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Orthopaedic Surgery

General

Orthopaedic Surgery is a very competitive field in medicine; however this should not discourage anyone from pursuing it if you are passionate about it. The following information is based on observations and anecdotes from attendings, residents, and other students on the interview trail. There are always special circumstances and outliers, but those that have been updating this guide believe that it is a fairly thorough and accurate guide to applying for a residency in Orthopaedic Surgery.

What makes a Strong Candidate?
  • First and foremost you have to get in the door by receiving an interview invitation.
  • Important Factors to becoming a strong candidate for an interview (expanded below)
  • Away and home rotation performance
  • Getting to know the powers that be
  • Board Scores
  • Grades, Medical Student Performance Evaluation
  • Alpha Omega Alpha (AOA)
  • Letters of recommendation (LOR)
  • Research
  • Extracurricular Activities
  • Away Rotations
    • The most important factor, when program directors were surveyed
    • This is their chance to get a lot of time with you and see what they are going to get as a resident. Make sure you know your anatomy, work tirelessly, are always enthusiastic, and try to get to know the residents and attendings.
    • One of the most challenging things about away rotations is that each program is different. The differences can be subtle or huge, so it helps to contact people familiar with that program (faculty, other students, etc.). This can help when both deciding where to rotate and when trying to make a good impression once there.
    • Find out who the big names are at that program and see if you can work with them. Always try and work with the Program Director or Chairman if you can. A letter from any of these individuals will go a long way, not only at that institution but at many others. You will soon realize how small of a world Orthopaedics can be!
    • A letter from any of these individuals will go a long way, not only at that institution but at many others. You will soon realize how small of a world Orthopaedics can be!
    • Picking a program to do an away may be one of the hardest things to do. Suggestions from the program director (meeting with Dr. Henn and Dr. Pollakcan be helpful because they have unique insight), attendings that you’ve worked with in the past, or residents may be helpful.
      • Dr. Henn created a document with resident and med student insight on where they did their away rotations. You will get access to this, and it is invaluable. Talk to students who rotated where you are interested - if they are at Maryland or elsewhere.
    • Most programs require an application to get an away rotation, so get the information off of their websites and get those in ASAP (January is NOT too early to be thinking about this) according to their deadlines. Ease of scheduling depends on the program.
    • Away rotations require LOTS of vaccinations, blood work, physicals, etc. You will be up to date on some immunizations, need some boosters, and need other forms filled out by Student Health. You will make multiple trips to them and each visit takes time. Again, start this EARLY (January) and try not to let it hold up your VSLO progress.
      • Recommend blood test over skin test for TB if you can swing it- blood test is valid for longer and some institution requires it
    • Check if the programs you're interested in have a separate health form in addition to the standard one for the VSLO application. Turn these in with your VSLO health forms because they delay to get them filled out by student health is 2 weeks. Get these forms filled out for ALL programs (even your 2nd choices) in case you need to submit an application fast later in the cycle.
    • Just because you perform an away rotation at an institution, that does not guarantee an interview. Some places are notorious for this (have 70+ rotators but will only interview a handful), while other programs interview all rotators. Keep this in mind.
    • Be ready for an exit interview, some programs count the away rotation as an interview, and won’t invite you for a later one. Don’t take this as a negative response. They are trying to free you up for other interviews during the interview season.
      • If they don’t have an exit interview and you liked the program, plan on meeting with the chairman or program director before you go. Let them know that you are seriously considering their program.
    • Aways are an excellent tool to help you decide how you fit in with the program. Even though it feels like you are being interviewed that month, it is also your chance to interview that particular program for the month.
    • Don’t expect it to be easy; it’ll be a new place with unfamiliar faces and you’ll be taking lots of call away from your normal support group. Other students will likely be rotating with you but you can only control how well you do. Stick with it when times are tough.
    • It’s important to know anatomy and “big concepts” on these rotations; however, it’s ESSENTIAL to just be nice, enthusiastic, and on time. This seems trivial, but you would be amazed how often away rotators lack these qualities and it shows.
    • Impress the residents! Work as hard as you can to make the resident’s lives easier and make them look good. Show up early, take initiative, stay late, take call. The current residents have tremendous input into resident selection.
    • You will only be able to get a letter from rotations in June - early Sept because applications are due mid-Sept. If you want to get a letter from a specific away, it will need to be during these months. You only need 1 letter (of 4 total) from aways, so choose wisely.
      • When choosing the order of your away rotations, also keep in mind that you will have more knowledge and be more confident after having done a couple of rotations. While it certainly isn’t the most important factor, it can help.
      • If you want to open a geographic region you are interested in (West Coast, South), you should get a letter from a rotation you did in that region. It can open up interviews in that area.
      • Programs won’t know where you did your away rotations (because it is not listed on your application) except for a letter from an away. That is why it may not help opening up a specific region unless you get a letter from that area. It is common that people will ask where you rotated during interviews so that's how you can highlight your other experiences.
  • Getting to know the powers that be
    • Orthopaedics is a tight network, particularly within the realm of academics. Everybody knows everybody, and certain people’s names go very far.
    • Get to know the Orthopaedic Surgeons at Maryland - they are your biggest allies. At the very least, schedule meetings with Pollak and Henn EARLY to get to know them and talk about your application. (Aim for spring, ideally before submitting away applications - really the sooner the better especially with Pollak)
    • Find out where the faculty members who you work with trained or worked prior to coming to Maryland. They often have many connections and will candidly discuss programs and make phone calls for you.
    • If you know doctors at other programs you may be interested in, or if family members know people, this can go a long way in helping to get an interview, and maybe even strong consideration for a spot as long as you have a decent application.
  • Board Scores
    • Although not designed to be, board scores are the only means of comparing applicants from different schools objectively. Therefore it is many times used as a cut-off for considering applications for interviews.
    • Again, knowing the right people and rotating at specific programs can trump this in many cases.
    • Only USMLE Step 1 is required. If you did well, don’t have to worry about Step 2 until after aways. If you take Step 2 and mess it up it can hurt you. If you messed up Step 1, study over break and try to ace Step 2 before submitting your ERAS application, but try not to sacrifice your grades in Sub-I’s or the ability to do an away rotation (maybe even take July off to study and knock it out of the park). Dr. Henn is a good judge of which path you should take.
      • There are a few (not many) programs which require Step 2 scores by a certain date to rank (Duke, UCSF, BU, etc). Make sure to check their websites.
    • The average board score for people that matched into Ortho has consistently been about 246 and the 25th percentile is about 240. (2015-174 NRMP Match Data).
      1. Below 230 will rarely have any interview offers. The only real chance to match is at a program where you rotated.
      2. Above 230, with other strong areas on the application will get you some interviews.
      3. Above 240, with other strong areas will get you several interviews, may be regional.
      4. Above 250, with other strong areas will get you interviews at the majority of places.
      5. Above 260, just have solid grades, a well-rounded application and letters, and you will likely have more interviews than you can go on.
  • Grades, and therefore Class rank
    • Class rank on the Medical Student Performance Evaluation (MSPE) is divided into the following categories: “top 10%”, “upper third”, “middle third”
    • Programs like Honors (the more Honors, the better)
    • Most programs want strong clinical grades (Surgery, Medicine most important)
    • Ortho Sub-I performance is crucial and mostly outweighs class rank
  • AOA
    • AOA is a surrogate for overall medicacl school performance and will greatly help your application, but isn’t mandatory.
    • Certain medical schools do not have it (Brown) or only offer it at graduation (JHU).
    • Some programs unfortunately use it as an objective criterion for giving interviews (unless you have politics in your favor).
    • Other medical school honors are always beneficial (Gold Humanism, etc).
  • LOR
    • Not a criteria to weed out applications, but once your application is selected for review, this is one of the most important parts of your application. Good letters go a long way to getting you an interview, and a consideration for a position. Again, remember how small the world of Orthopaedics is! A glowing letter from a big name at Maryland will be recognized on a personal level all over the country.
    • Be ready with your most recent resume and personal statement when they ask.
    • Everyone gets a letter from Maryland’s Chairman (Pollak)
    • Ortho Big Names help, but they have to be able to write you a good letter.
  • Who to ask?
    • Any orthopaedic attending that knows you well. Even if they aren’t a big name, a great letter from someone you worked closely with can go a long way.
  • Non-surgical
    • Uncommon - more likely you will have all orthopedic letters
    • Some programs may require a medicine or research-based letter
    • Asking people you did research with or worked closely is fine, but clinical letters from orthopaedic surgeons are valued most.
  • Letters from orthopaedic surgeons at away rotations
      • Likely to be helpful if they got to know you and can speak highly about you. A big name helps but is not necessary.
      • Can be difficult to get at certain programs depending on how you’re scheduled, but try to get one.
      • All programs moved to a standard letter format that your letter writers may ask you to send them. SLOR
  • Research
      • Certain programs will value this higher than others- ask about it on interviews.
      • If you haven’t done any up until this point, find something. This is a big interview topic. Many programs will have interview rooms dedicated to research.
      • Research within orthopaedics is preferable, but trauma, plastic surgery, vascular surgery, or bone radiology are good as well. Of course, any research, especially resulting in publications, is better than no research. Basic science research is valued at some places more than others (Columbia).

    Detailed information and statistics on the match can be found in Porter et al. Survival Guide for the Orthopaedic Surgery Match. JAAOS. 2017.

The Application and Picking Programs to Apply

  • Electronic Residency Application Service (ERAS)
    • Make sure there are absolutely no spelling errors on your application. Check, re-check, have friends/family check. And don’t do this checking the night before.
    • Make sure everything is 100% accurate (especially research and references).
      • Make sure it’s submitted at least a few days before the deadline.
        • Of Note: The ERAS system crashed this past year on the night before and day of it’s opening. Apparently it has happened before and may happen again. Just be prepared. Try to get as much into the system as early as you can before the opening deadline, and when it finally does open, stay calm and submit early.
        • Some programs do not start reviewing applications until all requirements including LORs are uploaded.
    • Make sure that you send your USMLE transcript! There are TWO parts to this. The first part is giving permission to transmit the transcript, and the second part is the actual transmission!
    • Format
      1. Application
      2. USMLE transcript
      3. Official Medical School Transcript
      4. Personal Statement
      5. LOR (limit usually 3-4 / program). Always assign the maximum.
      6. Medical School Performance Evaluation (MSPE) with class rank
      7. Program Selection
    • Application = Glorified CV
      • Biographical info, Education, Medical school awards, Work, Volunteer, Research, Publications, Language Fluency, Hobbies and Interests, Other Awards and Accomplishments
      • Make sure you include everything, especially any honors before medical school.
      • You will need dates (month/year) for everything.
    • Personal Statement
      • Can help you, people read it.
      • Don’t give anybody an excuse to eliminate you from an interview spot, try not to be arrogant; can hurt you.
      • Do not repeat your application.
      • Keep it to one page.
      • Try not to use “I” too much.
      • If you wrote about something specific, you will be asked about it during interviews.
      • The 3 most common themes in personal statements are 1, you had an injury growing up and your orthopaedist inspired you, 2, you played sports growing up, and 3, you loved anatomy. Try to think of something besides these three themes.
      • If there are programs you are particularly interested, it’s a good idea to write a personal statement with something that says that and why. You can upload as many statements as you want. You don’t need to rewrite the entire thing for each program, but you can add a sentence or two at the end that makes it specific to that program. Definitely don’t do this for every program – just the ones you think you really want to be at. If you have a connection to a program or a region that isn’t obvious on the rest of your application, you can put that in too.
    • LOR see above
    • Supplemental Info
      • Several programs require supplemental information like national background check (Case Western - FYI takes FOREVER), MCAT (UCLA, Rutgers), SAT scores, undergraduate transcript (also Case Western)
  • Picking programs
    • Now that the residency application is standardized, it is very easy to apply to many programs, and this is typically what happens
    • If cost is no object, then applying to all the programs in the country may fractionally increase your chances of matching. That said, your best chance of matching is at a program you rotated, so it not worth the money to apply to a bunch of programs. The cost/value ratio is going to be different for each applicant, so there is no ‘right’ number of programs to apply to. Most competitive applicants apply to 40-50 programs.
    • Also it is very important to know that many programs offer interviews on the same day, so just because you get an interview does NOT mean that you will be able to go to all of them. Most programs interview on weekends in late Nov, Dec, Jan. Believe us, you will have to cancel an interview or two.
    • Programs do NOT reschedule. Once you pick a date and time, you are essentially locked.
  • Common advice is to pick the places that you could live, and apply to the programs in that location. They might not be the exact location you want to live, but matching in a tolerable location is better than not matching.
  • The question of academic v. community programs should not matter now unless you know that you want to go academic.
  • Once you make a list, talk to Drs. Henn and Pollak about it! They can offer insight into programs you might want to add or remove.

The Interviews: accepting and interview day

  • Most programs offer 40-100 interviews for 2-12 spots (avg. 4-6 spots)
  • Be ready to get interviews from unexpected programs and rejected by what you thought were “safeties”—although there are no such programs.
  • The number of interviews to shoot for is 10-12 because this gives you about a 95% chance of matching.
    • If you’re a below average candidate or are couples-matching you may need to go on more.
    • If you only get 3 or 4 interviews, don’t be discouraged. Make sure you’re political, and have people calling for you at those places.
  • Accept all interview offers initially right away, even if you’re not sure you want to go there. You may wind up declining later due to scheduling or cost, but that’s ok. Just decline as soon as possible so that people on the waitlist will have a chance to interview.
  • Many places will offer interviews to more people than they have spots and it’s a phone or email race, so check your email several times daily from late Oct-Jan.
    • It helps to have someone else checking your email, especially if you are expecting to be in the OR during this time period. Setting up a dedicated interview email that chimes on your phone is another strategy.
    • Ortho is notorious for sending out interviews late in the season - late Oct/Nov. Don’t compare yourself to non-ortho medical students.
    • Dates fill up fast, so you might not get your first choice date, even if you respond quickly.
    • Many programs offer interviews all at once, and others send out offers slowly and over the course of many days, so if someone you know gets an interview at a place and you haven’t heard yet, you still could get one.
    • Not every program tells you that you’re on the waitlist, so you can get offers very last minute if other people cancel.
    • If there are programs you really want to go to and haven’t heard anything, it can’t hurt to call or email the coordinator and ask for an update. Don’t pester them, but let them know you’re interested and you would like to be considered for an interview if a spot becomes available.
    • Most interviews are December - January so keep your weekends (Thurs-Sun) free during those months. Good idea to take these off/chill electives - no sub-Is.
  • Selecting Interviews
    • By now you should have done your Sub-I’s and away rotations, so you will have an idea about what you want in a program.
      • Academic v. Community
      • Large v. small
      • City / Rural / East Coast / West Coast / Middle America
    • 6 year mandatory: Brown
    • 6 year research option many
    • Female applicants may want to keep some points in mind.
      • Find out how many women residents are in the program and how many women faculty.
      • Consider inquiring if female residents have had children while in the program.
    • Many interviews also have casual dinners before or after the interview. Attend these if at all possible. This is a great time to meet residents and attendings, to see if you fit in with them as well. Many residents will talk candidly about their programs.
      • For some programs this is very important and others it doesn’t matter. It is impossible to tell which program is which, so go whenever possible.
      • Don’t cancel another interview just to make the get-together. Programs are understanding that orthopaedic applicants can have crazy travel schedules at times. Just let the residency coordinator at those programs know in advance.
      • Always act professional. Never become intoxicated. You will hear stories.
      • It’s OK to have fun, but remember that you are being judged. At many places, the residents will go out after the social, and applicants are usually invited. They understand you have to wake up the next morning and be on your game so it’s perfectly acceptable not to join in, but the residents also want to work with people that will fit in with them. Just use your judgment.
  • Interview Day
    • Don’t be late! The entire day is an audition.
    • Remember this- once you are at the interview it’s a level playing field! They want to know if they can work with you for the next 5+ years.
    • Meet the residents.
      • Talk to them as much as you can, ask them questions.
      • Often they have input to the committee regarding who they liked on interview day, so don’t turn off your charm around them.
      • If you can get an email address or phone number of one you connected with, they may be able to help later when decision time comes.
      • Eventually you will rank your programs, and I assure you that much of your decision will be based on how you meshed with the people at the program.
    • Interviews
      • Usually 3-6 sessions of 10-30 minutes long with 1-4 interviewers at a time asking you questions. May be attendings, residents, or research faculty.
      • Bring any LOR, Chapters, Publications, or any other relevant items that may add to your application. If anything, it helps to look over these documents the morning of the interview or during any down-time you may have.

Interview Questions

    • DO you have any questions????
      • The most often asked question, have questions about the program even if you have to ask the same one over and over again.
      • Examples:
        • What is the relationship between attendings and residents like? Could I find a mentor here during my training?
        • Even though I didn’t do a lot of research in medical school, it is something I am very interested in during my training, what opportunities do I have here at this program?
        • Why did you decide to work here?
        • Is this a good place to raise a family?
        • What changes have happened at the program recently or are planned for the future?
        • What are you looking for in a program?
        • Why orthopaedics?
        • Where do you see yourself in 10-15yrs? (Academic, academic affiliated, community)
        • Why do you want to come here? Not just this city, but why this program?
        • What other programs are you interested in?
        • What are you most proud of?
        • Tell me about a time that you failed.
        • Tell me about your most interesting patient?
        • Tell me or explain to me what you did during your research. (Know this cold, including numerical results!)
          • When they ask you this, interviewers are looking for a conversation NOT a presentation! Getting this right might take a little practice.
        • What are your strengths and weaknesses?
        • What words would your friends use to describe you?
        • What do you think of Maryland’s program?
        • Did you spend any time at Shock Trauma?
        • How is Dr. Pollak doing?
        • Where did you do your away electives? Why? Why not here?
        • Who did you work with on your away electives?
          • It helps to make a list of people ahead of time because sometimes your experiences may blur together. People also LOVE hearing when you have worked with their colleagues- it’s an instant connection!
        • Ethics! Ex: You discover that one of the other residents is selling or taking percocet illegally, what do you do? You discover that an attending on call has been drinking and is about to operate, what do you do?
        • There are 17 muscles that attach to the scapula, name them.
        • Bend this wire into the shape of a pentagon.
        • Tie 4 knots in warm cheese as fast as you can.
        • What books have you read lately?
        • Who are your heroes?
        • Tell me a joke.
        • Teach me something.
        • What is the most amazing thing that has ever happened to you?
        • If there is anything that you would like me to think about when your name comes up in the candidate discussions what would it be?
        • What have you done to prepare you for intern year?
        • Read this Xray.
        • Tell me about yourself.
          • Variation: tell me something about you that is not on your application.
        • How do you see the new healthcare laws affecting orthopaedics?
        • What are your thoughts about (insert current event)?
        • What makes you stand out from everyone else interviewing today?

      After the Interview: Thank you letters, phone calls, and second looks

      • Thank you letters
        • Varying opinions.
        • Some programs expect it and don’t tell you, others tell you flat out not to send them.
        • Expect to write thank you notes to the program director and chairman of every place you interview. And if you bonded with another doc it might help.
        • If you’re going to write them at all, write one to the coordinator. Coordinators actually do have a small say in the rank order if you are nice to them!
      • Second looks
        • Going back to a program after you interviewed used to be common. It is strongly discouraged now.
        • Working assessment sheet – After you visit a school I would highly recommend making of list of each program’s strengths, weaknesses or just your gestalt feeling. After ~10 interviews, many back to back, this will be very helpful down the line when making your rank list.
        • 1st Choice – communication with programs after interviewing is discouraged and should be approached with caution. It is ok to inform a program about your intentions, but this should not have any bearing on rank. It is a violation of the Match to solicit information from the program.
          • Do NOT tell more than 1 program they are your number 1; programs talk and this could burn you.

        The Politics of the Match

        • Many programs will hold their rank meetings on the same day as their interviews while their opinions of candidates are still fresh.
        • Some programs wait until the last minute after they make phone calls to their top prospects.
        • Be prepared to get phone calls from programs (residents and attendings); however, this is increasingly uncommon.
        • No matter what, rank where you want to go in order and not where you think you’ll get in.
        • Books for Orthopaedic Sub-I

          • **Netter’s orthopaedics—good overview of ortho anatomy such as muscle insertions, innervations, common pathology etc.
          • **Orthobullets. Get the app on your phone.
          • Less common:
            • Koval and Zuckerman, Handbook of fractures, 2nd Edition—helpful for ED call
            • Physical Examination for the Spine and Extremities, Delahay and Wiesel
            • Essentials of Orthopaedic Surgery
            • Hoppenfeld, Surgical Exposures in Orthopaedics Hoppenfeld –a lifesaver when it comes to OR pimping, will highlight the relevant anatomy

Timetable

      • 1st Year
  • Do the best you can in the classroom
  • Introduce yourself to the Orthopaedic Department here at Maryland - shadowing, early research
  • See if there are any research projects that need med student help, even if it’s data entry
  • Set up something between 1st and 2nd year that is Orthopaedic related if possible
      • 2nd Year
  • Do the best you can in the classroom. Remember that everything you learn in second year is laying the groundwork for later doing well on Step 1, clinical rotations, and shelf exams!
  • Continue to stay in touch with or introduce yourself to the Ortho department
  • Follow up on previous or initiate some involvement in Ortho related research
  • Prepare yourself to study for the boards; these are extremely important. Start reviewing First Aid early and throughout the year. Almost all will agree this is the highest yield strategy for Step 1 scores. Do questions to supplement your studying for school throughout the year can help for boards too (various non-Uworld q-banks available).
      • 3rd Year
  • Do the best you can in ALL of your rotations - especially medicine and surgery
  • During the sub-specialty month, do your best to get the word out that you are interested in ortho, and get into the OR so you can spend time with attending
  • Begin to think about attendings who could write you letters
  • Put together a CV, or update the one you have
  • Get application forms for away rotations. Remember Student Health vaccines/boosters. These will take time!
  • Sometime in Jan/Feb/March, plan a meeting with Pollak and Henn to introduce yourself.
  • Plan your 4th year schedule.
      • Recommendations for early July, August, September, October
        • Plan to do your Ortho Sub-I at Maryland before an away
          • You want to be sharp at the away rotations and experience help
          • If it doesn’t work out that way, many have had their away rotation first and done well
            • Upside: you’ll look more competent on your home rotation
        • Plan to do away electives
          • If you have any desire to go to Hopkins, it’s a good idea to rotate there, especially coming from Maryland.
          • Plan on taking either December or January for vacation or research, you will be interviewing so much a Sub-I or elective is very difficult.
          •  If you didn’t take radiology yet, it is easy to fit interviews into that rotation. They are very understanding of taking multiple days off for interviews.
          • You can do your other required Maryland Sub-I in November or in the spring after January.
      • 4th year
  • Get to know the attendings well wherever you are assigned (VA, Joints, Spine etc.)
  • Get to know the residents
  • Try to rotate/interact with Pollak/Henn
  • As soon as you finish with the Sub-I ask Pollak and other attendings for a LOR
  • Remember that they are all very busy people, their assistants are very nice and always helpful

Other

      • www.orthogate.org is the equivalent of the orthopaedic “studentdoctor.net” that is dedicated to orthopaedic applicants
        • It was often used to see when interview invite dates were released (see below for new google document)
        • Take everything said on the forum with a grain of salt. Especially with this resource, you will find that biases and misinformation are abundant. You will have to sift through it all to get any information.
      • There is a shared google document that exists as of the 2017-2018 application year. You can find it with a google search or on orthogate.
  • CAUTION: this document may cause stress, is made by applicants and therefore subject to misinformation, and is loaded with applicant stats (board scores, number of research projects, tally of interview invites, etc.)
  • This is a great resource for getting a baseline of information and overall vibe of specific programs, although be aware that it is anecdotal and mostly opinion-based
  • This document is most useful to get information about interviews such as when programs send out interview invites and which programs have already sent out interview invites, when the interviews are typically held, etc.
  • Note: Just because someone posted that they got an interview from somewhere doesn’t mean you still can’t! The invites often come out in waves.
      • Have a back-up plan
        1. It’s not a positive thing to hear, but it’s a good idea to know what you’ll do if you don’t match.
        2. The 2 most common options are to do research for a year or to use the SOAP process to get into a surgical pre-lim year. If you’re going to do research, try to set up connections during 4th year and try to find a paid position and make sure you get multiple publications out of it! A year of research without anything to show for it will probably hurt your chances next year (think about the timeframe - can you get publications out between Match in March and applications due again in Sept?). iii. You can consider sending applications to a back-up specialty if there is something else you would enjoy doing, but don’t settle if you won’t be happy in that other specialty. If you do use this strategy and you match, just know that you won’t know if you got into ortho or your back-up until you open the envelope. Will you be disappointed if it isn’t ortho? Is it more important to you to get ortho or to match? Important questions with no obvious answers.

Best of luck

Last Revision: May 3, 2018