Most programs ask for three LoRs. Unless there are really unusual circumstances, one of these has to come from the chair of your home school's ortho department. For the other two, would a program where you rotated at prefer to see two letters from their own faculty, or one from their own faculty and one from a respected faculty member at another institution? I ask because I'm currently doing an away where I could probably ask for two letters, but I wasn't sure what the general rule was about that.
If you think it is better to have only one letter from the program being sent, is it better not to ask for two letters from the away elective? Could one of the letter-writers be offended if he/she were to go through the trouble of writing you a letter, only to see that you didnt even use it at all in your application?
I always counsel our own students to have the people who can be your strongest advocates write your letters of recommendation. I have seen far too many students fall into the "must have famous orthopaedic surgeon from program x" write me a letter trap. Get the people who you feel will write you the strongest letters possible and I would encourage you to have a serious conversation with the person you're asking regarding their comfort level in writing you a strong letter of support.
That being said, if you happen to rotate at a program where you have enough contact with 2 attendings then go for it --
Thanks for the response Dr. Levine. In this case, I didn't mean to imply that the letter from the other attending would be any less in quality. In fact, it's possible it might even be more detailed and personal because he was my preceptor and I was his only student for an entire month.
In any case, I'll send along the two letters that seem like they would be the best. As a follow-up, do you think an attending who writes a letter would be offended if you sent a different, "better" letter with the application to his own program? Is it a negative to send four letters instead of the requested three?
You can send more than 3 to most - not that big a deal. However, it's probably not a great idea to not send a letter from an attending whose program to which are you applying --
