The Ortho Gunner

Getting In - Directory of Posts

This category is about Getting In. Please check out the following posts:

Getting In - The 3 Pronged Approach
Are You A Competitive Applicant?
For 1st Years
For 2nd Years
For 3rd & 4th Years
Mapping A Program
The Chairman's Letter

The Chairman's Letter

If you are applying to Orthopaedic Surgery Residency, it is imperative that you have a letter from your department Chairman. The Chairman's letter is usually a summary letter of your relationship with the Ortho department of your home school. The better you know your Chairman, the better letter you will have. It is wise to meet your Chairman early in medical school to let him know of your interest in Orthopaedics.

Almost every applicant who is preparing for an Orthopaedic application will sit down with his Chairman and let him know that he is applying for Ortho. Most of you will be late in your third year when you actually decide for sure you are doing Ortho. That is too late of a time to be introducing yourself to your Chairman. Some schools actually have a Chairman's checklist cover that is to go along with the Chairman's letter. If you don't know your Chairman well, he may be inclined to write you a nice letter but then check the box on the checklist that indicates he really does not know you that well. That is bad.

What we advise is that you meet your Chairman early in your first or second year of medical school. Get involved in the department with several faculty. Meet every year with the Chairman to let him know what you are thinking. Get input from him on which programs he recommends for away rotations and which programs he has connections at. Finally, sit down with him, bring your CV, and ask him to write the Chairman's letter. If you follow this recipe, you will undoubtedly be better off than your counterparts who don't know him well.

Mapping A Program

What does "mapping a program" mean? It means exactly what it says - you need to draw a map or diagram of any Orthopaedic program you are rotating at. Like any culture, every Orthopaedic Program has a politic and life of its own. You need to put your finger on the pulse of the dynamic within the department. You need to be in the know. Here are some questions you need answered:

Who is in charge? Who makes the decisions? Who has input? Who is liked? Who is disliked? Who knows someone you know? Which residents will help you out? Which residents are most liked or disliked?

These are all questions you NEED TO KNOW when you are at a program. You do not want to ask an attending his name. If you do that, then just go home and forget about that program, you will be done.

When you rotate at a program, you are trying to break in and kiss some serious butt and get on their good side. You are really utilizing the 3-Pronged Approach in a face-to-face format and trying to break into Fort Knox. In order to do this, you need a map of the program and a plan of how you are going to use that map.

Once you figure out your strategy of getting in good with the people who have the most influence in the department, then you need to execute. Work hard, round early, stay late, and follow Away Rotation Etiquette and you will do well.

For 3rd & 4th Years

Third year can be a difficult year for Orthopaedic hopefuls. There is pressure to excel in third year rotations. There is pressure to maintain key relationships with your Orthopaedic mentors. There is pressure to start getting a leg up on the competition. As a third year, your number one duty is to do well on your third year rotations, keep working on your Orthopaedic projects, and start planning your 4th year rotations.

Fourth year is all about the Away Rotation. Please see the posts in the category "Away Rotations" including Choosing a Program, Mapping a Program, and Away Rotation Etiquette. The key for this year is to make smart choices about where you want to rotate and where you want to match. Choosing programs can be the difference between getting a coveted Orthopaedic spot and not matching.

For 2nd years

If you are a second year and you have already followed the instructions in our post about advice for 1st years, then listen up. There is one thing you need to focus on during your second year - STEP 1. You need to start winding up your research projects and start focusing on studying for the boards. There is a lot of temptation to give 100% to everything you are involved in - research, student interest group, clinical exposure, classes. The Step 1 is an important test. It can make or break you and help you get interviews at schools you do not rotate at. It is worthwhile for you to rock the boards. It will make your life much easier come application time.

Everybody has a different aptitude for test taking. Everybody has different study skills and habits for high stakes examinations such as the boards. We advise utilizing the online testing services our parent company provides. We advise memorizing basic sciences. We advise quizzing in study groups. We advise utilizing clinical vignettes and scenarios. Most of all we advise learning the material well during your first and second year classes so that come boards time, it is mostly review.

On the Orthopaedic front, don't fall off the face of the earth when studying for the boards. Keep in touch with your contacts within the Orthopaedic department. Let them know that you are starting your campaign to do well on the boards. Get their support. Give them a stake in your success. Meanwhile, study your butt off.

For 1st years

If you are a first year medical student and you have already read the previous posts about choosing Orthopaedics and getting in, and you still want to do Ortho, then you need to listen up. While the advice we have given about getting a broad medical education is true, you also need to start planting seeds that will grow and provide support for your application during your fourth year of school. There are four things that you can do now:

1. Research.
2. Clinical exposure to Orthopaedic faculty.
3. Starting or holding leadership in the Orthopaedic Surgery group at your school.
4. Excel in your classes.

You need to start showing your face in the Orthopaedic department of your home school. Don't be an annoying and overly eager little runt in the department. Play it cool, set up meetings with attendings, shadow Ortho docs in clinics, see if any residents or attendings need help with their research projects. Research is a great way to get in good with people and show them that you are dedicated and can work hard and follow through.

Leadership is very key to a successful application and to a successful career in Orthopaedic Surgery. Some students do not want to share their desires to go into Ortho with classmates or others. Some students view others as competition and as potentially taking their spot. Some students are very secretive about their studies and ambitions. The qualities most desirable in Orthopaedic Surgery residents are individuals who work hard, are fun to work with, and can show their endurance and leadership under stressful situations.

Starting or becoming active in the Orthopaedic Surgery interest group at your home school is an excellent way to show leadership as well as your interest in Orthopaedics to classmates, faculty and residents. Invite attendings and residents to come speak over lunch or dinner to classmates. Recruit classmates to check out Orthopaedics. In the long run, only those with a true desire will end up applying. In the long run, you will most likely all get into a program. In the long run, you will be known as a friendly, cooperative leader who loves Orthopaedics and wants others to join you in your exciting career choice.

There was once a spine attending to related medical students interested in Orthopaedics to the artistic painters and sculpters of the Renaissance. He said that while the Renaissance artists were in some sense competitors, more importantly, they were colleagues and knew they needed to stick together to make their movement thrive and grow. So the lesson here is to know that your classmates interested in Ortho are your colleagues, not your competitors.

Getting In - The 3 Pronged Approach

There's no question that it is tough to match in Ortho. We at OrthoGunner feel that there are many ways to match into a program. Before we begin, let us first say that if you are a non-allopathic student or an international medical graduate, you face an uphill battle trying to match into a US allopathic Ortho program. We are not saying it is impossible, but this post is directed primarily for those trying to get into programs that match their medical education. We recommend DO students to try to get into DO Ortho programs unless they are certain that an allopathic Ortho program does not care that they are not an MD.

If you read our post on Are You A Competitive Applicant? you'll see a list of all of those variables that are important. Despite that list, we feel that the three pronged approach to attacking a program is the highest yield. Getting into an Ortho program is like breaking into Fort Knox - you are trying to join someone's team and they have their pick of the litter. So you must come prepared for scrutiny. The three prongs are:

Step I
Away Rotation
Research

If you can rock your Step I, nail your away rotation, and have substantial research on your paper application, then you are a shoe in to any good program. There are of course applicants with these qualities that do not match. But those three prongs sum up much of who you are to a residency committee.

Your Step I shows that you can take tests well and thus you'll probably do well on the OITE (Orthopaedic In-Training Examination) every year and do well on your Ortho boards after graduation.

Your Away Rotation shows that you can impress people, are not a social outcast, and that you work hard, are personable and would be a valuable addition to the team.

Your Research shows that you can complete involved tasks under self-direction, that you have an interest beyond just clinical Orthopedics, and that you have the potential to contribute to the advancement of the field. If you have successfully participated in research then that also means that an Ortho attending liked you enough to do research with you and thus you probably have a good recommendation from that person as well.

If you are deficient in any of the prongs, then be aware that it will ding you in the application process. You have to make up for it in other ways and highlight your other strengths, while covering up your weaknesses.

Are You A Competitive Applicant?

In your quest to get into Orthopaedics, you are no doubt wondering if you are a competitive applicant or not. We have all gone through this anxiety and it is good to know where you stand on the spectrum of applicants. This can help you plan your away rotations and 4th year strategy accordingly.

Before we proceed we want to emphasize that our feeling at OrthoGunner is that all medical students interested in Orthopaedics as a career should pursue the specialty no matter what their numbers or paper application looks like. The field of Orthopaedics needs practitioners who are passionate about the field, not just people who can get into an Ortho program. No matter how bad you think your chances are, we have probably heard of someone in worse shape who got into a program eventually.

With that being said, we need to say that the preceding pep talk is directed more at marginal allopathic students who are worried that they cannot match into an allopathic Ortho program. If you are an  Osteopathic student or International Medical Graduate you face an uphill battle. If you are either of those then you need to be a very special student AND you need to be certain that the allopathic programs do not care that you do not have a US MD degree. Most programs on the West and East coasts do care and thus, please see our other post for Osteopathic and IMG applicants.

 

We'll be blunt and basically say that when it comes to Orthopaedic Residency Applicants, the main determinant of whether you are competitive is whether you get an interview or not. You cannot get onto a match rank list without getting an interview. Orthopaedic programs are inundated with applications and thus need to screen applicants by numbers. Most programs interview all of their away rotators and use a Step I cutoff. Here is our list of important variables (in no particular order):

1. Step I
2. Away rotation performance
3. Step II
4. Class Rank
5. Research
6. Third year rotation honors
7. Letters of recommendation
8. Strength of home Ortho program

Step I and Step II and Away Rotation performance are the major screeners for the interview process.  In general we feel that there are four types of applicants in terms of numbers:

Step I >240 Competitive
Step I 220-240 Average
Step I 200-220 Below Average
Step I <200 Marginal

Typically the Competitive Step I score will get your applicant perused for an interview by most programs. The Average score applicant will get similar treatment at programs that have a less stringent cutoff. For those in the Below Average and Marginal score areas, it is important to get interviews from away rotations.

Once you get the interview, all of those other variables will be used to rank you in the interview pool. Formulas vary from program to program, and some programs don't use formulas to create their rank list. In general we feel that most top programs will continue to use your Step I scores in the final rank list. Some good programs will weigh the score less. Some more thoughtful programs will basically toss out the score and compare all applicants on other factors in creating their rank list. If you are one of those Marginal or Below Average applicants, your mission is to find those more thoughtful programs to up your chances of success.

Let us please reiterate, if your dream is to do Ortho, follow your calling and don't let anybody stop you.