My story, sticking to the format of last year.

For those who choose to do a research year:
Why did you choose a research year over starting an internship?
My orthopaedic surgery mentor (who was an attending at a different hospital than my home program) suggested that I do a research year for several reasons.
1) Unless you have 25 publications, doing additional research will invariably improve your application. I got started with research the week after I found out I didn’t match, and was able to have 3 abstracts accepted, and I’ve written 4 manuscripts that are in the submission process since then (not on my formal application to ERAS, but I sent updates to all the programs I interviewed at, and places I did not interview at but was not rejected at). This gave me a ton to talk about on interviews, and I think showed my dedication to the field, and my willingness to contribute to it. Also, after speaking to one of the folks who interviewed me, they explicitly said the first thing they do when they review the application of a re-applicant is look for ways that individual improved themselves.
2) Networking is far easier to do as a research fellow. My research mentor and the department chairman both called a ton of places for me. I had more interviews this year, at places that were a better fit for me, 10 of which were completely new places that I was rejected at or didn’t apply to last year.
3) There is no guarantee that with a prelim year you will have support from your gen surg or ortho departments because you have no idea what the relationship between the two departments is like before going in. TexOrtho is absolutely right about the great things he has to say about Greenville and I am sure there are other very supportive programs around the country. But I think that you have at best a 50-50 shot of getting support from that program. With a research year, you are doing things for ortho attendings, who see your work ethic and will invariably go to bat for you. Having a champion, I believe, is the #1 thing you can do to match, not just anywhere but at programs that fit you the best. Last year, I didn’t really have anyone go to bat for me, and this year I had several people who were my champions, which I think is easier to get while doing a research year.

FYI: My dean and my home chairman (who is a great guy, but didn’t know me very well) both suggested I do a prelim year. Make sure you think about what people’s motivations are when they give you advice.

How did you go about securing a position? was it paid?
Luckily my mentor had research positions open which were paid.
Orthogate is a great source for this, Mayo, Cinci, HSS, NYU-HJD, Maryland, Penn, Jeff, and so on have research fellows.
Important things to think about with this:
1) Will I get to know people? If you are lost in the shuffle, you are toast.
2) Will I be able to go to resident conferences? Again, you not only are networking, but also improving yourself as a future orthopod
3) Time off for interviews? Not a guarantee, I was lucky enough to have all my interview days off but some I’ve spoken to did not.

Getting paid is not the most important thing if you can stay in school another year because of student loans, but if you are a graduate, try your best to secure a paid spot. It may be a faux pas to ask how much you are getting, so just be wise in how you frame this.

Did you delay graduation?
Nope, school said no way.

Do you feel good about how much you have accomplished during your research year?
Yes. I got a bunch done, and I learned a ton (about ortho and how to do research both of which are super helpful for my career pursuits).

Were you able to rotate at other programs?
Yup. So before I graduated from med school, I emailed about 30 programs asking if I could do a 2 week rotation. 2 places replied back saying yes but 1 of those places got shot down by their registrar, so I went with the other. It was a great experience, and it felt good meeting new orthopods and getting new letters from them (2 to be exact, both of which were mentioned a bunch during interviews)
In addition I did 2 “observational internships” (one for a week, and one for a few days) where I just hung around with the programs. I had to really push the envelope to get those two set up (several phone calls etc.) but both resulted in interviews. Even though you can’t touch patients, you can still help out in a bunch of ways. It sucks not scrubbing in, but your job there is to make your resident’s life easier/better, and they will thank you for that.
I also took call 2x per month at my research institution, which helped keep me fresh.

Did you find that there was enough time to get things published/presented before applications were due again?
I think what helped me out the most here was that I started early. Don’t just sit around and sulk after not matching and cry and whine. Toughen up, gather yourself, and get to work, even if it is for free. I worked for 4 months before I was officially hired at my research spot, and those 4 months resulted in 3 abstracts and a boatload of respect from attendings and residents. Think about it this way; the more time you complain, the less time you have to work.

How did your application differ the second time around?
All new letters, and more of them. I had a total of 8 letters that I used and sent to different programs around the country. More research, more activities. I also put awards that I had previously earned, and some cool and interesting things that I had done earlier in life on my application, that I left off last year because I didn’t do them during medical school. This was actually asked about on several occasions.

Did you stay at your home institution or go elsewhere for your research?
I left. One of my home attendings offered to have me do pro-bono research, but getting an offer with a paycheck was much more appealing.

What do you see as trade-offs for doing a research year rather than an internship now that you are through it? None really, except maybe the lack of getting in the OR. I really miss operating.

Do you think you received an appropriate number of interview offers?
Crappy question. I know folks that had 1 interview and matched. I have also met folks from top tier med schools w/ 20+ interviews who did not match. The most important thing is that you treat each place you interview as a location where you could see yourself contributing to the program, and making it better. Just be thankful (as I was) for every offer that you get, and treat them like they are your only interview

If you have interviewed already, how has your interview differed this year vs last year? On all but 2 of my interview I was asked, 'why do you think you didn't match’? If you don’t have a rock solid answer that shows that you are reflective, highlights how you have improved, and demonstrates why you would be an outstanding ortho resident and attending in the future, then you are a monkey and don’t deserve a spot in ortho.

Don't say “I must have fallen through the cracks” or any other permutation of that statement. When you show the person you are interviewing with that you are awesome, have a great attitude, and will be an asset to the program, your interviewer will say “wow, you are an extremely impressive candidate, I don’t know how you fell through the cracks”, which happened on several occasions to me.

Did you apply to ortho only or did you apply to another specialty? Ortho. Period!

If you don't match, what are you going to do?
I matched, so no worries. If I didn’t match, then I was going to do a prelim gen surg year to diversify my application and to open myself up for 2nd year spots (which do happen as sometimes folks who match in ortho change their mind about ortho as a specialty, and also because several programs expand the number of residents and back fill those spots). If I didn’t match after that, I would continue to do research, until someone had mercy on me and allowed me to be an orthopaedic surgeon.

Feel free to PM me w/ any questions, advice etc.

I agree that th reseach way is the way to go... mostly for working with orthopods.. getting your networking in, and getting to do ortho stuff.. The prelim year has the disadvantage of making you bitter.. and that's something I knew I would have battled with..