Aside from the typical anesthesia clinical letters, what kind of letters are program directors at big name institutions looking for in regards to the combined anesthesiology/CCM 5 year paths? My school doesn't have anesthesia-trained CCM attendings (well there are a few but they don't do any ICU work) so getting a letter from someone like that isn't feasible at my institution. I could get a great letter from a trauma/SICU attending. Would I need an IM/CMM letter? Or would I need to rotate somewhere with anesthesia in the ICU?