Navigating Postgraduate Orthopaedic Surgery Education

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Excerpt

Orthopaedic surgery continues to be one of the most competitive specialty choices within medicine.1 For the 2015 matching season, 1,058 orthopaedic residency applicants (874 US senior medical students) vied for 717 positions across the country. Of those who successfully matched, 650 were US senior medical students (for a 74% match rate), and no program went unmatched.2 The average annual percentage of all graduating US seniors applying to orthopaedic surgery has remained relatively stable at just over 4% for the past 30 years.
What is not captured by this statistic is the general increase in the number of medical student graduates over that same period (approximately 14%) or the exploding numbers of programs to which each applicant applies. With the creation of the Electronic Residency Application Service (ERAS), the process of applying to residencies has been streamlined to a very high degree of efficiency, allowing today’s applicants to apply to well over 80 programs. This leaves the 163 orthopaedic surgery residencies that participate in the Match in the unenviable position of having to sort through 88,169 applications for 717 total positions from just over 1,000 total applicants.2,3
The mathematics behind this is mind boggling, and many of the programs involved are forced to search for greater objectivity throughout an application process that has necessarily come to include a notable degree of chance. Simply because one person matched the year before with a certain set of character traits, many will see those traits as being indispensable for the participants in the next application season without evaluating the presence or absence of additional traits, the comparative strength or weakness of the many traits that yield a good match, or any traits that may have contributed to a failed match. Although many authors have proven that relationships exist between the likelihood of an applicant matching and that applicant’s United States Medical Licensing Examination (USMLE) Step 1 score, medical school reputation, American Orthopaedic Association status, numbers of honors on senior clerkship rotations, and the number of programs ranked on the applicant’s list at the end of the season, no studies have presented an agreed-upon definition of success in residency or in fellowship or how to predict such.4,5 Commensurately, no study exists that has identified criteria on which to base a successful match.6 Inevitably, this ultracompetitive and poorly defined contest leads to misinformation being promulgated by everyone, from deans to student advisors, about how students should position themselves to gain entry into an orthopaedic surgery residency program—with most advisors discrediting the degree to which chance influences the outcomes for orthopaedic surgery applicants.
Once an applicant matches, he or she becomes a part of Graduate Medical Education (GME). Over the past 10 to 15 years, GME has seen tremendous change in its core principles.7 At times, these changes have been innovative and have directly improved processes of quality control, evaluation of the learning environment, and providing feedback to the learners.7,8 Many authors, however, suggest that unintended consequences have become most apparent during the next phase in a resident’s evolution.9-11 With the multifactorial trend toward today’s graduates pursuing postgraduate training, success at the fellowship level is imperative for the young attending surgeon.12,13
The purpose of the following series of articles is to help the orthopaedic surgery residency and fellowship applicant better understand the logistical processes that, in part, form the underpinnings of orthopaedic surgery education, from medical student all the way to orthopaedic surgery fellow.
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