Advice from Ortho Residency Coordinator

rescoordinator-
thanks for your posts and advice! much appreciated! i'm one of those, i guess, lower-tiered would-be applicants (m3 w/4 mos to go til m4, 218 step 1, planning on working my hiney off for a >240 step2 , good mix of honors and high passes through the years, a 1st author pub -albeit in EM - and some interesting extracurriculars) who is trying to decide between ortho and a non-surgical specialty. i've always harbored an interest in ortho, but i'm honestly quite afraid that my application won't fly due to the competitiveness of the field and my mediocre app. i'm hopefully going to have more insight after my ortho sub-i next june ... so i'm really appreciative of your posting on here and the perspective of a residency coordinator.
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thanks a bunch!

This is the perfect time of year to get in on some ortho research. In almost all my interviews I have been asked about or commented on my research. Or attendings say, Dr. XXX has a project that you will really like, or some attending even comments that it would be nice to have someone match there with my reaserch interests......
In your case, specific ORTHO research may make you or break you......honestly its hard enough with a 240+ on steps I and II......so make sure you have some good ortho research......
Having EM research is nice, but if some guy is interested in the topic of a paper you have written it will make you stick out in his mind.....and with a low step I score you are gonna have to be extra impressive.....

Good advice all. To Bone Kollector, I would say Micky has a pretty good handle on things. If you're looking to go to top top programs only, they likely are very interested in top top students from top med schools. As for the rest of the country's programs, there are other things that are much more important than the name of your med school. And we've seen residents come through who went to great med schools who don't do as well as those from 'average' named schools, and we recognize this. Getting into a big name med school is no small feat, but at the same time everyone has had 4 years to come into themselves and that is taken into account. We'd much prefer you now have high scores, show you have interest in ortho, will be a hard worker and team player, would fit in with the group and are generally bright. Micky put it well "your med school can only help you, but it won't hurt you."
perpetualpriapism, I agree about the research. It's not necessary but is a definite plus if you were strongly involved and understand it thoroughly. It shows interest in ortho and a willingness to put forth the time and effort in a field you want to dedicate your life to. The interviewers will ask, and if you know your stuff, will impress.

rescoordinator

Glad you are still answering questions. All of your responses have been insightful. Hope you have time for one more. I am a first year MSTP student and highly interested in ortho. I will complete my PhD in biomechanical engineering in an ortho lab (started research this year). My preclinical grades are so-so, but no where near impressive. Question: HOW IMPORTANT ARE PRECLINICAL GRADES? I've heard anything from non-important to very important. I want to go into academia.

Should I reduce (or eliminate) my pre-graduate school research in order to honor more classes? I'm fairly sure that if I put in the time, I can do better. I just like spending my time on other (while ortho-related) activities. Thanks.

Hi ResCoordinator

First of all, thanks for all of your wonderful advice and for your clear message of stewardship and care for your residents and applicants. I come from an east coast school with a very involved PD who communicates high expectations to his residents but who always leads by example, and his influence on me, even as a fourth year, has been great.

I have a few questions that I was hoping you might answer, as they've been weighing heavily on my mind as I head into Interview Month, and the answers I get when I ask people tend to be either self-protective or conflicting:

1) The lack of a chairman. I am interviewing at some programs that have been playing around with interim chairmen or no chairmen, some with no resolution in sight. Other schools have aging chairmen that _ARE_ the program but might retire soon, and thus the threat of graduating from a residency and applying to fellowships without the benefit of that support looms large. How much would you weigh the role of the chairman/PD in ranking programs?

2) There are rumors about a few of the schools that the operative experience is either "top-heavy" or actually deficient. PD's will invoke the number of cases logged, but I've seen cases logged where the PGY-3 is 4-deep to sticky-handed attendings, multiple fellows and chiefs. So my questions: should I be worried? Is there any way to actually evaluate, from a distance or on interview day, whether the residents will get a chance to operate and whether they emerge well-trained?

3) During interviews, how would you rank the following, as expressed by the applicants: enthusiasm for the program, knowledge of the program, being interesting and unique, formality, poise and demeanor, knowledge of orthopedics, ability to characterize personal strengths and weaknesses, friendliness/congeniality, ability to talk about research, ability to talk about non-orthopedic interests? I'm wondering what are the factors that play into going from an academically-qualified interviewee to a ranked-to-match interviewee. I know the textbook answer is "how well does he/she fit with the program," but I'm wondering if that can be broken down somehow.

Much thanks! It's a great thing that you're out there.
Happy New Years!
Rankled RANKL

Back to business after the new year I suppose...
RANKL:
1) I think if you're visiting a program that is lacking a chairman, you first should consider why the chair is lacking. Is the program in trouble and they bailed or did they retire, etc? If you determine that the program seems to still be intact, I would hope the PD would address concerns during the interview, and I would certainly feel confident asking your interviewers what the plans for the program are in the absence of firm leadership. I would also ask the residents when you meet with them what their impression is, they will likely be honest about their own fears if any. It's something to consider but if a program is strong, I would not let it effect your choice if you feel confident about other aspects of the program.

2) Ask the residents. I often hear our PD discuss good students who end up going to big names where they will likely not do much surgery. Whereas our program allows a good deal of surgery at all levels. I would ask your clinical interviewers what cases are like with them and how much experience you should expect to get at what levels. I think with this one though your best bet is the residents, again, they will likely be honest. If they're bitter, you'll know it. We do have fellows so I hesitate to say to avoid programs with a lot of them. But if the program is set up properly this should not effect the juniors all that much. Ask the coordinator for a rotation schedule, so you can see how many residents are on each service. If there are 5 residents on every service, chances are the juniors are going to get the short end of the stick more often. If there are several rotations where there are 1-2 residents, your chances are better. But I believe most programs just "do" or "don't" allow a good deal of operative exposure. The only way to really know is to ask.

3. Always a tough question. I believe you've read my other posts before and I think I addressed this a bit. It's very difficult to come into a stressful situation like this and be cool as a cucumber. I don't think 'formality' is something our program looks for at least. We're not particularly stuffy so we would likely feel that being around a more formal person makes us a bit uncomfortable
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But surely there are more formal programs, where that might be more appropriate. Friendliness is important, but not overly (the interviewers aren't your best friends). I think it's just 'appropriate' that we're looking for. Imagine for a moment you are the interviewer, how would you want to feel around a candidate? It can't hurt to have some basic knowledge about the program so you can ask a question or two to your interviewers that applies directly to the program. Enthusiasm for ortho is important, moreso than enthusiasm for the program. If you are not from the area you can mention why you would want to come to that area of the country. I don't think any of our interviewers is testing you on your ortho knowledge... you're a med student and they don't expect all that much specific to ortho. If you did research, know about that. Have something to say (prepare something to say in the event that there IS nothing to say). I can't tell you how many times I've heard an interviewer say "it was like pulling teeth" to speak to them. Now you may be nervous and therefore go blank. I'd suggest some relaxation techniques for that. Just keep the conversation going, keep a few topics in your backburner to discuss just in case things get cold. You never know, the topic you bring up might spark something that really impresses your interviewer.

The bottom line, as much as you all hate to hear it is, you can't MAKE yourself something you are not. And it's going to be tough for you to fake it for 5 years. And if you don't fake it, you'll likely be unhappy. Be yourself, be yourself, be yourself. Be a prepared yourself. If you think you have poor interviewing skills, go speak to an advisor or student affairs dean, etc. Ask them for advice and to maybe do a mock interview with you so they can give you advice. It's very hard to know what you are like when you're not looking at yourself. They can give you great feedback.

Most of our residents are very happy, so in my mind I always think well, regardless of where you go, you're going to stick it out and be ok for 5 years. But I realize not every program is like ours, so I understand being concerned about various aspects of a program and how to really know what's going on behind the scenes. For those of you who have asked about the social events, etc. I think this is a good time to chat with the residents in a casual way. If they're truly unhappy with their training it will come across and you will know that maybe it's not the best program for you.

Good luck!

yeah, i realize that you make a good point; it's one i've thought about often. my first 2 years of med school (and part of my 3rd) i spent thinking i wanted to go into EM, so i got pretty involved, got some research in the area and that research is still ongoing (i should have a paper out by this summer) and i was thinking it'd not only look unprofessional but would also be kinda turd-like of me just to jump ship and abandon the project (kinda leaving the PI hanging; i'm the main person on the project) to get in some quickie ortho research before i (attempt to) match ... wouldn't that just kinda look sketchy? i really can't help that i came across the ortho interest kinda later in the game (mid-to-late m3 year.)

and maybe it would hurt me that the research is in EM, but i guess when it comes down to it, i don't want to give this project (and this lab) the shaft by bailing when the project is culminating. i don't know, it just doesn't seem right. *shrug* i keep up with new areas of ortho/ortho research, and they interest me, so hopefully i at least get the chance to talk about those. we'll see, i guess.
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thanks for your opinion on the subject, though (and yours, too, rescoordinator.)

Hi rescoordinator,

I would like to know what your advise and opinion is regarding my situation.
I am a foreign medical graduate. I completed my medical school in St. Kitts, BWI.
I was an above average student.
I completed my step 1>> 203/83 and step 2-CS on my first attempt.
I cannot see myself doing anything else except ortho. But looking at posts on this site and talking to others .. I feel I have no chance of getting in to orthosurg. I am doing spine surgery research currently. I hope to acquire good recommendation letters and maybe even get my name in publications this way.. do you think my chances are still too grim ??
If i dont get through in the place i am doing this research ,,, what are my chances of getting into other programs... if i work hard and get a 240 in step 2.
thanks in advance..
al

NOvas,

I agree that you should stick out your EM research. I completed a nice little clinical project in about 3 months that we are doing a poster presentation at the academy this year. So it is possible to come up with something reasonable in a few months if you work hard. ER research will show that you can do/are interested in research.

However, you have to think of this whole process as like getting into a fraternity. A lot of qualified guys apply and are rejected every year. So you have to ask yourself how do you get into a favorable position. If your project interests one of the attendings then they will remember you and if they know the attending that sponsored your project even better. In your interviews you will spend a decent amount of time talking about the attedings you know and they ones that have written you letters.

You have to think of this as like getting sponsored by an attending (someone who is willing to vouch for you) You have to make friends with some powerful attendings and then they will support you. So if you come from an ER background you are gonna have to work to integrate yourself into the culture that is Ortho. Grades/ Step Scores ? Letters are all huge but you have to get the "boys" to like you and go to bat for you or none of that matters. Thats why the ortho match is so crazy cause that "gut feeling/ fit" is ultimately how most places make up their rank list. And research is a great way to immerse yourself in the ortho culture and show attendings that you have what it takes.

I know this sounds like a lot of jibberish bit I cannot over emphasize how much of this is untimately not in your control and you need to do everything to stack the deck in your favor.

Also, some programs just filter with step 1 so it wont even matter at some of the more competitive places.

nah, it doesn't sound like jibberish. in fact, it's the feeling i've been getting all along. i'm a networking kind of gal, so i have no problem getting out there and meeting people. it's what i've been doing for a couple of months. i'm pretty aware of what i have to do and what i'm up against, so what you say makes a lot of sense.
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hearing it, actually, makes me less afraid of following this path.

as far as the research goes, both my ortho faculty mentor and another ortho faculty member at my school, as well as several residents with whom i've talked have said the same thing you have - i'm sticking to the research. i actually have a strong research background and can talk about several of the projects i've done with confidence. no worries there. thanks for your thoughts on it, too.
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the more thought i put into this and the more meeting people in the field that i do - the more i realize this is the path for me. if i can't make it happen the first time around, for whatever reason (be it the 218 step 1 or the non-superstar grades,) i'll do what i can and try again next year.

rescoordinator:

I have been reading your advice and want to thank you for all the helpful information. I do have one question for you that I haven't seen answered so far. I am a med 3 who is planning on going into orthopedics. I have good grades through medical school so far, have done a little orthopedic research, and got better than a 250 on Step 1. Now, I have some questions about scheduling my USMLE Step 2.

I have heard conflicting information about when to schedule Step 2. Many med 4 students that I have talked to have said to hold off and take it as late as possible because you can't do anything but hurt yourself after such a good step 1 score. I have also had one attending physician at my medical center tell me that if I can score that high on Step 2 again to take it early because that can just solidify my position. At our school, we are required to take Step 2 by the end of December of our fourth year so in reality I can't take the test that late. In your mind is there any real benefit to taking Step 2 early or later (with late being no later than end of December of the fourth year)? I would appreciate any advice you can give.

ResCoordinator -

I want to piggyback what everyone else is saying - it is GREAT to have you on the site helping to answer these tough questions. It is truly appreciated.

One question that comes to mind that I don't think has been brought up is the question of the prelim. surgery year --- if a candidate is in 220's on Step 1 and has GREAT prelim. year is that a bonus or are they "damaged goods" due to the prelim. year?

Also is being a "known quantity/entity" a help in getting a position at the place you do your prelim. year?

Thank you for your help.

Hello to all. I apologize, it's been a while since I've logged on. Interview season is going well but is keeping me busy.
jjbones: I tend to agree that it can only hurt you to take your Step 2 early. Mind you, I rarely see someone with over 250 on Step 1 who then bombs Step 2. So chances are you will do just fine on Step 2. Although I would say as long as you get somewhere above 225 or so it won't hurt you tremendously. But if you go below that there is the thought that you aren't consistent, which is something programs are looking for. They want to see a pattern of success, that will carry over to residency and the boards. In the end it is up to you, if you feel you have enough time to study and be successful, I think you will do just fine. But if you are doubting it and feel like your initial success was a surprise to you, then you might want to hold off. I will say that generally if someone has a very high step 1 score, they mysteriously have not taken Step 2 yet...
jmedsfu: As for prelim years, we have in the past matched residents who did a prelim year in GS, but not often. How did you do on Step 2? Did you do the prelim year because you didn't match the first time in ortho or because you weren't sure you wanted to do ortho and didn't apply? Whenever someone doesn't match the first year, there is always that black mark - why? I'm not saying it's impossible, but it's tough. If you just are doing a prelim year and decided to switch to ortho from something else, then you should say that in your personal statement somewhere and have your letter writers comment on it. You don't want to leave too many questions in the application reviewers mind, because they don't want to use up interview slots on someone who is a greater question mark then most others already are.
It never hurts to have your PD or Chair or someone who knows the Ortho PD or Chair to give a call in your institution and say hey, this guy/gal is here, they're a superstar, they want to go into ortho, trust me this will be a good move for you. If that is how they feel. But just having someone at the institution probably doesn't mean all that much. Since I've been here we've never had anyone from our school apply from GS who had not already not matched in Ortho with us prior. But if they did, I would imagine they would be reviewed the same way as everyone else. If they got an interview and the PD was curious, they'd probably just call over to the GS office and inquire about you.
Hope this helps.. I'm still here and will try to check the site more often. Good luck to all.

I received a PM with a question, asking me to reply to all so everyone could hear the answer. The question involved what to do if your No. 1 choice changes between December and the end of January and they are no longer your No. 1.
First, we always have a history of people who go on about how we're their No. 1 and they want to match with us, but we know from their placement on our list and where they matched that they did not rank us first. Does it look good? No. Will it come back to haunt you? Maybe, but I doubt it. It's nice that you want to clear up miscommunication or a change of heart, but frankly by telling someone you are no longer their No. 1, depending on the personality of the PD or chairman, they may lower you on their list. And unless you are prepared to not go there at all, I don't think it's worth it. If you're No. 1 doesn't choose you, or your #5 or whatever, and you end up matching at this program, they don't need to know that it wasn't your top choice.
Maybe this is dishonest, I don't see it that way. I don't know how other programs do it but we do not base our rank list at all on who we think will come to us... the match is set up so this does not work to our advantage or disadvantage. But like I said there's a lot of shmoozing going on at this point, and if someone who told me we were their No. 1 ended up matching elsewhere, we chalk it up as his/her loss and move on. You'll have to explain in 6 years when the PD of the program is your colleague
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. Hopefully they'll forget you by then. Possibly just best to tell a program they are among your top choices and would be very happy to match there. This gives you some movement. This is of course, all presuming that this program is very much wanting you... if they don't, it's a non issue. Good luck!

rescoordinator, I was wondering if you could comment on how you approach couples matching? I obviously want to do ortho, but if I couples matched with my significant other, how does that affect my chances? Anything you can share would be helpful. Thanks!

I do not even look to see if an applicant is couples matching, as it does not effect us. If someone gets selected for an interview, their personal situation may come up (ie, my S.O. is going into Optho and we are planning to stay near each other), but again, this will not effect our rank list. It does us no good to move that person down because they may not end up being able to come here. We do our rank list purely based on who we want and in what order we want them. That is what is great about the match system, we do not have to read anyone's minds to figure out who wants to come here.

Comment on telling programs they're you're "Number 1".

I cannot agree more with residency coordinator. I remember when I was applying I thought it was so important for a program to know that they were my top choice. Really it is a non-issue. Fact is that programs rank applicants they want REGARDLESS OF HOW MUCH THEY THINK YOU WANT TO GO THERE. Don't get caught up in this. Chairmen and faculty are not that concerned about where you rank them. Telling a program they're you're number 1 choice WILL NOT change your ranking on their list unless the Chairman is a lunatic egomaniac

micky,

funny you should say that if your location really is pitt!!! just look around your town and i am sure you will find a "lunatic egomaniac".

I must disagree with the statement that programs always want the 'best' without any consideration of whether the applicant wants to be at their place. 5 years is a long time and a 'great applicant' who has a neutral attitude toward the program probably would be passed over by some programs who would rather desire a competitive person who would love to be at their place. I personally think letting a program know they are your number one would probably make them rank you higher. They would rather be with a happy soul for 5 years than a miserable 'superstar'.

SwiftGhoul: I agree with what you're saying. I guess when I think of who is "best", I'm not only talking 'superstar' I am taking into consideration an interest expressed in ortho, the program and being here in general. Usually that decision is made during the interview process, and again can be expressed by just asking questions about the program, showing interest in it, and possibly stating that we will be high in their ranking (not necessarily No. 1). We do want happy residents who want to be here. And there are candidates who come in and are clearly apathetic about being here that day but that will reflect in their ranking. So they would no longer be considered a superstar. Apathy = poor impression = non superstar status = lower ranking.