Essential Guide to Letters of Recommendation for DO Graduates in Global Health

Understanding the Role of Letters of Recommendation for a DO Graduate in Global Health

For a DO graduate pursuing a career in global health, letters of recommendation (LORs) can be the deciding factor between matching into a dream program and falling short. While your COMLEX/USMLE scores, CV, and personal statement matter, residency letters of recommendation often carry more weight than applicants realize—especially when your interests are somewhat niche, like a global health residency track or international medicine pathway.

Program directors are trying to answer three questions:

1. Can you do the work safely and effectively?
2. Are you someone they want on their team at 3 a.m.?
3. Do you truly have a sustained, realistic commitment to global health—not just “medical tourism” or a one-time trip?

Strong, targeted letters help them say “yes” on all three.

This guide focuses specifically on LOR strategy for a DO graduate residency applicant interested in global health. We’ll cover how many letters you need, who to ask for letters, how to get strong LOR, and how to highlight your osteopathic background as an asset rather than a limitation.

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How Many Letters You Need—and What Types Matter Most

Residency programs vary slightly, but most require:

• 3–4 total letters of recommendation
• 1–2 specialty-specific clinical letters (e.g., internal medicine, family medicine, pediatrics, EM, or whatever your primary specialty is)
• Optional: 1 “plus” letter that emphasizes your unique strengths (e.g., global health, research, leadership, or international medicine experience)

The Global Health–Focused Mix

For a DO graduate applying to a primary specialty with an interest in global health (e.g., IM with global health track, FM with international medicine emphasis, Pediatrics with global health focus), a powerful LOR set might look like:

1. Core specialty attending #1 (e.g., Internal Medicine inpatient attending)
2. Core specialty attending #2 (e.g., continuity clinic or outpatient attending)
3. Global health-focused mentor or faculty member
4. (Optional extra) Research or leadership mentor in an area directly connected to global health, equity, or systems-based work

If a program allows four letters, using that fourth spot for a focused global health letter can meaningfully differentiate you from other applicants—especially if you’re aiming for a global health residency track or programs with robust international medicine curricula.

Where DO Graduates Sometimes Go Wrong

Common issues DO graduates face with LOR strategy:

• Underestimating the importance of specialty-specific letters and overloading applications with “interesting” but non-clinical letters (e.g., from undergraduate professors or non-clinical volunteers).
• Avoiding asking MD attendings because they worry about bias; in reality, strong MD and DO faculty letters both carry weight.
• Not using at least one letter to explicitly validate global health interest and long-term commitment in a serious, nuanced way.

Your goal is a balanced portfolio: letters that prove you’re an excellent resident in your chosen specialty, plus one or two that clearly position you as an excellent future global health physician.

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Who to Ask for Letters: Building a Strategic LOR Team

“Who to ask for letters” is one of the most critical decisions in the LOR process. Especially as a DO graduate, be intentional: you want letter writers who understand both global health and the realities of osteopathic training—or are at least willing to highlight the strengths of your background.

Priority #1: Clinical Attendings in Your Primary Specialty

For most global health–interested DOs, the primary residency specialty will be:

• Internal Medicine
• Family Medicine
• Pediatrics
• Emergency Medicine
• Occasionally Obstetrics and Gynecology or General Surgery

From these rotations, target attendings who:

• Directly supervised you clinically for at least 4–6 weeks (inpatient, outpatient, or both)
• Saw you manage patients, present on rounds, write notes, and interact with the team
• Are known to write strong letters (you’ll often hear this from residents or classmates)

Ideal ask:

“I’m applying to Internal Medicine with a strong interest in global health, and I really valued working with you on wards. Would you feel comfortable writing a strong letter of recommendation for my residency applications?”

That explicit use of the word “strong” gives them a graceful way to decline if they can’t endorse you enthusiastically.

Priority #2: A Global Health or International Medicine Mentor

For a DO graduate interested in global health, a dedicated global health letter is not optional—it’s a key plank of your application story.

Strong candidates for this role:

• Faculty who led your global health elective, international rotation, or global health track
• A mentor from your school’s global health office, public health department, or international medicine program
• A PI or supervisor from a global health research project, especially if you had substantial responsibility

What this letter should address:

• Your sustained commitment to global health (not just one short trip)
• Your ethical approach to international medicine and local partnerships
• Any cross-cultural communication skills they witnessed
• Your adaptability, humility, and professionalism in resource-limited or unfamiliar settings
• How they see you contributing to a global health residency track or international programs at the next level

This letter helps program directors distinguish you from applicants who simply did a brief overseas experience without deeper reflection or long-term engagement.

Priority #3: Research, Leadership, or Systems-Based Mentors

If you have significant involvement in:

• Global health research
• Quality improvement in underserved settings
• Leadership in student global health organizations
• Community health work with immigrant/refugee populations or rural/underserved communities

—then a letter from that mentor can be powerful “value-add,” especially if the program has a formal global health or international medicine pathway.

This letter can highlight:

• Your scholarly potential (important in academic programs)
• Your ability to design and implement projects in low-resource or complex settings
• Evidence of initiative and follow-through

What If You Don’t Have a “Formal” Global Health Mentor?

Many DO schools and smaller programs may not have a robust global health infrastructure. In that case:

• Consider a letter from a community health or underserved medicine preceptor (e.g., FQHC, Indian Health Service, migrant clinic).
• Emphasize health disparities, cultural humility, and systems-based practice—all key to global health.
• Use your personal statement and experiences sections to frame these as foundational to your interest in broader global health work.

Your letters don’t have to use the phrase “global health” in every paragraph; what matters is that they show your ability to work thoughtfully in diverse, resource-variable, and high-need environments.

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How to Get Strong Letters of Recommendation (Not Just Generic Ones)

Knowing how to get strong LOR is more than just asking the right people. It’s about making it as easy as possible for them to write detailed, persuasive letters that speak to your fit for global health–oriented training.

Step 1: Ask Early and Ask Clearly

Timing and clarity matter:

• Ask at least 6–8 weeks before your ERAS submission target.
• Make the ask in person (if possible), then follow up by email.
• Be explicit about:
  • Your target specialty
  • Your specific interest in global health residency tracks or international medicine
  • Why you value their perspective

Example email structure:

• Subject: “Request for Strong Residency Letter of Recommendation – [Your Name]”
• Brief reminder of who you are and when you worked together
• Statement of your specialty and global health interests
• Ask: “Would you feel comfortable writing a strong letter of recommendation in support of my application to [Internal Medicine/Family Medicine/etc.] residency, with a focus on global health opportunities?”

Step 2: Build a “Letter Packet” for Your Writers

When you ask for a letter, send them a concise, organized set of materials:

• Updated CV
• Draft personal statement (especially important if it highlights global health)
• Short summary (1 page max) including:
  • Your career goals in global health or international medicine
  • Specific programs or types of programs you’re targeting
  • 3–5 bullet points of experiences you’d love them to highlight

For a global health mentor, it might include:

• Key rotations or trips, with dates and locations
• Major responsibilities you held (teaching, supervision, project management)
• Specific examples demonstrating adaptability, resourcefulness, and ethical sensitivity

This is not “telling them what to say” but giving them raw material to write a more detailed, individualized letter.

Step 3: Highlight Your DO Background Strategically

As a DO graduate, your letters should underscore what osteopathic training brings to global health:

Encourage your writers (subtly, in your summary) to comment on:

• Your use of holistic, patient-centered care in diverse settings
• Your comfort working with interprofessional teams
• Your emphasis on prevention, function, and community context
• Any relevant exposure to osteopathic manipulative treatment (OMT) in underserved or resource-limited settings (if applicable and appropriate)

Many program directors value the DO approach, particularly in fields aligned with global health like family medicine and internal medicine. Let your letters reflect that.

Step 4: Keep the Focus Clinical—but Integrate Global Health

Even for global health–oriented applications, clinical excellence is non-negotiable.

Strong LORs should address:

• Clinical reasoning and judgment
• Reliability and work ethic
• Teamwork and communication
• Professionalism under stress
• Ability to learn from feedback

Ask your global health letter writer to include clinical or patient-care examples from your global or underserved experiences—how you handled a challenging case, navigated limited resources, or supported a struggling team member.

This dual emphasis—strong clinician, thoughtful global health advocate—is what programs want.

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Common Pitfalls for DO Applicants—and How to Avoid Them

Even strong DO graduates aiming for global health–oriented training can weaken their applications with avoidable LOR mistakes.

Pitfall 1: Overemphasizing Non-Clinical Letters

Letters from:

• Undergraduate professors
• Non-medical volunteer supervisors
• General character references

…are rarely as helpful as you think.

Instead:

• Prioritize clinical attendings and physician mentors
• Use non-physician references (if at all) only as a tertiary letter, and only if they can speak to long-term leadership or global health projects

Pitfall 2: Failing to Align Letters with Your Application Narrative

If your personal statement emphasizes global health and your CV showcases international medicine experiences—but all your letters describe only routine inpatient performance, programs may doubt your true level of interest.

Solution:

• Ensure at least one letter explicitly references your global health aspirations, not just in passing.
• Prime your writers (through your summary) to connect your performance to future global health work.

Pitfall 3: Ignoring the DO–MD Dynamics

Some DO graduates worry that MD letter writers might undervalue osteopathic training, or that DO letters won’t be viewed as competitively. In practice:

• Strong content matters more than degree type.
• A detailed, specific letter from a DO faculty member who knows you well is more valuable than a generic MD letter from someone barely familiar with your work.
• A mix of MD and DO authors can be ideal, but it’s not mandatory.

If you’re concerned, speak with current residents (especially DO graduates) at target programs about how your DO background is perceived and whether certain faculty are known champions for osteopathic trainees.

Pitfall 4: Not Waiving Your Right to View the Letter

Programs generally expect applicants to waive their right to see LORs. Non-waived letters can be perceived as less candid or less trusted.

• When you upload requests through ERAS, ensure you check “waive right to view”.
• This signals to programs that the letter is likely frank and unedited.

Pitfall 5: Last-Minute or Missing Letters

Letters arriving late (or not at all) can damage your chances, especially at programs where interview offers go out early.

Prevent this by:

• Asking early and confirming deadlines
• Politely following up 2–3 weeks before your target submission date
• Using a simple, appreciative reminder: “I wanted to check in and see if you needed anything further from me as you work on my residency LOR.”

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Tailoring LOR Strategy to Global Health Residency Tracks

Not all residency programs have formal global health tracks, but many have:

• Longitudinal global health residency tracks
• International medicine electives
• Partnerships with overseas institutions
• Emphasis on refugee, immigrant, or underserved care domestically

For programs with explicit global tracks, your LORs help answer a key question: Is this person committed enough, prepared enough, and grounded enough to benefit from and contribute to our global health efforts?

What Global Health–Oriented Programs Look for in LORs

1. Maturity and ethical grounding
   Your letters should show that you:

   • Understand power dynamics and resource inequities
   • Work collaboratively with local colleagues
   • Avoid a “savior” mentality

2. Adaptability in unfamiliar settings
   Programs want residents who:

   • Stay calm when things aren’t “by the book”
   • Can work safely when resources are limited
   • Are teachable and humble

3. Evidence of sustained interest
   LORs that reference:

   • Ongoing projects
   • Longitudinal engagement with global/underserved populations
   • Academic or scholarly work in global health

4. Alignment with program mission
   If a letter writer knows your specific interest in the program’s strengths (e.g., HIV care in Africa, refugee health, rural global surgery), that can be mentioned explicitly.

Practical Example: Aligning Your LORs

Imagine you’re a DO graduate applying in Family Medicine with a strong interest in global health. Your LOR lineup might look like:

• FM inpatient attending: Speaks to your clinical strengths, teamwork, reliability.
• FM outpatient/continuity clinic attending: Highlights communication, preventive care focus, osteopathic philosophy, chronic disease management.
• Global health rotation director: Describes your work during a partnership rotation in Central America, your humility with language barriers, and your long-term interest in capacity-building rather than one-off missions.
• Global health research mentor (optional extra letter): Notes your role in a project on maternal health outcomes, your data analysis and manuscript contributions, and presentations at a global health conference.

This combination tells a coherent story: you’re a clinically solid family medicine resident-in-the-making with depth and seriousness in global health.

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FAQs: DO Graduate Letters of Recommendation for Global Health–Oriented Residency

1. As a DO graduate, do I need MD letter writers to be competitive for global health programs?

Not necessarily. Program directors primarily care that your letters:

• Are detailed and specific
• Come from people who directly supervised your clinical work or global health projects
• Clearly endorse you as a strong candidate

A mix of DO and MD writers is fine, but strong content trumps credentials. One or two well-known global health or international medicine faculty (MD or DO) can be particularly impactful.

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2. Can I use a global health letter instead of a core specialty letter?

You can, but usually you shouldn’t—unless the global health letter writer also directly supervised substantial clinical work relevant to your specialty.

Most programs prioritize:

• 2–3 clinical letters from your target specialty
• 1 “plus” letter that highlights global health, research, or leadership

If your global health letter is from a physician who saw you deliver day-to-day care (e.g., on a global health rotation where you functioned as part of the clinical team), then it may count as both a clinical and global health letter. But verify each program’s preferences.

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3. What if I’m very interested in global health, but all my clinical experience is domestic?

That’s not a deal-breaker. Many global health–focused residents begin with:

• Work in refugee/immigrant clinics
• Service in rural or underserved U.S. communities
• Engagement in community health projects that address social determinants of health

Ask letter writers from those settings to emphasize:

• Your experience with cross-cultural care
• Understanding of health disparities
• Longitudinal community engagement

You can still frame your interest as global health by highlighting transferable skills and values, even if your current work is domestic.

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4. Should my global health letter focus more on my passion or my skills?

Both—but with an emphasis on skills and behaviors.

Passion alone isn’t enough; programs have seen many applicants with enthusiasm but limited insight or follow-through. Ask your global health mentor to include:

• Specific examples of your clinical performance
• How you handled logistical or ethical challenges
• Evidence of reflection and growth
• Any project outcomes or scholarly contributions

This shows that your interest in global health is not just emotional or ideological—it’s connected to real skills and disciplined work.

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Strong, well-chosen, and carefully supported letters of recommendation can transform your residency application from “another DO graduate” into “a future global health leader we want in our program.” Start early, be intentional about who you ask, equip your writers with what they need, and ensure your letters tell the same compelling global health story that runs through your entire application.