LOR from Aways

I'd suggest letting the attending know when you very first meet them (I don't mean the first words out of your mouth...more like right before you leave) that you "are interested in getting a LOR if you think I merit one after working with you." This doesn't put them on the spot later, gives them an early opportunity to tell you to go *&^% yourself (so you can place your efforts elsewhere), or more importantly it may cause them to pay more attention to you when you're around and possibly get to know you better resulting in a better letter.

It doesn't really hurt, either, to approach the chairman at the outset of a rotation to let him know that you would be interested in a letter from him at the completion of the rotation, if he feels comfortable. I got one from a chairman I worked very little with; he simply spoke with the underlings and wrote a very nice letter.

This is a good question; I think that most AI's that we do in ortho seem to give us suboptimal contact with any one attending because they are only one month, or even two weeks. I was concerned about this too when I did my AI's. My approach was to try to pick one or two attendings who were personable and respected enough that their letter would carry some weight, and try to scrub in with them on as many cases as possible (if given a choice) or attend office hours with them and ask good questions that showed them I had read.

Another way to gain their respect is to give a presentation at one of their morning conferences if given the opportunity. If you do a good job and show that you are well prepared then many of the attendings and residents at that program might remember you better. This will also give the attendings something specific about you to mention in the letter if contact with them is otherwise less than ideal, which is usually the case in a one month rotation.