I did the rotation a few years ago, so things might have changed some but below is how mine worked out.

The morning your rotation starts you meet the visiting clerkship people at one of the Northwestern buildings. They will give you some paperwork and an ID badge. You then go to the Ortho office in another building a few blocks away. There you will be hooked up with one of the two Chief residents. He/she will assign you to a service based on their needs and your preferences. When I was on, we switched services after two weeks.

That first day they will try to take care of your computer and scrub machine access, but I would bring set a scrubs with you just in case.

They are nice to work with, and have excellent conferences. Besides the usual things a student does, at their weekly fracture conference you will be responsible for interpreting the X-rays (i.e. this is a AP and lateral of the right tibia with a midshaft transverse fracture that is ...).

What is NU's reputation for ortho residency? How do they compare to other Chicago schools, or top programs on the West Coast? Any ideas on operating vs research vs quality of life etc?

Northwestern is more of a gentleman's program. There is not that much clinic, the facilities are very nice, etc. Unfortunately, like a lot of Northern programs, you do not operate that much as a PGY2 and PGY3. You watch more than do on many rotations.

They are such a large program that each resident does not get as many freebees (books, conferences, etc.). They do well on fellowships though because they have so many Attendings that are relatively well connected.

Having rotated at Northwestern a few years ago, I think it's a great program. Your best odds of getting in are rotating there. The program is top heavy. Operate a lot as 4s and 5s and even as a 3rd year. Second year about half of the rotations are good operative experience half are not. PGY 3 year, you're at the children's hospital a lot where the 3rd year is essentially the senior and doing the tougher cases and walking the 2nd year through easier cases. Primary weakness is joints experience as a junior resident but that gets markedly better as you progress.

Requesting a service is a good idea, especially if you know someone y ou want to work with. I did General/trauma service which was good because you can work hard and still do a little bit as a student.

I think you can't go wrong with programs in Chicago. Check out Loyola too. Solid program with good operative experience. No experience with west coast programs.

Good luck.

I hate to show off my complete lack of knowledge, but why would you not operate until 4th or maybe 3rd year? What exactly are you doing for the first two years? Isn't this a surgical specialty?

I didn't really mention intern year because you only do 1 or 2 months of ortho and the rest gen surg. Don't remember. Your second year is when your ortho residency starts. That's when you're an "ortho resident" in my eyes. During your second year, joints and spine you're in the OR a lot but not doing much. The rest of the rotations like hand, sports, peds are good. So maybe more than half the rotations. When I say not operating, I mean you're not doing the case. You're assisting the attending which can range any thing from holding hook to having the attending walk you through cuts of a total knee. It's never like you're doing a total joint when your attending's watch.

It's a great program. If you're looking at Chicago programs, NW and Rush are pretty much top 2 with Rush being more research oriented and NW being more clinical oriented. Other good programs you should consider in midwest are Michigan, Wisconsin, MCW, and Iowa and Loyola.

Just so you are aware, surgical subspecialty doesn't mean you're operating 5 days a week your whole career. Most orthopaedic and orther surgical specialty attendings operate maybe 2-3 days a week tops. So, ask about a program's clinic experience when you interview because you'll spend half of your career in clinic so you need to learn how to evaluate patients.

My advice for picking residency is choose a well rounded program that will get you to the next step in a location that you want. Location should be the most important. Every program is reviewed by ACGME for site visits and these visits involve resident interviews. So most residency programs, believe it or not, do whats best for the resident to keep them happy. If you are not operating at a residency, residents could complain to ACGME which is a big deal. >90% of programs will provide you a great eduction from an operative standpoint.

Good luck.