IMG Path to OrthoStep 4 of 7
Step 4: Secure US Experiences
For IMGs, U.S. experience is not optional. It is how programs evaluate your professionalism, communication, and fit — and how strong letters are earned.
Letters take monthsResearch is the bridgeVisibility matters
Clinical exposure in the US & letters of recommendation
Not all U.S. exposure is equal. The goal is meaningful supervision and credible advocacy.
Types of US exposure
- • Observerships: Shadowing only; limited but can open doors.
- • Hands-on electives: Best when available and permitted.
- • Research-linked clinical exposure: Clinics, conferences, case discussions.
What actually moves the needle
Exposure matters only if someone senior can say how you contributed, how you work on a team, and whether they would trust you as a resident.
What makes a strong US orthopaedic letter
Strong letters are detailed, specific, and earned over time — not requested after a week.
What great letters include
Specific examples of your reliability, initiative, communication, teamwork, and growth. Vague praise does not help IMGs.
How long it takes
Most strong letters take months of consistent work. Expect 3–6+ months before asking.
How to approach LORs
Ask attendings who supervised you meaningfully and know your work. Frame the ask honestly: “Would you be comfortable writing me a strong letter?”
Professionalism basics (non-negotiable)
These are silent deal-breakers if you get them wrong.
Know the rules
HIPAA, documentation boundaries, and OR etiquette are taken seriously. When unsure, ask — never assume.
Communication norms
Clear, respectful communication with residents, staff, and faculty matters as much as clinical knowledge.
Research fellowships (the most common IMG bridge)
For most IMGs, research is the gateway to mentorship, letters, and program advocacy.
Why research matters
Research provides credibility, proximity to faculty, networking, and tangible output — the currency IMGs rely on most.
Types of roles
Formal research fellowships, visiting scholar roles, coordinator-style positions, and selective remote collaborations.
How to find positions
Most roles are found through cold emails, networking, and word of mouth.See the research fellowship playbook →
Cold email strategy (simple but effective)
Short, respectful, and specific beats long and desperate.
6-line email formula
Who you are → why them → your credible signal → what you offer → 15-min call → attach CV. Follow up 2–3 times, spaced.
Common failure modes (avoid these)
These are patterns seen repeatedly in unsuccessful IMG applications.
What goes wrong
Being a “data grunt” without authorship, no senior sponsor, too many projects with no completions, or weak clinical visibility.
What success looks like (12 months)
Manuscripts submitted, abstracts presented, visible team contribution, and 2–3 strong U.S. letters.