A frank discussion

I think this is a valid discussion.

As someone with not so stellar numbers ( sub 255 on step 1 and step 2, top quartile but no AOA), I think another overlooked point that's more difficult to take control of is connections. I have 5 interviews right now. 2 are from aways (one away which I was only able to secure after a mentor advocated for me), 1 from a program where a highly regarded resident vouched for me, and another in a place that a mentor made a personal call for me (received an interview the very next day). Chances are you can't rely on your school to just automatically make calls for you unless you have a personable chairman and active program director who also both happen to be heavily invested in medical students. Not the case at many programs.

The in-school competition is also legitimate. Though I don't think there's any merit to closing yourself off from those classmates during the application cycle. The more open the better. (the only way I'm tracking which programs I still have a chance at are through the postings of the good people on this forum and texts with my classmates). It's good to keep tabs on the interview dates available at certain programs so you can schedule quickly when the interviews do come in. There's also little to no overlap in where you and your classmates will interview (at least that's been the case at my school), so you might as well keep each other in the loop. Birds of a feather and all that.

Sub-Is are crucial. And one thing that I found to work out for me that I don't believe enough rotators are open to is to collaborate with your fellow rotators and don't step on each others toes needlessly. I believe residents notice this, and every rotation where I vibed with sub-Is was infinitely more pleasant.

I'm very hopeful that the waitlists will move and a second wave of interviews trickle out, but I also don't believe this will be a saving grace for many of us.

I agree with everything said already, but I think the importance of research cannot be understated. After programs filter for step scores and class rank, there are still more applicants than there are interview spots. Academic programs seem to like applicants who say they are interested in academics and have a CV to back it up. Anyone can be involved in research, but publishing in a journal that your orthopod reviewer reads will help distinguish yourself from other applicants. Research experiences can be random, and sometimes unfair, but you can say the same thing about 3rd year clinical evaluations. Start doing research during the first or second year of medical school, be proactive with your PI about publishing and submitting stuff, and something should pan out by the time ERAS rolls around.

If I'm a 3 or younger reading this thread, the thing to take away is that your application doesn't hinge on one thing: it's the total package. Everyone has numbers, and AOA probably does help, but you can be pristine on paper and still struggle for interviews if you come from a smaller school, especially one without a home program. Connections and who you know in this process can not be understated. Unfortunately, these are the things you can't really control to an extent.

I have to agree with a lot of what is being said here. And I'm sure this has been said a thousand times on this site, but I would like to emphasize how important excelling at away rotations is. I'm a PGY-1 who matched last year and now currently getting a chance to see what it's like on the other side. If you do a great job and can get the residents to advocate for you, I think it's a HUGE advantage for matching. I was actually quite surprised by how many rotators we had mess this up, either by being lazy, calling out residents, and even being too aggressive.

I still think that you need to strive to be the complete package with solid board scores, good grades, research, etc... but for a below average candidate I really think this could push them over the edge to get a spot.

I also know this doesn't really help those applying now, but future applicants should certainly know this. There are some good tips for aways either here or on SDN. Most of it is common sense, but you would definitely be surprised.

Good responses guys. Like I said, this forum feels like it's been quiet but there is a lot of good advice to be had here so I'm sure this class and future generations of applicants will greatly appreciate it.

In addition to what the above poster said about away rotations, I want to emphasize the importance of rotating within your means and doing your homework on places to rotate. For example, certain programs do not interview all rotators. This can be a trap for an applicant who busts their ass on a rotation but has too weak of a paper application to be seriously considered. This happened to several people I have met along the trail. As mentioned above, the opposite is true where a strong paper applicant can torpedo themselves with a subpar rotation (committing the sins of either: laziness, incompetence, or bad/weird/awkward attitude), which I have also seen. Also, be aware that going to a program that interviews everyone is not always a great thing. Certain programs invite all rotators back for an interview or interview you while you are there. This can be a pity interview without you knowing it so beware. Worst thing that can happen is that you think you did a stellar job and you wind up at the bottom of their rank list because of either your paper application or the fact that they didn't like you --> recipe for disappointment

I think the best advice is to do your homework and find places that favor rotators and where you actually have a strong chance of matching given your paper application, which I think cannot be understated. At the same time, make sure it's a program that you like because your best odds of matching are at places that you rotate!

Qualifier - PGY1, feel like I just went through all of this.

Everything in here is great advice. Some of it I knew was important last year after interviewing, other stuff I've realized this year seeing rotators and hearing some of the discussion among residents and staff.

Sticking with the topic though, and echoing what others have said, the best advice I have for any applicant is to be honest with yourself before you apply for aways. I know the common formula is shoot for 1 reach, 1 realistic place, and 1 safety. I'm not a proponent of that formula though, especially coming from a lower-tier med school with a bunch of other applicants. If you have any doubts at all about your competitiveness, I really urge you to only rotate at places where you think you'll have a good shot with a good performance on your rotation.

The next question is, how do I know how competitive I am? Look to see if previous applicants from your school (or similar tier/reputation) have matched there. Everyone wants to rotate at HSS, I'm sure it's a great experience but probably not the most effective use of your very limited time for 90% of people.

What are your goals? Do you want to write books? Do you want to be a program director? Do you just want to operate all day long? There's nothing wrong with lying either way on the spectrum, just be realistic based on your goals. If you have a strong interest in research, I would advise against rotating at multiple community programs, even if you feel you're not a strong applicant. It's pretty obvious to residents whether or not you'll "fit in." Likewise, if you just want to learn how to be a great surgeon, I wouldn't waste time at a research powerhouse. Maybe you aren't sure about your goals now, and that's fine. Try to find some places that have a good mix of everything. These also tend to be the places with 5+ rotators every month, meaning by the end of it you're competing against tons of other qualified applicants.

These seem like simple guidelines now, but I really didn't think this way when I was looking at places to rotate. Bottom line is that rotating at a place is the number 1 way to increase your chances of matching at that place. Choose your rotations wisely, don't waste a whole month somewhere you aren't going to be a good fit.

Good luck everybody.

Agree with much of what has been said already. Also a PGY1 here so have recently seen both sides. Apologize ahead of the time for the length.

Away rotations- Bonedoc is spot on about away rotations. They can be extremely helpful if you do all the things you are supposed to do like reading for cases, being involved, interested and engaged, knowing the patients your team is taking care of, and generally being a normal human being. That may all sound like common sense but clearly not after witnessing some of our rotators this year. Laziness, not knowing a darn thing about the cases you are scrubbing on (provided you knew the cases ahead of time), falling asleep in conferences etc. This is a month long interview, it is a long process and its tiring but don't let up on your away rotations, it will hurt you and you will have wasted a month. Do all the things you are supposed to and do them well. Don't be fake, be yourself (really, trust me, everyone will be happier that way) and work hard. And absolutely what averagejoe said, pick your aways wisely and pick places you are really interested in ending up at.

Step 2- Step 1 is obviously one of, if not the, most important factors in getting interviews. However, Step 2 is becoming more important. If your step 2 score isn't in by applications or you drop significantly from your step 1 score that becomes a big deal in my opinion. There are plenty of people with high Step 1 scores, all else being equal, Step 2 can elevate your application or hurt it if you think that because your step 1 is high enough that it can overcome a pending or a lower Step 2 score. You've obviously done well on step 1, take step 2 early and take it seriously. If you score 270 on step 1 that is obviously hard to replicate but if you score 257 or something on Step 1, it looks weird if your step 2 comes in at 242. The vast majority of people improve on Step 2, do not underestimate the importance of improving or coming pretty close to matching your step 1 score.

AOA- I've mentioned it before but I think it is becoming more and more important in distinguishing applicants that all look very similar. Don't disregard early classes because you think no one cares about pre-clinical grades. Pre-clinical grades matter for class rank and they matter for AOA nomination.

Research- any research. Ortho is better but any research will do. Programs want to see that you have done some, understand the steps of a project and have demonstrated at least some minimal interest in advancing medical/scientific knowledge. You have to complete a project in residency, they don't want to hold your hand through the whole project if you have zero experience in how research works. Huge advantage if ortho, pubs, or numerous presentations but have some research on your app even if it didn't amount to anything, it shows you've done some and know something about the process.

Connections/Letters- not always a whole lot you can do about these but ortho is a small, small world. Everyone knows everyone in their field it seems and who your letter writers are and how strongly they recommend you play a big role come interviews. Multiple interviewers brought up my letter writers and where/how they knew them. One place even called up one of my letter writers to ask about me :ohmy: . We always say it is more important to have a great letter from someone who knows you than an ok letter from a big name. Whats even more important is a great letter from a big name. If there is faculty at your program that you feel comfortable with and have a good relationship, it may be worth it to have them contact people they may know at other programs and put in a good word. You have to have that type of relationship with them which is why it is important to start making connections as early as possible. I would recommend getting letters from people that are involved in their respective sub-specialty meetings/organizations because they are more likely to know and have relationships with faculty from other programs which can help out when they are reading your letters.

Just my two cents from my own experience and thoughts on a very convoluted, non-straightforward, stressful process. Others may disagree or have different experiences which I think just shows that nobody really knows everything that goes into a successful application.