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Selecting an orthopedic residency program? Talk to current residents, beware of red flags
Panel suggests examining several factors, including amount of hands-on experience and trauma call.
| PARTICIPANTS | |
| Scott Burbank, MD | Marlo Oyster, MD |
| Augustine H. Conduah, MD | |
![Ryan M. Dopirak, MD [photo]](images/content/OT/commonart/dopirak.gif)
ModeratorSelecting an orthopedic residency program can be a difficult process. Many factors should be considered and each individual will have a different set of priorities. In this virtual round table, we have drawn on the experience of a diverse group of orthopedic residents from across the country to help potential applicants select a program that is most compatible with their personal and professional interests.
Ryan M. Dopirak, MD: In general, what factors should be considered when selecting a residency program?
Scott Burbank, MD: The applicant should determine which program suits his/her interests, both academically and personally. First and foremost, a strong program will ensure that residents receive the most balanced and complete surgical training available. Strength is a subjective measure; however, it can be determined by such fundamental factors as national reputation, faculty experience, academic affiliations, productivity in the orthopedic literature, research endeavors, didactic conferences, etc. An applicant’s goal in pursuing a career as an orthopedic surgeon should be to develop the skills to become a compassionate and competent physician. Applicants must determine which program has the best balance of clinical, surgical and research experiences to match their interests and fulfill their expectations.
Other factors applicants should consider would be an academic vs. a community environment, as well as program size. Some applicants foresee a future in community or general orthopedics while others wish to pursue a future in academic orthopedics. Similarly, some students should consider the size of the program that best suits their personality and find the ideal environment in which to learn. Lastly, many applicants need to accommodate social factors, such as their significant other’s career and family/child considerations, and are influenced by location.
Augustine H. Conduah, MD: The factors that I feel applicants should carefully consider include the current residents’ satisfaction with a particular program, broad and complete subspecialty training, program location, attending teaching participation, research opportunities and program accreditation. Surveying current residents will allow one to glean the most important information about an individual program. More often than not, residents will give direct and honest answers. For example, one should inquire about the degree of actual “hands-on” operative experience, amount of trauma call, and attending involvement.
Because of personal preference and ties to friends and family, geography will always play an important role in program choice. Getting into an orthopedic surgery residency is quite competitive; however, everyone has the right to be selective about which region of the country they wish to live. Remember, the city where one trains will be “home” for at least five years.
Residency should be an academic experience. Therefore, one should consider a program that has dedicated weekly conferences, didactic sessions, journal review sessions and direct performance feedback. Furthermore, medical research is just as important as clinical medicine. In light of this, consider a program that has resources available to support basic science and/or clinical research projects.
Marlo Oyster, MD: Important factors include operative exposure, teaching staff commitment and well-rounded rotation schedules. Another factor that should not be overlooked is finding a program that matches your personality. Programs vary in terms of size, formality, diversity and lifestyles. Visiting rotations and interview days can help you determine how well you may fit with a certain group.
Dopirak: Are there any red flags that applicants should be aware of when applying to residency programs?
Burbank: There are a few specific red flags that should raise an applicant’s suspicion regarding a program’s standing and reputation. Applicants should investigate a program that is currently or has been on probation. The applicant should determine both the reason for the probation as well as the measures being taken to assure the problems are being rectified.
Increased faculty turnover and a history of residents leaving the program or transferring to another program are factors that cannot be ignored and may hint at a larger problem. Programs that consistently matriculate medical students from the same program(s) may present added difficulty for those applicants from outside programs to receive interviews or subsequently match. A good barometer of a program’s worth can typically be discovered in assessing the current residents’ happiness and loyalty to their program (at interview time).
The financial status of the health system that the residency program is affiliated with is worth exploring. The financial burden that many hospitals and health systems are facing may have a direct impact on the funding for resident training and education.
Conduah: First of all, don’t believe everything one might hear from other applicants while on the interview circuit. The interview circuit can be a forum in which falsehoods are perpetuated. Get one’s information directly from residents and attendings at the respective programs.
Be wary of trauma-heavy programs with long hours which do not allow residents adequate time for reading and literature review. Allocating time for reading is especially important in the dynamic field of orthopedic surgery. In addition, be cautious of programs that are not accredited or that are on probation. Investigate these programs further to find the reason for this status. Furthermore, steer clear of programs where the residents seem unhappy. A red flag would be a program that has a relatively high resident turnover rate.
Oyster: I would be wary of a program that did not give you an opportunity to interact with the current residents. When I was interviewing, I found it useful to talk to the current residents about the pros and cons of their programs. I think most people are pretty honest, and current residents have the greatest insight on the strengths and weaknesses of their programs. Also, it is never a good sign when a significant number of residents have dropped out of a program.
Dopirak: I strongly agree that it is important to determine if the program is currently on probation or has been on probation recently. This as the potential to affect program accreditation, which, in turn, may affect a resident’s for board certification.
Another critical factor to consider is the program’s passage rate of the ABOS Part I Examination. Failing your orthopedic boards can lead to a great deal of emotional and financial stress and can complicate the hospital credentialing process when you begin your practice. Additionally, you will be forced to spend a great deal of time studying for boards during your fellowship, a time when you should be focusing on your specialty training. In the past two years, the passage rate for U.S. and Canadian graduates who were first-time examinees was 92.9% and 96.3%, respectively. I would be hesitant to choose a program whose passage rate is substantially less than this as it may be an indicator that the program has a low education-to-service ratio.
What specific factors were ultimately most important to you at the time you selected your residency program?
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Burbank: I specifically sought out the program (among those at which I was granted an interview) that appeared to provide the most balanced clinical training based on the success of its graduates and the unbiased views of its current residents. At each interview session, I specifically spoke with the current residents to gauge their happiness and confidence with their training program. I also inquired about what the graduating residents pursued beyond their residency training. Lastly, I needed to accommodate my wife’s career as an attorney, and I was somewhat regionally limited in that regard.
The factor that ultimately was most important to me was the camaraderie that I developed with the residents and fellow medical students during my formal fourth year one-month rotation. I was provided an unparalleled look into the program and I was able to gain the trust and confidence in the training program. Applicants should take full advantage of this opportunity as there is no better way to evaluate the quality of a program.
Conduah: Ultimately, location and program reputation were most important to me when I ranked my residency program. I aspired to attend a highly regarded program while remaining in Southern California. I also wanted to train at a program that offered a very broad operative and clinical experience in each of the orthopedic subspecialties. Moreover, my mentorships in medical school significantly influenced my program choice. The orthopedic attendings I worked with not only fostered my interest in orthopedics, but also attracted me to this program because of its focus on academic medicine.
Oyster: I was looking for a residency that would give me a well-rounded rotation schedule in all areas of orthopedics with a dedicated teaching staff. I also wanted a program with a strong operative experience both in terms of case volume and independence. Almost every program I visited during interview season offered an excellent orthopedic education, but some programs clearly offered stronger faculty support and clinical experience. In addition, I chose a program where I had done a visiting clerkship, and in an area of the country close to where I grew up.
Dopirak: I wanted a program that provided enough well-rounded, hands-on experience that I could directly enter a general orthopedic practice upon completion of residency. Although the vast majority of orthopedic graduates now pursue fellowship training, this is ultimately the primary goal of an orthopedic residency. At the same time, however, I wanted a program that had a strong track record of matching its graduates into competitive fellowship programs in a variety of subspecialty areas.
It was also very important to me to select a program that had a strong academic curriculum with a well-structured conference schedule. My residency program had a very high education-to-service ratio with 100% passage rate for ABOS Part I; that was critical in my decision-making process. You have now been in residency for several years. In retrospect, are there any factors you would weigh more heavily if you had to go through the residency application process all over again.
Burbank: Upon entering my last year of residency, facing both fellowship training a year away and an orthopedic career to follow, I would weigh certain factors more heavily at this point. Operative experience, clinical confidence, and technical skills are factors that are critical to acquire as a resident as these are difficult to gain as an independent clinician. Therefore, it is imperative to find a residency program that habitually develops these skills in its residents.
Didactic teaching as well as board exam preparation and performance are also important factors to weigh when evaluating a residency program. Although residency training is adult, self-guided education, I would encourage students to pursue programs that encourage and facilitate learning during the early years of the residency training. Acquiring a sound base of clinical and scientific orthopedic knowledge during the first couple of years of residency is an important foundation to build upon that cannot be understated.
Conduah: Many orthopedic residents now participate in fellowship programs. If one is interested in fellowship training, it is important to consider the quality of the fellowships attained by residents at a particular program.
Are residents at a particular program matching at competitive fellowships? This speaks to both the caliber of the residents and to the programs’ commitment towards its residents. Training at a well-regarded fellowship that satisfies one’s educational and professional goals can provide excellent career opportunities.
I would also consider the case log activity of the chief residents at each program. Some chief residents may graduate with a heavy trauma experience and not a whole lot of basic arthroscopy training. Others may do several primary arthroplasties and pediatric procedures and have limited trauma exposure.
Ultimately, selecting a residency program that is the “best fit” is a personal decision that is influenced by one’s personality, educational and career objectives and personal obligations.
Oyster: From my experience, the match process works well. I would suggest that current applicants try to visit and apply to a variety of programs in terms of size, academic affiliation, and location. It is impossible to know what’s out there unless you look around.
Dopirak: If I had to do it all over again, I wouldn’t change a thing. I feel that received an excellent education and matched into my top choice for fellowship. However, there are a couple of intangible factors that I did not think about at the time of application, which ultimately proved to be very important during my own residency experience.
First, you need a chairman who is committed to his residents. Residency is a physically and emotionally challenging time.
You need a chairman who is approachable and willing to listen.
He/she also must be willing to go to bat for you when necessary. Second, a strong CV doesn’t necessarily guarantee a great fellowship. There are a lot of politics involved in the fellowship process. You need attendings with connections across the country who are willing to write letters and make phone calls for you, so that you can secure a competitive fellowship position. Last, you will be spending the majority of your time during the next 5 years with your fellow residents.
If you enter a program where residents are constantly trying to outperform one another, the atmosphere will be unpleasant and your experience will be miserable. In contrast, if the other residents are team players, you will have the opportunity to develop strong friendships that will last a lifetime.