How do you get an LOR at a teaching hospital?

[GreenShirt]

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My school rotates at community hospitals which means that there is just one student working with the attending (no interns, no residents, no other medical students) throughout the whole rotation. You're at the physician's side all day. You eat together. You work together. Of course, this makes getting a thorough LOR pretty easy.

At teaching hospitals, I've heard that it would be unlikely for a medical student to even speak to the attending b/c they are taught by interns/residents who in turn report to the attending. How do you get the LOR from the attending in that situation? Do they just rely on feedback from the residents when writing a letter?

 

[njbmd]

My school rotates at community hospitals which means that there is just one student working with the attending (no interns, no residents, no other medical students) throughout the whole rotation. You're at the physician's side all day. You eat together. You work together. Of course, this makes getting a thorough LOR pretty easy.

At teaching hospitals, I've heard that it would be unlikely for a medical student to even speak to the attending b/c they are taught by interns/residents who in turn report to the attending. How do you get the LOR from the attending in that situation? Do they just rely on feedback from the residents when writing a letter?

I speak with plenty of medical students on a daily basis and when I was a medical student, spoke with my attending physicians at every teaching hospital. Getting letters was a non-issue for me as a medical student and I certainly write plenty (if asked) as an attending.

 

[deuce924]

I would listen to njbmd....

 

[TinyFish]

Agreed. I've rotated almost exclusively at a larger teaching hospital, and although there are a few rotations during which you do not have too much interaction with the attendings, you do on most. Don't worry, you don't get lost in the throngs at a teaching hospital - in fact, there are plenty of people (attendings and residents) who take time to interact with you and teach you things.

w.r.t. LOR's - make sure you ask someone with whom you get along, who has seen you work clinically, but don't freak out about it. Most attendings are used to being asked for letters and know what the process is like. In some cases (as was mine), there is no choice but to ask people with whom you haven't had a TON of interaction with, but it still works out.

 

[twilightdoc]

...At teaching hospitals, I've heard that it would be unlikely for a medical student to even speak to the attending b/c they are taught by interns/residents who in turn report to the attending. How do you get the LOR from the attending in that situation? Do they just rely on feedback from the residents when writing a letter?

I hope that you are overstating the "unlikely to speak to the attending" situation; that doesn't seem to be the case on any rotation at the institution at which I work, or at most other "main" teaching hospitals of medical schools with which I am familiar. The faculty members who attend on the inpatient services at my institution are quite familiar with the students with whom they work, and are well-positioned to write letters of recommendation for them if asked.

In terms of letters, it is important that the person writing the letter has worked with you and can comment from "first hand" experience on your work habits, clinical and interpersonal skills, professionalism, knowledge base and the ability to "use what you know". In general, it is probably not a good idea to get residency letters from residents or fellows. While they may know you well, they may not have a good grasp of what the letter should say and emphasize, and the programs to which you apply may wonder why you couldn't find a faculty member willing or able to write the letter.

 

[ucsfstudents]

Agree with NJBMD. We have easy access to any of the attendings we work with. You might be surprised at how accessible they are.

 

[SouthernSurgeon]

yeah, I've had no issues with attending accessibility at an academic hospital.

On medical services there are formal rounds where you spend 1-2 (or more...) hours per day with the attendings, plus many attendings will hold specific teaching rounds for the med students. On services like GI or cards the attendings welcome the students in the cath lab and the endoscopy rooms so that is more opportunity to interact.

And then of course on surgery you will spend hours and hours scrubbed in with your attendings.

Residents have in my experience helped with the LOR process by telling you who the good attendings are to work with, helping you prepare for rounds and presentations, and putting in a good word for you with the attending.

 

[vicinihil]

Just to sound ignorant..how many LOR's should we be aiming to get during our 3rd year total for residency applications?

 

[twilightdoc]

Just to sound ignorant..how many LOR's should we be aiming to get during our 3rd year total for residency applications?

Usually 3 letters. Some programs ask for a "chairman's letter" or a "clerkship director's letter", which could either be one of the 3 or could be a 4th. But I wouldn't submit more than 4 letters. Depending on how your school's calendar is set up, you might be able to get a letter or two from electives taken early in the 4th year. In general, students have substantial contact with attendings on their electives, and arranging your elective year to increase your pool of potential letter-writers in your area of interest can be a good strategy.

 

[vicinihil]

Excellent thanks for your input. I will make sure I establish good rapport with my attendings next year. Our 4th year electives begin end of April so it should be a good time to get some Acting Internships and Away Rotations recommendations

 

[SouthernSurgeon]

Usually 3 letters. Some programs ask for a "chairman's letter" or a "clerkship director's letter", which could either be one of the 3 or could be a 4th. But I wouldn't submit more than 4 letters. Depending on how your school's calendar is set up, you might be able to get a letter or two from electives taken early in the 4th year. In general, students have substantial contact with attendings on their electives, and arranging your elective year to increase your pool of potential letter-writers in your area of interest can be a good strategy.

Sort of. This first part is all correct, except this is how many letters you need period for your app, not how many you need from third year. Personally I got every one of my letters from my fourth year rotations without any issues; most of my classmates got somewhere in the neighborhood of 0-1 letters third year and the rest 4th year.

 

[Neuronix]

It's almost impossible to get LORs on most core rotations here at the big academic centers. There's too little direct interaction with the attendings and the attendings change frequently. On one rotation my attending changed every 2 days and on many rotations attendings change every week. At the very least it was every 2 weeks.

We get them during fourth year electives and sub-Is.