UDLCO summary:
These are dyadic narratives between "letter of recommendation" aka LOR seekers and an LOR giver where many themes such as the correlation between patient centred learning outcomes and patient illness outcomes interplay in the background while the dyadic narrative shows a tussle between the seeker and potential giver in terms of trade offs around transparency and accountability integrating medical education and practice.
UDLCO Keyword glossary:
Conversational Transcripts:
June 2024:
[28/06, 11:15] anonymized medical student aka AMS: Good morning sir. I’m ..., from ... batch, completed 4th year and internship under you in ... and ... I’m applying to match in US this cycle and I wanted to ask if you can give me a letter of recommendation LOR. I will draft everything . The letter has to be uploaded by you in a website. I’ll be providing you with all the instructions . Please let me know, if it’s possible sir. Appreciate the help. Thank you
[28/06, 11:36] CBBLE moderator: Here's how my LOR looks like 👇
We provide a link to your online learning portfolio in the lor so that the program director can also assess it
[28/06, 11:38] AMS : Sure sir:) I will draft in this way and will provide the process to upload it. It’s that uploading should be done by department
[28/06, 11:40] AMS : Is it okay sir? I’ve explained it to medicine department office clerk, the uploading process
[28/06, 11:42] LOR giver LORG: I've done them myself many times in the past from my mobile
However few things
The lor should contain the link to your online learning portfolio
I will need to go through the link to your online learning portfolio to decide your formative assessment percentile if you can share it asap
I can only sign the document as a Professor of medicine without any other mention of my administrative position.
[28/06, 11:43] AMS: Okay sir
[28/06, 12:20] AMS: IM SEL format, do you give in this format sir
[28/06, 12:20] AMS: https://www.geisinger.org/-/
[28/06, 12:37] LORG: Yes but for this I need to assess the students here for a few weeks as elective trainees here.
[28/06, 12:46] AMS: Okay sir. Can I know what’s the role of global elective learning program?
[28/06, 14:33] LORG : Sure
Here's more about it 👇
July 2024:
[21/07, 04:07] Anonymous medical student lor seeker aka AMS LORs:
Hello Sir,
Good morning, hope you are doing fine.Can I have a letter of recommendation from you for the Internal Medicine residency application in United States in ... 2024.It would be of great help if possible.
Thank you.
[21/07, 13:12] LOR giver aka LORG: Here's how our LOR looks like 👇
We provide a link to your online learning portfolio in the lor so that the program director can also assess it
[22/07, 03:56] AMS LORs: Yes sir it will be a unique approach and will also be having credibility.Can I provide you with a draft of the letter so that I can submit in the office after your signature.
[25/07, 07:14] AMS LORs: Hello Sir
I have sent the draft.
If needed I will send it in the form of document or PDF.
I have a request sir.
My name in the table is mentioned as ...It will be very helpful if changed to "..." if possible.
Thank you Sir.
[25/07, 08:35] LORG: Here are my edits below to what you shared and I had to delete a few statements you used because we can make those statements only for a few students in the top 1% in our assessment, who have particularly worked with us here in the campus and we have given them a recommendation that allowed them entry to a paid research fellowship as well as faster processing of their green card. They passed out as interns from your batch (from a different college, although they spent time in your college too as an elective for nearly a month and helped us publish our flagship publication about our learning program)
Check out my edits below to what you shared 👇
Dear Program Director,
Dear Program Director, I am pleased to write a letter of reference for Dr... in his application for your program.
I am currently a full Professor in the Department of General Medicine at the ... Institute of Medical Sciences, India from where Dr... trained as an undergraduate
and other than a graduate residency training and undergraduate program, we also host a patient centred, global elective learning program.
Our department has known ..., since his second year General Medicine rotations, and he has interacted with us ever since in his group and most of his verbal
and non verbal interactions can be accessed from his online learning portfolio in our departmental (entry year wise) dashboard
here: at [https://medicinedepartment.
personal assessment ranks at the top 25% of his batch.
Our department can strongly attest to most of our students’ abilities as we've had the opportunity to oversee them in both the In-patient and Out-patient setting and work with them during their
internship.
We wish him well in this new learning journey in your own institutional program.
[08/08, 23:50] AMS LORs: Hello Sir,
I have been given the Opportunity to speak in the symposia on Aug 14th
[11/08, 22:43] LORG: What about sharing our original work with the PaJR network?
What you are planning doesn't sound like an original work?
[11/08, 22:45] AMS LORs: Yes Sir but I didn't know how to present that
Should I make a blog about the cases or any other way
[11/08, 22:45] LORG: Discuss this with our SR who is also presenting in the same session
[11/08, 22:46] AMS LORs: Yes Sir Got it
We will discuss about that
Thank you.
[11/08, 22:48] LORG: Hope you will YouTube your presentation and share the link soon after
[14/08, 02:04] AMS LORs: Sorry for the delay Sir.
Is this presentation acceptable.
[14/08, 07:26] LORG: Well done 👍👏👏
[14/08, 07:28] LORG: Emphasize in the very beginning that this is an age old technique that builds on the "case report as the unit of medical knowledge" model and the cases are meticulously deidentified as per global HIPAA guidelines
[15/08, 09:21] LORG: How was it yesterday? Hope all went well?
[15/08, 20:23] AMS LORs: Yes sir it was good
Thank you for the opportunity Sir !!!
Sir should I create a channel and post the video
[15/08, 21:32] LORg: Yes please. I'm looking forward to it
[16/08, 10:26] AMS LORs: video link
[16/08, 10:26] AMS LORs: Sir is the title and description fine or should I change
[16/08, 10:28] LORG: Looks good 👏👏
[18/08, 15:07] LORG: Summary: Below are links to videos and slides of our PaJR team presentation at NCBS Bangalore on 14th August, 2024 focusing on our PaJR platform methodology that is largely about integrating diverse paths of knowing through team based learning and their archival in online learning portfolios. This is followed by video links to Prof Sudhir Krishna's presentation of integrating modern science benches to clinical bedsides where diversity of approaches already abound.
[21/08, 05:50] AMS LORs: Hello Sir, Good Morning.
I have a request regarding the Letter of Recommendation for my Internal Medicine residency application.
Is it possible to provide it in the format of IMSEL ( Internal Medicine Structural Evaluation Letter) that I have provided below.
Thank you.
[21/08, 06:58] LORg: Yes for that I would need to evaluate you on our current patients and you would have to work for us for 3 months
[21/08, 11:09] AMS LORs: Yes Sir, but Currently I am doing clinical rotations in united States and recently I got to know about IMSEL for September application.
Okay Sir, I will communicate with medicine department clerk regarding previously mentioned format.
Thank you Sir !!!
[24/08, 08:12] AMS LORs: Yes Sir I have sent the LOR request for the above mentioned mail ID.
Thank you !!!
[24/08, 08:43] LORG : Something has gone wrong with the portal. It's not allowing me to the exact site now after I clicked to upload the LOR although the site is shown me as logged in
[24/08, 09:20] LORG: I guess there's some problem with their website
With great difficulty I was able to log out of it by deleting all my browser cache etc but now it's not allowing me to sign in and putting me in a loop. It's saying my username or password is wrong.When I'm entering my forgot username option it's sending me the same username that I was entering!
Not sure how to reach out to AAMC to report this
[24/08, 09:26] LORG: Your account has been temporarily locked. It will be unlocked after 10 minutes for you to log in. In case you have attempted to login before the account is unlocked, please wait and try again later.
[24/08, 09:28] AMS LORs: Sorry for the inconvenience sir
After it gets unlocked if you are unable to reset the password can you please fill your details in the link i have sent you.
[24/08, 09:32] LORG: It's the same link that takes me to AAMC where I have to sign in with my un and password
[24/08, 09:40] AMS LORs: Yes sir
Once you fill the details,they will reach out to you Sir.
[24/08, 09:40] LORg: I know I've done this countless times.
Only this time I'm unable to sign in
[24/08, 09:42] AMS LORs: Yes sir got it
I will try calling them and explain the situation.
[24/08, 09:52] AMS LORs: Okay Sir may be it will be better to do it from their side.
As tomorrow is a holiday for their office I will contact them on monday
and tell your name and email address so they will be able to contact you and resolve the issue.
[24/08, 10:02] AMS LORs: Sir will you be able to contact them through the link provided in this page
[24/08, 11:13] LORG: The same link is through what I have been trying and it's sending me into a loop
[24/08, 19:44] AMS LORs: Sir I am not understanding what to do about this...and this is the First lor for my application.
[24/08, 20:13] LORG: Some of the students are using different lor portals such as sophas
[24/08, 21:22] AMS LORs: Yes sir I have checked that out may be it is only for public health courses
[24/08, 21:28] LORG: 👆 Let's hope this plan of yours works out
[24/08, 22:10] AMS LORs: Yes Sir
I will let you know after speaking with them.
Thanks a lot !!!
[26/08, 23:03] AMS LORs: Hello Sir,
I have contacted them and they told to send an email regarding the issue to them so they can register a case and solve the issue.
The email Id is :
I have told them already that the username they are sending is not helping to log into the account.
Thank you Sir.
[27/08, 06:56] LORG:
Date: Tue, 27 Aug 2024, 06:55
Subject: Inability to log in to my AAMC account to provide an LOR
To: <eraslorportal@aamc.org>
I could log in initially with my old user name and password on 24/8/24 and was about to submit the LOR when suddenly the webscreen disappeared and then i was unable to log out as well as perform no other function.
With great difficulty later , I was able to log out of it by deleting all my browser cache etc but now it's not allowing me to sign in and putting me in a loop.
It's saying my username or password is wrong.When I'm entering my forgot username option it's sending me the same username that I was entering!
Please help.
best regards,
Professor of Medicine
India
[27/08, 07:06] AMS LORs: Yes sir thanks a lot !!!
[27/08, 08:52] LORG:
Dear LORG,
Thank you for contacting AAMC Services. We have received your request. Typically, responses are sent within one business day.
Your case number is ...
[27/08, 09:58] AMS LORs: Yes sir if there is a delay I can follow up with this case number.
Thank you.
[27/08, 21:06]LORg: Done
Uploaded
[27/08, 21:22] AMS LORs: Yes Sir
Thanks a lot !!! 🤗
Early September 2024:
[10/09, 01:26] Anonymous medical student LOR seeker aka AMS LORs: Hello sir!
[10/09, 01:26] AMS LORs: Hope you’re well.
[10/09, 01:27] AMS LORs: Coming to my request of your personalised LOR. As u told me to I made a draft of it with all the things I did over time with you.
Can you please sign it for me? I would send it with a student.
It would mean the world to me and my application for my residency.
I’m applying this match cycle for internal medicine here in the USA.
Hoping for a positive response.
[10/09, 09:41] LOR giver aka LORG: As discussed earlier I can't endorse this because I don't have any evidence to support the claims it makes. 🙂🙏
Sharing the last LOR i did last few days back below and it's what most of our students have had time to gather evidence for during their tenure with us. It's not their fault. It's just that no one told them earlier that gathering evidence is crucial.
[10/09, 09:46] AMS LORs: Sir I am involved in the care of our ... patient.
Part of many PaJR groups.
I did present some cases in the college
I did do a couple of central lines and abgs in the rotations.
I play sports , a lot of them Infact
I have proofs on watsapp and as pictures.
You told me that I could involve things I actually did. I just included them and detailed them into a better vocab. That’s all 🥲
[10/09, 09:47] LORg: I can empathise with it but trust me program directors see it all the time!
A smaller endorsement could actually make it better for you is what I sincerely believe
[10/09, 09:47] AMS LORs: No sir! They want
[10/09, 09:47] AMS LORs: That written dramatically
[10/09, 09:47] AMS LORs: That’s when they consider
[10/09, 09:48] AMS LORs: The things written in it makes all the difference
[10/09, 09:48] AMS LORs: And that coming from my mentor(I feel so) and someone who has seen me for so many years
[10/09, 09:48] LORg: That's what the people who you have paid to hear are telling you. Trust me they have no idea what even they want!
[10/09, 09:50] LORg : Trust your mentor to put the things he believes will be useful in your LOR
[11/09, 01:48] AMS LORs: Sir, Could I please provide you evidence for those things? And you would help me with that LOR?
[11/09, 07:05] LORg: Your online learning portfolio is the best evidence
[11/09, 07:09] LORg: Other than the single ... patient, please share with online dated traces (audit trails)what were your inputs and attempts to maintain informational continuity about the other 1000s of patients in our PaJR groups.
To me even your performance with that one patient was inspirational and i can put that into the LOR
[11/09, 07:25] AMS LORs: Sir I haven’t updated that in years because I got busy.
[11/09, 07:26] AMS LORs: I am mainly involved with our patient
And v v few inputs or conversations regarding other few but I don’t have the clinical texts cause they got deleted. Like many other due to some watsapp chat updating thing, unknowingly.
[11/09, 07:27] AMS LORs: I am so sorry to be asking like this, but I feel helpless.
[11/09, 07:32] LORg: Have you thought about why the others are happy with the standard format i gave them?
Can you talk to them and find out?
[11/09, 07:33] AMS LORs: Sir, if you want me to be honest .
they aren’t happy sir.
Not sure if they ll upload it even.
I’m speaking up because I know you and I feel that freedom with you to speak the truth.
[11/09, 07:34] AMS LORs: They won’t upload cause every other letter is very detailed and everything
Can’t have a standard letter cause it would hurt the application
Because you’re the only doc that has seen us the longest
[11/09, 07:55] LORg: I'm only talking about those who have already uploaded it.
We have also given special LORs to people junior than you who finished their internship later and straightaway joined in a paid research associate position in USA.
He spent a month here in our campus during his MBBS and achieved so much for our primary beneficiaries of medical education that most of our own students can't dream of achieving in 5 years with us. Also his father was admitted as a patient with us all the while.
[11/09, 07:55] LORg : I have seen that student the longest in one month that I couldn't see any of you in 5 years
[11/09, 08:06] LORg: What you have done with the single case of ... is nothing short of ground breaking but there are a few students in our campus who have done that with many more cases
[11/09, 10:49] AMS LORs: Sir, can you please give me the LOR of your choice? With the one PaJR and any other things you approve I did? Thank you :)
[15/09, 21:15] LORg: 👆Ask our medicine department clerk to prepare the draft of the standard format in which i shall make my positive additions
[15/09, 21:28] LORg: Ask him to show me the draft tomorrow and I shall edit it while in OPD
[15/09, 21:28] AMS LORs: Done sir. Will do.
[16/09, 09:23] LORg: Gave you an assignment in the PaJR group to test your patient centred EBM skills before I provide your LOR.
Will be looking forward to your inputs whenever you can
[16/09, 09:28] AMS LORs: Sir saw the assignment.
[16/09, 09:29] AMS LORs: I’m sloshed with work and application and so many deadlines
[16/09, 09:29] LORg: Where are you working currently?
[16/09, 09:30] AMS LORs: University of...
[16/09, 09:30] AMS LORs: Doing a cardiology Rotation sir
[16/09, 09:30] AMS LORs: Really hectic coming at 9pm at night
[16/09, 09:33] LORg: What kind of work do they make you do in that rotation? Knowing that would help me to formulate my individualized LORs better
[16/09, 09:38] AMS LORs: Take patient histories, examination , case presentation and do the EMR notes sir
[16/09, 09:38] AMS LORs: And case discussions
[16/09, 09:38] AMS LORs: I’m doing cardiology consult, so all the cardio cases in the entire hospital first come to us and we have to handle them
[16/09, 09:38] AMS LORs: Only one fellow me and one resident.
[16/09, 09:39] AMS LORs: That’s why v hectic.
[16/09, 09:45] LORg: You appear to be now doing all that we hoped you would have done as an MBBS student as well as Intern here. Tell me frankly how difficult would it have been for you and your batchmates to do all this with us here and what are the reasons it's not done here anywhere
[17/09, 06:51] AMS LORs: Hello sir. Makes sense. I asked this question to myself and about everyone else as well.
But I did try my best doing things there. I think it’s the lack of knowledge for me at that point, the responsibility we have when compared to the PGs and the patient load . And the utmost thing, I think is the desperation for us to come here as residents sir. We did not have the compulsion to do it sir. And that’s a bad thought.
And I think the entire curriculum not being organised and set on a lot of levels.
Like here it’s mandatory to document, being a doctor comes with the paperwork.
There when you introduced it , it was an extra effort people have to put and they did not receive it well. For a lot of reasons.
[17/09, 06:52] AMS LORs: And also, the SOAP notes u introduced is exactly what happens here
[17/09, 06:52] AMS LORs: That’s basic and that needs to be done every single day.
[17/09, 07:42] lorg: How about doing a project where you raise awareness in Indian UGs to reform themselves toward patient centred learning rather than rote memorization and indifference to patient requirements?
[17/09, 07:43] AMS LORs: Absolutely sir!
That’s my plan. To educate them
[17/09, 07:43] AMS LORs: Those are my future goals.
[17/09, 07:43] AMS LORs: Just not at the moment sir. I’m mentally sick myself handling all the things here. In a couple of months for sure.
[17/09, 09:41] LORg: Till our curriculum policy makers here learn to work for the primary beneficiaries of medical education in their program schedules and mandates, we shall continue to take things for granted at every faculty student level
Was just discussing with pan India medical education faculty around this today morning 👇
[19/09, 21:15] AMS LORs: Sir I was included in the quality improvement project also
[19/09, 21:15] AMS LORs: And presented it in the conference.
[19/09, 21:18] LORg: Do you have any link to that presentation?
[20/09, 19:43] AMS LORs: Sir I did the QIP as well.
[20/09, 19:43] AMS LORs: Can u pls add it!
[20/09, 22:27] LORg: It was not shared with our learning ecosystem at that time.
Academics is meant to be done to impact local and global learning ecosystems.
Academics is not done for LORs but if done to make an impact on the ecosystem, it automatically gets into the LoR
[20/09, 22:31] AMS LORs: Okay sir! Done!
I didn't do it for the LOR but just thought it would be a good addition since I did it.
But that’s fine sir.
[20/09, 22:31] AMS LORs: You will see the impact in the future from my end for sure.
[20/09, 22:31] AMS LORs: Thank you for the letter!!! :)
Late September 2024:
[26/09, 22:23] AMS LORs: Hello sir,
I am ..., I was a previous student of yours sir. I was wondering if you can write me a strong LOR because you have observed me during my time in the clinical rotation and also during my 3rd year of medical school with all the presentations and blogs. I am applying to Internal medicine this year sir. So if it is okay with you, would you be willing to provide an LOR sir? I am looking forward to hearing from you.
Thank you so much
[26/09, 22:45] LORg: Please share your online learning portfolio link.
This is how your LOR would look like 👇
[26/09, 23:01] AMS LORs: Sir, I would be really grateful if you wrote me a strong LOR, including some other moments you have seen with me
[26/09, 23:02] AMS LORs: It would really help my application
[26/09, 23:02] AMS LORs: I was just wondering because you have seen me from the 3rd year, so I think you would have more to say about me
[27/09, 06:58] LORg: Where are the outcomes of each patient in your learning portfolio?
For example this one?👇
...
Did you email the signed informed consent to ... for all your case reports?
Please share them with me.
[27/09, 07:02] lorg: In this LOR shared here, i remember knowing this girl much more than you largely because of the impact she had on our learning ecosystem for one patient. I can't recall yours having any impact on our learning ecosystem pivoting around any patient. If there are any WhatsApp transcripts of our learning ecosystem discussions around any patient that you participated please share those
[27/09, 07:06] LORg: None of the case reports in your online learning portfolio contain any discussion (learning outcomes) or follow up (patient outcomes)!
[27/09, 09:21] LORg: We remember this particular student's portfolio often as we have cited it many times in our global learning ecosystems.👇
The more your work is cited the more it creates impact and then you don't have to worry about your LOR as everyone would automatically write a good report on your good work!
[27/09, 12:26] AMS LORs: Okay sir
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