hey y'all,

i appreciate you guys writing back to my other threads...i have a new question...its a bit anal...but i could use the advice...

i have 5 docs i got letters of recs from. i know which 3 are top on my list...but i am not sure of the 4th one...the first 3 are from IM docs.

for my 4th letter, i have a letter from my acting internship (subinternship) from a univ attending, which i did alright in (high pass) but i had hard attendings...so the rec i'm sure will be pretty good but not the best ever...

or should i go ahead and use another rec from my family practice rotation, which i honored in, the doc i worked with was a community family doc who thought very highly of me and got to know me very well...

so is it better to use the sub internship rec, or the family doc? i feel family is definately stronger but i am not sure if the IM people would prefer the subinternship attending (especially at the stronger programs)....

thanks guys.

-dharmabum7

Originally posted by dharmabum7
hey y'all,

i appreciate you guys writing back to my other threads...i have a new question...its a bit anal...but i could use the advice...

i have 5 docs i got letters of recs from. i know which 3 are top on my list...but i am not sure of the 4th one...the first 3 are from IM docs.

for my 4th letter, i have a letter from my acting internship (subinternship) from a univ attending, which i did alright in (high pass) but i had hard attendings...so the rec i'm sure will be pretty good but not the best ever...

or should i go ahead and use another rec from my family practice rotation, which i honored in, the doc i worked with was a community family doc who thought very highly of me and got to know me very well...

so is it better to use the sub internship rec, or the family doc? i feel family is definately stronger but i am not sure if the IM people would prefer the subinternship attending (especially at the stronger programs)....

thanks guys.

-dharmabum7

You should use whichever letter you feel that will recommend you in the best possible light. Several factors to keep in mind.

From my reading and talking with my advisor, it is felt that letters from teaching attendings (ie. someone holding a professorial rank at a teaching institution) hold greater weight than a private practice guy. (Is the community doc in any way affiliated with the medical center?) Secondly, many institutions view subI grade and letters more heavily, as it is more "realistic" predictor of how polished you are as a 4th year and how ready you are in becoming an intern. Some institutions (including strong programs such as UT Southwestern) even said they particularly welcome SubI letters. Thirdly, letter variety (ie. from outside the field) always helps. Lastly, superlative letter is a superlative letter no matter the source, while a mediocre letter even from a big name attending wont help.

In most sitution, you will need 3 to 4 letters, even when program ask for 3 you can always assign an extra one:

1. Chairman's letter (you always need it for most programs)
2. Letter (most people use SubI if they did well)
3. Letter
4. Letter

Choice 1 is non-negotiable. Letter 4 will be your family medicine guy. (Even if he is not an academic attending, using it as a 4th letter wont hurt you because most programs require 3, and your 3 required letter are from academic attendings.) The problem is letters 2 and 3. Since you know the SubI letter wont be that strong, I would suggest looking at each program and their letter requirements. If they say SubI letter is REQUIRED or RECOMMENDED, use it, if it did not mention or have no preference, then 2 out of the 3 other letters. Talk this over with your advisor and ask for his opinion.

thanks renovar, that was a really good way of looking at it...
i appreciate the advice ...

Renovar,
Have you ever encountered a program that requires or states that they recc that you have a sub-i letter? That's annoying if they do. I did my sub-i at a private hospital, where the attending never even got to know my name since I was on one of the private medicine teams (private outside attendings), all not by my choice. Thanks.

Originally posted by ckent
Renovar,
Have you ever encountered a program that requires or states that they recc that you have a sub-i letter? That's annoying if they do. I did my sub-i at a private hospital, where the attending never even got to know my name since I was on one of the private medicine teams (private outside attendings), all not by my choice. Thanks.

Yikes, that's unfortunate. As I said, I am aware of UTSW's website saying they strongly favor such a letter, but it fell short of declaring it absolutely necessary. According to the PD at my institution's IM department, he says he would view a strong letter from subI favorably, but he says he wouldn't discount those with only consult/elective letters if a subI grade is available on transcript (inpatient medicine wards and MICU rotations all "count") and is strong. As far as an absolute requirement, of the ~20 websites I visited, I can't recall any program that say it is a requirement (maybe 1 or 2 that hinted they prefer a SubI), but you will have to talk to your advisor or PD regarding inside track of how each PD view subI letters.

Originally posted by Renovar
In most sitution, you will need 3 to 4 letters, even when program ask for 3 you can always assign an extra one:

1. Chairman's letter (you always need it for most programs)
2. Letter (most people use SubI if they did well)
3. Letter
4. Letter

Choice 1 is non-negotiable.

Are you saying that you need to get letter 1 from the chairman of the Department of Medicine? How often do you see him/her during your rotation? Do they really know you well enough, or do they just have your direct superior (resident/attending, etc.) write it so they can sign it? If this is the case, how much weight could the "chairman's" opinion have?

yes a letter from the dept chair is a necessity at many programs..

at our school, we set up a meeting where we discuss our interest in internal medicine and give him a copy of our cv and personal statement. then after that, he check out our transcript, etc...and talks to attendings we have worked with on the medicine clerkship or the subinternship. from there he comes up with a letter.

i'm sure there must be a very similar system at other institutions.

Originally posted by Fermi
Are you saying that you need to get letter 1 from the chairman of the Department of Medicine? How often do you see him/her during your rotation? Do they really know you well enough, or do they just have your direct superior (resident/attending, etc.) write it so they can sign it? If this is the case, how much weight could the "chairman's" opinion have?

Most school says "chair of his/her designate."

At my school it is the 3rd year clerkship director. The chair is too busy/arrogant to deal with writing our letters. He has access to all our 3rd and 4th year medicine rotation subjective and objective evaluations, and pretty much you just go in and tell him that you want to do medicine and give him your CV and PS and stuff. Then he will communicate with your faculty advisor and come up with a letter. Pretty much a "mini-dean's letter" regarding your experience with the department of medicine.

When I was choosing my advisor, glad I knew this fact and got hooked up with him and have him as my advisor in the hope that he know me better personally and write a better letter... So if you still havent choose your "advisor" yet and you want to do IM, find out who this person is in your school, and pick that person, might help you to a degree.