As a rising fourth year my experience is kind of limited, but for the most part it seems that your CLINICAL letters are the ones that will matter (unless, of course, you were doing heart transplants with your anatomy prof or working in a free clinic with your pathophys prof).
A lot of people tend to get letters from their fourth and fifth block rotations third year because: A) You've had enough time to figure out how floors work and you can look like a star; and, B) You're not f**king burned out and jaded by the crap you take from everyone else!
Fourth year can also be a valuable time to get recommendations because you're somewhat experienced (relatively speaking), you know what you want to do (relatively speaking), and those stinking fourth years never seem to have to work very much!!! However if you're early match (which includes military), you come up on the time crunch, especially since busy docs are even slower than college profs for recommendations in most cases!
And, of course, they say that a meaningful letter from someone who knows you well is much better than an impersonal letter from the department head. What this translates to is get one or two letters from someone who you worked with a lot - for instance, I worked extra nights around Christmas and New Year's in the peds ER at St. Chris because a doc hit it off with me and said he'd be willing to write me a letter - and then get three or four letters from those impersonal sources. There are few people who are gung-ho enough to hit it off with five or six docs whose letters will matter in their chosen field (surgery, for instance, will laugh at psych letters)(psych people on the other hand would probably be content with letters from the student nurses, or your mom) - and the few people who have are either brilliant ....or bastard gunners.
AF_PedsBoy
Drexel University College of Medicine in the Tradition of MCP Hahnemann
"Still the med school with the longest ...name"
