4th year stuff - letters, aways, etc.

Everyone has a different theory on this so feel free to disagree. Ortho people want to read ortho letters. A letter means more to the reader if it is someone they know or have at least heard of. The more "academic" the program, the more this holds true. For example, I did a rotation at a top tier academic program and the program director told me during my rotation that he wants to see letters from colleagues he knows well. He doesn't care for a glowing letter from someone that is unknown in the academic world. This was a shock and surprise to me because I had always been told that a glowing letter from a random attending that knows you very well is much much better than a so so letter from a big name guru.

That gen surg letter may only be useful if you are applying to community programs. Again, this is just my opinion. This might be a great question for the ask the attending section.

So say you did a research summer/time in a non-ortho lab (probably a decent amount of applicants). I personally spent my year2/3 summer in a gensurg lab and would get a great letter from the attending I did research with. Should I even use this letter for my apps other than the few places that require a non-ortho letter?

Don't waste your time doing a urology rotation to get a letter. A urology letter will not be useful to you. In my experience going through this application process last year I noticed that your letter writers weigh heavily into the interview invitation process. You'll get an interview from programs because someone on their selection committee is friends with one of your letter writers. The regional card comes into play here as well because if you get a letter from say Program X in Boston, you'll likely get an interview from Program Y in Boston because they are friends with the faculty member at their neighboring institution or see them at meetings regularly. Therefore do not waste your time getting a urology letter -- get all ortho letters. The urology research is still useful because research in another field is better than no research at all. I had a bunch of ophthalmology research and although it was talked about at maybe one interview it still showed that I was involved in scholarly activity.

For the guy who has no home ortho program, plan to do your away rotations early and try to get letters from each one.

My end of 3rd year/beginning of 4th year went like this: May SICU, June home ortho, July Step 2, Aug/Sep/Oct away ortho rotation X 3. This was probably overkill, but the SICU depending on what your home institution is like was actually very light and preparing for Step 2 was a breeze compared to Step 1. After the aways I did feel exhausted, but i definitely felt like I knew my stuff very well on those later rotations. And hey.. you're preparing for ortho residency and during residency you don't have a month off here and there to do an easy rotation. Just my thoughts.

The research is fine, however, I would shoot for all ortho letters.

You're right about being concerned for stacking tough aways back to back. They do wear you down. However, doing a lot of ortho makes you pretty comfortable with the bread-and-butter stuff that med students should know. I did 3 orthos back to back and really rocked my last one because I had become very comfortable with the common questions about hips, distal radius and ankles.

As for research, I really dont think its right to rank ortho/surgical/basic science research. What really counts is that you can actively talk about your research with interest and indicate that performing basic science or clinical research in ortho is what you plan to do in your residency (usually by force) and for your career (again, maybe not true, but most programs are in academic centers with research-minded staff).

So dont be afraid to take consecutive aways and be proud of your research!

Yea for me I'm doing three away rotations back to back to back. It's going to be a long three months away from the family, but I hope I have the stamina for it. I don't have a home ortho program, and don't even start 4th year until Aug 3rd which kind of puts me behind the eight ball. I think any research is good, research in surgery is probably better than basic science, and research in ortho is better than that. A lot of people have matched without research obviously, but it seems now it's just more of an equalizing factor than really putting a person above the pack.

Good luck to all this year, I know I'm nervous as all get out with this process.