the US. Another is because they know the American health care system better than most IMGs (even when IMGs did have credible USCE like electives, externships or mini-residencies). What I would like to point out in this post is that the documents that AMGs submit to ERAS when applying for residency is more "credible" than the AMGs.

What do I mean by "more credible documents"?

I will give a situation that is currently the standard procedure in my own country.

1] Medical School Performance Evaluation or MSPE

As the name implies, this is the document that the medical school must provide their students/graduates who are to apply for a residency through the Match or via walk-in applications to hospitals. It is a document where the med school's dean should/must write and create, either by him-/her-self or with the help of the one requesting the document. Details must include the class performance and clinical performance of the student/graduate throughout his/her studies in that particular medical school.

This is what happened when you go to the dean's office to ask for an MSPE: After confirming with the dean's secretary that the med school does supply MSPEs, the secretary will tell you (in a very bored tone):

"Doctor, you must make your own MSPE. Print a draft, give us a hard copy and a soft copy of the MSPE and the dean will correct it for you. If there are mistakes in the MSPE, you will have to revise it on your own, then give the revised and corrected soft copy to us and we'll print it on the official letterhead of the dean and the med school; the dean will sign it thereafter."

You did what you were told to do - you submitted the materials then wait for two weeks; however, you're enthusiasm will turn into disappointment/disgust because you'll learn that the dean will only check the grammatical errors in the MSPE. The dean won't even verify anything that you wrote, won't provide a single chart comparing any of the performances of medical students in the different subjects. Worse, the dean had no idea what an "official" MSPE looks like.

Med school in my country usually treat an MSPE like they way they treat an article for the high school newspaper. Hey, if the dean's job was only to correct grammatical errors, I would have done a better job on my own. A dean's purpose is to keep track of the performances of the students, not to be an editor. Most of the local med school were not serious about the welfare of the medical students/graduates, and most (if not all) the deans dismissed the MSPE as a document "for formality's sake when entering into a residency program". Yeah right.

This is the exact opposite of what American medical school would do. I've seen sample MSPEs from UCLA, UW Med, Penn State Med and other US colleges, and they really follow the guidelines on what is stated in the guide on how to make the MSPE. I do not know if my experience with obtaining an MSPE is similar with the other IMGs, but let's remember that words travel fast, and the walls have ears - US program directors know the documentation processes of foreign med schools. THEY KNOW. And because of that, I believe this is probably one of the reasons why US residency programs take foreign-made MSPEs as "less credible".

2] Letters of Recommendation or LORs

These is the easiest document to decode. ALL US PROGRAM DIRECTORS KNOW ABOUT THIS. When foreign graduates ask for LORs from the doctors in their own country, these doctors would say to them, "You write the letter, and I'll just sign it."

And now the complication starts here, because applicants to the Match should choose between the option of waiving or not waving their rights to see the LORs. Many forums outside USMLE Rockers had mentioned that it is better to waive one's right in seeing the letter because it gives more credibility to the LORs. But what is the point of waiving the LORs when you wrote the letter, right?

One reason that precludes a foreign doctor/faculty to write an LOR for a candidate is probably the amount of medical students enrolled in the med school at a given period. As a rough estimate, the most popular med schools in my country has at least 500 students PER year level. Can you remember all the names and performances of students from freshmen to seniors (which amounts to at least 2000 students)?

This is so unlike American med schools where most would apply meticulous and strict screening. In contrast to a typical medical college in my country, US med schools have approximately 400 students for ALL the year levels. The number of their graduates may be minuscule compared to the number of foreign graduates, but America's med schools were never really concerned about the quantity - it's the quality. The faculty can remember the students better, thus, give better evaluation.

So, what do you think about this? Do you have the same experience in your own country, or is it different? Leave a comment below, blog about it or discuss it with fellow IMGs! Share your thoughts!

Hope I've helped somewhat. Peace out, Girl Scout!

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Tags: LOR, MSPE, recommendation

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Comment by Rah, M.D. on September 16, 2009 at 6:38am
Thank you very much, Cyber MD. What you said about the the foreign LORs is true. However, if IMGs rely on the MSPE, then all the slots will have been filled already by the other applicants with "more credible documents"!


PS. Foreign doctors must NOT worry about writing an LOR or about their English writing skills, in my opinion. Like, English is not their first language, right? Foreigners are not expected to speak or write like Americans! As long as the LOR is neat, legible and understandable, that is more than enough! Besides, the IMG will discuss "what to write" in the LOR with the attending physicians anyways - and that is already a structure for the letter!

PSS. Thank you for commenting that my English is good. :-) And about the PS... Gosh, I had re-write mine more than 5 times! It's like you have so many things to put in writing but you have to do it in 500 words or less lest the PDs won't read it!
Comment by Cyber MD on September 14, 2009 at 5:47pm
Another reason why Attendings in Asian countries ask the med students to write their own LOR is because they either dont know how to write an LOR or they are worried about their English writing skills.
Comment by Cyber MD on September 14, 2009 at 5:40pm
Your English is pretty good..I guess you could have earned some money by editing others Personal Statements!! hehe..
Comment by Cyber MD on September 14, 2009 at 5:39pm
This is a very sensitive topic for an IMG! You have dealt with it in a very acceptable way. I agree with what you say. It is common in Asian countries especially India, Pakistan. I never knew that this is common in Phillipines as well. This is the sad part of the IMG story...but true!
May be because of this, the PDs dont wait until the IMG MSPE to send out the interview invitations. All MSPEs will not be out until Nov 1. But IMGs start getting interview calls by the end of Sep 1st week itself..
Also that is why probably PDs dont value a foreign LOR.

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