Letter of Recommendation (LOR) Policy
for pre-med internship

Purpose
This policy is created to set clear expectations and requirements for interns regarding their eligibility for a Letter of Recommendation (LOR) at the end of their internship. Both the practice and the interns must have a mutual understanding of the criteria needed to earn this highly competitive LOR. By establishing these guidelines, we ensure that all interns know exactly what they must accomplish to be rewarded with the best LOR possible.

Terms and Conditions

  • Minimum Internship Duration
    Interns must complete a minimum of two (2) gap years in the practice after finishing their college degree. These two years are intended to provide invaluable experience and growth within the practice, positioning the intern for a highly competitive Letter of Recommendation (LOR) when they apply to medical school.

  • Retirement Notification
    Interns planning to retire or leave the practice must notify their supervisor at least six (6) months in advance. This notice period ensures proper succession planning and the smooth transition of responsibilities.

  • Eligibility for LOR
    The Letter of Recommendation will be provided to interns who assume leadership roles within the practice. These positions include a maximum of:

    • 2 Practice Leads

    • 2 Clinic Leads

    • 2 Surgery Department Leads

    Please note that the number of leadership positions may vary based on several factors, including the number of individuals willing to commit to a two-year term, departures of interns during their tenure, and the operational needs of the practice. These roles are critical for demonstrating sustained leadership and engagement within the practice, and the final allocation will be adjusted to ensure alignment with the practice's capacity and goals.

  • Leadership Role Availability and Rotation
    Leadership roles will be filled as follows:

    • Year 1: 3 Leads will be selected and begin their leadership training.

    • Year 2: At the end of Year 1, the practice will retain 3 experienced Leads from Year 1, and will select 3 new Leads from incoming interns.

    • Year 2 will be the transition period, where 3 new Leads join and 3 experienced Leads remain. This pattern will continue each year, maintaining a balance of 3 well-experienced Leads and 3 new Leads in training.

  • Transition of Leadership
    Any intern in a leadership position who is preparing to leave the practice must ensure their responsibilities are fully transitioned to another intern. This ensures continuity in leadership roles and helps maintain smooth operations within the practice.

  • Responsibilities of Leads
    Interns in leadership positions are expected to meet the following standards:

    • Acquire a deep understanding of the practice's workflow.

    • Deliver weekly presentations on relevant topics.

    • Provide outstanding patient care, demonstrating professionalism and empathy.

    • Devote time to teaching and mentoring other interns and staff, contributing to a collaborative and supportive learning environment.

  • Responsibilities of Leads
    Interns in leadership positions are expected to meet the following standards:

    • Acquire a deep understanding of the practice's workflow.

    • Deliver weekly presentations on relevant topics.

    • Provide outstanding patient care, demonstrating professionalism and empathy.

    • Devote time to teaching and mentoring other interns and staff, contributing to a collaborative and supportive learning environment.

Additional Terms Regarding LOR

Reapplication for LOR & Withdrawal Clause

  • If a Lead does not get accepted into medical school, they must commit to another gap year in the practice to receive another LOR for their next application cycle. Continued leadership and dedication to the practice will be required to earn this renewed endorsement.

  • If a Lead quits the practice after receiving their LOR but before completing their full two-year commitment, the MSO MSK Education Division reserves the right to withdraw the Letter of Recommendation.

LOR Eligibility for Medical Assistant (MA) Program Graduates

  • Interns enrolled in the Medical Assistant Training Program must successfully graduate from the program after nine months to be eligible for further opportunities.

  • To qualify for an LOR, MA program graduates must apply for and secure a two-year gap year position within the practice. Completion of the MA program alone does not guarantee a Letter of Recommendation.

Conclusion
‍This policy aims to establish a transparent and structured process for obtaining a Letter of Recommendation at the end of the internship. By meeting these clear criteria, interns will demonstrate their leadership and excellence within the practice, making them highly competitive for their next step in medical school applications.

Return to the Internship

Letter of Recommendation (LOR) Policy
for International Medical Graduates (IMGs)

We are committed to providing meaningful clinical and observational experiences for International Medical Graduates (IMGs). Our Letter of Recommendation (LOR) policy ensures that our recommendation is based on genuine familiarity with your work, professionalism, and contributions during your time with us.
‍
To be eligible for an LOR, you must meet the following criteria:

  • Complete at least two months with our team:

    • One month at SDNeurosurgery.

    • One month at South Bay Neurosurgery.

  • Please note that while two months is the minimum requirement, it does not guarantee a letter. LORs are issued only if the majority of the clinical team members you worked with, including doctors, nurse practitioners, physician assistants, medical assistants, remote staff, and interns, agree that you demonstrated strong clinical insight, professionalism, and collaboration.

Requirements

Before beginning your observership with SDNeurosurgery, you must be approved to shadow at Scripps La Jolla Hospital, where most of Dr. Yoo’s surgeries occur. Without Scripps approval, your experience will be significantly limited.

  • If your Scripps application is still under review, you can begin your rotation with Dr. Dan White at South Bay Neurosurgery.

  • If you only plan to observe Dr. Yoo for one month, please do not travel to San Diego until your Scripps shadowing approval is confirmed.

We’ll help guide you through the Scripps La Jolla Hospital approval process so you can maximize your time with Dr. Yoo in the OR. Please follow the checklist below carefully to avoid delays:

📌 Scripps Observer Packet Checklist

  • Start and end dates (maximum 6 months)

  • Last 4 digits of your SSN (if applicable)

  • Negative TB test (within the last year, with placement and read dates)

  • Complete vaccination records (Influenza, MMR, TDAP, Varicella, Hepatitis B, COVID-19)

  • Photo ID

  • Medical Staff Sponsor (Dr. Yoo)

  • Confirmation from the OR that your name has been added to the observer list – contact: crowsey.rachel@scrippshealth.org

Important: Submit your completed packet at least 2 weeks in advance. If approval is not finalized 7 days before your start date, you will not be permitted to shadow, even if all documents are in order.

This policy applies to all IMG applicants and is designed to maintain a high standard for clinical training and professional endorsements.

For questions or clarification, please get in touch with our education team at education@mskmso.org.

Return to the Observership Form