excellent post! going to go read the article now.

Early operative experience is a positive aspect of a program but is not essential to producing competent orthopaedic surgeons. Orthopaedic training is 5 years in length. Where you start is far less important than where you finish at the end of your training. Some programs offer superior operative experience and independence for senior level residents. Other programs that may get the junior resident into the OR early may not offer as good an experience for the senior resident. As an applicant, ask more about the operative experience of the senior residents rather than the juniors...I am a pgy5 right now and firmly believe that the operative experience you get as a PGY4 and especially PGY5 is far more important than "early" operative experience. I remember when I was a student and a junior resident thinking about the importance of early OR training. Yes it's fun getting into the OR and it is a gradual process. Early experience is important but should NOT be the reason you choose a program. Keep the big picture in mind...you want to GRADUATE as a competent skilled orthopaedic surgeon. Some programs offer such outstanding training for the senior resident that it matters little how much these residents got to do as pgy2's.

So my long winded response is that I agree with the article, not with the poster above.

Micky,

Thanks for the reply. It was very well put.

Just to clarify, I dont disagree with the article. I thought the article was interesting and disagreed with the entirely separate editorial discussing the article on one issue and only one issue which was:

the editor's belief that research experience was likely far more important than early operative experience in training future orthopaedic surgeons.

I recognize that research is a valuable component of orthopaedic training (even if I dont personally enjoy it), but definitely DONT feel that it is neccesarily MORE important than early operative experience. Again, I find the original article interesting because it sheds light on what an admittedly small percentage of recently successful ortho applicants valued when ranking and choosing orthopaedic residency programs. The article is not trying to validate that applicants' desires line up with what will be most beneficial to their training and eventual practice. I felt the article might be interesting for students/applicants because it would suggest what previous applicants considered important and for residents would suggest factors on which applicants may focus and provide points for discussion.

Micky, I appreciated your comments on residency training and thought your comment, "where you start is far less important than where you finish at the end of your training," is extremely well stated. It is almost certainly true that your operative experience as a senior resident is relatively more important than your operative and clinical experience as a junior resident. However, your post seems to practically assume that you can not have balance in a program with a strong clinical and operative experience at both the junior and senior levels. Maybe I am misinterpeting your post, but there is no reason why applicants and residents should not expect strong, balanced training throughout the entire five years of their residency. I completely agree that early experience should NOT be the reason to choose a program, but I DO feel that early clinical and operative experience is a huge boon to the training of a future orthopaedic surgeon assuming that the countless other important factors are also present. I simply believe that it is possible to have your cake and eat it too when it comes to junior and senior experience. Either way, the vast majority of programs will train residents to be comptent, skilled orthopaedic surgeons regardless of their experience hierarchy.

I guess I am even a little bit longer winded Micky.

I also found the results of this study very interesting. I remember seeing this at the '06 Academy meeting. But, I think that this article surveying PGY-1 and 2 residents is flawed, due to the pool that they surveyed.

I think the reason that this study was done was to give residency programs a glimpse into what their applicants are looking for when they come to interview. So if that is what you want to ascertain, why ask interns and 2s? Why not ask applicants before they submit their rank lists?

I also think it is not a coincidence that when you ask residents early in their training, that they say that early operative experience and geography are most important. You are basically asking a group that just moved to a new place who may or may not be getting to do anything in the OR what they think is important. Of course they are going to say that those are the two biggest concerns. At the risk of sounding like a research nerd here, I think they surveyed the wrong people for the information that they were trying to get.

Plus, if a 4th year student is reading this study, I would caution you to lean more on what senior residents say is important to your training. I am a current PGY1 and while I think I know what is important in a program now, I'm sure I'll have a vastly different perspective at the end of my training. I may eventually find that some of the things that I previously thought were important weren't all that big of a deal after all.

Anyway, just my opinion. I think if you really wanted to do a study to inform programs about what applicants really want, you have to survey applicants, not residents.

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