Requesting A Letter of Recommendation

One of my students recently asked me for a letter of recommendation for residency application. While I don't mind writing these, I did suggest she tries to get letters from elsewhere as well- my little hint that I really didn't get to spend enough time with her to give a glowing review. But I thought perhaps some of you out there might these tips find this helpful:

• Try to get letters from the physicians/professors in the specialty for which you are applying. No, you don't need ALL your letters from a surgeon, or a pediatrician, etc, but perhaps a couple.
• Let them know early on in your rotation that you are hoping to get a letter from them. This allows them to perhaps challenge your knowledge more, or give you more opportunities to shine or to do presentations.
• At the finish of the rotation, ask if they'd be comfortable writing you a good letter. If you sense some hesitancy, look elsewhere. Because most letters are confidential you never know what they may say and a good letter from an unknown physician is better than a bad letter from a renowned professor. I'd prefer not to write a student a shitty letter, but if you keep pushing you might just end up getting one.
• If your rotation is early in the academic year, it's probably too early for your referees to be submitting the letter. However you'd want to at last tell them before you are done so that they can start a file on you so that when the time comes to ask for that letter, they remember who you are.
• Best to get some letters from the hospital to which you are applying. Or at least some from US hospitals, because the truth is these carry more weight for many than an overseas letter.
• Plan to spend at least a month in that rotation. I personally have trouble writing letters for people with whom I have worked for less than a couple of weeks.
• Kissing ass helps. No, I'd go as far as to say kissing ass is a necessity. And I don't meant wanting medstudents to wash my car or fetch me coffee. But SHOW SOME ENTHUSIASM! Take the initiative to find articles relevant to what we talked about. Offer to give a small presentation to your peers in our group. IMPRESS ME!
• Don't expect a letter if you're going to be lazy. The one person I subsequently declined had the cheek to tell me she didn't study up the topic we were going to discuss because "It was Mardi Gras yesterday!"
• When you submit to your referee your info and instructions for the letter, also give them a copy of your CV. This may help reinforce their points.
• It's good manners to say thank you, or to write a thank you card after the letter has been sent.
• It's also good manners to update your referees after Match Day to let them know where you matched. Really, we'd like to know.

Many of these are really common sense, but I thought some of you might find it helpful. The academic year is in full swing, and soon many of you will be submitting your applications. Good luck!