Advice from Ortho Residency Coordinator

Thank you very much for your advice.
I think one of the biggest frustrations for us is the fact that many interviews fall on the same days forcing people to choose between programs while those who have multiple interviews within the same geographic region are unable to schedule them during the same weekend because the dates are so inflexible. I am hoping that something could be done about this. I realize that a lot of constraints are due to OR schedules, logistics of getting attendings to be present, and maybe even the desire to limit the number of programs we interview at. But, if program coordinators communicate with each other, I wonder if a few changes could be suggested:

1. Could programs in the same city / vicinity schedule interview dates in succession - for instance, it would be very convinient if the two programs in Cleveland could interview on successful days.

2. It would also be helpful if there was more flexibility in interview dates. Some programs only offer one date, and often this date is shared with several other programs. While I am ok with one date interview, I hope that some effort can be put in to making sure that that one date is not the most popular one. Perhaps program coordinators can circulate amongst them suggested dates and try to work out a schedule that limits these conflicts.

3. It seems that some programs send out more interview invites than they have available spots. I hope that a message can be passed on that this practice is somewhat unfair, and it results in us being extremely paranoid about checking email.

Anyway, thank you very much for your post. I hope these issues can be at least discussed among your fellow program coordinators, and hopefully this process will be less frustrating in the future.

Thanks for your post.
To address your first point... there is an organization called the Association for Residency Coordinators in Orthopaedics (or ARCOS). Annually, a representative from that organization puts together a list each year of interview dates which is then distributed to all coordinators who are members (most). Whether or not the coordinator chooses to look at it and consider it when choosing a date, is dependent on the program. However that effort is made.
Our program offers more than one interview date and I personally do not feel it is fair to only offer one date. I do not know whether those programs with one date check the above mentioned list to try to accommodate or not, but I can certainly suggest it at our next meeting.
I have no idea why a program would send out more invites than there are spots. As a coordinator that would stress me out immensely, so I can't think of what the positive would be for doing that. It seems much easier to send out invites to additional candidates as open slots become available (which is what we do).
I hope this was somewhat helpful, if for no other reason then for you to understand how we do things. Our dates are similar each year, but we try to mix up the days of the week to accommodate our attendings so the same ones don't miss their OR or office hours every year.
There is an ARCOS meeting during the AAOS meeting this year in Chicago, I would happy to bring these issues up at the meeting. Maybe I could make some changes for those who come after you.

Is it looked upon poorly if we can't make the pre-interview social due to travel constraints?

I would say it's always beneficial when possible to make the event, but any program that would hold it against you is not really one where you want to be. I would make a point (although do not gush... most coordinators don't want to hear gushing) that while you are very interested in the program and wish you could attend the event, you unfortunately have another interview. I'm not sure how formal other programs are with regard to this... how much feedback they get from the residents about the behavior/personality of the attendees. We try to get feedback about each candidate, just a brief impression. Definitely let the coordinator know ahead of time you will be unable to make it and just make sure they know you want to, but just can't adjust your schedule. I don't think any decent program is going to drop your ranking because you couldn't party with the residents. I think it's half to check you out and half for you to get to know the residents and see if it's a good fit for you and the programs know that.
In short, if you can't make it you can't make it. Don't stress over something you can't control.

Thanks a lot for offering your help.

Since you mentioned step 1 scores, can you give us some insight as to how your program deals with them? Also, how much consideration do you give to step 2 scores, if the applicant did not have a fantastic step 1 score?

Sure. Our program splits up applicants based on Step 1. Over 220 goes through the 'regular' review process, under 220 gets reviewed individually by the PD to see if there is anyone outstanding in that group. He will generally pick out around 10. Those 10 then get put into the batch of "over 220s" and go through the review process. Often the thing that might swing them is a very high Step 2 score. Although in all honesty a very very low step one score is hard to rebound from. 215/245 is one thing, 193/230 is another, Step 2 can pick you up from decent to moderate, but likely will not pick you up if you're in the bottom batch of scores. Every program's review process is different and that number (220) will vary. But, as I advise any student in my own school who comes to me with a low step one and step 2, it's a good idea to have a backup plan. I never want to discourage someone from going for where their heart is. But at the same time, it's wise to be realistic. As my boss tells me, some people think that ortho is EVERYTHING and they will not be happy doing anything but. He says, if they could see me every day doing stacks of paperwork, they'd think differently!
I hope no one is offended or hurt by my comments, as I said I just want to be honest. Everyone needs to make their own decisions in the end.

so, this is a question some ppl on this board have asked, but have been told to do a search.. only to find half-decent information. i'm a FMG-to-be and i'm currently in a MS3 from st. george's university in grenada, but i'm a US citizen. we do our 3rd and 4th years in the US, mainly NY/NJ. I'm really interested in going into ortho, but don't know what my chances are. I was wondering how you, as a residency coordinator, would look upon an applicant with decent scores from a school like sgu. I got a 245/99 on step 1 and currently have a 3.75 gpa after my first rotation (med-got an A). I'm planning on getting involved in some ortho or surgery-related research.

thanks

Well this is a tough one and I'm sure very program dependent. Some programs will not, under any circumstances, interview an FMG. Others will consider them but at a lower level. I'm not sure if there are any that consider them on equal footing. This is becoming increasingly complicated since ortho is getting so competitive. My best suggestion is to pick a few places where you feel you have a chance and you feel would be a good match and do an away there. Then go and really do your best to knock their socks off. Having good scores as an FMG is good, having good scores and showing the program in person that you're a great candidate is better. I imagine your school probably has stats on their past graduates - how many matched to the programs they wanted. This is a good place to start to see what the numbers are. Our program is becoming more difficult when it comes to FMGs, whereas we used to be more open to them, it's become a direction the PD and Chairman prefer not to go.
I haven't looked around much to see, but I imagine there are some good posts from residents on how to do your best while on a rotation. I would read up on those and take them seriously. There is a fine line between knowing your stuff and being cocky - our program does NOT like cocky. There's not much you can do to force yourself to be the perfect rotator, other than be yourself. But definitely look into what qualities they are looking for. The best rotators we have are said to be "like having another resident on service". Anticipate the resident's needs, learn when shown something the first time so you can do it for them the next, work hard, stay late, be interested!. You don't have to be the smartest or know your anatomy better than anyone else. But they want to know if you were on their team, they could feel confident trusting you.
Best of luck.

Another thing I forgot to mention to the FMG candidate above is that some programs have 6 year slots with a year of research. This may be another 'in' for him and others who maybe don't have the scores or resumes as others. It all depends on who is applying that year, but they might have a better shot at some of those tracks instead of the traditional 5 year.

With regards to so many programs offering interviews on the same day: Dr. Simon at UChicago told me that it is done to help weed through the many applicants in Ortho each year. B/c you can only go to one a day, multiple offers helps the individual programs interview candidates more interested in that particular program, not those who want a long ROL. Also, Dr. Levine at Columbia picks his date so that no one will conflict. I've heard that the HSS / Lenox Hill conflict isn't a mistake either.

Good luck, interview at Miami.........

With regards to so many programs offering interviews on the same day: Dr. Simon at UChicago told me that it is done to help weed through the many applicants in Ortho each year. B/c you can only go to one a day, multiple offers helps the individual programs interview candidates more interested in that particular program, not those who want a long ROL. Also, Dr. Levine at Columbia picks his date so that no one will conflict. I've heard that the HSS / Lenox Hill conflict isn't a mistake either.

Good luck, interview at Miami.........

I have no doubt that the above is true, particularly for the big name programs. They feel like if they offer one date you should be honored enough to take it. And that if you're going to think of taking someone else's offer on that date ahead of yours, they don't want you anyway. Along those lines, if I have a bunch of people who can't make one full interview date and want to be wait listed, I often feel like, "obviously they are choosing another program over ours and are just willing to come here if it's on a day they have nothing else to do. I'd rather offer the spot to someone on the wait list who will be happy to get the invite regardless of when it is". However, while that's in the back of my mind, we do keep to our system for the most part. I don't feel someone should necessarily know before they get here whether or not this is the place for them, so forcing them to choose by purposely putting your interview date the same as another strong program or only giving one date thereby making people choose doesn't seem to make sense. I'd rather give them the opportunity to check the place out and make that decision. If they get an invite and are no longer interested in the program, just turn it down and we can invite someone else who is.

rescoordinator-
Not sure if you are still fielding questions, but I thought that I would throw one out that I have always been curious about. When a student is offered an interview, does that mean that he or she has a good shot of being ranked highly (assuming fitting in well, making a good showing during the interview process, etc) irregradless of their application? Another way of asking the same question would be, is the ball in your (the applicant's) court once you have been offered an interview? The reason why I ask is that I know there a many applicants out there with astronomical numbers (boards, grades, etc.). There are also many students with good numbers that will always approach this process with a mentality that the chips are stacked against them, and that when it comes down to it, it will be hard to convince programs to pick them over the guy with better numbers (obviously this assumes the guy with the big numbers isn't a social misfit). Do you think that this is misguided anxiety, or is there reason to be wary of this reality?

On a separate but related topic, I know alot of students on this forum have read that Bernstein JBJS 2002 article about residency selection. In that article, Program directors listed away rotation at director's institution, Step 1 score, class rank, politeness at interview, and appearance of candidate as the top 5 criteria for selection. Do you feel that this accurately describes the most important criteria at your institution or at the institutions of your colleagues? Do you think that residency selection criteria has changed at all since the time of that article?

Thanks- I know that was a lot to digest all at once.

Jude,
Thanks for your quesitons, I'll try to cover them all from my perspective.
1. First, all programs handle their ranking differently so it's VERY difficult for me to tell you how that's done for anyone else. But impression wise, I would not say everyone coming to interview is on equal footing. I'm not just talking numbers. I know of students who had fairly decent numbers and did not match and those with average numbers who did. I imagine there are some programs that are all about numbers. We are looking for someone who is a good fit. We have more than one person interview candidates and all interviewers discuss the candidate and their impression of them together to come up with a composite idea. Often it's as simple as, "Nice guy, good numbers, I don't know if he's a good fit for our program". Or conversely, "Nice guy, average numbers, but seems like a hard worker and a good fit for the program". What determines those things? Nothing you can really control... it's just personality, what seems important to you, your priorities and expectations, etc. And you should be honest about these things and not try to put on a show, because you will only end up in a bad fit if you put on too much of an act.
I would not say the ball is in the applicant's court once they are offered an interview. Just like the ball isn't in a job applicant's court when he goes to interview with the boss. If your numbers are astronomical, you're probably at a better footing then someone with lower numbers. But you'd best believe if that guy comes off as a weasel, cocky or disinterested or like he's going to be unable to step up to the plate, his numbers suddenly don't matter as much. In summary, yes board scores help, yes it sets up high expectations. But the interview DOES matter. Average board scores (220s, 230s) are still very good candidates, presuming you make a good impression and your interviewers think you're a good fit, you'll do well. Below 220s you've got you work cut out for you, but just be yourself and be confident. Know that you can do a good job, play up other aspects of your application without being pushy and stand firm when questioned on your scores. Actually, everyone should stand firm (or at least have an answer prepared) on any less than stellar performance (class rank, grades, scores, etc).
2. As far as the JBJS article goes, I'm presuming since it mentions 'politeness at interviews' that this is AFTER you've been selected, not determining IF you'll get an interview. I would say if you have high board scores it's a plus, without a doubt. If you have lower board scores they want to see something special about you, but again this is something you can't plan for, it's mostly fit. Which goes along with politeness, although I don't know about the appearance. I have never seen someone walking into an interview in jeans... frankly you all look very much alike on interview day
Rendering Error in layout BBCode/Image: Layout 'BBCode/Image:default' Not Found. Please enable debug mode for more information.
If it's referring to race or sex, I'm sure some programs do take that into consideration, I am a part of a very diverse program so it never comes into play for us. I would say more than class rank your rotation grades tend to be discussed more as in "he high passed 5 rotations and only honored 1". So I would put that above class rank. Letters of recommendation are reviewed and mostly noted if they have something outstanding to say, "Dr. so and so raved about him and said he's the best student to come through his program in the past 5 years" (good thing). Or three letters saying, "He is a good candidate, we recommend him for your program" (ie YOUR program, not ours). I myself wonder why if someone is SO gung ho about our program (calling me incessantly asking when invites will go out because they so want to go to our program) why they did not do a rotation here? For the candidates that DO do a rotation with us, it's a risk but it's a necessary one. Either the residents liked you, didn't like you, or didn't have much to say one way or the other. If they didn't like you, it's not a good thing. We will not rank a rotator who the residents deemed poor highly, they will be the ones working with the student once they become a resident and they know who they want to have as part of their team. However if you're good, we know it, we want you.
I know THAT was a lot to digest. Hopefully it was somewhat helpful to you. I think a lot of what it comes down to is candidates trying to mold themselves to what they think a program wants to hear. But that's a bad idea for everyone involved because if you make yourself out to be something you're not, you may match, but to the 'wrong' program. At this point, you've done all you can do as far as your grades, rotations, board scores go. All you can do now is show up to your interviews, put on a nice suit and brush your hair, be polite to everyone you meet, and be yourself. If that means being more quiet, that's ok. If it means being talkative and laughing it up with the residents, do that. One tip: if you've done any research, KNOW about it. I've often heard interviewers say, "well I asked him/her about their research and they sort of hemmed and hawed, but it doesn't appear THEY actually did any of it". Even if you're more on the shy side - especially if you're on the shy side - think of some things to talk about so there isn't too much dead air... a question to ask about the program, something interesting to share. Interviewers don't like sitting in a silent room any more than you do, be prepared in case it happens.
I guess this ended up being more of a 'tips for interviews' which I could do in a separate message if people were interested, I imagine most of your schools have some sort of program where this is reviewed, I don't know that I'd have much more to offer than they would.
I hope this answers some of your questions.

One more thing, since I reread your post... as far as "will you be ranked highly if you're invited for an interview"... I'm not sure what you consider a high ranking... maybe top 10? If a program is interviewing 25 or 50 or 100 candidates... only 10 of them can be ranked at the top. So no, getting an interview doesn't really guarantee you anything. I hate to stress everyone out more than necessary... everything I said in the prior post is relevant about being yourself and preparing for your interview. But one program's No. 1 may be another's #20. I have no doubt that there are great candidates that are in the top of many of their interviewees lists. But not everyone can be that. Some programs will match all their residents in their top 5 or 10. Some may go much further down their rank lists. Some programs only rank a handful of candidates (top names) and some rank everyone interviewed. All of these things will come into play. Just be a nice person, know what you're talking about, be interesting, be SINCERE (we also get "seemed a bit fake"). And you'll do ok.

Now here is someone with good communication skills and a lot of common sense! I am sure you have a very well run program--of course much of your job is dealing with residents _after_ they get in. I hope I get someone like you coordinating my residency. Thanks for your thoughtfulness.

Thanks Ironman, I do what I can. The best way you can thank me is to be good to your coordinator, whomever he/she may be. That doesnt just mean being nice, it means getting your work done!! I'm glad someone is finding this helpful, luckily I'm a fast typist.

and know you will be ranking them extremely high (top 3, maybe 1 or 2), whats the best way to let them know?

All you can really do is send a thank you note to the PD and/or chairman letting them know you were impressed with the program and will be ranking them very highly. I would say something specific about your interview or interviewers, so they know it's not just a 'form' letter. "I really enjoyed talking with Dr. So and So about the research opportunities there, particularly in XXX. It would be great to get involved in that project". Or "I had heard good things about XXX Program but getting to visit, meet the residentsand hear how excited they were about their training really sealed it for me".
Can't do much else besides that that's legal. I suppose you could call the coordinator and let him/her know you were impressed as well. If that were me and you were a candidate we liked, I'd mention it to the PD.

I think all the things rescoordinator has been posting are great, but I wanted to clarify a common mistake.

It is not a violation of the match to volunteer information about where you plan to rank a program, or where they plan to rank you. They just can't ASK you where YOU plan to rank THEM. A quote from the NRMP web site:

"Although the Match Participation Agreement does not prohibit either an applicant or program director from volunteering how one plans to rank the other, it is a violation to request such information."

So you can go ahead and tell the program you are ranking first that you are ranking them first. It is without question dishonest to send "I am ranking you first" letters to more than one place. And that stuff will come back to bite you, because ortho is a small world. But if you write a letter saying that you loved such and such place, and you are ranking them first, there is no violation of the match.

Here is a link to the NRMP website if you have more questions: