Although I agree with OSU03 about the fact that it varies from program to program, I disagree that the Dean's letter is the most important. Probably far more important are letters from Orthopaedic surgeons that you've worked or rotated with. The fact that Dean's letters aren't released until Nov. 1 and most candidates will hear back about interviews either around that time or very shortly thereafter attests to the relative unimportance of that particular document. I would also strive to have all of your submitted letters come from Ortho surgeons, as letters from other physicians (except maybe those from docs that you've done research with) carry, on average, very little weight. In fact, one of my now ortho intern friends had a non-ortho letter thrown into the trash during his interview as his interviewer was reviewing the contents of his file. Just my $0.02.