IMG Residency Guide: Securing Strong Letters of Recommendation for OB GYN

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

For an international medical graduate, letters of recommendation (LORs) can be one of the most powerful—and most misunderstood—parts of the OB GYN residency application. Programs know that you trained in a different system, with different grading scales and clinical expectations. Strong, specific letters from trusted US-based obstetricians and gynecologists are often the clearest “translation” of your abilities into language program directors trust.

This IMG residency guide focuses entirely on helping you secure, structure, and use letters strategically so they strengthen your obstetrics match chances. Whether you are still overseas, in a research role, or already rotating in the US, you can apply these steps to build a compelling LOR portfolio.

Key goals of your OB GYN letters of recommendation:

• Prove you are clinically ready to function as an intern in a US OB GYN program
• Demonstrate you are safe in labor and delivery, the OR, and clinic settings
• Show that you are adaptable, hardworking, and able to work on diverse teams
• Provide evidence of your commitment to women’s health and the specialty long-term
• Compensate, in part, for limited US clinical experience or gaps in training

To accomplish all of this, you need to think strategically about who to ask for letters, how to get strong LOR, and how to use your experiences to generate detailed, credible narratives.

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Understanding What Makes a Strong OB GYN Letter of Recommendation

Before you start asking for letters, you need to understand what program directors actually look for in residency letters of recommendation for OB GYN.

1. Clinical, Specialty-Specific, and US-Based (Whenever Possible)

For an international medical graduate, OB GYN residency programs strongly prefer at least:

• 2–3 letters from US-based physicians, ideally in OB GYN
• At least one letter from a department chair or program leadership (if feasible)
• Additional letters from related fields (family medicine, internal medicine) only as supplements, not replacements

A strong “core” package for the obstetrics match for an IMG might be:

• 2–3 US OB GYN letters (attendings from inpatient L&D, gyne surgery, and/or clinic)
• 1 letter from a research mentor or a related specialty who knows you very well (if strong and detailed)

2. Detailed, Behavioral, and Evidence-Based

Generic praise (“hardworking, pleasant, did a good job”) is not enough. Strong letters include:

• Specific stories or cases: e.g., you calmly managed a shoulder dystocia under supervision; you organized a postpartum hemorrhage workup; you counseled a patient in a delicate situation
• Direct observations: “I observed her perform pelvic exams, assist in vaginal deliveries, and participate in C-sections”
• Comparisons: “Among the many IMGs and US students I have supervised, he is in the top 10% in work ethic and reliability”
• Skill domains: professionalism, communication, teamwork, clinical judgment, procedural skill, and teachability

3. Endorsement Strength and Clarity

Program directors look for the writer’s level of enthusiasm:

• Clear endorsement language like:
  • “I recommend her without reservation for OB GYN residency.”
  • “I give him my strongest recommendation.”
• Explicit statements of readiness:
  • “She is ready to begin residency training in a busy US OB GYN program.”

Soft, neutral language (“I believe she would do fine in residency”) is viewed as lukewarm.

4. Alignment with Your Story and OB GYN Fit

Your letters should support the narrative in your personal statement and CV:

• Interest in women’s health and reproductive justice
• Passion for surgery + continuity of care
• Commitment to underserved populations or global women’s health
• Long-term career goals (academic OB GYN, MFM, MIGS, community practice, etc.)

If your entire application says “I love OB GYN,” but your strongest letters are from internal medicine, that can create doubt. Letters should echo your specialty commitment.

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Who to Ask for Letters: Building the Right LOR Team as an IMG

Understanding who to ask for letters is critical. As an IMG, your choices may be more limited, but also more strategic. You want letter writers who combine:

1. Credibility (known roles, US-based, OB GYN expertise)
2. Proximity (they actually worked closely with you)
3. Advocacy (they are willing to strongly support you)

Ideal Letter Writers for an IMG OB GYN Applicant

1. US OB GYN Attending Physicians (Top Priority)

   • From:
     • Observerships or externships in OB GYN
     • Electives in L&D, gynecologic surgery, or ambulatory women’s health
   • Why they matter:
     • Provide direct evidence that you function in a US system
     • Can describe your performance on call, in the OR, and in clinic
   • Example:
     • “Attending supervising your 4-week L&D rotation where you worked closely on postpartum rounds and triage.”

2. OB GYN Department Chair or Program Director (If Possible)

   • Often writes a more “summary” letter, referencing feedback from multiple faculty
   • Particularly valued if you rotated at that institution
   • Not mandatory, but very helpful if you’ve had substantial exposure

3. Research Mentors in OB GYN or Women’s Health

   • Especially helpful if:
     • You have substantial research output (posters, papers, abstracts)
     • Your clinical letters are fewer or limited
   • Focus should be on:
     • Work ethic, reliability, academic curiosity, teamwork, communication

4. Letters from Other US Clinical Specialties (Secondary, Not Primary)

   • Family medicine, internal medicine, emergency medicine
   • Can be helpful to highlight:
     • General clinical skills, patient communication, reliability
   • Should supplement, not replace, your OB GYN letters

When Non-US Letters Still Matter

Programs strongly prefer US-based letters, but high-quality non-US letters can still help, especially if:

• Written by an OB GYN with a known international academic reputation
• Very detailed and enthusiastic
• Clearly explain your responsibilities (e.g., resident-level duties, independent overnight call)
• Offer context: “In our system, final-year students function at a level comparable to US interns…”

If you have only one or two US letters, you should still include your best non-US OB GYN letter to fill out your ERAS limit (usually up to 4 letters per program).

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How to Get Strong LOR as an IMG: Step-by-Step Strategy

Many IMGs know they “need letters,” but not how to get strong LOR that truly stand out. The strength of a letter begins months before you actually ask for it.

Step 1: Plan Your US Experiences with LOR in Mind

Think of each observership, externship, or research role as a potential LOR opportunity.

• Prioritize rotations where you’ll be visible:
  • Smaller teams where attendings directly supervise you
  • Opportunities to present cases, give brief talks, or join QI projects
• Duration matters:
  • 4–8 weeks with one team is usually more effective than a 1-week “fly-through” at multiple places
• Reputation of the site:
  • A letter from a known academic OB GYN department may carry extra weight—but only if it is detailed and strong.

Step 2: Behave Every Day as If Your Letter Is Being Written

Letter writers rely on concrete examples from your behavior. Give them material.

Demonstrate:

• Clinical engagement:

  • Volunteer to present patients on rounds
  • Ask for feedback on your notes, presentations, and physical exams
  • Learn the workflow of L&D (triage, antepartum, postpartum, OR)

• Reliability & professionalism:

  • Arrive early and stay until work is done
  • Offer help to residents and staff without overstepping
  • Respect patient confidentiality and boundaries

• Curiosity & growth mindset:

  • Read about your patients’ conditions the same day
  • Ask targeted questions, not constant basic ones
  • Respond positively to feedback and show visible improvement

• Teamwork and communication:

  • Build good relationships with nurses, midwives, sonographers, residents
  • Demonstrate cultural sensitivity and clear communication with patients, especially in emotionally charged settings (miscarriage, fetal anomaly, high-risk pregnancy).

Step 3: Signal Early That You Hope for a Letter

You don’t need to ask for a letter on day one, but you should signal your intent during the rotation.

Around the second week of a 4-week rotation, you might say:

“I’m applying to OB GYN residency as an international medical graduate this coming cycle. I’m working hard to learn as much as I can here and would really appreciate any feedback on how I’m doing, particularly on things that would help me be a strong candidate for US training.”

This does two things:

1. It tells the attending you are serious about OB GYN and the match.
2. It prompts them to observe you more closely, which improves the quality of a future letter.

Step 4: Ask the Right Way, at the Right Time

When to Ask

• Ideally in the last week of your rotation or soon after completing a major project together
• Avoid asking long after you’ve left unless you maintained active contact and updated them on your progress

How to Ask

Prefer in-person if possible, then follow up with email.

Example script (in person or via email):

“Dr. Smith, I’ve really valued working with you during this rotation and have learned a great deal about OB GYN in the US. I’m applying to OB GYN residency this fall as an international medical graduate and would be honored if you felt able to write a strong, supportive letter of recommendation on my behalf, based on your direct observations of my work.”

That phrase—“strong, supportive letter”—gives the attending space to decline if they cannot honestly support you at that level. If they hesitate or seem unsure, accept that gracefully and ask someone else.

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Helping Your Writers Help You: The LOR Packet

Even a supportive attending will write a better letter if you make it easy for them. Prepare a LOR packet for each writer, tailored to OB GYN.

What to Include

1. CV or ERAS-style resume

   • Highlight: OB GYN experiences, women’s health projects, leadership, volunteer work, publications.

2. Personal Statement Draft (OB GYN-focused)

   • This helps your writer align their letter with your narrative: why OB GYN, why the US, long-term goals.

3. Brief Rotation/Project Summary

   • 1 page or less, including:
     • Dates of your work together
     • Settings: L&D, gyne clinic, OR, outpatient, research lab
     • Your roles and responsibilities
     • Specific patients, projects, or cases (no identifiers) you think show your strengths
   • For example:
     • “I presented 2–3 patients daily on postpartum rounds.”
     • “Assisted in 10 C-sections and observed 15 vaginal deliveries.”
     • “Gave a 10-minute talk on management of preeclampsia.”

4. Strengths You Hope They Might Highlight (Optional but Helpful)

   • A short bullet list, not a script. Example:
     • “Ability to quickly adapt to the US healthcare system as an IMG”
     • “Strong communication with patients despite language/cultural differences”
     • “Work ethic and reliability on busy night shifts”

5. Instructions and Deadlines

   • ERAS letter ID and submission instructions
   • Your target submission date (ideally before Sept 15 or your application submission date)
   • Clarify that letters must be confidential (you will not see them).

Follow-Up Without Being Pushy

• Send a polite email reminder 2–3 weeks before your deadline if the letter is not yet uploaded.
• Express appreciation and share short updates (e.g., exam scores, new research) if appropriate.
• Always thank them again after submission and update them about your match outcome.

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Practical Tips, Examples, and Common Pitfalls for IMG OB GYN Applicants

Balancing Your Letter Portfolio

For an international medical graduate, an ideal mix for OB GYN might be:

• LOR 1: US OB GYN attending (L&D rotation)
• LOR 2: US OB GYN attending (gyne surgery or outpatient clinic)
• LOR 3: OB GYN department chair or program director (summary letter) or
  a research mentor in OB GYN who knows you extremely well
• LOR 4: Best non-US OB GYN letter or a strong US letter from another specialty emphasizing clinical excellence

Use ERAS to assign 3–4 letters per program, prioritizing OB GYN letters for all OB GYN applications.

Sample Strong Letter Content (What You Want Them to Say)

You cannot write your own letter, but you can create opportunities and give your writer the material that leads to content like this:

“During her 4-week rotation on our Labor and Delivery service, Dr. Rao consistently arrived early, pre-rounded independently on assigned patients, and presented them clearly during rounds. I observed her perform pelvic exams under supervision, assist in both cesarean sections and vaginal deliveries, and counsel patients about postpartum contraception options with cultural sensitivity.

As an international medical graduate entering a new healthcare system, she adapted quickly, learned our EMR without difficulty, and gained the trust of nurses and residents on the team. Her work ethic and professionalism were exemplary; when our unit was short-staffed during a busy night shift, she volunteered to stay late to help complete discharges and patient education.

Among the many visiting students and IMGs I have worked with over the past decade, she is in the top 10% in reliability, maturity, and dedication to women’s health. I recommend her without reservation for a position in OB GYN residency.”

Your goal is to produce real-life behavior that makes paragraphs like this true.

Common Mistakes IMGs Make With LORs

1. Relying entirely on non-US letters

   • Programs may worry you are untested in the US system.

2. Using generic or weak letters

   • Asking a “famous” professor who barely knows you can lead to a bland letter that hurts more than it helps.

3. Too many non-OB GYN letters for an OB GYN application

   • Sends a mixed signal about your commitment to the specialty.

4. Last-minute requests

   • Rushed letters are often short and vague.

5. Inconsistent messaging

   • Letters emphasizing internal medicine, while your personal statement insists on OB GYN, may confuse programs.

Special Situations for IMGs

If You Have Limited US Clinical Experience

• Maximize quality over quantity: 1–2 excellent US OB GYN letters can be powerful.
• Supplement with:
  • Strong, detailed non-US OB GYN letters
  • A research mentor letter in OB GYN
• Use your personal statement to explain:
  • Visa, financial, or logistical barriers to early US experience
  • How you are actively gaining US exposure now

If You Are Switching from Another Specialty to OB GYN

• At least one letter must come from OB GYN to prove your genuine interest.
• Use previous specialty letters to highlight:
  • Operative skills (if surgery/EM)
  • Continuity of care (if family/internal medicine)
  • Work ethic and professionalism
• Be transparent with letter writers about your specialty change so their letters support your new path.

If You Have a Gap in Training or a Low Score

• Ask letter writers who:
  • Can speak to your recent performance and growth
  • Have directly supervised you in the last 1–2 years
• Request that they address:
  • Your current level of readiness and reliability
  • Evidence you have matured or improved since any past difficulties

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FAQs: Letters of Recommendation for IMG OB GYN Applicants

1. How many letters of recommendation do I need for OB GYN residency?

Most OB GYN programs accept up to 3–4 letters via ERAS. Aim for:

• At least 2–3 strong OB GYN letters, preferably from US attendings
• If possible, 1 letter from a department chair or program leadership
• The remaining letter(s) from a research mentor or another US clinician who knows you well

Check individual program websites for any specific requirements.

2. As an international medical graduate, can I match OB GYN without US OB GYN letters?

It is much more difficult but not impossible. US-based OB GYN letters are one of the strongest predictors that a program will feel comfortable ranking you. If you currently lack US letters:

• Prioritize obtaining at least 1–2 US OB GYN observerships or externships
• Meanwhile, submit your best non-US OB GYN letters
• Seek research or volunteer positions related to women’s health in the US to generate new LOR opportunities

3. Should I waive my right to see my letters of recommendation?

Yes. ERAS allows you to indicate whether you waive your right to see the letter. You should waive your right. Programs consider confidential letters more credible. If you’re concerned about a letter’s strength, address it before the writer submits (by asking if they can write a strong letter); do not request non-confidential letters.

4. Is a letter from a famous professor better than a detailed letter from a lesser-known attending?

For most IMGs in the obstetrics match, a detailed, enthusiastic letter from an attending who knows you well is far more valuable than a generic letter from a well-known but distant professor. Program directors care most about:

• Specific observations of your behavior
• Clear endorsement of your readiness for OB GYN training
• Evidence you will be safe, teachable, and hard-working

A famous name helps only if it comes with a truly strong, specific letter.

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By approaching your letters of recommendation as a central, strategic part of your OB GYN residency application—not just a formality—you significantly improve your chances as an international medical graduate. Plan your clinical and research experiences with letters in mind, choose your writers wisely, and give them the tools to advocate for you powerfully.