This is likely the hardest time in your life thus far. You have spent 4 years and thousands of hours working towards a singular goal only to have it narrowly slip through your grasp.... I know exactly what you feel like because I was the same way last year. Not matching was horrible, but the support that I got through people on this site and similar posts to what I am making here really helped me move forward.
So, you didn't match. I am sorry. Unfortunately, I nor anyone else can change that. However, what you have to do is pick yourself up, dust off and keep working.
You have 3 options:
1. Give up on Ortho and do something else
2. Prelim Gen Surg
3. Research (either delay graduation or get a fellowship)
I will assume you did not pick #1, because you are still reading. Now, there is no "right" or "best" answer here. This is a very personal decision. Some people will do better in a prelim year and some people will do better in a research year. You need to looking at yourself and be honest what you are good at and what you aren't. You also have to look at what deficiencies are in your application, what went wrong and what you can do to fix it.
I can't talk about other people, but I can talk about myself and how I made the decision.
I was not the strongest application to Orthopaedics. I was a 226/227 (step 1/2), got all passes my 3rd year (except HP in family med) and did gen surg research. When you looked at my application, there was nothing special, nothing that stood out.... that said Ortho. When I didn't match, I asked myself - what can I change for next year? I couldn't change my grades or my board scores, but I could change my application to show that I work hard and that I would be an asset to whatever residency program that took me.
I had 2 options - as stated above - prelim vs research. Additionally, I was also part of a couples match where my wife matched and I was now locked into a region (we were told where she matched). I knew that if I did a prelim year, I would work hard, get 1 month on ortho (hopefully early in the year) and get some ortho support. However, I felt that a prelim year would do the most for my application to GenSurg (which was my back up if ortho didn't work out). This would have been an overall easier choice up front because I had alot of support around me from the medical school for the scramble. NB: Do not take just my word in this area - look at posts from to see some of the really positive aspect of a prelim year.
As far as research was concerned, this would be more difficult. I did not have any research lined up. However, thinking about it more, I knew that I would do well in a research position. I had been doing research all my life (undergrad and med school) and always wanted to stay in academics. I knew how to do research, keep organized and work hard. Thus I personally decided to peruse a research position. I felt that a research position would strengthen my application the most. I would be able to add many projects, would be able to work with multiple attendings over a period of months. This would allow them to know me better and be able to vouch for me and call other programs. Additionally I would be able to intelligently talk about many areas of Ortho on the trail the next year. This is where another very important choice came into play....
Remaining a med student vs graduating. There are pros and cons to both. If you remain a medical student, you will be considered a US senior next year (being an IA is a flag that I was asked about at every interview this year), you will be able to take loans for living expenses, you will be able to do rotations at your medical school to feel out other fields (if you want) and most importantly, you can still do away rotations for ortho. When you graduate from medical school, you lose the malpractice insurance that your med school normally covers when you are at an away rotation. Chances are you will not be able to scrub in (or even rotate at all) if you graduate. How to delay graduation? Do not take a required clerkship. I had ED scheduled for April and was able to drop it if I wanted to.
Fellowship: In order to take a fellowship position, you need to graduate. This is a formal position where you are generally paid and with it come expectations. There are a few research fellowship opportunities that post on these forums and you can apply to them. If you take a position, you will not have time to do away rotations.
Because I was locked into a region (didn't want to live apart from the wife for a year), I contacted the Ortho departments (the coordinator from the ERAS site) in the region and inquired about research opportunities. I was told that multiple places didnt have anything set up for research. However, at 2 places, they said there was the possibility of a position being open and they gave me names to contact. I followed both of these leads and in early April, I was offered a fellowship position.
This year has been amazing and I have been working my butt off. I generally put in just as many hours as my wife (who is in her surgery intern year), but I was able to get onto ~10-12 projects by the time the next application cycle came around. Have some papers in submission. I have had daily contact with attendings. I am present for clinic where I see study patients for testing, I am present in the OR for cases where we will be getting tissue/samples for research. I had the opportunity to attend grand rounds, journals clubs and interact with alot of residents in a research setting. I got 3 new letters for applications and had attendings call other programs for me.
Whatever decision you make, it needs to be for yourself. There is no right answer, but if you work hard, people will support you - and the most important aspect for your application next year will be the support you receive.
Good Luck!
Feel free to PM me with questions.
