Mastering Letters of Recommendation for Caribbean IMG OB/GYN Residency

Why Letters of Recommendation Matter So Much for Caribbean IMGs in OB/GYN

For a Caribbean medical school residency applicant, letters of recommendation (LORs) are not just a formality—they are one of your most powerful tools to overcome bias and stand out in a competitive obstetrics & gynecology (OB GYN) residency match.

Program directors know less about Caribbean schools than U.S. MD or DO programs. That means your clinical performance, work ethic, and potential as a resident must be communicated clearly and convincingly by physicians who have worked closely with you. Strong, detailed letters can:

• Validate your clinical skills and reliability in U.S. settings
• Reassure programs about your readiness for an OB GYN residency
• Offset concerns about Caribbean medical school training
• Help explain red flags (gaps, Step failures, transfers) when needed
• Differentiate you from other Caribbean IMGs applying to the same programs

If you are from a well-known Caribbean school (e.g., SGU), an SGU residency match is still not guaranteed. Programs are selective and may receive hundreds of applications. Your letters are a key way for you to rise to the top of that stack.

This guide will walk you step-by-step through:

• Who to ask for letters (and who not to)
• How to get strong LORs (not generic ones)
• Timing, strategy, and ERAS logistics
• OB GYN–specific tips for Caribbean IMGs
• Sample approaches and practical scripts you can actually use

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Understanding What Makes a Strong OB/GYN Letter of Recommendation

What Program Directors Actually Look For

Program directors in OB GYN consistently rate letters of recommendation as one of the most important parts of your application. A strong letter for an obstetrics match should:

1. Come from the right person

   • OB GYN attendings (especially in academic or teaching hospitals)
   • Faculty who know you well and worked with you directly
   • U.S. clinical supervisors whenever possible

2. Provide specific, behavior-based examples

   • How you handled labor and delivery triage
   • Your role on L&D nights (admissions, deliveries, postpartum care)
   • How you managed gynecology consults in the ED or OR
   • Stories that show your bedside manner, professionalism, and resilience

3. Compare you to peers

   • “Among the top 10% of students I have worked with”
   • “Comparable to U.S. MD students we routinely host”
   • “Stronger than many of the U.S. seniors on the same service”

4. Address common concerns for Caribbean IMGs

   • Adaptation to U.S. healthcare system
   • Efficiency and documentation skills in a busy service
   • Communication with staff, nurses, patients, and consultants
   • Ability to handle high-acuity OB cases under pressure

Content of a Strong OB/GYN Letter

A strong OB GYN residency letter often includes:

• Context: Where and how long the writer supervised you (e.g., 4-week OB GYN sub-I at a busy community hospital)
• Clinical skills: Pelvic exams, prenatal visits, postpartum care, OR participation, operative notes
• OB-specific strengths: Fetal heart tracing interpretation, understanding labor progress, OB emergencies (PPH, preeclampsia, shoulder dystocia)
• Teamwork: Working with nurses, midwives, residents, and other staff
• Professional traits: Work ethic, responsibility, integrity, teachability, reliability on call
• Summary statement: Clear, strong endorsement (or not) with whether they would rank you highly

Weak letters, in contrast, are short, generic, and vague:

• “Pleasure to have on service.”
• “Hardworking and polite.”
• “Completed tasks satisfactorily.”

For a Caribbean medical school residency applicant, generic is dangerous. You need strong advocacy, not polite neutrality.

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Who to Ask for Letters (and Who to Avoid)

Priority List: Who to Ask for OB/GYN LORs

If you’re wondering who to ask for letters, especially as a Caribbean IMG targeting an obstetrics match, prioritize:

1. U.S.-based OB GYN faculty from your core or sub-internship

   • Attending physicians who saw you daily on L&D, gynecology, or clinic
   • Site directors for your OB GYN rotation (if they know you personally)

2. OB GYN clerkship or sub-I directors

   • Especially at hospitals with residency programs
   • They can speak to your overall performance and growth

3. OB GYN residency program directors or associate PDs

   • If you rotated at a residency site and worked closely with leadership
   • These are particularly powerful for an OB GYN residency application

4. Other U.S. attendings in closely related fields (if needed)

   • Maternal-fetal medicine, reproductive endocrinology, family medicine with strong OB exposure, or internal medicine where your performance was exceptional
   • Use these as supplementary letters, not a replacement for OB GYN letters

How Many OB/GYN Letters Do You Need?

• Aim for at least 3 strong letters, with 2 from OB GYN attendings
• If possible, get a 4th letter, especially if one writer is a department or program director
• ERAS allows you to assign up to 4 letters per program

For Caribbean IMGs, it’s better to have 3–4 strong, U.S.-based letters rather than a mix of weak or irrelevant ones.

Letters from Home Country or Non-U.S. Hospitals

These can help only if:

• The writer is well-known or has U.S. connections
• They supervised you very closely in OB GYN
• The letter is detailed, specific, and addresses your ability to adapt to the U.S. system

If you must use a non-U.S. letter:

• Use it as the 3rd or 4th letter
• Make sure your primary 2–3 letters are from U.S. experiences if possible

Who Not to Ask

Avoid letters that are:

• From physicians who barely know you (“shadowing only” or 1–2 days together)
• From basic science or preclinical faculty unless they know you exceptionally well and can speak to a compelling story (and even then, only as an extra letter)
• From non-physicians (unless for a special leadership or research letter, and only as a supplemental letter)
• Written by someone you suspect may be lukewarm or hesitant

If you are asking yourself, “I’m not sure this person liked my performance,” do not ask them for a LOR.

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How to Get Strong LORs (Not Just Polite Ones)

Step 1: Perform Like a Future OB/GYN Resident

Before you even think about letters, you need performance that supports a strong letter. On your OB GYN rotations and sub-internships:

• Show up early, stay late – especially on L&D and OR days
• Volunteer for responsibility – taking first call on pages (under supervision), writing notes, following patients through admission to postpartum
• Read daily – quickly review common guidelines (ACOG bulletins, preeclampsia management, postpartum hemorrhage, induction of labor)
• Communicate clearly and respectfully – especially with nurses and midwives; OB GYN is team-based and nurses’ opinions carry weight
• Be reliable – never late, complete every task you accept, and follow through on patient updates

Faculty will remember your behavior more than your Step score. For a Caribbean IMG, “she works like a PGY-1 already” is the kind of phrase you need in your letters.

Step 2: Signal Early That You’re Interested

During your OB GYN rotation:

• Tell your attending within the first week:
  • “I’m very interested in OB GYN and plan to apply this cycle.”
  • “I’m a Caribbean IMG, and I know letters are extremely important for my application.”

This sets the stage and makes it natural to ask for a letter later.

Step 3: Ask the Right Way: “Can You Write a STRONG Letter?”

When you’re ready to ask, do it in person if possible, or by a carefully written email if necessary.

In-person script example:

“Dr. Smith, I’ve really valued working with you on this OB service. I’m applying to OB GYN residency this year as a Caribbean IMG, and strong letters are especially important for me. Based on the time we’ve worked together, do you feel you could write a strong letter of recommendation in support of my OB GYN application?”

This gives them a chance to decline if they can’t be enthusiastic. A neutral letter can harm you more than no letter from that person.

If they hesitate or say something like, “I don’t know you well enough” or “I can only confirm you were here,” respectfully thank them and ask someone else. Do not push.

Step 4: Provide a Helpful “Letter Packet”

To help them write a strong, individualized letter:

Give them:

• Your CV
• Your personal statement (even if in draft)
• A brief paragraph about your career goals in OB GYN
• A one-page “brag sheet” or bullet list:
  • Specific cases you were involved with (e.g., managing a case of severe preeclampsia, counseling a patient on VBAC vs repeat C-section)
  • Times you took extra initiative (staying late, following complex patients)
  • Anything they praised you for during the rotation

For example, you might include:

• “I was primary student following Ms. X, a 32-year-old G2P1 with gestational diabetes, through prenatal visits, induction, labor, and postpartum.”
• “On call, I helped triage multiple laboring patients and presented them to the team.”
• “You once commented on my ability to contain my emotions and communicate calmly with a distressed patient.”

You are not writing your letter—just reminding them of concrete examples they can use.

Step 5: Clarify Logistics and Deadlines

Tell them:

• When ERAS will open and when you hope to submit (ideally by mid-September)
• That they will receive an ERAS link to upload the letter
• Whether the letter should be specialty-specific for OB GYN (it should)

If they ask whether to address it to a specific program, advise them to address to:

“Dear Obstetrics and Gynecology Residency Program Director”

This works for all programs.

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Timing, ERAS Strategy, and Common Caribbean IMG Challenges

When to Ask for Letters

• Ask near the end of the rotation, ideally after you’ve had time to show your best work
• Don’t wait months; the longer you wait, the less detail your writer will remember

General timeline for a typical U.S. cycle (adjust for your graduation year):

• During your OB GYN rotation / sub-I: Signal interest + perform well
• Last week of rotation: Ask for the letter
• June–August: Upload CV/personal statement; send polite reminders if needed
• By early September: Aim to have all OB GYN letters uploaded
• ERAS opening/match season: Apply early with a complete application

Caribbean IMGs sometimes finish clerkships later or have off-cycle schedules; if that’s you, communicate your specific deadlines very clearly to your writers.

How Many Letters Should You Upload to ERAS?

• Upload 3–4 letters total
• Try to have:
  • At least 2 OB GYN letters
  • Preferably 3 U.S.-based letters
  • 1 additional letter from a related specialty or research mentor, if strong

You can assign different combinations of letters to different programs but cannot mix and match after submission per program, so plan carefully.

Addressing Caribbean IMG Bias Through Letters

As a Caribbean medical school residency applicant, your letters can directly and indirectly combat biases:

Encourage your letter writers (through your interactions and their natural observations) to address:

• Clinical competence relative to U.S. students

  • “Her fund of knowledge and clinical reasoning were on par with our U.S. MD students.”

• Adaptation to the U.S. system

  • “Despite training at a Caribbean school, he integrated seamlessly into our U.S. teaching hospital.”

• Work ethic and resilience

  • “He routinely arrived early to pre-round on patients and often stayed after his shift to follow critical deliveries.”

You don’t tell them what to write—but by performing strongly and providing context in your CV/personal statement, you invite them to include these elements.

If You Had Academic Struggles or a Gap

If you’ve had:

• USMLE Step failure
• Extended time to graduate
• A leave of absence or academic probation

A trusted, senior OB GYN letter writer who knows you well can help:

• Emphasize your improvement and current reliability
• Highlight maturity and insight into what changed
• Reassure programs that you are stable, focused, and ready

You should not ask them to “explain away” your struggles, but they can provide important perspective.

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OB/GYN-Specific Strategies for Caribbean IMGs

Use Away Rotations and Sub-I’s Strategically

If you can secure an OB GYN sub-internship or audition rotation at a residency program:

• Treat it as a month-long interview
• Your goal: earn at least one very strong letter
• Show that you function at or near intern level:
  • Pre-round on your own patients
  • Write thorough, concise notes
  • Present confidently at sign-out or rounds
  • Take primary responsibility (under supervision) for several patients

A glowing letter from a residency site where you auditioned often reads like:

“We would be very excited to have her as one of our residents.”

That single line can dramatically improve your odds of matching, especially for a Caribbean IMG targeting a competitive OB GYN residency.

Combining OB GYN and Other Letters

For an obstetrics match, your core letters should be OB GYN. But you can strengthen your application with:

• Family Medicine letter highlighting:

  • Continuity of care, prenatal visits, women’s health clinics
  • Communication skills and patient education

• Internal Medicine letter emphasizing:

  • Management of complex medical conditions in pregnancy
  • Professionalism and teamwork in a busy inpatient setting

• Research mentor letter (OB GYN or related) describing:

  • Your analytical ability, persistence, and scholarly curiosity
  • Commitment to evidence-based practice

Just make sure these supplement what your OB GYN letters say, not replace them.

Example Letter Mix for a Caribbean IMG Applying OB/GYN

A strong LOR set might look like:

1. OB GYN attending from your sub-I at a U.S. teaching hospital (primary, very strong)
2. Residency program director or clerkship director from your OB rotation (strong, comparative)
3. Family Medicine attending with heavy women’s health or prenatal care who loved your work (strong, complementary)
4. Research mentor in OB GYN or women’s health (if you have meaningful research) – used selectively for programs that emphasize research

For community OB GYN programs, you might assign:

• Letters 1, 2, and 3

For more academic OB GYN programs:

• Letters 1, 2, and 4 (plus 3, if allowed and all strong)

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Practical Tips, Follow-Up, and Professional Etiquette

Polite Reminders Without Being Annoying

Attending physicians are busy and may forget. To follow up:

• Wait about 2–3 weeks after you requested the letter
• Send a brief, professional email:

“Dear Dr. Smith,
I hope you are doing well. I wanted to gently follow up regarding the letter of recommendation for my OB GYN residency applications. ERAS will open for submissions on [date], and I’m aiming to finalize my application by [date]. Please let me know if there is any additional information I can provide.
Thank you again for your support,
[Your Name]”

If the deadline is very close, you can add:

“Programs start reviewing applications immediately after ERAS opens, so having the letter uploaded by [specific date] would be extremely helpful.”

Waiving Your Right to View Letters

ERAS will ask if you want to waive your right to see the letter. You should almost always waive:

• Waived letters are viewed as more honest and credible
• Non-waived letters may raise doubts about their frankness

If you’re not comfortable waiving, consider that you may not fully trust that writer—perhaps you should choose someone else.

Saying Thank You and Maintaining Relationships

Always:

• Send a thank-you email after they agree to write the letter
• Send a second thank-you after you confirm it was uploaded
• Update them on your match result in March:
  • “I’m excited to share that I matched into OB GYN at [Program]. Thank you for playing such an important role in helping me reach this goal.”

Maintaining these relationships is valuable:

• For future fellowship letters
• For networking and mentorship
• For potential opportunities if you need to reapply

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FAQs: Letters of Recommendation for Caribbean IMGs in OB/GYN

1. How many OB GYN–specific letters do I really need for an obstetrics match?

Aim for at least two OB GYN–specific letters, ideally from U.S.-based attendings who directly supervised you. A third letter can be OB GYN, a closely related specialty, or a research mentor. ERAS allows up to four letters per program; for Caribbean IMGs, having 2–3 OB GYN letters is especially valuable for a strong obstetrics match application.

2. I’m a Caribbean medical school residency applicant with limited U.S. OB GYN exposure. What should I do?

Prioritize:

• Getting at least one OB GYN rotation or sub-I in the U.S.
• Performing at your highest level and clearly stating your OB GYN interest
• Securing one very strong OB GYN LOR from that rotation

Then supplement with:

• A strong letter from another U.S. specialty where you excelled (e.g., Family Medicine or Internal Medicine)
• A strong research or home-country OB GYN letter as your 3rd or 4th, if it is detailed and enthusiastic

3. How can I make sure my letters are “strong” and not just generic?

You can’t control their exact wording, but you can heavily influence letter quality by:

• Performing at the level of a future PGY-1 during rotations
• Asking directly: “Can you write a strong letter of recommendation for my OB GYN residency application?”
• Providing a CV, personal statement, and a one-page list of key cases and strengths
• Choosing attendings who worked with you closely and praised your performance

If someone seems hesitant, thank them and find another writer.

4. Do SGU or other Caribbean school “name brands” matter less than strong letters?

Caribbean school reputation (including SGU) influences how programs initially screen, but strong, detailed, U.S.-based LORs often matter more for final ranking decisions. A powerful OB GYN letter stating, “I would be thrilled to have this applicant as an intern in our program,” can do more to secure an SGU residency match (or a match from any Caribbean school) than school name alone. Your letters are your chance to show programs who you are beyond your school name and test scores.

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Letters of recommendation are one of the few parts of your application that can truly change how programs see you—especially as a Caribbean IMG. If you choose the right writers, ask effectively, and back it up with excellent clinical performance, your LORs can turn your OB GYN residency dreams into a realistic, achievable outcome.