Reference letters for IM?

[geegeesarehere]

What reference letters are accepted for IM? Could I use a subspecialty, or a peds sub-speciality that is similar to the adult world? 

[bearded frog]

Technically any letter would be "accepted" but assuming all letters are equal in terms of the feedback about your performance, usually the letters that discuss your performance actually doing the things you would be doing in residency are most valued. For example, a letter from your IM rotation would be better than a FM rotation, even if it was primarily discussing your performance in a hosptialist environment (but this FM letter would be better than nothing, or say a letter discussing your performance on an outpatient psych elective). When it comes to IM/peds then the letters from relevant subspecialities are also valued, but I will defer to my IM colleagues if general IM/CTU is preferred. In peds they are equally valued in my experience, as long as the interest is not restricted to that subspeciality and they can comment from a general peds perspective as well. I think a peds subspeicality letter might not be that great for adult general IM and vice versa, since the bread and butter of each subspeciality and the practicalities of practice are quite different in peds vs adult (peds cardiology and adult cardiology are completely different for example). In my experience, if you were applying to peds, I'd rather you have a FM letter talking about your performance with children and their families over an adult subspeiality, even if the content was similar (ie. a T1DM clinic, unless you saw both children and adults).

[cardio_enjoyer]

Subspecialty is ok, I would not advise using peds subspecialty letters for IM even if it’s not explicitly not allowed for certain schools.