Miriyam Ghali, B.A.: Miriyam Ghali is an MD/MBA Dual Degree Candidate at the University of Miami Miller School of Medicine (UMMSM), Class of 2024, and currently serves as the UMMSM Student Government Diversity Representative, American Medical Women’s Association Secretary, and Association of Women’s Surgeons Mentorship Coordinator. Miriyam graduated from Columbia University in the City of New York in 2019 with a degree in the Biological Sciences and competed for Columbia’s NCAA Division I Women’s Swimming and Diving Team.
Ram Yakkanti, MD: Ram Yakkanti MD, is a PGY 4 Orthopedic Surgery Resident at the University of Miami/Jackson Memorial Hospital Department of Orthopedic Surgery. He is the Academic Chief Resident for the residency program and is involved in orthopedic curriculum development for residents, as well as being involved with mentoring of junior residents and medical students pursuing orthopedic surgery. He is headed to the Rothman Institute in Philadelphia to train as an adult reconstruction surgeon.
So You Want to be an Orthopedic Surgeon?
Orthopedic surgeons specialize in the prevention, diagnosis and treatment of musculoskeletal system diseases and injuries. The field of orthopedic surgery is immense and includes general orthopedics as well as surgical sub-subspecialties in trauma, hand, foot and ankle, pediatrics, sports medicine, adult reconstruction, shoulder and elbow, spine and musculoskeletal oncology (1). Orthopedic surgery is arguably one of the most competitive residencies, and the 2021 Match Rate for US Allopathic Seniors applying to Orthopedic Surgery was 79%.2 This article serves as a practical guide for motivated medical students looking to increase their chances of matching into orthopedic surgery.
Shadowing
If you’re interested in Orthopedic Surgery, you should shadow as much as possible during your pre-clerkship years. Shadowing will expose you to the field and its various subspecialties, allowing you to understand if orthopedic surgery is the appropriate field for you, and maintain your motivation to pursue one of the most competitive surgical subspecialties in medicine. In addition, shadowing will help you cultivate meaningful relationships with current residents and faculty at your institution and prepare you for performing well during your surgical clerkships. Ultimately, building a strong Ortho Network early in your education will help you secure future research opportunities, strong letters of recommendation, and network with passionate mentors in the field of orthopedic surgery.
Academic Performance
Most medical schools in the United States are moving towards a true pass/fail curriculum. Although this levels the playing field and reduces stress during the preclinical years, it eliminates one mechanism through program directors can stratify applicants from a crowd of qualified applicants. In light of these changes, there are several extracurricular opportunities you should engage with to build your CV early on and ultimately create a competitive residency application. On the other hand, if you attend a medical school that still provides preclinical grades, be sure to stay at or near the top of your class. Preclinical grades have historically been a major component in the Alpha Omega Alpha (AOA) Honor Society selection process, which is an opportunity you don’t want to miss out on. If your school recently eliminated AOA Honors in light of a pass/fail curriculum and board scores, don’t worry. Only 40% of 2020 applicants who successfully matched into Orthopedic Surgery were AOA members (2).
USMLE Step 1 and 2 Exam Scores
Now that the USMLE Step 1 Examination is graded on pass/fail basis beginning January 2022, program directors are likely to place a greater emphasis on USMLE Step 2 CK scores. Although this change is generally positive and mitigates specific stressors throughout medical school, no one knows for certain how this will affect aspiring Orthopedic Surgeons until we see the results of the 2024 Match. We recommend that students interested in Orthopedic Surgery aim to outperform their peers by a wide margin. Program directors will likely continue to look for outstanding test takers, through Step 2. For example, the mean Step 1 and Step 2 scores of Orthopedic Surgery applicants who successfully matched during the 2020 residency application cycle were 248 and 255, respectively (3). Both of these scores are significantly higher than the national averages, and applicants should consider preparing as soon as possible for a successful Step performance. Keep in mind, however, that program directors generally take a holistic approach when looking through applications. A less than stellar step score doesn’t define you, and it won’t preclude you from becoming a successful Orthopedic Surgeon. However, a great Step score will ensure that all doors are open for applicants, as many orthopedic surgery residency programs tend to have a cut-off score for prospective applicants to earn an interview at their program.
You may be asking yourself “how am I supposed to stand out from a crowd of exceptional applicants when everything is pass/fail?” Well, here are several ways to demonstrate your impeccable work ethic, dedication to the field, and leadership qualities to Ortho Residency Program Directors:
Research
Orthopedic Surgery research will prove highly valuable and help demonstrate your dedication to the field. On average, successful Ortho applicants in the 2020 Match had over 5 meaningful research experiences and reported 14.3 abstracts, presentations, and publications (2). Additionally, engaging in clinical and/or biomedical research throughout medical school will allow you to build a strong skillset and impressive CV for residency and future fellowship applications. Start off by identifying areas of interest, connecting with residents and faculty, and reaching out to your school’s orthopedic surgery interest group to find available projects.
Community Service and Leadership Experiences
As a medical student, there are ample opportunities for you to become involved in community outreach. Whether you’re traveling abroad for a medical mission trip or taking vitals at your school’s local clinic, your time is valuable and it’s truly making a difference to your community. Identify initiatives that speak to you and get involved early on. If you are passionate and successful, apply for leadership opportunities at your school’s free clinics and health fairs. Be sure to keep track of your involvement and include every project on your CV, especially if you served an administrative or leadership role. For reference, successful Orthopedic Surgery applicants in the 2020 match reported an average of 8 community service experiences (2). Finally, be prepared to speak about your experiences passionately during interviews. Program directors will value your enthusiasm and the work you’ve done to make an impact in your community. Leadership experiences are highly valued by program directors and may include involvement in student organizations and interest groups, athletics, and personal hobbies.
Letters of Recommendation
With historically standardized metrics becoming pass/fail, strong letters of recommendation from faculty and mentors in your field of interest are becoming increasingly important. Students must aim to obtain meaningful letters of recommendation from academically involved orthopedic mentors at their home institution. A letter of recommendation from either your school’s Orthopedic Surgery Program Director or Chairman of Orthopedic Surgery will help get your application through the door, especially since these faculty are well-connected and eager to advocate for standout students. Great letters of recommendation are earned through diligent work on clinical rotations, exceptional dedication to research projects with faculty, and open lines of communication with faculty throughout your medical school experience.
Away Rotations
Away rotations are a great opportunity for students with a weaker application on “paper” (average academic performance, low step exam scores, and minimal extracurricular activity) to demonstrate their ability as hardworking, thorough, safe, and diligent clinicians. Successful orthopedic surgery applicants over the past several years have completed between 2 to 3 away rotations prior to the residency application cycle (4, 5). Many programs place a lot of weight on outstanding away rotators even if their “numbers” are not as strong because they know that a great rotator is likely to make a strong resident. Away rotations allow students to network with faculty at their dream program, leave a lasting impression, and earn a meaningful letter of recommendation for future applications. More importantly, students directly experience what life as an orthopedic surgery resident would be like at institutions they are strongly considering as their top choices.
Applying
ERAS data from the 2021 Match shows that Orthopedic Surgery applicants submitted an average of 77 applications at institutions across the United States (2). When crafting your list of residency programs, apply broadly but strongly consider where you want to spend the next 5 to 6 years of your life. Additional factors to take into account include career aspirations and networking potential, location and proximity to your support system, spousal and familial needs, and an honest evaluation of your experiences on away rotations. Finally, consider coordinating your applications with your peers, especially if a large pool of your class is applying to orthopedic surgery. Programs will not be able to interview every single applicant from a single institution. If you absolutely know where you want to complete your Orthopedic Surgery training, share this information early on with your mentors and peers to optimize your chances of matching at your dream program.
References
1. Gehrig LM. Orthopedic Surgery. American Journal of Surgery. September 2011;202(3):364-8.
2. “Advance Data Tables for the 2021 Main Residency Match.” The National Resident Matching Program, March 2021. PDF File.
3. “Charting Outcomes in the Match: Characteristics of U.S. MD Seniors Who Matching to Their Preferred Specialty in the 2020 Main Residency Match.” The National Resident Matching Program, July 20210. PDF File.
4. Davis, W, Uribe, J, Yagnik, G. A practical guide to orthopedic surgery away rotation success, Current Orthopaedic Practice: January 2019; 30(1):4-7.
5. Baldwin K, Weidner Z, Ahn J, Mehta S. Are away rotations critical for a successful match in orthopedic surgery? Clin Orthop Relat Res. 2009 Dec; 467(12):3340-5.