Chossing an author for a letter of recommendation should be considered thoroughly and well before asking. The process of narrowing down potential writers should begin in the 3rd year and carry on into the 4th year with electives and away rotations. It is important to understand that there is verbage that experienced faculty and academicians use to communicate with other program directors, etc. about candidates that are not well known to community physicians.
In fact, an important consideration is to not request letters from non-academic physicians. This is due, once again, to word context, recognition, etc. They may have been great to work with and/ or advisors, but if they’re in private practice they aren’t usually well known in academics or may write a letter that’s viewed differently than they intended. Even more important, even if you have chairs, etc. that are in academic hospitals, but don’t have a residency program, don’t ask. My letter from a department chair who did not have a residency was never discussed in interviews – while those from chairs with residencies were consistently brought up with glowing references.
Further delineation between selecting professors to whom you will approach for a letter should also be considered. You should not have more than 2 assistant professors write you a letter with the majority coming from chairs/ vice chairs of departments or associate professors. This is due to the nature of promotion in the academic hospital, the time spent in research and publishing, and the overall name recognition that comes with more senior faculty. It can be hard to do since a lot of assistant professors are more involved with med students, but try to get some time in with the big guns. Letters can also be obtained from chairs while on away rotations and is often viewed favorably. It shows that you did well enough in a program outside of your institution for that chair to write you a letter. Just make sure to ask everyone you're requesting from if they feel that they could write you an outstanding letter (work on that wording so not to offend). It is important to know since some will write for you out of politeness, but don't feel you've been a great student and their letters reflect this thought.
As far as the dean’s letter, aka Medical Student Performance Evaluations (MSPEs), these are usually scheduled to be uploaded to your ERAS application the 1st of November and are essentially a comprehensive record of your time at your school. They invariably contain transcripts, information about any difficulties you’ve encountered (like repeating a class, year, etc.), perceptions of your talents, and may contain your class ranking. As I’ve said earlier, many programs don’t wait for these before offering you an interview, but some will want to see these before they ask. It is in your best interest to talk to the program coordinators at your intended programs (not the program directors mind you) about their policy on interview offers well in advance in order to know who will be offering interviews earlier than November 1. This will save you some hair pulling as you don't receive offers from some of your premiere choices while others are pouring in.
An extremely important, but often overlooked item, is that the coordinators can provide a great deal of information for you about the residency. Their contact information is easily found on the Frieda website. It is wise to be very nice to these coordinators, no matter how stressed you are, as they can make it a lot harder for you to be considered for residency. It was once explained to me that they can't vote you in, but they can sure as hell keep you out.Interviews themselves range between late October through February, unless you’re early matching or military. As I’ve already said, I don’t know much about those so I won’t be discussing them. Scheduling can be a hassle. Know that now. Interviews may only be held on certain limited dates, interfere with other interviews already scheduled, don't correspond to another interview time in the same area, and should be replied to ASAP to avoid being waitlisted.
Additional concerns relate to those programs that wait until the dean’s letters are out – as you will invariably receive many offers prior to this that may narrow your acceptance time and force you into deciding between two programs. Once again, it is important to know where you think you’d like to go and what their policy is regarding interview offers before dean’s letters are out. This can help you decide where you'll be more willing to request another date or cancel altogether when such problems arise.
Hopefully these couple of posts have been helpful and don't just make you more crazy. I feel that the more you understand and take action now, the less it will hurt in the end.