shine on a fourth-year sub-internship and earn strong letters of recommendation

My acting internship in internal medicine starts next month, and I am hoping to ask the inpatient attending for one of my primary ERAS letters of recommendation. What separates a strong sub-intern from a good third-year clerk, and when is the best time during the four-week block to ask for a letter?

The transition from MS3 to sub-intern comes down to ownership and anticipation. As an MS3 you report what happened; as a sub-intern you act as the patient’s primary intern under supervision:

1. Close the loop without being asked: Follow up on afternoon potassium replacements, pending CT reads, microbiology gram stains, and consultant recommendations before the senior resident asks, and update the team.
2. Own transitions of care: Start discharge summaries, medication reconciliations, and outpatient follow-up planning 48 hours before discharge, and call primary care or family members to clarify baseline function.
3. Support the MS3s on the team: Helping third-year students practice their presentations or teaching a 3-minute chalk talk on hyponatremia shows teamwork and resident readiness.

For the letter of recommendation, ask for a brief midpoint feedback check-in at the end of Week 1 of that attending’s service block ("I am strongly applying into internal medicine and would love any feedback on how I can function at an intern level this week"). Then, on the final day you work together while specific patient stories are fresh in their mind, ask: "Do you feel you know my clinical work well enough to write a strong, supportive letter of recommendation for my residency application?"