My Residency Reviews

Thomas Jefferson

Interview Experience
The hospital and residency pride themselves on efficiency, and the interview day was no exception. The day started at 7am and was done by 11am. They make the rank list after the interviews conclude, and said that they would be done by lunch. There was 1 hour of individual interviews in a 3x20-minute format with a faculty member +/- a chief resident in each room. Very conversational and laid-back, with a lot of questions about my research interests. In one room, I was asked questions while fitting a pile of 3D acetabular cups into reconstructed pelvis models. There was also a 20-minute group interview with Dr. Vaccaro (the chairman) and Dr. Purcill (the PD), where you gave a fun fact about yourself. The day concluded with a tour and a resident presentation. There was a social the night before, which was rumored to be among the best on the interview trail, and it did not disappoint. It was on the top floor of a downtown skyscraper, with good food and drinks. All of the chief residents knew my application from memory, which I thought was pretty impressive. They interview 50 rotators and 30 non-rotators for 6 residents per year, and usually take 4 or 5 rotators and 1 or 2 non-rotators. In recent years, they have taken a lot of Jeff students (4 of 6 last year, 5 of 6 the year before), but the residents said that they have brought this up as a concern to the faculty and that the program is actively trying to diversify its resident pool.

Staff/Faculty/Chairman
Dr. Vaccaro (spine) was named the new chair last year, when Dr. Albert left to become surgeon-in-chief at HSS. Since the Rothman Institute is a private group with an academic affiliation to Jeff, he was selected internally by the other orthopaedic faculty, unlike most hospitals where the department chairs each cast a vote. He is the CEO of the group, so he is clearly business-savvy, and he projected the slick business executive image during interview day. Very direct, concise, articulate, and focused on efficiency. In the group applicant interview, he was relaxed, told a few jokes, and shot the shit with us. The residents spoke highly of his leadership, and pointed to the fact that 0 faculty left after the regime change. Dr. Purcill (joints) is the PD. He also has the business executive feel, although he seems a little quieter and more calculated than Dr. Vaccaro. The residents said he is approachable and is very responsive to their feedback, and pointed to last year's change in the peds rotation schedule (from 6 months straight at DuPont during PGY3, with a lot of nonop management -- to 2 months at Shriner's during PGY2, with mostly complex operative cases, and then 4 months during PGY3 at DuPont). This change was in response to resident complaints about the DuPont experience. While on this topic, the residents are also lobbying to change a month of the PGY5 spine rotation to an open elective. As for the rest of the faculty, they have big names in literally every subspecialty. Their trauma faculty is small, but that is a product of having a privademic program with no rotations at public hospitals. Dr. Jerry Williams (shoulder/elbow) is on the presidential succession line at AAOS, and a number of other faculty are high up in the subspecialty group leadership food chains. Residents said that the structure of the program/hospital is such that they contact attendings directly, and there is minimal red tape. Again, it's all about efficiency.

Didactics/Teaching
They have 2 hours of lecture on Monday from 5 to 7pm, then 1 hour of lecture Friday morning from 6 to 7am followed by grand rounds from 7 to 8am. All lectures are attending-led, and lectures run on a 2-year cycle. There is also journal club once per month, where an attending will host a catered dinner at their house and residents will present and discuss the assigned articles. Most subspecialty rotations also have their own monthly journal club. There are also some cadaver/anatomy labs during the year. They don't have formal OITE review, but the residents said they have enough free time to study and do practice questions.

Operating Experience
Huge strength of the program. They have massive operative volume in every subspecialty, so you will get tons of reps for both routine and exotic cases. As an intern and PGY2, you do quite a bit of floor work, but your operative months are hands on. The juniors (intern/PGY2) are often double scrubbed with the PGY5/fellow, who will walk them through the case while the attending watches and/or bounces between rooms. This is done on purpose, so that the junior learns how to operate. However, the learning is hands-on, and the seniors have enough operative reps that they are focused on teaching. By PGY-3, you are given your own room with the attending, and you will never be competing for cases with the fellow. On many rotations, medical students don't even scrub in because they are considered to be an inefficiency in the surgical production. This rubbed a few rotators I talked to the wrong way, as they felt like they had no opportunity to showcase their skills or personality. Joints and hand are arguably the busiest services here. Many of the joints attendings will do 10 to 12 cases per day, but since the privademic model emphasizes efficiency, they will start around 8am and routinely finish by 2 or 3pm. One of the foot and ankle attendings does 20 cases per day twice a week, but he wants to be done by 5pm. They can do so much volume for a few reasons. First, the room turnover time is unbelievable, routinely 3 or 4 minutes at Rothman sites and 10 minutes at Jefferson. Second, they have a ton of ancillary staff support to keep the cases moving along. Third, there are a lot of expectations on residents to operate correctly, and some attendings can have low tolerance for mistakes. This may be a little stressful, but it forces you to get good at operating. Attendings acknowledged that some residents are better/quicker than others, so they will tailor their expectations and level of instruction to the individual resident. They also spend a few months at Bryn Mawr hospital (~30 min drive) as a junior and senior, where they get reps in more of a community setting with a lot of bread and butter orthopaedic cases across different subspecialties and a mix of hot and cold trauma. Residents say that they routinely get 1 or 2 operative cases per call shift. For peds, the operative experience at DuPont is light, with an operative-heavy PGY2 rotation at Shriner's.

Clinic Experience
For most blocks, you spend 3 days in the OR and 2 days in clinic. With the mentorship model, most of the attendings will have you see the patient yourself, then present your impression and plan for workup and management. Most of the residents do all of the documentation, and attendings teach residents how to dictate with an emphasis on key words for billing purposes, how to use billing codes, and how to run the clinic efficiently.

Research Opportunities
Every resident is expected to do research. There are a ton of resources at your disposal, including a "research sweatshop" as one resident described it, where there are >20 dedicated ortho support staff who help with IRB's, stats, lit review, manuscript submission, grant writing, etc. If you want a list of all of the distal radius fractures, what implant was used, and how much each one cost, someone will pull the data and send you a report within a few days. If you want access to a large insurance database for a research project, they will work to get you access ASAP, no questions asked. Most of the research is clinical, with not much basic science. The focus is on outcomes, cost efficiency, and business modeling. This is very relevant to the private Rothman Institute group, since they are always looking for ways to increase efficiency. They have become a leader in orthopaedics in this area because of the overhaul of the entire healthcare system with bundled payment reform and a focus on quality measures. The chairman and a number of other attendings have MBA's, and their biostatistician has advanced knowledge of economic modeling. They are developing a "business of orthopaedics" curriculum in collaboration with Temple business school, which they have identified as an area of under-education among orthopaedic surgeons and physicians as a whole. Overall, amazing research enterprise.

Residents
They take 6 per year, so 30 total, with 25 male and 5 female. Around 50% are married, a couple with kids. There is definitely camaraderie among the residents, especially within each class, and they are an energetic and fun bunch. They drink beers and watch sports outside of work, and most of them live nearby each other. I got a bit of a county-club feel from the residents, as most of them were in good shape, well-dressed, and clean shaven. Definitely not a fit for everyone, but I felt like I would fit in fine.

Lifestyle
This is a gentleman's program. You operate a ton, but since most surgeries are elective, and you don't work in a city/county hospital, you will almost never work >80 hours. Rounding usually starts around 5am and you are done when surgery or clinic is over, which is usually in the early afternoon. Some of the seniors said on certain rotations they regularly leave the hospital around 2 or 3pm. Clinic usually runs until 5pm. You do night float as a PGY2, which can be busy. You take weekend call for two weekends per month (with two golden weekends), although they often utilize 12-hour shifts instead of 24. Getting back to efficiency, the attendings can't afford to have the residents dragging in the OR or clinic, so there is no overnight call during the week. At Bryn Mawr, call works out to q4, I forgot to ask how post-call works here. There are a lot of perks for the residents, including research travel grants, money for lead/loupes, fleeces, book money, etc. Overall, very lifestyle-friendly, as you will have time when you get home to do research, read about your cases, exercise, hang with your family, make dinner, etc.

Location/Housing
Philadelphia has all of the amenities of a modern city, but is much more affordable than nearby NYC, DC, and Boston. Rent is reasonable and you can live comfortably in an apartment near the hospital in Center City. There is plenty of good food, beer, and sports to keep you entertained on days off. Public transit is generally good, although you will need a car for this program. Most of the PGY1/2 rotations are at the main Jeff hospital (except for the Bryn Mawr rotations), but starting with PGY3, you will need to drive to the ancillary Rothman sites (ranging from 20-40 minutes away) as well as DuPont in Delaware (40 minutes away). However, this is usually a reverse commute in the morning, and since the hours are good, the afternoon commute home is fine. Parking in the Jeff garage is subsidized by the hospital, and parking at the other sites is usually free.

Limitations
There is limited trauma exposure here. You will see some community fracture cases at Bryn Mawr, and their traumatologist at Jeff is really busy (rotate with him as a PGY4 or PGY5, I forget), so residents say that they feel comfortable taking primary call at a community hospital. However, without a city/county hospital, you do lose some of the daily grind of residency. Also, while this program is very team-based, it is rarely with other residents, and you largely function as a cog within the Rothman surgical team (attending, fellow, NP, PA, surgical team). Residents are spread out across different sites, and there is quite a bit of driving for this program, with a car as a requirement. With a huge faculty (not sure of exact number, but easily >50), you have a lot of different learning opportunities, but you may not get to work with everyone or build long-standing relationships. The predominance of Jefferson medical school graduates in the residency is also a negative, although this may be changing.

Conclusion
Amazing operative experience and research opportunities. Lifestyle-friendly program, with good work hours and sufficient time for research and your personal life. Top notch fellowships for all the residents (Shock Trauma, HSS tumor, HSS joints, etc.). Big names in every subspecialty, with stable leadership at the top. The lack of hot trauma is a bit of a negative, but it is a trade-off for logging a huge amount of cases in elective surgery. Philly isn't as alluring as NYC or SF, but it is a very affordable and fun alternative. The business-focus and privademic nature of this program definitely makes it different from the other programs I have interviewed at. For some people (but not me), I think this program is a tough "fit" because it has a very unique structure and identity. Overall, I think this program is in the conversation for the best residency in the county. Tier 1 for me.

Tufts

Interview Experience
Arrive at 7am, welcome from the chairman (Dr. Cassidy) and faculty, followed by 2x30-minute interviews with 2 faculty members in each room. The interviews were spaced out by an hour or two, during which time you could speak with residents, faculty, and Dr. Cassidy, as well as take a resident-led tour. They keep the interviews long on purpose, because they think they can get a better feel for the applicant's personality over 30 minutes instead the 5 or 10 minute speed interviews that are commonplace. Laid back conversational interviews, nothing tricky or weird. I think they interview around 80 applicants for 4 spots. They actually don't have many Tufts students in their residency, and they take a mix of rotators and non-rotators.

Staff/Faculty/Chairman
Dr. Cassidy (hand and upper extremity) serves as both the chairman and the PD. Residents describe him as intimidating and business-like, but a great resident advocate. He is generally hands-off in day-to-day resident matters, and allows the residents to work their issues up the food chain to the chiefs before getting involved. However, residents say that he is very approachable and is always trying to create the best residency experience possible for them. He mingled with all the applicants on interview day, and seemed like a humble, cerebral, genuine, down to earth guy. Dr. Braun (I think) serves as the assistant PD to Dr. Cassidy, and he has slowly been gaining responsibilities over the last few years, with the plan that he will eventually take over full responsibilities as PD. The rest of the faculty is spread out over their 3 network hospitals - University, Newton-Wellesley, and New England Baptist. Most of the attendings at NWH and the Baptist are privademic, in that the patients have private insurance, the hospitals have very few inpatients, there is a lot of PA support, but they have residents with them in the OR. Well-represented in subspecialties, especially joints, sports, spine and hand, with only 1 F/A and 1 tumor. They have 1 traumatologist at University Hospital, and it became a level 1 trauma center in 2012, so this area of the faculty may expand in the coming years.

Didactics/Teaching
The residents are split across 3 different hospitals, and each hospital has its own didactics curriculum. They don't have a formal lecture series where all 20 of the residents come to TUMC each week. The only exception is that interns and PGY-2's from NWH and the Baptist come to the fracture conference at TUMC every Monday. The residents stood by this format, and said that all of the lectures are attending-led at each site, with the exception of chief-led basic science lectures on Wednesday morning at TUMC. They also have anatomy labs with fresh frozen cadavers during the year.

Operating Experience
Touted as the biggest strength of the program. The joints experience at the Baptist is incredible, as the volume of both primary and revisions is really high. At NWH, they have a general/community orthopaedics experience, where residents get bread and butter orthopaedics and hand (as a PGY2). Residents also rotate at Rhode Island Hospital as a PGY4, where they are in a room with one of the Brown superchiefs (PGY6's) and get a robust experience of simple and complex trauma cases. At RIH, the experience is hands on, same as the Tufts sites. Double scrubbing at Tufts is very rare, except for the occasional complex revision case at the Baptist with a joints fellow. There is a hand fellow at TUMC who works closely with Dr. Cassidy, but on the Dr. Cassidy OR days for the PGY4, he runs two rooms and you are 1-on-1 with him. At TUMC, they utilize a mentorship program, where you spend a few weeks with each attending on that service, do clinic with them, and operate with them. At NWH and the Baptist, you are basically in the OR for the entire day. Even as an intern and PGY2, you are almost always the first assist, with PA's scrubbed in for additional hands on big cases when needed. The residents said that there is a good balance of autonomy and teaching, especially when you are a junior.

Clinic Experience
The bulk of clinic experience is at TUMC, where you attend clinic with your assigned mentor on that service. Clinic in this setting is 2 or 3 times per week depending on the service. At NWH and the Baptist, you are in the OR most of the time, and usually will spend 0.5-1 day in the clinic. The residents spoke highly of their clinic experience, and said that even for the private patients, the attendings let you see the patient, formulate a plan, and then present.

Research Opportunities
As much or as little as you want to. There is a combined F/A and research block during PGY3, where you operate 3 days/week and do research for the other 2 days. The program is not known for its research, and most residents go into private practice, but attendings are open to collaborations. They have a little bit of biomechanics, but most of the research is clinical. The Baptist has a lot of joints patients with long-term follow-up data, and they also have some support staff to help with stats and IRB's. Dr. Cassidy said during interview day that he would like to grow the research aspect of the program/department over the next few years. They are limited resource-wise, however, so this may be a slow process. They will sponsor your travel to research conferences if you are presenting.

Residents
4 per year. The camaraderie among the residents was emphasized as a strength of the program, and since it is on the smaller end of residency programs, all of the residents work with and know each other. The program personality is on the more “bro” side of the spectrum, but there are 5 female residents who fit in seamlessly. Many of the residents hang out with each other outside of work as well. They enjoy the perks of living in Boston and take advantage of them when they can.

Lifestyle
This is a hard-working program, especially when you are at TUMC. With only 20 residents who are spread thin (usually 7 at TUMC, 5 at NWH, 5 at Baptist, 1 at Brown, 2 interns on gen surg), call at TUMC is covered by the PGY2 floor resident during the day, then a PGY2 or PGY3 at night. They don't have post-call days, so 36-hour shifts are commonplace. Residents said that it sucks but is just a part of life and getting through the program. Life as the floor resident is brutal when you are on call, since you end up holding the pager for 36 hours straight. TUMC is now a level 1 trauma center, so the amount of trauma/consults has increased steadily over the last few years, although this is generally seen as a plus because you get some additional trauma exposure. Outside of TUMC, there is minimal call. At NWH, the ER will call the attending directly, and the attending will only call in the resident if there is something urgent that they need to see or get ready for the OR. I don't think that the Baptist even has an ER, so there isn't any call there.

Location/Housing
Boston is a great place to work and live. Good diversity, food, sports, nightlife. The residents live in Boston, the surrounding neighborhoods (Cambridge, Brookline, South Boston), or the suburbs. The day starts at 5:30am at TUMC, so a car is a must since the train doesn't start running until 6am. The Baptist is ~15 minutes from TUMC and NWH is ~25 minutes from TUMC, so there will be driving, but parking at NWH/Baptist is free and TUMC is a subsidized garage (~$100/month). Boston is on the expensive side of places to live, especially if you want to live in Boston proper.

Limitations
Residents are fairly spread out, and didactics are separate for each site. Trauma exposure is okay, and you will see some trauma at NWH and on subspecialty rotations (i.e. distal radius on hand) but you only have formal trauma rotations as a PGY4 (at Brown) and PGY5 (at TUMC in their newly-minted trauma room). Plus as a PGY4, you have to live in Providence for 3 months. There aren't any post-call days, and you will work >100 hours as a junior at TUMC. Light on research, and most residents go into private practice. Minimal perks for the residents, as the hospital is short on capital. Tumor and F/A only have 1 attending, and you rotate through each of these services only once, during third year. Boston is fairly expensive, you need a car, and there is a bit of driving between the sites.

Conclusion
While Tufts is a well-known academic medical center, I would characterize this program as more community than academic. You get an awesome operative experience, especially in joints, which is hands-on from the very beginning. You get to learn orthopaedics at a number of different settings (academic at TUMC, community at NWH, with the Baptist as sort of a hybrid). However, research is not a focus of the department, the residency is on the smaller side, and the trauma exposure is less than I would like. This is very solid program, and will be in the mid-tier 2 for me.

Rutgers - NJMS (Newark)

Interview Experience
Arrived by 8:30am, with 6x10-minute interviews, a brief video presentation on the residency, and a campus tour with an intern and a PGY2 resident. Each interview room had 1 faculty member and 1 chief resident, including the room with the PD. The chairman did not make an appearance. The tour was the only opportunity to speak with the residents on interview day. The department was business as usual for the most part, so all of the residents except for the chiefs were busy with their normal responsibilities. Compared to some programs, where the program makes many residents available on interview day, this was a little underwhelming. Interviews were conversational and friendly. In one room I had to take out a jenga block, another I talked about an interesting case I saw during my subI's. They interview ~72 for 6 spots, so fairly good odds. Take a mix every year of 1 to 3 NJMS students, 1 or 2 rotators, and 1 or 2 non-rotators.

Staff/Faculty/Chairman
The PD is Dr. Berberian (foot and ankle). He is very involved with the residents and cares about their education experience. He gave all of the applicants his cell phone number, and said we can call him at any time with questions. The residents and the rotating medical students spoke very highly of Dr. Berberian, who went to medical school and did his residency at NJMS. The chairman, Dr. Benevenia (tumor), interacts very little with the residents. He sits on a number of committees at NJMS, so he has been able to get some assets for the program (bioskills lab, call rooms, access to new clinic facilities). However, outside of the tumor rotations as a PGY2 and PGY4, you rarely see him. As for the rest of the faculty, they have representation in every subspecialty, and are especially strong in trauma and tumor (3 attendings). They only have 1 hand attending currently, but another will be starting later this year.

Didactics/Teaching
Formal didactics are on Thursday mornings. It is a 3 hour session, broken into hour-long components: first, each class breaks up and reviews some readings with an attending; then there are case/topic presentations; and finally there is a formal lecture. Last year, Dr. Berberian didn't think that the residents were reading enough, so he created an oral quiz contest, where residents are split up into teams and each resident is asked 1 question per week based on the assigned reading. At the end, the winning team of residents and the individual resident with the most correct answers each get $1,000 bonus in educational money. Last year was the first year they did it, and it has become very competitive, with resident book knowledge increasing significantly. However, residents admitted that book knowledge has never been a priority of this program. You will have all of the core knowledge, and there is 100% pass rate on ABOS part 1 for the last 20 years, but OITE scores are not viewed as being important.

Operating Experience
Emphasized as a strength of the program. You will leave this residency comfortable with trauma and all of the bread and butter orthopaedic procedures. University Hospital in Newark is the home base, where you will spend more than 50% of your time as a resident. It is a level 1 trauma center, and a very busy one. Peds and tumor are also very busy services at UH. On trauma, the operative experience is back loaded, however, and double scrubbing is common according to the rotators. There is also a trauma fellow who will compete for the complex cases. At UH, the sports, spine and joints experiences are weak. Hand (Ahmed) and F/A (Berberian) at UH are hand-on experiences for the residents, but relatively low volume. Rotations at outside hospitals give juniors and seniors complementary experiences, including the VA (20 min drive, good joints), Hackensack (30 min), Overlook (30 min), Newark Beth Israel (10 min, many junior attendings are moving here as they recently inherited 6 OR's), Manhattan Beth Israel (good joints), and Monmouth (1.5 hours away, apartment for residents by hospital). Most of these ancillary sites are privademic and have good hours and limited call with good operative experience.

Clinic Experience
There is a resident-run clinic at UH, where the residents are often the only doctors seeing the patient. Juniors run management plans by their seniors, but they have the freedom to indicate patients for surgery as long as they run it by an attending. The patient population is underserved, so clinic can be busy, and juniors who are on light services are often sent to the clinic to provide an extra set of hands. There are also private offices at UH for the attendings private patients, and residents will also see the patients and come up with their plans, and then present to the attending. Trauma has clinic once per week, peds is more like three times per week.

Research Opportunities
There is an 8-week protected research block during the PGY3 year, and each resident is required to submit a paper for publication as a graduation requirement. However, research is not a focus of the program, and residents cited this as an attractive part of the program for them. They said you can do as much or as little research as you want, with most residents opting for minimal involvement. That said, one of the PGY3's is quite interested in research and published 3 papers this year. However, he was noted to be the exception, not the rule. There is some research support here, and they maintain an active biomechanics and tissue engineering lab with 2 affiliated PhD faculty members. There is a public health institute at the medical school, and it seemed like collaborations between departments are possible if you seek them out.

Residents
6 per year. No research track. There are only 2 females in the program, and both are chiefs this year. About half of the residents are married. I get the vibes that the residents are a bunch of hardworking, blue-collar guys, who are battle-hardened from working in a poorly-functioning hospital system with an underserved patient population. I would describe the residents as very bro-y, talk a lot about sports, swear a lot, and joke around with each other. There seems to be great camaraderie among the residents, and some of them do hang out with each other outside of work. I heard rumors that historically the residents were malignant, and the residents addressed this directly during the day, and said that this was definitely true in the past, but no longer the case. Morning report can still get pretty aggressive, and seniors and attendings like to put the juniors on the spot, but it is supposedly a lot more benign than it used to be.

Lifestyle
You will work hard at this program. Hours on trauma can be long, especially in the summer, where you will be logging 100+ hours regardless of your PGY year. Some of the other busy UH services like tumor and peds can be long hours as well. However, most of the ancillary sites, as well as the lower volume subspecialties at UH (hand, F/A, spine) are much lighter on the hours, definitely below 80. They have adopted a night float system, where you take 2 months straight of nights as a PGY2. This is really challenging, as the ER is busy at all hours of the night, and there is no back-up available. However, once you finish this you don't have any more nights except for weekend 24-hour call about 1x/month. The interns on spine have buddy call during the day to get themselves ready for nights. The day pager is held by a junior on the service that is light for that particular day.

Location/Housing
Newark on the whole is a rough city, and all of the residents live in surrounding areas, with about 1/3 in Hoboken or Jersey City, 1/3 in Manhattan, and 1/3 in New Jersey suburbs. The hospital isn't easily accessible by public transportation, and there are a lot of ancillary hospital sites, so a car is a requirement. However, parking in Manhattan, Hoboken and Jersey City can be a pain in addition to being expensive. Manhattan is obviously an expensive place to live, Hoboken and Jersey City are slightly less, and the suburbs obviously the most affordable and are where most of the residents with kids live.

Limitations
Less subspecialty exposure than I would like, especially in sports and joints. Only 1 hand attending currently, although that may be changing in the near future. Limited operative experience and double scrubbing as a junior on the UH trauma service. Car is required and there is a lot of driving to ancillary hospital sites, including treks to Manhattan and Monmouth (on the Jersey Shore). Chairman has limited involvement with the residents and the program. Book knowledge and research are not emphasized.

Conclusion
Solid program. I think this is a community program at its core, where you will come out well-versed in the bread and butter of orthopaedics, will be comfortable taking call, and will have a good foundation of orthopaedic skills to take with you to fellowship. That said, while there is a medical school affiliated with the program, it isn’t very academic here. Most of the graduates go into community practice, or will work at a private practice with academic ties. The location in the NY metro area is close to family and friends, which is a plus. However, Newark isn't a desirable place to be, and residents said that they go to work then leave the city as soon as they’re done. Make no mistake about it, this is a solid program, and the PD Dr. Berberian is a stand up guy. However, it is on the lower end of the tier 3 spectrum for me.

UCSF (San Francisco)

Interview Experience
This was among the longest interview days of the year. Started with presentation by the chairman Dr. Vail, followed by a chief resident presentation. Then all of faculty and residents introduced themselves. The department said that the two interview days are the most important days of the year for them, so all residents and faculty cancel their clinical responsibilities to help with the day. It was a really impressive showing actually. In the morning, there was a bus tour with the residents, followed by lunch and an hour of panel interviews in the afternoon. There were 4 rooms, each with 4 to 6 interviewers, consisting of faculty and chiefs residents. The rooms were themed, including chairman/general, research, knowledge/pimping, and leadership. I was a little nervous for the knowledge room, but everyone was very pleasant and the questions were not overly difficult. After the interviews were over there was a reception at the school, where the faculty drank beers and talked casually with the applicants. The residents then hosted everyone at a beer hall in SF, which was quite the scene, but overall was a fun experience where I got to speak with a few of the chief residents who interviewed me earlier in the day. They typically take 5 or 6 rotators and 1 or 2 non-rotators for their 7 spots, but they only interview 48 applicants over 2 days, so you have good odds if you get an interview.

Staff/Faculty/Chairman
The chairman, Dr. Vail, is a joints surgeon who has been at UCSF since 2007, when he came over from Duke. He reminds me of a CEO, very professional, well-mannered and laid back. He knows all of the residents, and they speak very highly of him. He is well-connected and respected in the orthopaedic community and helps the seniors land great fellowships. Dr. Kim, the PD, is a joints surgeon and is in charge of the VA. He was unable to come to interview day, but the residents also spoke highly of him. They said that they don't work with him much until they are the senior at the VA, but said he is very available to the residents if something comes up. The faculty has seen some expansion since Dr. Vail took over, and is now >50 strong. They have multiple faculty in each department, including 2 tumor attendings and 3+ each in hand, F/A, spine, joints, and trauma. Residents have 1 clinical mentor and 1 research mentor that they are assigned at the beginning of intern year. However, residents mentioned that they are always able to reach out to any of their attendings and they can get a response.

Didactics/Teaching
They have formal didactics in the middle of week, with the bulk of the lectures on Wednesday(?) and some additional conferences on Tuesday/Thursday. They have formal cadaver sessions that are set up for them in the summer. A lot of the teaching is resident-led, but attendings are usually present to ensure that relevant topics are covered.

Operating Experience
A strength of the program. Resident autonomy is a focus, and juniors are given opportunities to fly in the OR, particularly at SF General Hospital, where they spend 4 months on trauma/general as a PGY2, PGY3, PGY4 and PGY5. The residents are split up into two teams here, with each team covering specific services (e.g. spine, hand, F/A) in addition to trauma, so you get some subspecialty exposure in the bread and butter cases. At the VA and even at the University Hospital at Parnassus and the new Orthopaedic Institute (OI) in Mission Bay, the junior residents are given ample opportunities to operate. As seniors, they are basically allowed to serve as the primary surgeon, with the attendings providing advice and appropriate supervision. There are only a few fellows (2 in trauma, 1 in joints, 2 on spine), and the residents said that the fellows do not steal cases and serve primarily as teachers on bread and butter stuff.

Clinic Experience
Usually 1 or 2 days per week depending on the site/service. They have Epic EMR at Parnassus/OI. SFGH has a patchwork system with labs/orders in the computer and paper for notes and consults. Mark Zuckerberg recently donated a large sum of money to build the new SFGH, and the rumor is that they will get Epic within the next few years. Residents spoke positively about clinic, and said they see their own patients and come up with their own management decisions before presenting to a senior resident or attending. Even for private patients at the OI, junior residents get to see the patient first by themselves.

Research Opportunities
UCSF as a whole is a research haven, and the orthopaedics department is no exception. They have a number of basic science labs, and 1 resident per class has a dedicated year to use for research. They also have a lot of outcomes-based research and cost/quality stuff, particularly in joints. Unfortunately, Dr. Bozic, who was the field leader in value-based orthopaedics, took a job as the dean of surgery at UT-Austin, so his former research team is in a transition state. However, the residents emphasized that tons of opportunities are available here, and if you have a project idea, you can definitely find collaborators at UCSF. There is an 8-week research block during the PGY3 year, which most residents use to perform the bulk of the work on projects they set up during their intern/PGY2 years. Residents are required to submit 2 manuscripts before graduation, and each resident is also required to submit a grant application to the OREF. Many of them actually get funded, and current residents have been awarded more than 200K of grant money, which is really impressive. This is also a good place to mention the international elective, which every resident is required to take during their fourth year. It is a great opportunity to teach and operate in a third-world country, and residents spoke positively about the experience.

Residents
7 per year, 1 of which is in the 6-year research track. I really liked the residents, and thought that they were a fun, energetic, cohesive group that actually spent time with each other inside and outside of work. Since so many residents from different classes rotate at SFGH at any one time, everyone in every class has worked with each other and there is a lot of between-class camaraderie. Many of the residents have West Coast ties, but they have a few East Coast transplants. About half of the residents are married, but most of them still find time to hang out with each other. Not a ton of "bros" per se, but energetic and fun city dwellers.

Lifestyle
SF is a world-class city, and is really fun place to live. Great food, culture, neighborhoods, activities, diversity, etc. Fantastic weather year-round, close proximity to the ocean, and lots of opportunities for outdoor activities. Tahoe is a 3-hour ride away. The residents said that they generally work around 80 hours, although summer at SFGH can be brutal. Their call works out to q4 at SFGH, q6 at University, and q2 home call at the VA. They get post-call days. Residents work out their own call schedules in advance, and can request specific days off at the beginning of the rotation. Residents in each class also work out their service rotation schedule at the beginning of each year. Chiefs basically run the entire orthopaedic service at SFGH, so there is still a lot of work as a senior, but it is good practice for working as an attending.

Location/Housing
SF can be expensive, but residents are given a stipend of $10K/year to help defray housing costs. Public transportation in SF is available, but not really an option for the residents given their odd hours and the distance between the clinical sites around the city. Therefore, a car is a necessity, and parking can be difficult. Street parking can usually be found in the early mornings, but is a bit of a crapshoot and can take a few minutes. You can buy garage passes at the hospitals, but they are 100 to 200 bucks depending on the site. The residents said that most of them live within walking distance of 1 of the hospitals, and then they drive 15 to 20 minutes to the other sites. The costs can add up, but the residents said it comes with the territory of living in SF.

Limitations
The cost of living is high, car is a requirement, and parking is difficult. There is some driving between the sites, although everything is within city limits. Spending 4 months at the county during years PGY2 through PGY5 is good operative experience, but can be quite tiring and sacrifices subspecialty exposure. SFGH doesn't have the best patient records system. West Coast location is far away from family and friends. I have heard reports from rotators that some of the residents and attendings can be difficult to deal with, not malignant per se, but unnecessarily anxiety-provoking. I didn't get that feeling during the interview, but the reputation is out there and must be acknowledged.

Conclusion
Outstanding program in an outstanding location. Early hands on operative experience, minimal fellow encroachment, big names in the field, stable leadership at the top, and great research experiences. Residents felt like a very dynamic and cohesive group that I felt like I would fit in well with. Fellowship list was also top notch (i.e. HSS sports, Rush sports, Harvard hand). SF is an awesome place to live, cost of living and distance from home aside. I think UCSF is in the conversation for best program in the county, tier 1 for me.

Pittsburgh

Interview Experience
The day started with a presentation by the residents, with the chairman Dr. Fu personally giving his own presentation on the program during the lunch hour. Dr. Fu then met with each applicant individually for 5 minutes, and you met with either the PD Dr. Deeney or assistant PD Dr. Hogan for 8 minutes. Then you met with 4 additional attendings for 15 minutes each. Conversations were friendly with nothing out of the ordinary. They interviewed 90 applicants this year, 30 on the first day and 60 (in two groups) on the second day. During Dr. Fu's presentation, a slide mentioned they aim for 2 Pitt students, 3 away rotators, and 3 non-rotators. They take 8 residents, 4 research track (6 years) and 4 clinical track (5 years).

Staff/Faculty/Chairman
Freddie Fu is the chairman and is a very visible face of the program. He has been at Pitt since the 1980's, and has overseen a huge growth in the program. He specializes in sports, but the residents don't operate with him much. However, he is very involved in their education and the day-to-day operations of the department and the residency program. Dr. Deeney (peds) is the program director, and seems like a funny, down to earth guy, and the residents all spoke highly of him. He is planning to retire soon, and Dr. Hogan, a young foot/ankle specialist, was recently chosen as the assistant program director and is being groomed to replace Dr. Deeney. Dr. Hogan was very energetic and enthusiastic during interview day, and he is a really likable guy. During interview day, Dr. Fu made comment in passing that he might retire when his board certification is up for renewal in 2018. I think this comment was made partly in jest, although some rotators said that they heard rumors that he is considering stepping down in the near future. Another resident, when asked about this, said didn't know anything specifically, but thought that Dr. Fu has a ton of energy left in the tank and they didn’t envision him retiring anytime soon.

Didactics/Teaching
They reserve Wednesday morning from 7am to 12pm for protected teaching time. Usually they have an internal attending speak for 1 or 2 hours on a given topic, followed by senior residents lecturing on OITE-related topics for the remaining 3 to 4 hours. The sub-specialties are well-represented among the faculty, including multiple hand, tumor, and F/A attendings. I didn't get too much detail about the quality of the lectures, but two resident graduates from the program that I have worked with as fellows seem to be well-versed on book knowledge.

Operating Experience
This was a point of emphasis during interview day. UPMC is a high volume center, which means that residents aren't fighting for cases with fellows, and double scrubbing isn't that common. Trauma at Presby (the main hospital) and joints (at Shadyside, ~10 min drive) are busy services with good operative experiences. Every year or two, a resident chooses to forego a fellowship and go into community orthopaedics, which the residents said speaks to their level of comfort with bread/butter cases. At the VA (~5 min drive), the senior residents are the primary decision makers. For the residents doing the 6-year research track, they are board certified superchiefs during their 6th year and take primary trauma call at Presby. I had some concerns about the number of fellows, particularly in hand, but on interview day one of the hand attendings told me that they use a 1-on-1 mentorship model, with the attending running two rooms, one for residents and one for fellows. When I spoke with some of the rotators about their OR experience, they said that double scrubbing does happen occasionally, but it usually a PGY5/6 with a PGY2/3. They were also short one spine attending this summer, so there was a bit of double scrubbing on that service. They said, though, that the general attitude was to let the juniors get some hands-on experience and not just relegate them to watching. I didn't hear much about the sports or peds experiences.

Clinic Experience
Didn't hear too much about clinic. They use Epic EMR, and only have to login to the computer once to access all of the EMR applications. I didn't hear many complaints about clinic, and it seems like the residents get opportunities to see patients on their own and come up with their own plans, especially as seniors.

Research Opportunities
This is touted as a strength of the program. It is basic science heavy, with 4 of the 8 residents each year assigned to a laboratory where they perform bench work on stem cells, biomechanics, cartilage regeneration, tissue engineering, etc. The entire program has a basic science feel to it, and Drs. Fu and Musdahl are among the best-published sports attendings on ACL repair in the world. I am more interested in clinical outcomes and quality research, which is not a focus of their research, but Dr. Yates at the VA and Dr. Hogan (the assistant PD) are working on a new database that should create some great research opportunities. Dr. Irrgang is a PhD researcher and handles most of the clinical studies with the residents, but I did not get an opportunity to meet with him.

Residents
8 per year, with 4 doing the 5-year track and 4 doing the 6-year track. Everyone seemed very normal, friendly, and enthusiastic about their choice to do residency at UPMC. I got the feeling that you really have to buy into the Fu culture if you want to do well there, but residents said that he is a great advocate for them and is well connected within the orthopaedics community. Around half of the class is married, and some have kids. There are quite a few women in the program, and the residency won the diversity award from the AAOS a few years ago. Since the residents are spread out around Pittsburgh clinical sites (even though they are all within 10 to 20 minutes of each other), I heard from some rotators that residents don't spend a ton of time with each other outside of work. Everybody knows each other, but after intern year, everyone starts doing their own thing and the level of resident camaraderie seems to fade. One rotator said that the program forms a bunch of cliques/factions, where similar groups of people hang out (i.e. family-oriented, locals, party boys). I would describe the personality of the program as a bit nerdy, not particularly bro. The residents didn't speak about the fellowship list in detail, but said that they can get great fellowships because of the reputation of Pitt and Dr. Fu's connections. Many residents go into sports, but there is obviously variation year-to-year.

Lifestyle
This is a program where you will work hard while you are at the hospital, but they emphasized that they adhere to the 80-hour workweek. Years ago, it was taboo to take a post-call day, but now the faculty will send you home if they see you lingering around the hospital in the late morning after an overnight. PGY2 is the hardest year of residency, as is typical for most programs. PGY3 recently instituted a night-float system, which is considered an easy block since you are providing in-house assistance to the PGY2 on call.

Location/Housing
Pittsburgh was voted the most livable city in the US by Forbes(?) magazine. Housing is affordable, and many residents own homes just outside of the city. Traffic isn't bad, there is an emerging restaurant and arts scene, and there is great sports culture in town. Dr. Fu has tickets to a ton of arts and sports events and his secretary regularly sends out emails to the residents with a listing of available tickets. One negative about the Pittsburgh is its lack of diversity. Out of the 100 largest metro areas in the US, it is the 99th least diverse. There is diversity of residents in the residency program, but the patient population is almost entirely white, middle-class, English speaking patients.

Limitations
As noted above, there may be a changing of the leadership during the next 5 years. Dr. Fu has immersed himself in every facet of the residency, and it would be difficult for another chair to replicate him. The city of Pittsburgh, while affordable and livable, is relatively isolated from other major cities and is lacking in diversity and culture. Many of the residents have ties to Pittsburgh, and the lack of a cohesive resident feel is concerning, particularly since all my family and friends are far from Pittsburgh. The basic science research focus is not particularly interesting to me. Lastly, if you want to go to Pittsburgh, you are strongly encouraged to do a second look before the match list is due, and it helps if you tell Dr. Fu that Pitt is your top choice. An intern matched last year without doing the second look, but he said he is the only current resident he knows of that this happened for.

Conclusion
A balanced program with a great operative experience (especially on trauma and joints), good resident autonomy with limited fellow encroachment, and great research opportunities. Some people might consider this a tier 1 program. However, because of location, questions about resident cohesion, and the need for a second look, it is going to be a low tier 2 program for me.

Yale

Interview Experience
Very large group, as they interview 100 applicants over 2 days for only 5 spots. Social the night before was actually a sit-down dinner with 1 resident at each table. Interview day consisted of 3 sit-down interviews for ~20 minutes each (2 faculty and 1 chief resident). Interviews were conversational and friendly, and nothing out of the ordinary was asked. The chairman and PD served as faculty interviewers, but the majority of applicants did not get a chance to meet individually with either one, which was definitely a negative.

Staff/Faculty/Chairman
Nice mix of faculty. On the academic side, there are some older, experienced, well-known attendings, as well as some younger attendings that are in the early or prime stages of their careers. The residents also work extensively with private community attendings at the St. Rafael's Hospital down the street. During third year they go to Waterburg (45 minute drive), to work with one of the pioneers in anterior hip replacement. The chairman, Dr. Friedlander (hand), has been at the helm for 20+ years, and is a funny, personable guy. However, he is likely to step down in the next few years, certainly during my potential training time. Dr. Smith (peds) is the residency director, he is smart, but reserved and soft-spoken. The residents seem to like both Drs. Friedlander and Smith.

Didactics/Teaching
There is fracture conference on Wednesday, as well as grand rounds on Friday, with a lecture given to residents by the guest speaker beforehand. Many specialties also have weekly conferences of their own. The residents emphasized how great their grand rounds speakers are, but did not speak too much about the weekly didactics. There is an anatomy course in the spring, rotating each year between upper and lower extremity. In the operating room, the faculty seem to understand that the resident education is important, and are all willing to teach.

Operating Experience
This is a strength of the program. They are a high volume trauma center, and 30% of the cases go uncovered because only 3 residents are assigned to trauma at any one time. Double scrubbing is rare, and the PGY1's and PGY2's routinely get to be 1st assist in the OR. Responsibility is gradual and there is a good balance of autonomy/skill development with instruction/supervision. The residents say they get their best operative experiences on trauma as well as joints and sports with their community attendings at St. Rafael's and the VA.

Clinic Experience
Did not hear too much about clinic. Most of the clinic sites are at Yale or within greater New Haven. There is some driving for peds and spine(?) subspecialty clinics. They have Epic EMR, so that helps with efficiency. Residents said that clinic was as enjoyable as could be and they had a good mix of teaching with autonomy.

Research Opportunities
Residents get 10 weeks during PGY3, PGY4 and PGY5 to do research or clinical elective rotations. During PGY3, there is a lot of call coverage, so research is harder to work on, but PGY4 and PGY5 are very conducive to research. Dr. Grauer does outcomes and database research with the medical students and residents and is very active with publishing. Dr. O'Connor, who is heading the new musculoskeletal center, is also interested in patient-reported outcomes and value-based orthopaedics. Most of the residents end up in private practice, but there are abundant opportunities to get involved in academics and research if you seek it out.

Residents
5 per year. Cohesive group of residents. Seemed overall to be laid-back, collegial, and fun. Spent time with each other outside of the hospital. Some had families and kids, others were single. They have a relatively diverse group, with quite a few female residents and attendings. Did not come across as particularly "bro-y" during my interview, but seemed like a great group of people I could see myself fitting in with. Fellowship match was good, but not crazy good. Many residents go into private practice.

Lifestyle
PGY3 is the hardest year for residents here, as this is their year of overnight call. PGY2 is day call, and PGY1 has night float for floor work. They have an army of PA's to help with floor stuff, allowing the residents to spend the majority of their time in the clinic and in the OR. Their weekend call schedule also seems nice, with "golden weekends" and no required rounding when you are off. PGY4 and PGY5 seem relatively easy, with the focus on operative experience. Some of the seniors use the 10 weeks for research to take vacation, hang with their families, travel, etc.

Location/Housing
New Haven is a small New England city. The downtown has gentrified in recent years, and there is an arts presence, good restaurants, and a small nightlife scene. Many of the single and younger residents live in downtown New Haven, while the older residents with families live in some of the suburban communities that are 10 to 20 minutes away from the hospital. Cost of living is cheap, and the pay is comparable to NYC programs, so you get more bang for your buck. Residents still noted that parts of the city aren't safe, and there isn't a ton to do in the greater New Haven area, but it has all of the amenities of a modern city. Would definitely need a car.

Limitations
There may be changes to the program with a new chairman in the coming years. The hospital would like to add more fellows to increase their USNWR ranking (as per Dr. Smith), but he would prefer to add more residents. Regardless of the ultimate outcome, the anatomy of the program will likely change in one way or another in the next few years. I also would prefer a bigger city than New Haven. They still are weak in some areas including joints and hand.

Conclusion
A balanced program with a great operative experience, good trauma exposure, well-rounded in most of the specialties, and with abundant time and resources for research. The program is resident-centric, and there are only 2 fellows currently, which is a big plus. The location is good but not great, with added points for the East Coast. Upper-level Tier 2 program for me, and would be happy to end up here.

Stanford

Interview Experience
Interviewed during my rotation there, which consisted of 5x10-minute interviews with the faculty. One room was a chief/attending tag team. Nothing asked out of the ordinary, although some interviewers asked me specifically about the details of individual research projects that I had worked on. Had a few behavioral interviewing type questions from the PD Dr. Avedian. The chairman Dr. Maloney was not involved with the interview day.

Staff/Faculty/Chairman
Dr. Maloney runs the show. He is a big name, and is very ambitious in creating a world-class orthopaedic department at Stanford. He came from WashU a few years ago, and there has already been tremendous growth in terms of expansion of the residency (from 5 to 7 residents/year) and faculty. There is also an increasing emphasis on research and publications. Dr. Maloney has minimal interaction with the residents, even when they are on his joints service. However, all the residents spoke highly of his leadership, and said that he works in the background to build a great residency program for them. He is in the line of succession to become AAOS president next year, and he is extremely well-connected, which helps him secure good fellowships for his residents. The program director, Dr. Avedian (tumor), is a funny, relatable, down-to-earth guy who is adored by the residents. The faculty has some big names in joints, spine, and sports, and they are looking to expand the faculty in other services (hand, F/A, tumor), although these departments are still fairly well represented.

Didactics/Teaching
Wednesday morning is reserved for didactics, with 1 to 2 hours of faculty-led lecture on a given topic and another hour of related OITE questions, where the residents go down the line and read/answer questions while an attending from that subspecialty makes sure that everyone understands the reasoning behind the right and wrong answers. They have cadaver dissections in the summer/fall, where the junior resident takes everyone through various approaches to the hip/knee/ankle/shoulder and an attending/chief pimps the presenter and other residents on related clinical pearls.

Operating Experience
Variable depending on the site and service that you are on. At the main Stanford Hospital, the joints and sports services are relatively hands off, and residents are double scrubbed with fellows. Stanford's main hospital is a level 1 trauma center, so the residents are fairly busy, but they usually only run 1 trauma room, and there is a trauma fellow who can get between the resident and the knife. The residents get the bulk of their hands-on operative experience at the Santa Clara Valley Hospital, which is a level 1 trauma hospital located in San Jose (~20 minute drive from Stanford). Residents rotate here as a PGY2, PGY3 and PGY5. The hospital is busy, especially during the summer, and there are two dedicated ortho rooms with a mix of trauma and elective bread and butter cases. The operative experience at the Palo Alto VA (~10 minute drive) is also supposed to be very hands on, especially for joints.

Clinic Experience
The main outpatient center is in Redwood City (~15 minute drive). Many of the big-name attendings want the senior residents and fellows in clinic, leaving the juniors to handle floor work, cover cases for the junior attendings, or cross-cover on another service. Clinic at the Valley and VA are much more hands on, with even the junior residents seeing their own patients and making management decisions before presenting to the attending.

Research Opportunities
Research is becoming an increasing focus of the residency, although I did not come across many many residents who were particularly interested in research. Dr. Goodman, a joints attending, is well-published in basic science and biomechanics, and some of the other attendings dabble in clinical research and outcomes-based stuff. I got the feeling that residents can do as much or as little research as they want here.

Residents
7 per year. I got a West Coast vibe from the residents, even from East Coast transplants. Residents are generally laid-back, friendly, and down to earth. Many of them are outdoors-y, and a number were college athletes. However, I didn't get a strong sense of community among the residents, and many of them seem to do their own thing outside of work. The residents are spread out across a couple of different sites, and the program did not feel like it was particularly team-oriented. Many of the residents do fellowships and go into private practice. I didn't get to see the specifics of their fellowship match, but I think you can get a great one on the strength of the Stanford name and Dr. Maloney's reputation.

Lifestyle
The culture is definitely work hard. All of their call is “home call”, even at the Valley hospital, which is a scam because both of these hospitals are level 1 trauma centers. They don't have post-call days, and even though call at Stanford Hospital is ~q8 for juniors, you often will be in the OR all day after a 24-hour shift. At the Valley, the juniors (2 PGY2 and 2 PGY3) are on call q4. PGY2 and PGY3 are both busy, but the schedule lightens up quite a bit by PGY4, except for the PGY5 rotation at the Valley. There has been talk of moving to a night float system, especially since the program has expanded in recent years, but it doesn't sound like it will be happening anytime soon.

Location/Housing
Palo Alto is a suburb about 45 minutes south of San Francisco and 20 minutes north of San Jose. The city of Palo Alto and the surrounding towns are suburban paradise, but the cost of living is quite expensive. Residents can live in decent size apartments or even houses, but the rent is high, nearly as high as SF. You need a car to get anywhere, and public transportation is non-existent. Residents can trek into SF during days off, which you can get to using the Caltrain or driving. However, many residents cited that they liked Stanford because they aren't city people and they like to do outdoors-y stuff like surfing, hiking, biking, golf, running, etc.

Limitations
Call schedule and work hours are long and hard. Operative experience on many of the subspecialty services can be hands-off and subject to fellow encroachment. Cost of living is expensive, there is a considerable amount of driving, the suburbs are less desirable to me, and the Bay Area is far away from family and friends. Limited interaction between the residents and chairman, although he does seem to care about them placing into good fellowships. They also lost a few residents in recent years, and the circumstances about their departures were not entirely clear, but seemed more related to personal problems rather than program problems. Residents also didn't have a strong cohesiveness, and I felt like the residency structure was not particularly team-based.

Conclusion
Solid program, and one that I see continuing to improve over the next few years. Stanford has a great name with famous attendings, solid research resources, great bread and butter hands-on training at the Valley/VA, and shiny new facilities. That said, while I really wanted to love this program, it has a lot of limitations. On the lower end of the Tier 2 spectrum for me.

Med School: East Coast, not top 25
Boards: Step 1 and Step 2CK >260
Rank: top 10%
AOA: Yes
Preclinicals: honors
Clinicals: honors in surgery and medicine
Ortho: honors on home and 3 away rotations
Research: multiple ortho-related publications and presentations
Extracurriculars: ortho club, competitive athlete

What I was looking for in a Program:
-Strong operative experience with early opportunities to get in the OR
-Good trauma exposure and strong subspecialty rotations in joints and sports
-Rotations through multiple hospital types (public, private, VA), with limited travel between sites
-Hands-on learning, with a focus on resident autonomy and limited fellow encroachment
-Resources and support for resident research, preferably with outcomes and cost/quality projects
-Urban location, preferably in the Northeast
-Preference given to large residency programs (6+ residents per year)
-Good resident cohesiveness and "bro-friendly" atmosphere
-Stable program leadership (chairman, PD) that is responsive to resident feedback

How many Programs:
Applied to: 70
Offered Interviews: 45
Attended: 21

My Program Rankings:
Tier 1: UCSF, Jefferson, Rush, NYU
Tier 2: Stanford, Yale, Pittsburgh, Tufts, Hopkins, WashU, Einstein/Montefiore, Mount Sinai, Brown, UW, UPenn
Tier 3: Rutgers-NJMS, Rutgers-RWJ, Albany, Maimonides, SUNY Downstate, NS-LIJ

Matched at: my #1

Advice for future applicants:
-Be honest with yourself when it comes to choosing away rotations. These are your best chances at getting into a program. If you are a borderline applicant, don’t waste your time rotating at top tier programs.
-Once you are done with each rotation, reflect on your experience to figure out what you value in a program (i.e. program size, prestige, resident autonomy, research focus, location). There are a lot of good orthopaedic surgery residencies, and I would argue there is no “bad” residency out there. However, there are very few residencies that can offer you a perfect fit, and you need to figure out what tradeoffs you are willing to make.
-Getting interviews is fairly formulaic, since there are only a few criteria programs can really evaluate you on. Perform well on Step 1, honor you surgery and medicine rotations, and publish some research, and you will be in the conversation at every program.
-Once you get to the interview, it’s all about showing some personality. Be friendly, courteous, and humble, but personable. Obviously you don’t want to be overly talkative or obnoxious, but you want to make a good impression and not just be another generic applicant. The interview format for orthopaedics is akin to speed dating, so if you keep it super vanilla, you will blend in with the dozens of other faces from that day.
-Apply broadly. There are so many competitive applicants, that getting interviews as a non-rotator can be difficult. Don’t worry about spending a few hundred extra dollars on applications, since the opportunity cost of not matching is so high.