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If you haven’t done it earlier, you should be actively requesting letters of recommendation in June, July and August, as you move into your 4th year.
Letter writers need at least 4-6 weeks of advance notice to complete a letter.
The letters will be stronger and more specific if you solicit them at the end of your rotations!
Most programs ask for three or four letters of recommendation.
If you already have sent in the maximum of four letters to a given program, and want to add a more recent recommendation, you will have to withdraw one letter in order to add the new one.
Ask your letter writers early and communicate your deadline to them. When possible, include faculty who have observed you in your fourth year electives and clerkships where you functioned more independently.Remember that the salient comments from your clerkship evaluations will be included in the MSPE so you may try to avoid the redundancy that will result if you ask the same faculty for LORs.See the Departmental Career Advisors Survey (PDF) for discipline-specific advice about whom you should get LOR’s from.As you go through your clerkships, try to anticipate whom you can ask for recommendations.Work enough with this individual so they will possess the kind of firsthand experience that allows them to advocate for you.
A recommendation from a faculty member in the program you are applying to can carry significant weight as may a letter from a faculty member who knows the residency director in that program.