Step 2, Rotations, LORs, ERAS: What Should IMGs Prioritize?
A physician sitting at a table with four students listening.
Everything feels important during ERAS season.
Do I prioritize studying for Step 2 or do I squeeze in one more rotation?
How many clinical rotations do I actually need?
What makes a strong letter of recommendation?
How many programs should I apply to?
What happens after I hit submit?
Do I have enough experiences?
These are all important questions. The challenge is that trying to address everything at once can quickly become overwhelming—and sometimes counterproductive. During ERAS season, good planning isn't just about figuring out everything you need to do. It's about understanding what deserves your attention first.
At RotationSync, we work closely with IMGs navigating these decisions alongside physicians who understand the residency process and are passionate about mentorship. So let's dig into how to determine what deserves your attention most during ERAS season.
Priority #1: Get the non-negotiables in order
Recently, one of Dr. Karmali's students came to him with a decision.
She had an opportunity to complete an observership where she could potentially earn two letters of recommendation. The tradeoff? Completing the experience could delay Step 2 completion until late September or early October.
Her alternative was to prioritize Step 2 first and complete a different observership afterward. That could mean applying with only two letters of recommendation, with no guarantee of earning another.
Which should she prioritize?
Dr. Karmali didn't hesitate: Step 2.
When we asked Dr. Karmali why he considered Step 2 the higher priority in her situation, his reasoning was simple:
“This particular student already had the required letters of recommendation, so the additional opportunities she was considering would have simply added to what she already had. That's why the choice in this situation was so clear.”
In other words, additional letters may have strengthened an area of her application that was already sufficient, while delaying Step 2 would have left a much more important piece unfinished.
Priority #2: Build the strongest application you can, not necessarily the fullest one
It’s very easy to get sucked into the idea that more is better when it comes to your application. But we’re here to challenge that mindset because sometimes, more isn’t better. Imagine a student who already has several meaningful clinical experiences and strong LORs. Should they automatically pursue another rotation simply because one is available?
Maybe.
But if their personal statement is unfinished, their ERAS is unpolished, or they haven’t spent enough time strategizing where to apply and how best to leverage their signals, what is the opportunity cost of spending another four weeks rotating?
Before adding something else to your application, ask yourself:
What specific weakness am I trying to address by doing this?
OR
What meaningful improvement will this add to my overall application?
When speaking with Dr. Karmali about what he often finds himself talking to his students about, he mentions:
“It's important to remember that every choice involves a trade-off. You need to understand what that trade-off is and, more importantly, how it impacts your overall application.
You should treat your ERAS application as a cohesive narrative of your professional journey. Adding too much can dilute that narrative. Conversely, knowing when and how to trim experiences to better represent you as a residency applicant demonstrates academic and professional maturity. It shows an ability to see the bigger picture—an appealing attribute in a prospective candidate.”
Priority #3: Know what still needs time from other people
We can't overstate how important it is to account for other people's time during application season.
LoR requests
Transcript processing
MSPE
ECFMG documentation
Remember that these requests involve someone else's time and responsibilities. Giving physicians, medical schools, and other professionals adequate notice isn't just good planning—it's professional courtesy.
Anything dependent on someone other than you needs extra lead time.
Priority #4: Protect time for the application itself
In case you weren’t aware… your ERAS application will take time. A lot of time. Some of the most time-consuming elements include writing and revising your personal statement, thoughtfully describing your experiences, researching programs, developing your application strategy, and proofreading everything—and that's just the beginning. In fact, we put together a few tips you should know before submitting your application.
Building this time into your schedule gives you room to be thoughtful rather than simply racing to get everything submitted.
Priority #5 - Stop chasing perfection
There seems to be a pervasive misconception among IMGs that there is some magical formula for creating a competitive ERAS application. While there are general “rules of thumb,” creating a cookie-cutter application is a major disservice to the applicant. Your application should be as unique as your journey itself. It should be as unique as you.
At some point, the marginal benefit of adding another thing becomes smaller than the benefit of directing that time somewhere else.
When you're unsure whether something deserves more of your time, start with these three questions:
What specific weakness am I addressing?
Will doing this meaningfully strengthen my application?
What am I giving up in order to do it?
There is no universal checklist that tells every IMG exactly what to prioritize. Someone who still needs meaningful U.S. clinical experience is in a very different position from someone who already has several strong rotations and letters of recommendation but hasn't completed Step 2 yet. The goal isn’t to do everything. It’s to understand your application well enough to know what deserves your attention right now. And sometimes, knowing what deserves your attention requires recognizing what you can stop chasing.
