My Residency Reviews

I would say to reply to the 2015-16 one. I created my own thread because I had so much material and it was in a different format than the program reviews of years past.

Hi everyone, congrats on the Match! Excited to call some of you colleagues.

For our reviews, would it be preferred to reply to the other thread, or this one? I wasn't sure if this was just one person's personal reviews or if it was open to all.

This is the most clutch thread in the history of orthogate. Thanks for taking the time to write all this up!

2nded that the review of my home program seemed pretty accurate and objective, so I'd err on the side that all these reviews have relatively good info.

I disagree with the previous posting. I am familiar with at least three of the programs (one home program) that you posted about and I think what you wrote is SPOT ON (especially about my home program). Overall, I think you did a great job providing objective info along with some impressions, which are obviously subjective to your experience. I really appreciate these detailed reviews!!

@ACDF, I encourage you to share your program reviews with the readers of Orthogate. The more reviews and experiences available to future applicants, the better informed they will be in their decision making.

Like I said in my preface post, my experiences and opinions may differ from other applicants. I wrote fairly extensively in my reviews about the limitations of each program. I made a conscious effort to ask multiple residents and rotators about the things they didn't like or wish could be done better. Obviously, some residents and rotators were more candid than others.

I generally kept my written reviews heavy on objective information, because I felt I was more likely to forget those things when I was making my rank list. Feel and overall impressions are much easier to remember, and that is typically what is posted in residency review threads of years past.

No offense bro, but if you actually believe 1/2 of the things you wrote here then you were guzzling some ...s e r i o u s... kool aid while interviewing. UPenn a "blue collar" program? Rush operative experience top notch? Did you even talk to rotators? I know at least a dozen rotators whose experiences contradict much of what is written here about various programs.

While we appreciate your efforts in typing this up, readers should be aware that these reviews contain a lot of hyperbole and very little critical analysis.

UPenn

Interview Experience
Social was held in a private room at the Penn Inn. The attire was “business professional”, meaning that you were expected to wear a suit. They make it no secret that this is a formal program, starting with the dress code. All the residents were clean shaven, and this is a requirement for residents. At the social there was plenty of space to speak with residents and attendings, with ample food and drinks to go around. The chair Dr. Levin made a brief speech in the middle of the event to welcome the applicants and talk about how they invested the resources for this venue instead of the foyer in the hospital because of resident feedback from past years. Afterwards, the residents walked the applicants to a local bar, where they had reserved a private room and we got to speak with them in a bit of a less formal setting. Interview day was broken up into AM and PM sessions. The day started with a 30-minute presentation by Dr. Levin about the program, followed by 5 minutes from Dr. Israelite (the PD). The applicants were subdivided into different groups for interviews, a resident presentation, and a tour. There was an hour of interviews, with 6 rooms for 8 minutes each. There were 4 rooms with 2-3 faculty each, a resident room, and the chairman’s room. We did not meet or interact individually with the PD Dr. Israelite, which I found to be a little bit odd, although the two associate PD’s (Dr. Mehta and Dr. Ahn) were among faculty interviewing applicants. Two of the rooms had themes (letters of recommendation and research), and there were a couple of “tell me about a time when…” questions, but no clinical or ethical questions. In the resident room, they asked me to suggest a Pandora station and tell a joke. The resident presentation was fairly straight forward, and the tour was fairly long and probably unnecessary. They hold interviews towards the end of the season, so I had already seen a ton of trauma bays, clinic rooms, and research labs. On the flip side, I will say that there was a nice view of Philadelphia from the helipad on top of the trauma center.

Staff/Faculty/Chairman
Dr. Levin (hand/plastics) is the chair. He was at Duke for 25 years before taking the chair position at Penn 7 years ago. He has a unique background, in that he is double board certified in orthopaedics and plastic surgery. He has a dual appointment to the faculty of both departments, and his clinical rotation is actually referred to as “orthoplastics”. He does so many flaps for the trauma service that he is a member of both the trauma and hand divisions within orthopaedics. He is very well known and connected within the orthopaedics community, and he goes to bat for his residents when it comes time to get them fellowships and jobs. The fellowship match list is phenomenal, and I have been told he asks you at the beginning of your PGY4 year what fellowship you want, and then he gets on the phone and gets the fellowship for you. While he seems like a great guy to have in your corner, he runs a very tight ship at Penn. All of the residents and fellows are required to wear suits and be clean-shaven while they are on his service or at an event where he will be present. Residents take every consult with a smile, and can be disciplined if they are reported as not acting “professionally”. Apparently the medicine and ER services are very influential at Penn, and they are very quick to file complaints about the residents on different consult services, so this definitely adds a stress level to daily work. From what I hear, the residency is quite hierarchical and rigid, with Dr. Levin calling the shots. That said, Dr. Levin is definitely ambitious for making the residency first-class, and is always looking for ways to make it better. He has feedback sessions with residents from each class, decides what can and needs to be changed, and then asks the PD Dr. Israelite (joints) to design and implement the changes. Dr. Israelite seems like a happy-go-lucky guy, with a dry sense of humor, who makes a lot of jokes. He has more day-to-day interaction with the residents, although it still seems like Dr. Levin is the primary decision maker for the residency program. There are also two associate PD’s, Dr. Mehta (trauma) and Dr. Ahn (trauma), who are quite involved in resident education and are the primary teachers during the trauma blocks. Otherwise, their faculty has made a lot of hires since Dr. Levin took over. About 10 years ago, they lost a lot of faculty to Thomas Jefferson, so it has taken some time to rebuild the departments. They have 5 faculty in trauma, 7 in joints, 5 in hand, and 4 in joints, which are probably their strongest departments. They have 1 tumor and 3 F/A (2 of which are new hires), and they have 2 spine (with 2 more new hires starting soon). There are also 20 affiliated peds attendings at CHOP, although they are not full-time faculty.

Didactics/Teaching
Didactics have traditionally been a weakness here, according to some residents I spoke with. They have 1-hour morning conferences 4 to 5 times per week, with an additional 2 hours of lecture and 2 hours of bioskills or anatomy lab on Thursday morning. Most lectures are resident-led, and moderated by 1 or more attendings to make sure the residents are learning the salient points. However, some residents noted that they would like more attending-led lectures, and that they often miss conferences because of work on the floor or cases to cover in the OR. Dr. Levin recently hired some additional NP/PA’s to help with floor work and cover the resident responsibilities during Thursday morning so that everyone can go to didactics, but education is still difficult, especially for the juniors. They have a month-long intern boot camp, but no dedicated OITE preparation.

Operating Experience
Generally a hands-on experience here. As a junior, you will get in the OR as a PGY2 at the VA and CHOP, but the trauma is backloaded into your senior years, with a single 6.5 week block on trauma as a PGY3, PGY4 and PGY5. There is a lot of volume and autonomy here, with PGY3 and PGY5 in one room and a PGY4 in the other room. The attendings, especially on trauma and at the VA, will let the residents fly if they come prepared and generally know what they are doing. The subspecialty rotations are set up like a mentorship model, so you get graduated responsibility during the rotation, although some attendings are more hands-on than others. I heard this is especially the case on joints and hand, with a mixed bag on sports and peds. They don’t have many fellows here, and they have good volume, so there isn’t much double scrubbing. At CHOP, there are quite a few fellows, but there is high volume and they parse out the cases at the start of the week, so the residents get to scrub on mostly basic cases and a few advanced ones. The residents said the spine, tumor and F/A experiences are decent, and will be improving with the hiring of new faculty. They do each rotation as both a junior and a senior, with the exception of a single F/A block as a PGY3. They also have a community orthopaedics rotation about an hour drive away, which they do as a PGY5.

Clinic Experience
They spend 2 or 3 days in clinic depending on the rotation. These are all private clinics, and they do not have a resident-run or free clinic at any of the sites. They are given a good amount of autonomy in the clinics though, seeing the patients, presenting to the attending, and writing the note. They are making the transition to Epic from their old EMR, which will be complete by the end of next year. The residents spoke highly of their clinic experience, and felt that it was among the most educational parts of their training. When there are extra cases in the OR where resident coverage is needed, they have PA’s who can help cover the clinics.

Research Opportunities
They take two residents per year for the 6-year research track, which is a dedicated year between PGY2/3 to work in the basic science, biomechanics, or tissue engineering labs. They have invested a lot of resources in infrastructure and full-time PhD faculty to staff the labs, and there is a lot of high quality work coming out of there. Most of the residents not in the research track, however, are involved with outcomes research. The joints and trauma attendings are the highest volume for publishing, and residents can get involved if they show interest. They don’t have a dedicated research block, so you have to find time to work on research during the lighter blocks like sports and hand. Some of the residents graduate with double-digit publications, but many do not. It is really what you want to make of it. They have some support staff to help with IRB filings and data collection, and have some affiliated biostatisticians to help with methods. They will support travel to present at conferences.

Residents
They take 8 per year, which includes the 2 research residents on the 6-year track. They seemed like a hard-working, blue-collar group, and a bit on the nerdy side. They take pride in their hard work, and according to some rotators, they are always staying late because it is expected of them and not necessarily because they feel compelled to stay to learn and help out. They are a fairly diverse group, with a number of female residents, married residents, and residents with children. Fairly hierarchical structure here, and it seems like there is good cohesion within the class, but less outside of it. I got the feeling that a lot of the residents were tired and run down, and although they expressed enthusiasm about the quality of their training, I didn’t feel like they were as fun as some of the other resident groups I have been around. It may be that the program selects for these types of people, or the program just tires them out over the years. That said, I didn’t get the sense that it was a bad or malignant work environment.

Lifestyle
Blue-collar feel here, and you will work a lot. The trauma blocks are difficult every year here. The interns are slammed with floor work on the general surgery and orthopaedic services, where they are in charge of trauma, joints, and general ortho patients. The PGY2 year has 3 months on trauma, with a combination of day/night float. They are so busy taking care of consults as a PGY2 that there is no OR time for them. The rest of PGY2 is a bit better, with decent hours and some opportunities to get into the OR, especially at the VA. The trauma rotation is 6.5 weeks for the PGY3/4/5 years, and these guys are literally at the hospital for 100 to 110 of the 120 possible hours between Monday morning and Friday night. Each trauma attending works in 24 hour shifts, and the attendings like to operate and teach for the entire time. However, the residents have to stay at the hospital when the attendings switch over in the morning, so you never go home. It sounds like a miserable existence, and Dr. Levin talked about possibly changing the structure, but the residents actually lobbied to keep it because they felt like they learned a ton. Outside of trauma and joints (80-100 hour weeks but not as insane as trauma), the other senior rotations have better hours with time for basic activities of daily life and research. Since they have night float as PGY2, the call schedule works out to q8 for the PGY2 and PGY3’s covering the orthopaedic services at the 3 different hospitals (sometimes you need to drive from hospital to hospital to see consults or floor stuff), with a separate ~q4 call pool for the residents at CHOP. The seniors have home call, but often the primary trauma team stays at the hospital and handles all the cases, so the call team just needs to get the case teed up. Overall, this is among the worst lifestyle programs that I have seen.

Location/Housing
The hospitals are located the University City area of Philadelphia, which is located by the main campus of all of the UPenn undergrad and graduate schools. Most of the residents live in Center City, which is a long walk (~20 to 30 minutes) or short drive (5 to 10 minutes) away from the hospitals. All of the clinical rotations except for the PGY5 community rotation (45-60 minute drive) are within 10 minutes of each other and within the city limits of Philadelphia. The rent is very reasonable, and you can live in a decent sized place for a lower rent than nearby NYC, DC or Boston. They have some clinics located in the suburbs, and combined with the fact that you have to travel between different hospitals while on call, you absolutely need a car to be a resident at this program. Philadelphia has all of the amenities of a modern city, with plenty of good food, beer, and entertainment. The residents seem to spend some time with each other outside of work when they have the time to.

Limitations
The lifestyle here seems pretty brutal, especially as a junior and as a senior on trauma. I am not afraid of working hard and getting my hands dirty, but it seems a little extreme here. They didn’t seem to hide the fact that they are over work hours, and I got the feeling they were kind of proud of it. It seemed like the residents were tired and I didn’t get a sense that it was particularly fun to work here. I heard from a home rotator that one of the interns is leaving, since he felt like the program was too tough; while this is probably more related to the person than the program, it still raises concerns about the work environment. The didactics here are mediocre, and there doesn’t appear to be a ton of time for research. The availability of a research block certainly would be nice. I don’t mind the formality here, but it seems like Dr. Levin really runs a rigid hierarchical system. Philadelphia is a solid location, but it’s not as fun as NYC, and I would need a car.

Conclusion
A blue-collar program with a great name to back it up. You will work hard as a resident here, but you will come out well-trained with a good pedigree and will match at the fellowship of your choice. Despite its shortcomings, I think this is one of the premier programs in the country, but you have to be okay with long work hours, high expectations, and a formal, high-stakes work environment. Unlike many other programs, orthopaedics is not the most influential department in the hospital, and you are constantly under a microscope as a resident and are expected to perform. The academic reputation here is great, and they have good basic science labs, but the clinical research seems to still be developing. While this is arguably a tier 1 program, I am going to put it at the top of my tier 2, as I just didn’t get the sense it would be as fun to work here for 5 years as some of the other places I interviewed.

North Shore - LIJ (Northwell Health)

Interview Experience
There was a massive blizzard in New York during their interview weekend, so the pre-interview social was cancelled. They still held interviews on Saturday and Sunday, with a fairly solid turnout by applicants (about 45 of 60 made it). Not sure if they decided to have a make-up day or Skype interviews for the stranded applicants. The interview day was somewhat makeshift since everybody was arriving at different times, but overall it was still fairly organized all things considered. There were 5 rooms, each for 10 minutes, which were panel-style with 3-5 faculty each. The rooms were themed, and the theme was the only topic of conversation in the room (compared to other programs, where the room had a few themed questions but also had some general small talk). There were 2 knowledge rooms: the first had 3 brief cases where you were asked to read the X-ray and answer a few simple questions about diagnosis and management. The other room was a single case, where you were asked to read the X-ray and then talk about that topic more in depth. I didn't know a ton about the topic, but I was able to reasonably move through it. I think this is the challenge with knowledge rooms, in that the knowledge base of medical students is fairly limited and is completely dependent on the smattering of services you rotated on. The attendings were still nice about these pimp-style rooms, and I feel like they just wanted to see we had a grasp on some of the basics of orthopaedic management. There was an ethics room with a complex scenario, a research room, and a chairman's/general questions room. There was some down time between interviews to speak with the residents in the boardroom. They had lunch and then Dr. Sgaglione (chairman) and Dr. Lane (PD) made some remarks about the program.

Staff/Faculty/Chairman
Dr. Sgaglione (sports) is the chairman. He is a very personable, friendly guy, and is fairly well known in the academic community (past president of AANA). The department has grown a lot in the past few years, and he has overseen the hiring of 10+ full-time faculty members. The PD is Dr. Lane (hand), who was in private practice for 20+ years before joining the faculty 5 years ago. He has overseen a number of changes to the program, which were all in response to resident feedback, including the creation of a night float system at LIJ hospital. Since LIJ used to be affiliated with HSS, a lot of the faculty here are HSS-trained. They have multiple attendings in every subspecialty, with the exception of 1 tumor attending. They go to Memorial Sloan Kettering during the PGY4 year for 6 weeks for a formal tumor rotation. They are strongest in joints, sports and hand.

Didactics/Teaching
They have formal didactics for 2 hours on Wednesday morning, with attending-led lectures on various topics. The residents said that the lectures are good, and have improved significantly over the past few years with the addition of new faculty members with expertise in different areas. On Wednesday afternoon, the residents typically have bioskills (they have a massive new lab/sim center) or anatomy sessions. There is also a single lecture on Thursday mornings from an attending.

Operating Experience
The residents get extensive operative experience. There are more cases than the residents can cover, and they have PA's and NP's to cover the floor work during the day. The residents are almost always single-scrubbed on cases with the attending (with the exception of some trauma cases where the senior walks the junior through), and even the interns spend the majority of their ortho months in the OR. They split their entire residency between North Shore and LIJ hospitals (about a mile apart), aside from the 6 weeks at MSK as a PGY4. Most of the residents at each hospital are on the general orthopaedics service, which covers most of the trauma, recon, spine, and tumor cases at each hospital. As a PGY2/3/4/5, there is an ambulatory rotation, which mostly covers hand, sports, and F/A. There are no dedicated blocks for the subspecialty services (with the exception of hand as a PGY2/4 and tumor as PGY4), and you may be covering different types of cases each day of the week. There is generally a good amount of autonomy in the OR, and you get to operate a lot. The North Shore Hospital is their Level 1 trauma center, and while the volume isn't crazy busy, you will get a lot of the bread and butter trauma cases.

Clinic Experience
There is a resident-run clinic on Wednesday morning from 9am to noon. They hold clinic at both North Shore and LIJ hospitals, and each clinic is staffed by an attending. You get a lot of autonomy in clinic for the short time you are there. On Wednesday afternoons, if there aren't any educational activities scheduled, and there aren't any cases to cover in the OR, you get farmed out to various attendings' office hours. The hospital system has its own EMR, which can be a bit clunky, but is manageable once you get the hang of it.

Research Opportunities
The program has historically been community-focused, with limited research resources and productivity. Over the past few years, with the creation of Hofstra medical school, the growth of the orthopaedics department, and the increase in the size of the hospital system, the research has grown. They have a number of full-time research faculty (3 or 4 I think), with a lot of work in cartilage regeneration and biomechanics. There isn't a ton of outcomes research yet, but they have invested resources into creating their own data collection system. In addition, the North Shore-LIJ system became Northwell Health this year, and they have enough hospitals now throughout New York that they created their own health insurance network. There will be opportunities for a lot of research down the road, but it will likely be a few years before this is really booming. Not many of the clinical faculty are publishing regularly here, since they are basically private practice surgeons, but they will support projects if residents are interested in putting in the work. There is dedicated time for research during the PGY3 and PGY4 years.

Residents
Nice group of guys. Had a little bit of a blue-collar feel to them, not particularly "bro" though in my opinion. Only 4 per year, so they all get to work with each other and know each other. They are spread out across the two hospital sites, and are dispersed housing-wise across Long Island, but they said that it isn't too hard to spend time together outside of work. Most of the residents here do fellowships and go into private practice. A number of them have ties to the New York area.

Lifestyle
As a junior, there is quite a bit of call here. At LIJ, you have 2 months on night float as a PGY2 and 1 month as a PGY3. At North Shore, call for the PGY2 and PGY3's is q2 24-hour with post-call days. The pager isn't crazy busy during the day, but consults can add up, and you are also handling all of the floor pages overnight. The seniors are home backup call, and their lives seem fairly reasonable. This residency also has the highest intern salary in the country ($69K), so you have plenty of money to spend on educational and recreational items. They don't have any additional perks, but they will sponsor you if you present research at a major conference.

Location/Housing
The hospitals are located on the western part of Long Island, about a 45-minute drive from Manhattan and 30 minutes from Brooklyn and Queens. Some residents live in Manhattan and the outer boroughs, while others live near the hospital or in suburbs in eastern Long Island. You need a car here to get around, and the highways can get jammed with traffic during rush hours. The area near the hospital is entirely suburban, but the city isn't too far away and the beaches on eastern Long Island are great during the summer. Rent isn't quite as high as the city, and you have sufficient salary to comfortably cover your housing and transportation costs.

Limitations
I don't love the structure of the rotations, with residents placed on general orthopaedics and covering a wide range of orthopaedic subspecialties. This makes it difficult to learn in depth about a particular subspecialty, since you are constantly bouncing between them each day. While North Shore is a Level 1 trauma center, its volume isn't that high and it doesn't get much high-energy trauma. The call schedule is fairly difficult, and I would prefer a program a little bit larger than 4 residents per year. The research is solid for a community-type program, but it is mostly basic science and is lacking in the type of clinical research that I want to pursue. The suburban location is also a negative for me, and I don't love the idea of living in Brooklyn and driving 30-45 minutes every day to work. There is very little clinic here, which I think is a negative, as indicating and managing patients is just as important as becoming a skilled technician in the OR.

Conclusion
Solid community program that will only continue to improve over the next few years. You will get a strong operative experience here, and will get in the OR early and often. The research opportunities are growing, and with the hiring of more faculty and acquisition of more hospitals, the academics should continue to improve. This program has some limitations, but for me the biggest one is the location. I don't think there's that much of a difference between the training here and some of the other community-type NYC area programs. Given the suburban location and the lighter trauma experience here, it will be a tier 3 for me.

SUNY Downstate

Interview Experience
The social was held at a shuffleboard bar in Brooklyn. A little less than half of the residents showed up, with a mix across the different years. Got a chance to talk to a few of them about the program and living in Brooklyn. Unlike other socials, it wasn't nearly as loud or crowded here, which was a good thing. The interview day itself was fairly short. It started with an overview of the borough of Brooklyn and the history of the program from the former chair Dr. Gordon, followed by a presentation on the program from the current chair Dr. Urban, and finally a resident presentation. We moved downstairs for hot breakfast (among the best I've had on the interview trail), with 8x10 minute interviews with residents and faculty. Typically 2 interviewers per room, with the exception of Dr. Urban and Dr. Paulino (the PD) each having their own room. Mostly generic interview conversation, with a "tell me about an interesting case" in one room. Interviews concluded with lunch and some brief conversation with the residents in the break room.

Staff/Faculty/Chairman
Dr. Urban (sports) is the chairman. He was a medical student and resident at Downstate, and has been the chair here for the last 15 years. He has a businessman feel to him, and is a straight shooter. He was very direct with the applicants during his presentation and in his interview room. The program has had some ups and downs over the past decade, and they were placed on probation three years ago. Dr. Urban addressed this directly on interview day, and mentioned that they have worked diligently to correct the problems. One of the probation citations was for insufficient research output, and in response they hired a full-time research coordinator. This past year, they had 15 acceptances to the AAOS annual meeting and published ~10 manuscripts. The other probation citation was for insufficient full-time faculty, as they lost half of their faculty about 5 years ago due to financial restrictions due to New York State's budget woes. However, after the probation ruling, the orthopaedics department has received an infusion of resources from the state, and they have hired 5 new attendings over the past year (1 each in peds, trauma, spine, sports, and shoulder/elbow). In addition, they are looking to add one hand, one trauma, and one recon attending. Their core full-time faculty work out of University and Kings County Hospitals (which are across the street from each other), and they have 2 faculty in each subspecialty (except for 1 in F/A and tumor). They have a lot of volunteer faculty at their 5 affiliate hospitals (Lutheran, Brooklyn Hospital, Staten Island, Brookdale, Brooklyn VA). Most of the faculty are community-oriented, and don't publish much (outside of Dr. Paulino, their senior spine attending and PD; and Dr. Maheshwari, their joints/tumor attending). In regards to the structure of the program, Dr. Urban is relatively hands-off with the residents and leaves the day-to-day decisions to the chief residents and PD Dr. Paulino (spine), who is a big, burly, blue-collar guy. He was also a resident in the program, and the residents really like working with him.

Didactics/Teaching
They have formal didactics on Monday afternoon from 4-7pm. The lectures are a mix of resident- and attending-led, and rotate across the subspecialties. They often have guest lecturers who are past graduates from the program working in the community or are volunteer faculty at the affiliated hospital sites. They have grand rounds on Friday morning, where the chief residents will present the cases from the past week on their respective services and pick one case each for deeper discussion. On occasion, they will have a guest speaker for grand rounds. They also hold journal club once per month on Mondays in place of the lectures, hold OITE reviews in the fall, and there are occasional skills sessions for the junior residents in the anatomy lab. However, there is no dedicated surgical skills month for interns. They have a morning fracture conference every day, where all of the residents on different services at University/Kings County will show up (as well as 1-2 trauma attendings) and the PGY2 consult residents will present everything that came through the previous day or over the weekend. There is a lot of pimping here, and it can get aggressive at times, especially from senior residents to junior residents (although I heard it has become a lot more benign over the past few years). OITE performance is largely dependent on self-preparation, since the depth and quality of lectures is variable. Some residents perform very well, and others very poorly. The same goes for ABOS exams, with some scattered failures over the past few years.

Operating Experience
The residents get a lot of hands-on experience here, especially on the trauma service as a PGY4/5 at Kings County (the Brooklyn city/county hospital). There are no fellows here, and there is definitely a culture of letting the residents do the cases. The operative experience on the subspecialty services is a bit of a mixed bag, and often depends on the rapport you develop with the attendings. Spine and joints are relatively hands-off. There aren't a ton of tumor cases here, and they are mixed in during the joints rotation since the same attending does both subspecialties. There hasn’t traditionally been much shoulder and elbow here, but with the hiring of two new sports attendings, this should be improving. While there is a ton of volume in the hand clinic, the operative hand experience here is weak since the attendings are all part-time faculty. The operative experience at the other clinical sites is quite variable, and each site has a junior and senior running the general ortho service (except at Brooklyn Hospital, which is PGY3 only). The VA is fairly slow and you typically only can get 2 cases done in a day, although the residents are given a lot of autonomy with the joints and sports stuff they get there. Staten Island, Lutheran, and Brooklyn have a lot of bread and butter orthopaedics, with some low-energy trauma, sports, joints and hand cases. Residents do every subspecialty rotation at Downstate/Kings County as a junior and senior, and each subspecialty service covers both hospitals simultaneously. Overall, residents come out of here confident in all of the basics of orthopaedic surgery, although they don't get a ton of exposure to the complex subspecialty cases. Operative experience as a junior is variable, and often depends on the seniors you are paired with, as well as the rapport you develop with the attendings.

Clinic Experience
Most services have 2 days of clinic per week. The clinic at Kings County is essentially resident-run, with each resident taking a room and seeing the patients on their own, presenting to a senior resident or attending, and then writing the note. The clinics at Kings County can get busy, often with 70-80 patients in a day. The clinic at Downstate is a little less busy, with the attending seeing each individual patient after you present to them. Many of the patients in Brooklyn have serious unmanaged comorbidities (i.e. morbid obesity, diabetes, hypertension, CHF), problems with insurance/access to care, and poor follow-up, so there is a lot of non-operative management in clinic.

Research Opportunities
The research output has grown quite a bit over the past few years. They started the research coordinator position a few years ago, and these guys are highly motivated to publish because they are looking to bolster their residency application. They had 15 projects accepted to AAOS this year, and published ~10 manuscripts. Most of the research is biomechanics and database stuff. Not a ton of basic science here. If you get a presentation accepted at a major meeting they will sponsor your travel. While there are a decent amount of resources available here, the projects are still largely resident-driven. You need to submit 1 paper to graduate, and many residents just do that, although a few have published more. There are a lot of clinical responsibilities, especially as a junior, so it can be difficult to get stuff done if you aren't motivated. The attendings are always interested in research, but only a few have published more than a few articles.

Residents
They have 6 per year, so 30 total. The residents have a blue-collar, average guy feel, and they all seemed relatively friendly and knew each other. There are only 3 girls here, but they seemed to fit in well with the guys. There is a lot of cohesion within each individual class, although there is a bit of hierarchy and division across classes. I heard that it was a bit malignant in the past, especially in the morning fracture conference, but this does not seem to be the case anymore. Most residents go on to fellowships, with nearly all going into private practice. The sub-specialties selected most often are sports, hand and spine.

Lifestyle
The junior residents work hard here, but life is fairly easy for the seniors (with the exception of the 2 months on fracture during PGY4/5). Intern year is easy, even on the ortho rotations, with limited floor work. The PGY2's do 2x2 months (4 total) on fracture, where they have alternating weeks between nights and days. They work entirely on ER consults and floor work, with no operative time. They had a PA to help with Kings County floor work, but he recently left, so they are looking to hire a new one. The consult service can get busy, especially during the summer, and they are always on triple threat call, since there are no plastics or neurosurgery residents in the hospital to split up the hand and spine call. The PGY2 and PGY3 residents split up the weekend call (Friday night, Saturday all-day, and Sunday day) at the various hospitals they cover. Seniors have home call, which is operative only, and very few cases go in the middle of the night here. There is also weekday call at some of the other hospitals, but it is fairly light since none are major trauma centers. Not a ton of perks (i.e. no meal money, lead, loupes, books), but I think they get a educational allowance of ~$250 per year.

Location/Housing
Brooklyn is a cool place to live. Great diversity, lots of stuff to do, places to eat, craft beer to drink. It is a city/borough of neighborhoods, and there are a lot of different places you can live. Many residents live in Park Slope brownstone apartments, and some of the seniors live in lower Manhattan near Wall Street. There are also a couple of residents who live on Long Island and commute in every day. Rent is lower in Brooklyn than Manhattan (low $2000s for 1BR in a good neighborhood), although the salary is only marginally higher than programs outside of NYC. A car is needed here, since the different hospital sites are spread out and most are not easily accessible by subway. Theoretically, you could take public transit to most of the hospitals if you are willing to invest a ton of time into commuting, although Staten Island Hospital is only reachable by an hour-long bus ride from downtown Manhattan.

Limitations
The program was on probation a few years ago, and remains "accredited with warning". Many of the cited issues have been resolved, but the program is still in rebuilding mode. The full-time faculty is ~10 attendings, and they only have 1 or 2 attendings on many services, which is small for a 30 resident program. In addition, there isn't a dedicated tumor block, and the operative hand and F/A experiences are weak (the F/A block is only 3 days per week, with the junior cross covering sports and the senior having research time). While they get a lot of exposure to the bread and butter orthopaedic cases, and get some weird complex pathology from the immigrant and uninsured populations (e.g. massive osteosarcomas or adults with untreated DDH), the case volume here is fairly low. I also would like to have some dedicated operative trauma experience as a junior, but it is back loaded to the PGY4/5 years here. Research is growing, but most of the residents seem to have limited interest in academics. The Brooklyn hospitals are run very inefficiently, with the residents needing to do a lot of the floor scut (i.e. drawing labs, transporting patients, helping with X-rays), and cases constantly delayed by slow room turnover (45-60 minutes on average). Despite being in NYC, you need a car to get between the different hospitals and parking can be difficult (no subsidized parking except for Staten Island and VA). The residents are also spread out across the different sites, so you don't see many of your colleagues for extended periods of time.

Conclusion
Solid community program in a solid location. You will get a strong operative experience in trauma and the bread and butter subspecialty procedures, and have opportunities to train in a variety of different hospital settings (VA, private, public). They have above-average research here for a community-type program, although you do need to take the initiative to get it done. Brooklyn is a fun place to live, although it can be expensive and you need a car to get to the different hospital sites. The core faculty is small, but is growing. The program was on probation just a few years ago, but has rebounded nicely, and seems overall to be on the upswing. This program will be tier 3 for me, since it has a number of limitations and I am seeking more of an academic atmosphere.

NYU

Interview Experience
Social was held at a bar in lower Manhattan. There was a smattering of residents from each class, although I don't think any interns were in attendance. Attendings were present for the first hour, with the PD and chairman making rounds and greeting the applicants. The venue was a bit on the loud side, and was quite crowded, especially when the attendings were there. NYU is a formal program, and I would actually recommend wearing a tie as an applicant to the social. I heard Dr. Zuckerman (the chairman) making some remarks about it, so it’s better to play it safe. Overall, there were ample opportunities to speak with residents and get a feel for the program. This is a huge program (62 residents total), so it is impossible to meet everybody, but I would say between the social and interview day, you got to interact with 20 to 25 of them. The interview day itself started early, at 6:30am, with a sample didactic lecture from Dr. Zuckerman to the residents. Dr. Egol (PD) then gave an overview of the program, followed by a presentation by one of the executive chief residents. The applicant group was then split in half, with some applicants going on a tour and the rest heading upstairs for interviews. It was 7 rooms for ~10 minutes each, with 2 faculty per room for 6 rooms and the 3 executive chief residents in the 7th room. In the resident room, you got to putt into a golf hole. The other rooms were mostly general conversation, with typically 1-2 "hard" questions (ethical, behavioral interviewing). In the room with Dr. Strauss (assistant PD), he asked pop culture trivia questions rapid fire for the last 30 seconds of the interview. After the interviews, I had about an hour to hang out in the boardroom with 5 of the residents and talk about the program. Then, a different group of residents came to take us on a bus tour, with some walking around each of their Manhattan facilities. The tour was admittedly a bit on the long side, and I could live without going inside the buildings. The day ended with lunch at their uptown clinic. They interview 84 for 12 spots, with 2 being 6-year research positions. Starting with this year's incoming class, they have 1 NYU student who matched directly into the residency as a pre-med, and who went to NYU medical school for only 3 years. Therefore, applicants this year are competing for 11 spots instead of 12. The program may be expanding to 14 residents within the next few years, since the hospital system recently acquired two hospitals in Brooklyn, expanded their surgery center, and is building a huge addition to the private Tisch Hospital. Residents may start rotating at those sites in the future, so the manpower definitely seems like it is indicated. However, this year's class will remain at 12 residents.

Staff/Faculty/Chairman
As a preface, NYU is a huge program, the largest in the country at 12 residents per year (tied with Harvard and Mayo). The faculty has around 100 attendings. As such, it is very hierarchical here, and as a resident you work your way up the chain of command. The chairman is Dr. Zuckerman (shoulder/joints). He is a past president of the AAOS and has been at the helm for the last ~15 years. Under his leadership, the department has seen tremendous growth and increase in name recognition. He has a suave businessman vibe to him, seems very cool and collected, and is always making witty one-liner jokes. He comes to the Wednesday morning lectures every week, and is the face of the program, but he has limited involvement in the day-to-day activities of the residency. You don't rotate on his service until your PGY5 joints rotation, and while he knows every resident's name and biographical background, you typically don't develop much of a relationship with him until you become a senior resident. Dr. Egol (trauma) is the PD, and has been in that position for the last ~10 years. He keeps tabs on the residents, but again, since NYU is so large, you won't get to know him on a personal level until you are a senior resident. You rotate on his service as a PGY3, and he shows a lot of tough love, but he is very dedicated to teaching and always prioritizes the needs of the residents over the fellows. He can seem a little intimidating at times, but he cares a lot about the residents and the quality of the program. Dr. Strauss (sports) is the assistant PD. He graduated from NYU in 2009, and is energetic, friendly, and quite interactive with the residents. The faculty leadership holds an annual "resident gripe session" at a bar at the end of the year, where the residents from each class talk about their issues with each rotation. If an attending isn't letting the residents do enough, they reserve the right to pull resident coverage and tell the attending to hire a PA (this has actually happened in the past). If you have a serious personal issue, you can contact Dr. Egol directly and I have been told he is very accommodating. For more routine complaints, it typically funnels up through the chain of command and eventually up to the 3 executive chief residents (aka super chiefs), who have close relationships with Egol and Zuckerman. The faculty here is huge, with 100 attendings spread across 4 hospitals. They have ~20 attendings each for joints, sports, and spine, ~10 trauma and hand, ~5 hand, 3 F/A, but only 1 tumor. Despite the huge faculty, there are 3-4 core teaching faculty for each rotation, and they try to structure it as a mentorship model as much as possible (e.g. if you are on hand, you mostly work with 2 attendings for the first month and the other 3 for the second month).

Didactics/Teaching
They have 3 hours of attending-led didactics every Wednesday morning. The time is protected for education for every resident, and they report to their clinical sites once the lectures are over. The lectures are fairly interactive, with many attendings using a case-base approach and then pimping the residents from each class with appropriate knowledge-level questions (e.g. juniors read the XR and give a differential, seniors discuss the management, surgical approach, and complications). This can be a little bit anxiety-provoking since you know you will get pimped a little bit each week, but the residents say it encourages them to read and prepare for the lectures. Most of the subspecialties have an additional 1 to 2 hours of conferences each week (i.e. indications conference, journal club), and they also have a general journal club for all the residents every month or two. They have started to create core reading lists for certain blocks, but this is still a work in progress. While there are a lot of educational activities built in here, it still involves a lot of self-directed learning and preparation. The residents here have a lot of clinical responsibilities, so reading can be difficult on certain blocks (i.e. Bellevue, Jamaica, joints). This is also a good spot to mention that there are a lot of opportunities to teach medical students during splinting and sawbones sessions (they get 90 rotators per year and 40 MS1 students each summer), and you can also use 1 week of vacation for an international trip to Haiti.

Operating Experience
This a resident-focused program, and operative experience is prioritized here. The caseload is high with all of the hospitals that they cover, and the volume is only expected to increase with the recent growth in both facility number and size, which consequentially is creating a massive referral network to HJD for orthopaedic care. The residents here cover the two busiest Level 1 trauma centers in NYC (Bellevue in Manhattan and Jamaica in Queens), where the orthopaedic services are essentially resident-run. It is fairly common for the attendings to not scrub and let the residents fly in the OR. This is also the case at the Manhattan VA, where the residents get a lot of autonomy on bread and butter joints, sports, hand and trauma cases. HJD is their orthopaedics-only specialty hospital, and this is where the majority of the elective cases happen. The operative experience at HJD is attending-dependent, but generally the residents are actively participating in the case and not observing or holding hooks. They have some fellows on joints, spine, hand, and sports, but the caseload is high enough such that the residents are rarely double scrubbed, with residents given priority for scheduling the coverage for most of the cases. The Tisch Hospital is the NYU private hospital that is right next door to Bellevue, and a lot of the complex peds, joints and trauma cases happen here. They also have a surgery center in midtown with 8 OR's and fast room turnover (the turnover at Bellevue and HJD is slow, like 30-45 minutes, versus 10-15 minutes at the surgicenter). While there is quite a bit of floor work as a junior, you do get some opportunities to scrub on cases at the VA, HJD, and Jamaica. As a senior, you are basically all operative with some clinic mixed in, and many of the attendings will time you out and let you function as a junior attending if you know what you are doing.

Clinic Experience
Most of the clinics here are resident-run. There is a ton of autonomy in terms of seeing the patients, coming up with diagnosis and plan, and writing the note. In most of the clinics there will be one or two attendings that staff it, listening to presentations and making sure the plan is reasonable. Some services have a private clinic in the uptown offices, which involves a mix of shadowing and seeing patients. Residents said they don’t mind this, since it's a good place to learn some of the fine details of working up certain orthopaedic complaints from the attendings, and then applying that to your own patients in resident-run clinics later on. There is generally 1 to 2 days of clinic per week for most services. They have Epic EMR for all of the NYU sites, with QuadraMed (which is a bit clunky) at Bellevue, although Bellevue is supposed to be switching to Epic in the next few years. Clinic days can be busy, but you typically can get out of there by 5 or 6pm.

Research Opportunities
There is a strong research culture here, with a lot attendings who publish frequently and are field leaders in their subspecialty. Nearly all of the residents are involved in research, although their level of involvement is somewhat of a mixed bag. Some residents publish a ton, while others fulfill the minimum requirement of 3 papers (case report, original project, review article). Dr. Egol said during his presentation that the average resident has 10 to 12 submitted projects by the time they graduate. In addition, all residents must write a grant during their PGY3 year to graduate. They have their own PubMed indexed journal (HJD Bulletin), so all of your projects will get published somewhere. They do not have a dedicated research block, and some projects require the resident to drive the project to completion. However, this really depends on your mentor and research team. Some attendings have full-time and volunteer research staff that help with projects, with the attendings driving the projects to make sure they get done and published. They have a good mix of outcomes and basic science projects, with a large amount of stuff on quality, outcomes and cost effectiveness. There are 2 research residents per year who get a fully protected year between PGY2 and PGY3 to work on their projects (which are typically basic science).

Residents
This is a resident-run program, and I felt like despite the program’s size, it was a cohesive group with a similar type of team-player resident personality. They spend a lot of time with each other in the hospital, and the rotations are very team-based (i.e. at Bellevue there is an intern, 3 PGY3's, 2 PGY4's and 2 PGY5's). This program has a reputation for being a "bro" program (it is true that they have a weight room in the HJD OR and a 300-pound bench press club), and while I wouldn't say that is absolutely true across the board, it is definitely "bro-friendly" and has the feeling of a grown-up frat or sports team. The residents are definitely fun, energetic, they work hard, and they are battle-hardened from working in some difficult NYC hospitals. However, they are very collegial and help each other out. Again, it is very hierarchical here, so you need to respect the chain of command and know when to ask for help. A lot of the teaching is occurring from senior to junior, so you need to be able to work well in a team environment or else you will struggle to fit in. The program is so large, that you won't get to know everyone in the program on a close personal level. However, there is a ton of cohesion within each class, and all the residents gradually get to know each other across different classes. Fellowship choice varies from year to year, with a lot of joints, sports and hand. Residents said that even though some years multiple residents apply for the same subspecialty, there isn't that much competition amongst each other for fellowship spots, and they usually get their 1st or 2nd choice.

Lifestyle
This is definitely a work hard program. The hospitals aren't easy to work in (especially Bellevue and Jamaica), and the residents have a lot of responsibilities. As a junior, you can work 100+ hours on your trauma rotations, and most of this is floor (PGY1) and consults (PGY2/3). The call at both Jamaica (PGY2/3) and Bellevue (PGY3) is q3 with post-call days. Overnights can be busy but variable, with 8 to 10 consults on average, but bad nights could be up to 20 or 25. There is no night float here, which the residents said they prefer, since they have an entire post-call day to sleep and take care of other stuff during normal business hours. At Tisch, it's a Level 2 trauma center, so you are expected to take overnight call and then scrub the first case the next day before going home. As a PGY2 on certain services (peds, sports), you run I-Care at HJD, which is their all-ortho emergency room. You see some low-energy trauma and a lot of BS stuff (i.e. chronic back/knee pain), but you get to make a lot of your own decisions as a junior, with backup from the senior resident if you need it. This counts as your HJD "call", but it’s not too horrible, since I-Care closes at 10pm and you are typically out of there by ~11pm. The residents are paid among the best in the country (interns make 62K), and they have a lot of perks, including $10/day meal cards, $600 annual book fund, conference travel funds if you are presenting, and entry fees for intramural sports teams (they have a basketball team that plays in the city league, and had an ice hockey team a few years ago). In response to resident gripes about lack of moonlighting opportunities, the program recently set up moonlighting in I-Care on the weekends (as long as they score >50th percentile on OITE), where they make $100/hour and have fairly limited responsibilities. They get 4 1-week vacations spread across the year (a lot of programs give 3 weeks), which is nice. Interns have a month-long boot camp in July.

Location/Housing
Located on the lower east side of Manhattan, in the Gramercy/Kips Bay neighborhood. There is a ton to do, eat, and see in NYC, and all of the hospitals are clustered in a 20-block radius. The exception is Jamaica, which is a 20-minute drive from HJD. They have a shared car for the residents at Jamaica, which they pile into every morning from HJD. The on-call resident at Jamaica can take home an Uber the following morning and get reimbursed, or they can take the train back, which takes about an hour. The rent in the area around the hospital is expensive, with a 1BR running in the mid to high 2000's. There is limited subsidized resident housing, which is allocated based on a lottery system, with preference given to out-of-towners. Some residents live on the Upper East Side, where you can get a little more bang for your buck (a lot of married residents live here, especially those with children), and a few residents have lived in Brooklyn. None of the residents have a car here, as the public transit system is extensive and cabs/Ubers are everywhere.

Limitations
The schedule during the junior years is difficult, with quite a bit of call. All of the hospitals can be difficult to work in, with poor ancillary staffing and slow turnover time. The program is large, so you won't get a personalized experience with the PD and chairman as a junior resident. The hierarchy is necessary to allow this huge program to work, but there can be inefficiencies, and you are often at the mercy of your seniors. While research is emphasized, there is no dedicated research block to work on projects. The pimp-style of lectures force you to read, but can be unpleasant if you are on a tough block and haven't been able to prepare. They also don't get to rotate on F/A or tumor until PGY4 year, and they only get 2 months of hand as a PGY3. The trauma, joints, and sports are strong here, but you don’t spend much time on the other subspecialties. NYC is expensive, and you are often on your own for housing.

Conclusion
This program has a big-time academic reputation and is in a great location, but it is a blue-collar program at its core. I think this is a very balanced program, with good trauma, joints and general orthopaedics exposure. There is good diversity in the hospital sites, which include private, public, and VA. There are big name attendings scattered throughout the faculty, with plenty of resources for research. If you are willing to put in the work, this program has as many opportunities as any program in the country. Here you can make your own adventure, and if you want to focus on taking advantage of the available research, clinical, teaching, or extracurricular opportunities, you can do it. This program is also very resident-centric, and while there are a few fellows, they aren’t clashing with the residents because of the sheer size and case volume of the program. I think this program is in the conversation for best program in the country, tier 1 for me.

Washington (UW)

Interview Experience
The pre-interview social was unique. It was held on Dr. Hanel's (the PD’s) houseboat in Seattle Harbor. You literally have to walk onto a dock to get to his front door. All of the applicants in attendance get a few minutes of facetime with Dr. Hanel as well as the residents who came (only 2 per class, which I was told is because the boat has a weight limit). The interview day itself was split into AM and PM groups. The day started with a presentation by Dr. Chansky (chairman), followed by a presentation by Dr. Hanel (the PD). Interviews ran for the next few hours, with 5 total rooms for 15 minutes each. Two of the rooms were individual meetings with Chansky and Hanel, which were designed for the applicants to ask them questions about the program. Chansky and Hanel said they don't have that much input into the rank list, and wanted it to be a low stress environment. The other 3 rooms were panel-style, with 4 or 5 interviewers per room sitting on one side of a banquet table and you sitting on the other. These were among the most formal interviews I have experienced, and many of the questions were complex and designed to make you think. Not too many bread and butter questions like “tell me about yourself”, “why ortho”, etc. The interviews were a bit on the stressful side, and were definitely harder than I was used to, but at no point did I feel uncomfortable in the room. However, what was somewhat off-setting was that few of the interviewers showed any emotion, instead maintaining poker faces and/or staring at their computers. This made it difficult, if not impossible, to gauge their interest in your responses and figure out if you should keep talking or move on to the next question. From talking to the other applicants, they had similar experiences. Day ended with a "tour", aka a trip to a local Seattle brewery. In the evening, they had a second social event with at a local restaurant. Buffet-style food and beer and an opportunity to hang out with the residents and applicants. They have the second social because Seattle is a far trip for anyone outside of Washington, so they want to give the applicants some activities while they are there. They interview around 75 for 8 spots (around 15 UW students, 30 rotators, and 30 non-rotators).

Staff/Faculty/Chairman
Dr. Chansky (joints/tumor) is the new chairman, and he is the 3rd chair in the last 5 years. Dr. Matsen was their longtime chair, but stepped down a few years ago to focus on his research and his clinical practice on the shoulder/elbow service at UW. They chose Dr. Chapman (spine) to take over for Dr. Matsen, but Chapman’s tenure was cut short by a poor fit and a legal problem, and he ultimately left UW for a private practice. Dr. Chansky was chosen as the next chair after a long search, and he has been on the UW faculty for over 20 years. He has a heavy Boston accent and he seems like a friendly, blue-collar type of leader. The residents say that he is very pro-resident, and is very approachable. Dr. Hanel (hand) is the long-time PD. While his personality is a bit quirky, he is very outgoing and nice. The residents say that he can be a bit intimidating, and he is very much a solutions guy, as in if you go to him with a problem, you better also come to him with proposed solution. I got hints from some residents that he is a bit entrenched in his ways, and is somewhat resistant to change, but that he can be responsive to resident feedback if someone makes a good case for a change. He will likely retire within the next few years, so there likely will be new residency director during my training. The remainder of the faculty is fairly balanced, with their biggest strengths in trauma, hand and shoulder/elbow. The joints service lost quite a few faculty over recent years, but is turning nearby the Northwest Hospital into a center for excellence and is aggressively making new faculty hires. The faculty is around 70 or 80, but they are spread out across Harborview, UW, and Children's Hospital.

Didactics/Teaching
The majority of their didactics come when they are at Harborview. They have weekly fracture conference, where the PGY2's on trauma will go through all of the major consults and cases from the previous week. There is a lot of pimping here, and it can get aggressive at times. Some rotators said that while the sessions were highly educational, it can be somewhat of an anxious environment. However, residents finish PGY2 with a huge fund of knowledge on orthopaedic trauma. At Harborview, they also have attending-led lectures on various topics, and the interns have an interactive anatomy teaching session with an attending every week on Friday. They also have grand rounds on Wednesday. Other services have monthly journal clubs and an occasional teaching session. Performance on the OITE is emphasized here, and they scored in the 90th percentile as a program last year. However, most of the preparation is self-directed. They are in the process of designing a core reading curriculum for each rotation block.

Operating Experience
The operative experience here is good, but it is definitely back loaded. As an intern, you spend 4 months on orthopaedic trauma floors, and 2 months on peds ortho floors. The PGY2 year is 4 months of trauma consults at Harborview, and although you technically assigned to 1 OR day per week, typically you can’t go because you are swamped with consults. One of the PGY2's told me that they did about 10 cases on trauma all year. As a junior, however, the other services do seem to have solid operative experiences. They use a mentorship model, and you do each rotation as both a junior and a senior. They spend 6 months straight as a PGY3 at Seattle Children's Hospital, and they are split into mini-teams, with each resident covering a subset of attendings there. There is a lot of autonomy at the VA, and the PGY4 on service gets to run their own room. There is 6 months of trauma as a PGY5, where you get your own room and run the gamut of simple and complex operative trauma cases. They see every sort of fracture imaginable, since they cover all of the high-grade trauma for the states of Washington, Idaho, Alaska, Montana and Wyoming. The residents said that they have heard from past graduates that the operative experience ends up as being above average. However, you have to be okay with the back-loaded nature of it. The juniors don't do a ton here, and there are fellows on a number of the services (specifically, trauma, shoulder/elbow and F/A).

Clinic Experience
The clinic experience here is good. The residents function relatively independently. They are given an opportunity to see patients themselves, come up with a plan, and write notes. It's usually 3 days in the OR and 2 days in clinic for most services, although as the intern/PGY2 on trauma you will be in-and-out of clinic taking care of floors and consults. They do not have a resident-run clinic.

Research Opportunities
They have a lot of research resources available to the residents, although the projects are generally resident-driven. It is a mixed bag in terms of resident research productivity, with some publishing a few articles per year and others fulfilling the minimum requirement of 1 submittable project. They don't have a dedicated research block, and instead have 1-day per week during the entire PGY3 year. It is protected for research, but some of the residents use it for scrubbing on additional cases if they don't care about doing research. Only the shoulder/elbow service has a dedicated research coordinator to help with administrative work. Dr. Leopold (joints), is the editor of CORR, and is a great resource to bounce ideas off of. They have one attending working on cost and quality research (Dr. Davidson), and Dr. Chansky mentioned that he is in the process of hiring 2 PhD health economists/epidemiologists to build the outcomes-based research arm of the department. Most of the resident research here is clinical, with not much basic science/biomechanics (partly due to the fact that they only get 1 day/week instead of a few weeks/months straight). They support travel to present at research conferences.

Residents
Overall, a very laid-back and friendly group. Many of them have West Coast ties, although some do not. The Pacific Northwest is awesome for outdoor activities, and many of them are big into hiking, climbing, skiing, etc. They have 8 residents per year, so there is a bit of variety in resident personality, but I would say that they have a generally nerdy feel. Not too many bros here, at least among the residents I met. The residents emphasize that they are a fairly tight-knit group, especially within classes, and have each other's backs in the hospital. Despite the program's size, it seemed like all of the residents knew each other. The dynamic between classes here is less hierarchical than programs of similar sizes, and that's generally what I have seen with the West Coast programs. The most popular fellowships here at joints, sports, and hand, with very few going into trauma.

Lifestyle
This is a blue-collar program, and you will work hard for every year while you are here. They have placed an emphasis on staying within the 80-hour workweek, and have hired a number of mid-level providers over the past few years to help with floor work. The long hours during the trauma experiences in the summer and fall are unavoidable. Trauma has 3 teams at Harborview (red, blue, green), with an intern, PGY2, PGY5, and fellow on each, and the call during PGY2 works out to q3.5 with post-call days (the PGY2 on sports also takes some call). There are 4 PGY3's at Seattle Children's, and they take q5 call (residents at Madigan Army program help with call). The PGY3 also takes 5 weekend calls per month at Harborview. As a PGY5, there is a night float system at Harborview. This is designed so that chiefs aren't post-call, and the night float chief is there to take care of any operative night float cases for any of the 3 teams. Apparently this rotation is fairly easy since there aren't a ton of orthopaedic surgical emergencies anymore, and you can use your down time for research or other activities. While the trauma call here is difficult, you make up for it on many of the subspecialty services, where you may work 40 to 50 hours on services like hand, F/A and sports. Joints and the VA can be busy, but not Harborview busy.

Location/Housing
Seattle is an increasingly desirable place to live, and with the growing tech market here, it is really exploding in terms of population size and cost of living. The residents are fairly scattered around the different neighborhoods of Seattle, and rent here for a 1BR is typically in the high $1000's. If you are willing to live a bit further from the city, there are opportunities to buy. However, traffic in Seattle can be brutal. There is a single highway that runs through town (and this is the best way to get between all the Seattle hospitals), but it can get absolutely jammed during the day. The ortho program counters this by assigning residents to one site, with no cross coverage at other sites except for call. Parking is free at all sites (I believe), and a car is a requirement. Seattle has a lot of great features, including close proximity to the mountains and ocean, good food, and plenty of fun stuff to do. During the spring and summer months, the weather is awesome. During the fall and winter, it is cloudy and/or rainy almost every day. They get less rain volume than many other cities, but the frequency of rain is definitely higher here.

Limitations
The lifestyle here is definitely difficult here, with a lot of time spent on trauma with call and long hours. The amount of call during PGY3 year is above average for most programs. For PGY5's, you spend 6 months on trauma and even take night float, which is definitely suboptimal. Also, for all of the talk about the great trauma experience here, you don't get to operate on any trauma until your PGY5 year. I think that UW graduates can manage any type of complex trauma in the ER, but I would prefer to master the bread and butter trauma cases and get in the OR more as a junior on these cases. They are in the process of adding a community trauma experience as a PGY3 or PGY4, which I think is great, but I still would like to some basic operative trauma experience before that. I also think I would like to split up the peds exposure into 2 or 3 smaller blocks instead of the single 6-month-long experience as a PGY3. The didactics outside of trauma seem a bit underwhelming. Research support is limited, and while there are resources available to residents, it does not appear that research is quite as prominent among residents as I would have imagined. Seattle seems like a great place to live, although I'm not huge into the outdoors scene and would prefer to see some sunshine during the winter months. While they have stable leadership at the moment, the program went through some transitions recently, and could have more in the future. Dr. Hanel may be retiring in the next few years, and Dr. Chansky is still getting settled into his new role. Residents are on the nerdy side and I didn't get much of a bro-friendly feel.

Conclusion
This is a well-rounded academic orthopaedic program. They get good trauma exposure with balance in the subspecialties. Big name faculty in many of the fields. There is no area of true weakness here, but you have to be ready as a resident to work hard. This program has a number of minor individual limitations, and collectively they add up to make it a tough fit for me. I think UW residents get excellent training experiences, and would be happy to go here, but I think that the program has a lot of missed potential. Mid-tier 2 for me.

Brown

Interview Experience
Pre-interview social was held at a gastropub in downtown Providence, with some decent food and plenty of space to speak with the residents. The resident turnout was pretty good, with around half of them in attendance. There are quite a few senior residents who have children, and I think they were among the absent. The interview day was split into AM and PM sessions, with the morning starting at 6am. There was an introduction and overview of the program from the PD, Dr. Eberson, followed by a few remarks from the interim chair, Dr. Ackerman. The longtime chair, Dr. Erhlich, will be retiring within the next few weeks and was not in attendance. The interview day was structured with 4 faculty interviews and 2 group sessions with the PGY5 and PGY6 classes (as in, 4-5 applicants met with some of residents in that class). There was a research interview that was a bit odd, with one of their senior attendings grilling me about how I would design a basic science study. Otherwise, the interviews were conversational and laid back. At lunch, a representative from each subspecialty department gave an overview of their specific rotations and research projects. The day concluded with a tour of their basic science laboratory facility, which I could have done without.

Staff/Faculty/Chairman
The longtime chair, Dr. Erhlich, announced his plans to retire about a year and a half ago, and they have been conducting a nationwide search to find his replacement. They are down to two finalists, who are each currently in contract negotiations with the hospital. The new chair should be announced within the next few weeks, with an absolute deadline of April 1. Dr. Ackerman (hand) is the internal candidate, and is the favorite to get the job. He is president of the hand society, is well known and respected in the orthopaedics community, and has been on the faculty at Brown for over 20 years. The external candidate is a prominent sports attending from the West Coast. Dr. Ackerman had an opportunity to speak to all the applicants during the start of the interview day, and he said that regardless of who is hired, it will be a good environment for the residents, as both he and the other candidate are passionate about teaching. The faculty aren't expected to leave with the chairman change, as Brown orthopaedics is a privademic model, and the majority of them have been at Brown for decades. The PD is Dr. Eberson (peds/spine), who took over last year for Dr. DiGiovanni, who left to head the F/A department at Harvard. Eberson was a resident at Brown himself, and he is very pro-resident. He is a friendly, enthusiastic guy, and he talks really fast, but I definitely liked his energy. In the short time he has been there, he has made a number of resident-suggested changes. For example, the general surgery months of intern year were historically brutal, and he swapped out two months of general surgery (aka lots of floor scut) for a month each of radiology and anesthesia. He established both junior-to-senior resident and faculty-to-resident mentorship systems, and he also made adjustments to the didactic curriculum in response to resident feedback. The faculty is a mix of old and young, with a lot of established names and some up-and-comers. They are strongest in hand and trauma, with solid peds, spine, joints and sports, but only 1 faculty each on F/A and tumor. Dr. Froehlich (joints) is the assistant PD, and he is responsible for supervising the resident experience at the Miriam Hospital's joint replacement center.

Didactics/Teaching
They have 30-minute lectures in the morning on Mon/Tues/Thurs/Fri, which are subspecialty topic-based and usually attending-led. This is followed by 30+ minutes of fracture conference, where the residents go over their consults with the attendings and superchiefs (PGY6 residents). They have dedicated OITE review lectures during the summer and early fall, where they will walk through various textbook chapters. Dr. Eberson mentioned that they are developing reading lists for each rotation of the highest yield materials for that block. Some residents mentioned they would like to model it after WashU, where there is a packet of papers and textbook chapters that are specific to the year and the rotation (i.e. junior vs. senior joints rotation). They also have journal club and tumor board each once per month. Most of the subspecialty services have a few additional didactic sessions every week. The residents I spoke with said they felt the didactics were generally good, and that Dr. Eberson is working to make them even better.

Operating Experience
This is definitely sold as a strength of the program. The core of the operative experience is trauma, and you spend time on trauma as a 1/2/3/5/6. The intern year is floor work, the PGY2 year is consults, the PGY3 year is purely operative, and the PGY5 year is running the service and operating. The PGY6 year is obviously unique here, and it is considered a mini-trauma fellowship (but not board-certified fellowship), where you will act as a junior attending with your own patients, run your own clinic, and take primary q6 trauma call. The residents noted that there is a huge jump in operative skill between PGY5 and PGY6, as you are taking on complex cases, although you do have backup from the trauma attendings when you need it. On other services, the PGY1 spends 2 months on hand with their junior hand attending, and it is a 1-on-1-mentorship model. There is good operative autonomy on the VA rotations as a PGY3 and PGY5, where you will run the orthopaedic service and take care of mostly joints and sports issues. They get 4 months doing primary joints at the Miriam Hospital as a PGY2, and then get joints again as a PGY3 (or PGY4, don’t remember) and PGY5, with the PGY5 doing a lot of the complex revision cases. Their F/A rotation comes as a PGY4, and tumor comes as a PGY5. They have sports as a PGY3 and PGY4, with a separate shoulder and elbow rotation as a PGY4. Otherwise, everything else is done as both a junior and a senior. As mentioned, every rotation outside of trauma utilizes the mentorship model. The residents felt that they had good autonomy, with graduated responsibility in the OR. However, as with most places, the level of autonomy can be attending dependent, and the residents said there are a few attendings that let them do a little less than they would like. The operative sports experience is apparently not the greatest, and the F/A attending is fairly new and still building his practice.

Clinic Experience
The clinic experience here is fairly robust. Dr. Eberson and a number of the faculty emphasized during the interview day that knowing when to indicate patients is more important than knowing how to do the procedure. To this point, they have indications conference every week for every service. Clinic is typically 2 days per week, with some services having it 3 days per week. There is also a resident run weekly longitudinal clinic that you attend from PGY2 through PGY5. The only other program with something like that I know of is Mount Sinai. You see uninsured patients in clinic, and will retain them over the duration of your residency, from the initial workup to nonoperative treatment to surgery and postoperative care. There is an attending that staffs the clinic at all times, and if you book a clinic case for surgery, you will scrub on that case regardless of the service you are on. The residents are given a lot of autonomy in the service-specific clinics, where you will see the patient and present to the attending. There is very little shadowing in clinic, although it can happen with a few attendings. Overall, the clinic experience is definitely above average here. As a PGY6, you run your own clinic with your own patients, and learn how to bill and code your encounters.

Research Opportunities
Research is definitely a focus of the interview day and the residency. They have 2 months of dedicated research time as both a PGY4 and PGY5. During the PGY6 year, you also have a decent amount of free time to work on research if you want to. The bulk of the research here is basic science, and they have ~10 PhD researchers in the department working on a combination of biomechanics, tissue engineering, and genetics projects. Dr. Terek, their tumor attending, has an NIH grant for his lab work on chemotherapy resistance in osteosarcomas. They have some clinical outcomes research, which is headed by Dr. Owens (sports), who was recently hired from the military and has 200+ publications. Some of the attendings work on cost and quality committees, but Brown doesn't have much in the form of internal databases or faculty with experience in these fields. The faculty is very enthusiastic about research, although it is generally resident-driven. They fully support conference presentations if you get something accepted. The residents collectively published ~40 papers last year.

Residents
They were a laid-back, down-to-earth group. They had a bit of a blue-collar feel, even though it was an academic environment. Not very "bro-y", with little bit of a nerdy vibe, but everyone seemed cool. There is only 1 girl in the entire program, which apparently was not intentional, as there were ~5 girls in the program consistently up until a few years ago. Nearly all of the residents are married, and many have kids. Most do not have Rhode Island ties, so they are generally a tight-knit group, get along well, and spend a lot of time with each other.

Lifestyle
With all of the trauma rotations, the lifestyle is definitely more difficult than average here. The intern year used to be fairly miserable, but it has improved a lot in recent years with less general surgery. They also hired a couple of PA's over the past few years to help with floor work and discharges on each service (which was done to help residents maximize time in clinic and OR). The interns spend 2 months on trauma taking care of the floor work, with the PGY2's doing 4 trauma months split between days and night float. The PGY2's also take all of the weekend call, which I think is set up into power weekends (Friday night/Sunday day for one resident and Saturday 24 for the other). The pager is busy here, and they can get 25-30 consults each night. The PGY3 is on home call, but with all the volume of consults, they spend the first quarter/half of the year in-house. The PGY5 is on operative backup call. The call for PGY6 is ~q6, with the trauma attendings available by phone for questions, or in-person if needed for a case. It is worth mentioning that the PGY6's are technically graduates of the program, and do not spend time on any of the other services outside of trauma. However, if they are interested in a particular area, they can negotiate for relevant trauma cases among each other (i.e., interested in hand, do a lot of upper extremity trauma). The salary for PGY6 is around $110K (listed as 150 on the website, but this was back when they had 5 PGY6 residents per year). The fellowship is not board-accredited, and everybody does a separate fellowship afterwards. The hours on the non-trauma subspecialty services are supposed to be pretty good, since it is essentially private practice and built for efficiency.

Location/Housing
Providence is a small but very livable city. There is a great food and beer scene here. It is about 30 minutes south to the beaches, an hour north to Boston and 3 hours west to New York. The residents are spread out around the city, but you have the option to live in a modern apartment building downtown, an older building in one of the Providence neighborhoods, or a house in the suburbs. The housing is affordable on a resident salary, somewhere in the low 1000s for a 1BR. While a car is a requirement here, all of the hospital sites are within a 10-minute drive of each other, and there is very little traffic here. Parking is free at all of the hospital sites.

Limitations
The PGY6 year is definitely a big factor here. The opportunity cost of a year of my life as well as the lost salary of delaying being an attending are definitely negatives from my perspective. While there are a lot of potential gains from the extra year, I think you can get sufficiently good at trauma during the 5-year experience at many programs. It also feels a bit like exploitation for cheap and easy labor, since none of the faculty attendings there take trauma call, you generate a ton of money for the hospital, and you are paid at 40% of a junior-level attending's salary. The other big concern is the uncertain chairman situation. Even though the potential candidates sound great, there is still the unknown of how they will fit into the program, the changes they might make, and a potential exodus of faculty who don't fit in with them. Smaller limitations include the F/A and tumor experiences that are delayed until PGY4/5 years, the general lack of clinical outcomes research, and the lack of a "bro-friendly" resident feel. I also would like a strong sports experience if possible, and I didn't hear a ton about sports during my interview.

Conclusion
Overall, a very well balanced program. They get a great foundation in trauma, there is very limited encroachment by fellows (around 5 total, all on non-trauma services, and with the mentorship model, you rarely interact with them), and they have a solid experience in all of the subspecialties. Providence is a very livable city, the residents seemed like a great group of guys, and they have a strong academic reputation with resources available for research. My big issue with the program here is the sixth year. While I think it has some unique advantages, it is hard to bring myself to commit to an extra year of my life to residency. I think trauma is important, and I want to be good at it, but I don't plan to go into trauma and I think that I can get the necessary trauma experience and surgical skills from a 5-year program. I think that if Brown turned itself into a 5-year program, it would be among the most desirable programs in the country. However, they have no plans to change, and all of the residents there stand by the value of the 6th year. It is definitely a hard place to rank, but I think it will be in the middle of my tier 2.

Maimonides

Interview Experience
The pre-interview social was held in a private room at a pub in Brooklyn. There were booths to sit down and talk to the residents, and they kept the pitchers of beer flowing. You could order food off the menu, and overall it was a good time. Good resident turnout, with an appearance by the PD, Dr. Razi. Residents were very casual here, with many in t-shirts and one even in sweatpants. The social was on the later side of ones I have had, running from 7:30 to 10pm. The interview day was split into separate AM and PM sessions. After a brief presentation by the chairman Dr. Choueka, which included some generic video clips, we were subdivided into two groups, either interview or tour. The interview rooms were 6x10 minutes, and each room had a theme. There was a knowledge room, an ethics room, a behavioral interviewing room, a research room, the chairman's room, and a random room (tell me how you make your PB&J sandwiches). The questions made the interview day generally refreshing and everyone was very friendly and engaging. The tour was generic, with a walk-through of the hospital wards, ER, research lab, and simulation center. The facilities were actually pretty unimpressive, with an old city hospital feel. The new Bone and Joint Center (where the interviews were held) was actually really nice, and they have some private clinic and outpatient surgeries there, but most of the residency is spent at the main hospital.

Staff/Faculty/Chairman
The chairman Dr. Choueka (hand and upper extremity) seems really nice, and he is very interested in the well-being of the residents. When he took over about 10 years ago, the program had some issues, and he has steadily worked to make improvements each year. He is more of an ideas guy, with the PD Dr. Razi (spine) figuring out how to implement the ideas. They are relatively responsive to resident feedback, and the residents fill out surveys after each rotation. Even as the boss, Dr. Choueka seems like a blue-collar orthopaedic surgeon. I liked Dr. Razi as well, and he is quite friendly and is always smiling. The full-time faculty is fairly small, probably on the order of 10 to 15 attendings, with a few additional private practice surgeons serving as volunteer faculty. They have 1 or 2 surgeons for each subspecialty, with hand and general ortho (and a ton of hip fractures) as their busiest services. They recently lost their hotshot tumor attending to LIJ, and they do not have a full-time spine attending (most of the spine rotation is spent with neurosurgeons). They recently added a young trauma attending, and they will be transitioning from Level 2 to Level 1 trauma center over the next few years. Dr. Razi said they may also apply for a 4th resident spot within the next few years.

Didactics/Teaching
They have an hour-long fracture conference on Mondays, with presentations followed by pimping from the new trauma attending. On Fridays, they have ~2 hours of didactics that is a mix of attending and resident-led lectures on selected topics. Residents are also required to complete the OrthoBullets OITE curriculum, with assigned reading and questions. Performance on the OITE is really important here, and the residents typically do well because their didactics are geared towards it. Pass rates on the boards have been 100% over the last 5 years.

Operating Experience
Attending-dependent according to the residents, with some attendings being quite grabby and others letting them fly. Residents double scrub on joints and hip fracture cases, since they don't have ancillary staff to help with retracting and holding the leg. The entire PGY1 year is spent on floor work, and PGY2's split time between consults and the OR. They have quite a bit of general orthopaedics each year at Maimo and Lutheran Hospital (also in Brooklyn, about 15 minute drive). Lutheran is a level 1 trauma center, but not a super busy one. The residents also go to Hartford for peds as a PGY4, and Shock Trauma for general surgery trauma as a PGY1. The sports, F/A, tumor rotations are mentorship-based. The spine experience is with neurosurgeons, and is a lot of non-op stuff. Hand with Dr. Choueka is among the best rotations. The operative experience at Lutheran is fairly hands-on compared to Maimo.

Clinic Experience
They have resident-run clinic three times per week. However, it is typically covered by 1 junior and 1 senior from services that aren't busy that day. Some subspecialties (but not all) have private clinic office hours as well during the week. For each resident, it works out to about 2 days of clinic per week. The residents said they enjoyed the autonomy of clinic, but weren't overly enthusiastic about the constant commitment to staffing it every day.

Research Opportunities
Of the 3 residents per year, 1 is required to take a research year between PGY2 and PGY3. This is not decided until the middle of the PGY2 year, and if nobody volunteers to do it, the decision is left to a coin flip. They have a research lab with a full-time research coordinator, and most of the projects are biomechanics. Dr. Razi is also on the faculty at NYU, and they often collaborate with NYU and Mount Sinai on projects where Maimo is lacking the facilities or field expertise on a particular topic. The research resident typically gets at least 1 presentation or paper from the research year, but there isn't a ton of push for productivity from the leadership. The research resident also takes call once per week at Maimo and gets $400 for the shift, which helps to supplement income. Overall, research is not a focus here, and the residents did not express much interest in academic pursuits.

Residents
With only 3 per year, they are a tight-knit group. They know each other well, and spend time together outside of work when they can. Felt like a blue-collar group, and didn't get any bro vibes from them. They were very casual in the social, seemed like they had fun, but they weren't particularly academic, and they didn't seem that passionate about their training. Most do a fellowship, and sports and hand seem to be the most popular. Nearly all of them go into private practice.

Lifestyle
One of my interviewers said this is a gentleman's program, and I would agree. They rarely work 80 hours (except for junior general ortho rotations at Maimo), and rounds never start earlier than 6am. The Lutheran rotations are mostly just operating, with most of the floor work handled by PA's and NP's. The call schedule works out to about q4 to q5, and it is split between the 3 PGY2's and the 1 PGY3 at Maimo and the research resident. They have power weekends, with Friday night call, Saturday off, then Sunday all day. They have post-call days, and the program is good about sending residents home. There is plenty of free time to enjoy Brooklyn and NYC, and many of the residents seemed like they placed a premium on maintaining their social life.

Location/Housing
The hospital is located in the southern part of Brooklyn. Most of the residents live in the brownstones of nearby Park Slope and downtown Brooklyn, although it is feasible to live in lower Manhattan. There is no subsidized housing for residents. The subway runs near the hospital, but with a number of different hospital sites and early hours, all of the residents have a car. Parking at the hospital is street-based, and it can get dicey in the mornings. The cost of living in Brooklyn is relatively high, but is definitely more affordable than Manhattan. Brooklyn has plenty to do, including great food, bars, sporting events, diversity, etc.

Limitations
The trauma experience here is light for a community program. They do a ton of hip fractures and bread and butter subspecialty cases, but the services don't seem that busy and the volume is fairly low. Working with neurosurgeons on spine is suboptimal, and many of the other subspecialties have 1 attending, so there isn't much diversity in teaching style. The Lutheran rotation is their only Level 1 experience, but the hospital was recently acquired by NYU, and Maimo residents may be kicked out within the next few years. Similarly, the Maimo hospital was bought by North Shore-LIJ system last year, and while we received assurances that the program isn't going to be absorbed, there may be changes to the department and the hospital within the next few years. Maimo is turning into a Level 1 trauma center, but it's unclear how long this will take and what the final product will be. The requirement for 1 research resident in each class is a huge negative, as you might get stuck doing a 6th year of residency. Furthermore, there isn't a strong research focus here, and the resources to do projects are limited. Going to Hartford for peds and Baltimore for general surgery trauma are also undesirable. I didn't get a strong sense of program pride from the residents.

Conclusion
This program has an "identity crisis", as one resident put it. They have a research resident, but otherwise don't have much of a focus on research. They are a community program at their core, but the trauma is much lighter than most of the community programs that I have seen. This program is lifestyle-friendly with a good location, and you will graduate as a competent orthopaedic surgeon, but I feel like there is a ton of untapped potential here. This is at the lower end of my tier 3.

Mount Sinai

Interview Experience
Social the night before was held in a private room at a bar on the Upper East Side. Great resident turnout and there were abundant appetizers to eat. Wasn't too loud and I got an opportunity to talk with a number of residents from different classes. The interview day was split into two separate groups, AM and PM. They interview 50 applicants for 4 spots, and they do not interview many rotators. That said, their intern class had 4/4 rotate, with the PGY2 and PGY3 classes having 2/4 rotators each. The day started with a brief welcome from Dr. Galatz (their new chair) and Dr. Parsons (PD). There was a 30-minute presentation by the chief resident on the program, followed by 6x10-minute interviews with multiple faculty in each room. On the interview schedule, the rooms were labeled as themed (clinical, ethical, general), but there were almost no knowledge or ethical questions at all. The interviews were mostly about my application, my letters, and what I was looking for in a program. There was a bioskills room, which involved a styrofoam ball, a K-wire, and a mini C-arm. The interviewers in that room asked everyone to talk about what they were thinking as they worked through the task. From my conversations with other applicants, I think performance was a mixed bag during my day. Many of the current residents said that they failed during their interview days, so I think that the problem solving and reasoning are most important. Furthermore, when you consider that it was one room out of 6, mediocre performance in bioskills is only worth a minor component of your overall interview score. After interviews, there was a brief tour, and the entire day ended up lasting for about 4 hours.

Staff/Faculty/Chairman
Dr. Galatz (shoulder/elbow) is the new chair. She came from WashU in St. Louis and just started in September. The residents said that she is very visible in the program and has made an effort to get to know all the residents. Residents described her at somewhat "motherly" in her approach to the residency, but also said she has business-savvy vibes and projects an image of a corporate CEO. This is in contrast to the prior chair, Dr. Flatow (shoulder/elbow attending, who runs the entire St. Luke's hospital), who was not that involved in resident education. The administrative duties of the program are handled by the chief resident (1 of the PGY5’s), and in many regards this resident is the de facto PD, running the day-to-day activities of the residency program. He meets with Dr. Galatz and the PD Dr. Parsons (also shoulder/elbow) at least once weekly to air concerns about the program. Dr. Parsons himself was a resident of the program, and has been on faculty for 10 years. He is intricately involved with the didactics, and gives lectures himself at least once per week. He is a big believer in pimping as a form of teaching, and while he sets high expectations for his residents, he was noted to be approachable and friendly. The big news on this interview was that Mount Sinai recently acquired St. Luke's/Roosevelt Hospital, and created the Mount Sinai Hospital Network. After next year, the St. Luke's ortho residency (3 residents per year) will be merged into the Mount Sinai residency (currently 4 residents per year) into a 7 resident per year program under the Mount Sinai name. This also means that the faculty will be combined, with certain services being integrated at 1 clinical site (except for joints, which will be at both sites). The Sinai faculty is strongest in hand and spine, and with the merger, shoulder and elbow will be expanded to the point that it will get its own rotation. Hand at St. Luke's is also really strong (with the renowned CV Starr fellowship), and the hand experience figures to get even better for the residents at Sinai. The joints experience is robust here as well, as it is at most Manhattan programs. They have 1 F/A attending and 1 tumor attending currently, although they both have high-volume practices. Dr. Galatz said she plans to hire 15-20 additional faculty over the next 5 years, and wants to add a mix of established names and young up-and-comers.

Didactics/Teaching
There are didactics every day, with 1 hour of attending-led lecture on Mon/Tues/Thur/Fri and 2 hours on Wed (resident-led fracture conference followed by grand rounds). Interns also have 3 additional hours of interactive lecture with the chief resident with assigned reading for each topic. Following Dr. Parsons' style, there is a lot of pimping in every lecture, from attending-to-resident and senior-to-junior resident. I had heard rumors from rotators that the pimping was extremely aggressive, and that they were scared shitless during their rotations. However, according to the residents, although the pimping was borderline malignant a few years ago, it was toned down a lot and now is utilized as a teaching style to make sure the residents are keeping up with their reading and building their knowledge base. Junior residents said that at no point have they felt uncomfortable, and that they are driven to read because they don't want to look bad in front of the other residents and their attendings. It is a reasonable expectation, since this residency is lifestyle-friendly and there is ample time to read for lectures and cases. The anatomy labs in the summer are also another source for pimping, and here the expectations are very high for knowledge, and you may get an earful if you don't know your approaches cold. With all of the focus on didactics, the residents perform well on the OITE as well as their boards. They have around 30 PA's to cover clinical responsibilities and their academic time is protected, so they never miss it. As a PGY2, it can be hard to read when you’re on some of the busy services, and you will inevitably have a few poor pimping performances, but overall the didactics are a definite strength of this program.

Operating Experience
As alluded to earlier, they have a ton of PA help with the floor, and the majority of time is spent in the OR, even as a PGY2. The rotations are service-based, but there are typically only 2 residents on the service, so it functions basically as a mentorship model, where you work with a few attendings for each rotation. You rotate on each service as a junior and senior resident, although the sites and order of these rotations will be changing with the residency merger in two years (when I would be a PGY2). Because of the high faculty to resident ratio, residents are almost never double scrubbed, and PA's are assigned to cover cases that residents can't cover. They have a few spine fellows, but there are 10 spine attendings, with more than enough volume to go around. Many of the other services have 1-2 fellows, but there is enough volume that double scrubbing with fellows isn't common. The trauma experience is at Elmhurst Hospital, which is the county/city hospital in Queens and is a Level 1 trauma center. You rotate there as an intern, PGY2 and PGY3, with the PGY3 acting as the chief of the service. The other Sinai surgical residents (ie gen surg, vascular, plastics) do an Elmhurst ortho rotation, so as an intern you act as the “chief” intern and see the ER consults while they help with floor work. The PGY2's and PGY3's spend their time in the OR with the 2 Sinai trauma fellows. They have a q4 24-hour call system (2 residents, 2 fellows) with 3 residents splitting up the OR and 1 being post call. During PGY4, there is also a trauma rotation at Westchester Hospital, where you spend the entire day in the OR on complex polytrauma cases. With the merger, they will also go to Memorial Sloan Kettering as a PGY3 (or PGY4, cant remember) for tumor, with another tumor rotation at Sinai as a PGY2 (or PGY3?). They will also go to DuPont Hospital in Wilmington, Delaware for the complex peds experience as a PGY4, with another Sinai peds rotation as a junior. Overall, the operative experience here seems good and generally hands-on, although it can be attending-dependent (but this is typically the case everywhere).

Clinic Experience
There is typically 1.5 days in clinic per week, with private office hours for your subspecialty service on Wednesday after lectures, and an entirely resident-led clinic on Tuesday afternoon. This clinic is very unique, in that you keep your patients over time. If you see an ER consult as a PGY2, you can have the patient to follow-up in your personal clinic. Many of the new patient referrals for Medicaid are sent here, and specific subspecialty complaints are typically sent to the resident on that service (i.e., hand issue is referred to the junior on hand). You then book your own clinic patients, and choose an attending to do the case with. Clinic operative cases take priority over your subspecialty rotation, and they will get PA's to cover your rotation cases while you take care of the clinic case. Residents also refer patients between each other – for example, if a patient has a complex hand issue, you can send it to the senior resident that is planning to go into hand. Overall, it is a very unique experience. All of the clinic rooms have EMR (I think Epic, but didn't ask), and the clinic is relatively efficient. You are given a lot of autonomy in coming up with your diagnosis and plan, and usually get to write the notes and enter billing codes.

Research Opportunities
There are a lot of opportunities for research here, although resident interest and commitment can vary. The residents collectively were authors on ~70 papers last year. Podium presentations are fully funded by the department, and you don't have to take vacation to attend and present (due to PA coverage). There is 1 dedicated PhD basic science researcher, and 1 of the chief residents also has an NIH grant and runs his own basic science lab. Most of the research is clinical outcomes stuff, and there is a spine attending who specializes in cost effectiveness research. A number of residents have worked with him and then apply their acquired skills to the subspecialty they are most interested in. The lifestyle here is good, so you have ample time to work on research projects if you want. There is a dedicated research block during PGY3, and you are required to have 1 publishable project by graduation. However, many residents do more, and their chief resident (the one with the NIH grant) has put out ~40 of his own papers during residency. Their spine and hand groups are the most active in terms of research productivity, with a few highly-published shoulder/elbow attendings as well (Galatz, Flatow). They have some departmental research staff to help with stats and IRB's.

Residents
With 4 per year (the PGY4 and PGY5 classes have 3 residents), they are a tight-knit group. After morning rounds, they have breakfast (might I mention it’s free) and then they attend lectures, so they wind up spending a lot of time with each other. Contrary to many other programs, it actually seems like there was a lot of camaraderie across the different classes, maybe since the program is among the smaller ones I interviewed at. They have quite a few girls and a few bros, with some other personality types scattered in. Most of them had ties or reasons to be in NYC, and they were energetic, fun city folk that enjoy the hustle and bustle of the city. However, the lifestyle is good here, and they said they all value their lives outside of medicine. The majority of the residents are in serious relationships, and the program is good about giving time off for family-related and personal issues. Many of the residents go into private practice, although there are plenty of opportunities to get into academics if you desire. The seniors said they have no problems getting into the fellowships of their choice.

Lifestyle
As mentioned previously, there is a ton of PA help here, and the program is very lifestyle-friendly. The PA's cover the floor during the day take primary call for the overnight consults at Sinai (a Level 2 trauma center), so as a PGY2 and PGY3 at Sinai you are taking q5-6 home call. The PGY2's take q3/4 24-hour call on Saturdays (the only night with no PA on call), and the PGY3's take 12-hour Sunday day call. At Elmhurst, there is no call for the interns, with 24-hour rotating q4 call with post-call days for the PGY2, PGY3 and the 2 fellows. The PGY4 and PGY5's take a week straight of backup call, but this is for operative emergencies, and they almost never come in. The juniors on home call get a post-call day if they have to go into the hospital after 1am, and apparently this only happens 3 to 5 times during the entire 2 years of PGY2 and PGY3 home call. With their call system, you get most of your weekends off, and your rotation hours are typically 5 or 6am until 4 or 5pm. There are a lot of perks in this program, including free breakfast, $1000ish for educational purposes every year, an additional $700 per year to attend educational courses, full travel expense coverage for national meetings, and 1 educational course/conference every year (i.e. AO Basic as PGY2, Miller's review as PGY4, AAOS as PGY5) in addition to the courses you choose to attend using your course funds. The PGY2 year is supposed to be the hardest, but it is fairly easy outside of the busy rotations (Elmhurst, spine, joints). There is a department-provided car to drive up to Westchester for the PGY4 trauma rotation (30 minutes away). I believe that there will also be a department-provided apartment in Wilmington for the DuPont rotation.

Location/Housing
Located in the Upper East Side of Manhattan, which is a relatively quiet part of town by Central Park. NYC sells itself, with great food, culture, and activities. In this program, you also have the time and money to enjoy it. They have highly subsidized resident housing (studios if you're by yourself, 1BR for couples, 2BR with roommate) with rents in the low to mid $1000s. The buildings are located close to the hospital, have a doorman, and are fairly spacious. A few residents live in other areas of town, but about 75% of them live in the resident housing. As mentioned, there is a car to drive to Westchester and a shuttle to Elmhurst. There also is a shuttle between the different Mount Sinai campuses, which will be useful in the future to get from morning lectures to clinical rotations at the St. Luke's campus.

Limitations
The pending integration with the St. Luke's residency program is definitely a source of uncertainty, as it is unclear how the core experiences will change for the residents. While the faculty and residents were adamant that the program will stay the same, and that they will simply be expanding in the size of the residents and faculty (and making new hires), the program will clearly be in a state of transition during the course of my education over the next 5 years. I also think that the type of resident at St. Luke's is much different from Mount Sinai, and the addition of 3 St. Luke's residents to my class and each of the 3 senior classes above me is a bit unsettling. Dr. Galatz is apparently sitting on the interviews for St. Luke's residents this year, but I still think the applicant pools are very different for each program. The core knowledge and experiences I imagine will be much different for the existing St. Luke's residents, and while I don't think it will be a huge problem, I would prefer some continuity of my seniors from intern year onward. Another limitation is the away rotation at DuPont in Delaware, although this does help augment their relatively weak peds experience at Sinai. While you get a taste of trauma call at Elmhurst, the call here is really light and you don't the blue-collar experience that can be valuable to get comfortable with running an orthopaedic service. Elmhurst also seems like it is a much less busy city hospital compared to Bellevue in Manhattan and Kings County in Brooklyn. While the chair seems to have a great vision for the program, the fact that Dr. Galatz is new gives the program another element of transition and growing pains. I also don't know how I feel about having lectures and reading for every single day, and the constant flow of pimp-style learning seems like it might be unnecessarily anxiety provoking. I didn't get quite as much of a "bro-friendly" feel from the program as I would have liked, but the residents were a fun group I could see myself fitting in with.

Conclusion
A lifestyle-friendly academic program, with a well-rounded operative experience, unique clinic experience, and solid research opportunities. The program has a ton of perks, so the residents have a great work-life balance and can enjoy the benefits of living in NYC. The program is in a state of transition, with a new chair and a pending department/residency merger with St. Luke's. While in the long run I think this will be a net positive and will enhance the residency experience and the academic reputation of Sinai, I do have some reservations. It is quite possible that the product that was advertised on interview day may not be the product that exists in a few years. That said, I think this is an excellent academic program in a great location, and many of the negative reviews about Sinai on Orthogate are no longer applicable. This program definitely exceeded my expectations and will be at the top of my tier 2.

Albert Einstein-Montefiore

Interview Experience
The social was held at a bar in Manhattan the night before. It was really loud, and the resident turnout was so-so, maybe 5 or 6 residents total for ~30 applicants. Many of the residents were talking with each other, and didn't make as much of an effort to speak with the applicants as I would have liked. They got a couple games of flip cup going later on in the evening, which was fun, but a little less professional than I was accustomed to seeing at the other socials. The applicants were split into morning and afternoon sessions. It is a relatively short day, with the morning session running from 6:45-10:30am. I know some people who did the morning session at Einstein and the afternoon session at Mount Sinai, or visa versa. The day started with some breakfast (the bagels were actually good for a change) and a welcome by Dr. Cobelli (chairman) and a "why Montefiore" PowerPoint by Dr. Levy (PD). The interviews themselves were 4 rooms by 10 minutes, with 2 interviewers per room, with 6 faculty and 2 chiefs among the interviewers. The questions were a mix of the generic "tell me about yourself" and "tell me about your research", but also some more serious questions like "why would you come here?" and "why should we take you?". None of the interviews ever felt uncomfortable, but the questions were a bit pointed at times, and there wasn't much small talk. After the interviews, there was a chance to speak with a group of 5 residents about the program, followed by a tour of their new outpatient center. That was it, short and sweet.

Staff/Faculty/Chairman
Dr. Cobelli (joints) is the chairman. He is relatively hands off in the residency, but has played a big role in the growth of the department, including the development of a joint replacement center, a new outpatient ambulatory surgery center, and hiring of new faculty. Dr. Levy (sports) is the PD, and he is an eccentric guy. He wears thick pink-rimmed glasses and went on some short, albeit amusing and informational, tangents during his presentation. According to the residents, he is very open to resident feedback and meets with the chiefs every two weeks to go over the concerns from all class levels at the various sites. During the interview, he talked about how he wants to structure the program’s leadership like the military, where he gets a steady stream of real-time info from his senior residents (aka his “boots on the ground”). The residents said that he makes as many improvements as he can within reason, as the hospital system is still limited in terms of staffing, funding, and system-wide inefficiencies. The entire faculty is spread across 3 main campuses, all within a 10-minute drive of each other. There are about 35 faculty members, with approximately 10 joints, 4 hand, 5 sports, 4 peds, 3 tumor, 2 spine, 1 F/A, and the rest trauma/general at Jacobi (the Bronx city/county hospital). They recently hired Dr. Otsuka from NYU as their peds chief, and they also hired a junior spine attending to replace 2 of the senior spine surgeons they lost last year (who went to NYMC and LIJ). The faculty is generally interested in teaching, but at the same time give the residents a lot autonomy to run the orthopaedic services at each respective hospital.

Didactics/Teaching
They have formal didactics once per week on Friday afternoon (I think). The lectures are completely resident-led, and attendings occasionally show up. They have grand rounds once per week in the morning as well. The residents are often busy with clinical responsibilities and don't always make it to didactics. They have had some scattered poor performances on the OITE and ABOS board exam failures over the last few years, which were said to be related more to the residents themselves than the education in the program. The didactics have been improving over the last few years, and one of the PGY4's is already working on changes for next year's curriculum. They have a surgical skills lab that is tool-based (instead of anatomy-based), and the juniors say this has helped them get comfortable with drills, saws, etc.

Operating Experience
This is a blue-collar program, and you will come out of here knowing how to operate. The interns spend most of their ortho blocks taking care of floor work, and the PGY2's split time fairly evenly between operating and taking consults. However, from PGY3 through 5, the residents are operating all the time. Jacobi is mostly trauma with some general orthopaedics sprinkled in, and it is a rotation for 2 months in PGY1, 2 months in PGY2, 4 months each in PGY3 or 4, and 2 months in PGY5. They typically have 2 trauma rooms running, with the 5 in one room and the 3/4 in the other. There is a focus on resident autonomy here, and if the resident is comfortable with the case, the attending will let them go skin to skin. The interns spend 2 months each on ortho at the Weiler (mostly consults and general ortho stuff) and Moses (joints and general ortho), with PGY2's spending 2 months at Moses on general and 2 months at Moses on joints. The PGY3/4 structure is a single 24-month cycle, with 4 months on peds, 4 months sports (combined with research), 2 months tumor, 2 months F/A, 2 months Weiler joints, 2 months spine, 2 months peds/spine, and 2 months hand, in addition to the 4 months at Jacobi trauma. PGY5 is 2 months sports/joints combined, 4 months on general at Weiler, 2 months on general at Moses, and 2 months on peds, in addition to the 2 months at Jacobi trauma. The joints experience here is excellent, with peds very busy as well. Spine is a little bit slow with the loss of faculty, but it should be picking up in the next year or two with new hires. There are only 2 fellows here (1 joints and 1 peds), so the seniors are almost never double scrubbed, although PGY2's and an occasional PGY3 can be double scrubbed with a senior on big trauma or joints cases. The opening of the new ambulatory surgery center has helped with room turnover (10 minutes), and leads to higher daily case volume than the old community hospital setup for elective cases. The joints center at Moses is also much more efficient, and a few of the attendings (but not all of them) will run 2 rooms and slam in 6 to 8 joints a day. A few of the rotators I spoke with said that the technical skills of the Einstein seniors were among the best they saw during their ortho experiences, and they are very well-trained with bread and butter orthopaedics.

Clinic Experience
Residents typically spend only 0.5 to 1 day per week in clinic, with some of the usual exceptions (peds, spine). At Jacobi, the clinic is entirely resident-run, and is usually 2 to 3 days per week for the juniors and 1 to 2 days for the seniors. Even as a junior in clinic, you are making your own diagnoses and management plans, and then presenting complex or operative cases to the senior residents (attending is available by phone if you need him). The subspecialty clinics with the private patients are still characterized by a lot of autonomy, although you will present these patients to the attendings directly. Some private clinics go uncovered by residents because they are needed in the OR/floor, so PA/NP's help cover those clinics.

Research Opportunities
The research is "there if you want it", as one resident put it. You are required to present a research idea during your PGY3 year, and then use the research block and PGY4 year to get a publication submitted by your PGY5 year. Most of the residents don't do any more research than the minimum requirement, although they have an occasional resident who will pump out a bunch of publications and podiums. They recently hired 2 research coordinators to help grow the research branch of the department, and there are medical students from Einstein who are interested in getting involved, but overall if you want to do research here you have to drive your own projects from start to finish. There are limited resources for your utilization, most notably funding, staff and sources of data. The extensive time commitments to providing clinical care, especially as a junior resident, make it hard to find time to work on meaningful research projects. Dr. Otsuka, who was recently hired from NYU, is trying to increase the research culture, but it likely will be a slow process over the next few years.

Residents
The residents were a fairly close-knit group. The culture has changed over the past few years, from a hierarchical environment where the seniors rode the juniors hard, to a much friendlier, collegial atmosphere. The residents joked a lot with each other, and busted each other’s balls like typical New Yorkers do. The Bronx can be a grueling place to work, with a difficult hospital system and patient population to navigate, so you will be battle-hardened, but I didn't sense that the residents were jaded or had lost faith in what they were doing. In fact, it seemed like quite the opposite. They said that they all work hard, but at the end of the day, they feel good about the difference they are able to make in the community. Nearly all of the residents do a fellowship and go into private practice, with sports and joints being the most popular. Many of the senior residents are married and some have kids, but they try to find time to hang out outside of work. Many have NY area ties and will hang out with their med school or college friends or their family. A mix of personalities, with some nerds, some girly girls, a couple bros, and a lot of regular guys. The program has around 25% women.

Lifestyle
You work hard in this program. The residents are vital to the daily functioning of both Jacobi and Montefiore, as these hospitals are understaffed and inefficient. As an intern and a PGY2, you will regularly work over 80 hours. It is very tiring, but you learn a lot and provide needed care to the community. You spend 2 months on the Jacobi night float system as a PGY2, and they recently eliminated night float for covering the Moses floor and Weiler ER, in favor of q4/5 call system for PGY2's with post-call days. The intern takes noon to midnight call once per week, with PGY3's and 4's on backup home call. PGY5 is only for operative emergencies, and they rarely ever have to come in. The lifestyle for PGY3 to PGY5 is generally pretty good, especially on the ambulatory services like sports and hand.

Location/Housing
The hospital sites are spread across 3 sites in the Bronx, which are about 10 minutes apart from each other. The public transportation in this area of town is spotty, so every resident in the program has a car. Many of the junior residents live in the hospital housing, which is cheap, only $700 per month for a 1 bedroom. Other residents live in nicer areas of the Bronx for low $1000's in rent, while many of the seniors live in the Upper East and Upper West sides of Manhattan (usually 20 minute drive to the hospital, low $2000's for rent). If you are willing to spend (and commute), you can live pretty much anywhere in NYC. However, given the long hours and lower salary for juniors (no housing stipend like some of the Manhattan programs), it typically doesn't happen until the senior years. There is tons of food and culture throughout NYC, and within the Bronx, there is the zoo, botanical gardens, Yankee stadium, and Arthur Avenue (Little Italy of the Bronx, great food).

Limitations
There is a lot of floor work for junior residents, a lot of which is scut like social work and discharges, patient transport, drawing labs, etc. The operative experience in the junior years is less than other programs, and the occasional double scrubbing for juniors is suboptimal. Jacobi is a difficult place to work, with minimal ancillary staff and tons of inefficiencies. Resident-led lectures are a big minus, compounded by the fact that residents often don't even get to go to lecture. The lack of interest and resources for research would make it fairly difficult to launch a successful academic career from here. Furthermore, there is a ton of general ortho and trauma, with only 1 experience on each subspecialty. You can typically work out your schedule to have your target fellowship rotation during the 3rd year, but this may not always happen if the field is popular among your co-residents (like sports or joints). Work hours are brutal for juniors, with little time to pursue research or extracurricular interests. Even though clinic sucks, I would like more than 1 day per week, especially as a senior, and I would like more attending supervision to make sure I am indicating the right cases. The Bronx has some nice areas, and you can live in Manhattan, but the requirement for a car and the cost of living in NYC are definitely negatives. I also thought the residents were nice, but didn't get as much of a "bro-friendly" feel as I was hoping for.

Conclusion
A blue-collar community-type program in NYC. You will be a skilled technician in taking trauma call and will be well versed in the bread and butter of joints, sports, hand and peds. There are a number of limitations for this program, but they are reasonable trade-offs for the strong clinical experience and the location. Furthermore, the trauma, joints and tumor experiences are strong compared to many programs nationally. You need to be independent and tenacious to thrive in this program, and it will push you outside of your comfort zone. This may be a tier 3 for some people, but it is on lower end of my tier 2 spectrum because of location.

Rush

Interview Experience
Pre-interview social was held at a local steakhouse. It was a sit down dinner with a phenomenal spread: steaks, chicken and salmon served family style. The residents rotated at the different tables, and there was a good turnout (around 15 to 20 of the 25 residents, apparently everyone who could go attended). The interview day started at 7am with grand rounds, followed by a welcome from Dr. Jacobs (chairman) and a PowerPoint from Dr. Kogan (PD). Faculty then left the room and there was a PowerPoint from one of the chief residents, which included slides addressing common Orthogate rumors (i.e. too many fellows, not enough trauma). Starting at 9am, everyone had 5 interviews of 10 minutes each. Each room had 2 interviewers, with 4 faculty rooms and 1 resident room. The interviews were generally laid back and conversational, although 1 room had you perform a physical task: solving a block puzzle, suturing, or drilling. The interviews were spread out over the entire day (from 9am to 5pm), so there was a lot of waiting around in between interviews, with the time designated to ask residents questions, take a tour, or just speak to other applicants. I think it would have been a lot more efficient to have applicants grouped into 1 hour blocks for interviews, with another group touring, another speaking with residents, another listening to a PowerPoint. Lunch was held from noon to 1pm in the faculty club restaurant, which also had a nice spread. The day was over by 5pm. Overall, a solid experience and I felt like I got a good feel for the residents and the program. They interview 35 non-rotators and around 35 rotators. They typically take 3 rotators and 2 non-rotators. According to some residents, they rank a lot of the non-rotators high in hopes of getting a couple of them, so rotating doesn't wind up helping you that much.

Staff/Faculty/Chairman
Dr. Jacobs (joints) is the chairman, and he has been at Rush since his joints fellowship in the late 80s. He was president of the AAOS a few years ago, and is extremely well connected and well liked in the ortho community. This helps immensely with fellowship placement and politics within the Rush system. The residents said that he travels a lot (to meetings, conferences, and courses), so he isn't that involved in the day-to-day residency activities, but he is very responsive to resident issues and wants to make sure that the attendings are dedicated to teaching the residents. Dr. Kogan (peds) is the PD, and she took over from Dr. Levine (joints) at the beginning of last year. According to the residents, Dr. Levine was a great advocate, but he was frequently embroiled in battles with administrators. The change in leadership has been seen a positive development, as Dr. Levine remains involved with the resident education but has less administrative duties. The resident dynamic with Dr. Kogan was described as being "motherly", and she has focused on improving intern skills workshops, developing a formal mentorship model between junior and senior residents, and meeting with class representatives each month to discuss concerns and ways to improve the program. The program as a whole is very responsive to resident feedback: for example, they pulled residents out of the Cook County PGY4 trauma rotation because it was felt to be overcrowded (with 2 Northwestern seniors and a senior from a DO program). Dr. Jacobs/Kogan also reserve the right to pull coverage from attendings who aren't letting the residents operate enough. As for the rest of the faculty, there is a mix of established names and younger, up-and-coming talents. Aside from Dr. Jacobs and Dr. Rosenberg (both joints), most of the attendings are in their late 30s to mid 50s. Next year, 3 of the subspecialty group presidents will be from Rush. The faculty is in the 30 to 40 range, so not huge, but not small either. The joints, sports, and spine departments are probably the strongest in the program, with hand, tumor and F/A being smaller but still high-volume. They only have 1 dedicated peds attending (Kogan), and residents go to Shriner's for additional peds exposure during the PGY4 year. They don't have an in-house traumatologist either, but there may be one starting next year, and they would create a new rotation with 1 of the senior residents to get them some additional trauma exposure.

Didactics/Teaching
The bulk of the academics are on Monday night. From 5 to 6pm, there are surgical skills labs for interns, with an optional sports conference for the seniors. Then, there are either lectures or anatomy labs (with hardware to perform relevant fracture repairs) from 6 to 8pm. The lectures are led by a resident and moderated by an attending. On Wednesday morning from 7 to 8am, there are department grand rounds, typically with a faculty speaker. Thursday morning from 6:30 to 7am, there is a short lecture that rotates between tumor faculty, peds faculty, and trauma residents. Friday morning from 6:30 to 7am, there is a service specific conference. Overall, the residents said they feel they get adequate book learning, and they typically perform well on the OITE, although there is no dedicated OITE prep here.

Operating Experience
This is clearly a selling point of the program. Rush (aka Midwest) orthopaedics is a privademic program, and the operative experience is structured as a mentorship model, with residents from each year spending a given number of weeks on that attending's service. They have a high-volume practice, so despite the large number of fellows on sports, joints, and spine, double scrubbing is rare. The only times it typically happens are with PGY1's and PGY2's with spine or joints fellows or with a senior on trauma at Cook County. Junior residents felt that the fellows actually enhance the learning experience, because they let you do the approach and some of the easier parts of the case, without the pressure of having the attending in the room. For hand and F/A, there is only 1 fellow, so you barely even interact with them. The attendings almost always run 2 rooms, with one room for the fellow and the other for the resident. Most of the time, the resident room is bread and butter cases for that subspecialty (primary total joint, knee scope, ACL, carpal tunnel, etc.), but if the senior is interested in that field they can negotiate with the fellow on more interesting cases. The residents said that the responsibility is graduated, as in the attendings won't let you use the saw/drill until you can properly place the retractors, or harvest the ACL graft until you have mastered the diagnostic knee scope; however, they said they feel like they get good autonomy in the OR, and rarely feel that they are watching the attending work. If the attending is not letting the resident do enough, they can speak with the PD and resident coverage for that attending can be pulled, since cases at Rush still go uncovered and are staffed by surgical PA's. There are some additional rotation sites, including ortho trauma at Rockford for 10 weeks each during PGY4 and PGY5 (1.5 hours drive away, live in on-site apartment), peds at Shriners for 10 weeks as PGY4 (20 minutes away), and ortho trauma at Cook County for 2 months as PGY1 and 10 weeks as PGY2 (10 minute walk from Rush). Despite the distance, the Rockford rotation is among the highest regarded experiences by the Rush residents. You basically show up and operate for 6 to 10 hours a day, every day, with focus on trauma, but opportunities to scrub on subspecialty cases of your choosing. I didn't hear much about Shriner's, but it is a renowned peds hospital with lots of complex deformity and CP cases. Cook County is mostly floor/consults as PGY1, with PGY2 spending some time in the OR. It can get crowded with all the residents at County, but there are still ample opportunities to get in reps on the junior-level cases like hip fx, distal radius, tibial nail, ankle fx. However, the trauma here is fairly back-loaded as a whole, with the operative-heavy Rockford rotations coming as a senior. One nice thing about the rotation schedule is that you get to work on each rotation as a junior and senior, with different mentors each time, giving you sufficient exposure to make a fellowship choice and master the basics of that field.

Clinic Experience
Typically 2 days in clinic and 3 days in the OR, with some exceptions (peds and spine have 3 clinic days). The clinics are all private patients, but the residents said they nearly always get to see the patients and come up with their own diagnosis and management plan. There is resident-run clinic at Cook County for the few months you're there as a junior, but there is currently no resident-run Rush clinic. They have discussed the idea of a general ortho resident-run clinic, but there are some issues with faculty staffing and liability, so it isn't happening anytime soon. The facilities are fantastic, and the clinics are run efficiently. Usually you get to dictate notes, although this can be attending-dependent. Often there is free lunch courtesy of the attendings. They use Epic in the main Rush hospital, but a different EMR for the private clinic. You can't access it the clinic EMR remotely, making ER consults during home call a nuisance patients of the private clinic.

Research Opportunities
This is a huge strength of the program. During the morning PowerPoint, they flashed a slide that residents have more than 500 cumulative publications. Many of the faculty have dedicated medical students and research staff, and there are a ton of national and institutional datasets to perform clinical outcomes research. Clinic patients complete outcome questionnaires at every follow-up visit, so there is a ton of data at your fingertips if you have an idea. There are a few attendings working on cost-effectiveness and quality projects (Dr. Singh, a spine attending is quite involved), and given their privademic model, that sort of research is becoming more relevant to the program. They have 9 PhD basic science researchers, although I'm not particularly interested in this area of research, but it is there if you want it. The sports fellows are required to publish 12 articles each during their 1-year fellowship, so if you are interested in sports and are willing to help them, you can get your name on a ton of projects over the course of residency. Joints and spine are also very active in the publication arena. There is also a 10-week dedicated research block during PGY3 year that you can use to work on projects. You get full support to present at national meetings (AAOS or the major subspecialty group meetings).

Residents
They have 5 per year, so 25 total. The residents seemed like a fun and cohesive group. Very down-to-earth, joked with each other, and it looked like they all got along. There is definitely a lot of intra-class cohesion, with a little bit less inter-class interaction, but this wasn't absolute by any means. This is partly due to the setup of the program, since the mentorship model has you typically on your own for most of the week. However, the program does have some aspects of team-based work, since each service has a junior and a senior (who work together on conferences, rounds, etc.). The program was described as "bro-friendly", with quite a few hard-working, hard-playing bros in the junior classes. I heard that the current seniors have a different vibe, and are a little more nerdy, but that they still get along well with everyone. Many of the residents have Midwest ties, but not everyone. About 80% are in a long-term relationship, and about 50% are married, but most the married residents still find time to hang out with each other. Fellowship matches are fantastic every year, at big name places, with sports being most popular. Everyone does a fellowship, but it is about a 50/50 split for academics and community ortho; some residents opt not to do much research, and plunge straight into private practice after their fellowship.

Lifestyle
This is a lifestyle-friendly program aside from the PGY2 year. As a PGY2, there is q4 home call with no post-call days, so you will be tired and overworked all year. Cook County as a PGY2 has night float calls as well. As a PGY3, you take a single Friday call every 5 weeks. Then backup call for operative cases as PGY4 and 5. However, since Rush is a Level 2 trauma center, it is rare to have cases go in the middle of the night. Mostly, for the resident holding the pager, it is returning pages on floor patients and seeing some low-energy trauma consults (ankle fx, hand/foot pus, distal radius fx). However, when you aren't on call, the hours are fantastic. The day rarely goes longer than 5am to 5pm, and many times is done by 2 or 3pm. This is one of the advantages of the privademic model, since they are interested in efficiency and have quick turnover time (15 minutes on average). This gives you the opportunities to scrub on plenty of operative cases, but have time to go home to exercise, work on research, hang with family, make dinner, read for cases, etc. There isn't a ton of driving for this program, although living in Rockford for 4 months as a senior is a negative. However, it's only 1.5 hours from Chicago, so you can come back to the city for the weekends because Rockford has PA's to cover the call pager. This program also has a ton of perks: you get $5000 to spend as you please during residency, and that is in addition to lead and loupes. There's meal money while you're on call, and they give you an additional $1000 travel stipend to academic conferences that you don't even present at. Parking is free at all hospital sites. Overall, a very cushy program, and residents said that the perks make their day-to-day that much more enjoyable.

Location/Housing
Chicago is a very solid location. It has all the amenities and attractions of a large city, including tons of bars and restaurants, a good public transportation system, accessible airports, a good sports culture, and a beach/boating scene at Lake Michigan. There are a lot of different neighborhoods to live in, with rental prices much cheaper than NYC, typically mid 1000’s for a nice 1 bedroom in an older building in a nice neighborhood. Everyone in Chicago has a car, and with early hours at the hospitals, ancillary sites (Shriner's, and there is also a private clinic 20 minutes from Rush), and the fact that the area around Rush isn't super residential, you can’t survive on public transit. However, parking is free at the Rush sites, and traffic isn't that bad outside of downtown. The winters can be brutally cold and windy in Chicago, but there isn't a ton of snow. The residents definitely take advantage of the city's offerings, especially with their favorable call schedules, and they cited the city as one of the biggest attractions of the program. This is also a good spot to mention the AAOS headquarters, which is located in Rosemont, Illinois, about 45 minutes outside of the city. They frequently have courses for residents and attendings, and you can volunteer to help with a course and sit in on all of the lectures and observe the labs. Definitely an underrated perk of the Chicago-area residency programs.

Limitations
This program is relatively light on the trauma and general orthopaedics rotations, with the majority of the trauma operative experience back loaded into the PGY4-5 years. I spoke with some senior residents about this, they all said they felt comfortable with the amount of trauma they see, and feel comfortable taking primary call. However, I think there is something to be said for getting trauma reps in as a younger resident, as this is where you get a lot of autonomy and can master the fundamental techniques of orthopaedics (using a drill, plating, making cuts) that you can apply to other subspecialties. As a corollary to that, Rush doesn't give you a blue-collar experience, where you are left to grind a little bit and get comfortable when shit hits the fan. Furthermore, some rotators said that on days where cases were running behind schedule, the attending just did the entire case, and the resident was watching. PGY2 year is hard everywhere, but it seems fairly brutal here, and the lack of post-call days is definitely a negative. The home call system at Rush is tough, since you will be up most of the night answering floor pages and seeing consults without a post-call day. Chicago is a relatively desirable location, but it is far away from my family and friends, and the winters are tough. Resident-led lectures are a negative, as attending-led would be better, especially with so many field leaders in the department. They also have a fairly weak peds experience at Rush, and going to Shriner's isn't great either because the cases are so complex. It would be nice to have more bread and butter peds exposure. There isn't a ton of driving here, but there is some, and living in Rockford as a senior resident kind of sucks.

Conclusion
This program sits in the academic sweet spot. Renowned field leaders, a diverse subspecialty operative experience, and high volume so that fellow encroachment is quite limited. For the "no trauma" reputation that Rush sometimes gets in the rumor mill, there seems to be a good amount of trauma exposure (8 weeks PGY1, 10 weeks PGY2, 10 weeks PGY4, 10 weeks PGY5), and they may eventually be adding another trauma block at Rush with an incoming faculty member. The research opportunities are abundant, and the favorable lifestyle and work hours permits the residents to work on plenty of projects. The fellowship match list is great. Chicago is a fun city to live and work in, and is affordable on a resident's salary. I got a good vibe from the residents, and felt like I would definitely fit in. Lots of perks makes life enjoyable, the call schedule from PGY2 aside. I was really impressed here, and I think it is in the conversation for one of the best programs in the country. It will be tier 1 for me.

WashU (St. Louis)

Interview Experience
Solid day, and it was memorable for its early start time. Met a resident in the hotel lobby at 5:45AM, then walked over to the hospital for a brief welcome from the chairman (Dr. O'Keefe) and an overview of the program from the PD (Dr. Rick Wright). Dr. Wright was very comprehensive in his presentation and sold the program well. He had slides prepared to answer all of the typical applicant questions (e.g. any changes coming, how are residents/faculty evaluated, resident/fellow dynamic). He used a lot of numbers to quantify the case volume and research output from the program, and mentioned the Doximity rankings multiple times. After the presentation, half of the applicants interviewed, and the other half went on a tour. There were a lot of interviews here, I think 8x20 minutes, with 2-3 interviewers in each room. I had heard there was X-ray interpretation in previous years, but this was not the case for me. Conversational interviews, mostly about my CV, hobbies, and research interests. No ethical, clinical, or weird questions. In the committee room (chairman, PD, chief resident), Dr. Wright did most of the talking, while Dr. O'Keefe occasionally chimed in. It seemed like as far as the residency goes, Dr. Wright is the face of the program. The day finished with an indications conference (applicants watched while 2 attendings and 5 residents went through some hand and joints cases. Was definitely impressed with the level of interactive teaching here), as well as a tour of the hospital and some authentic St. Louis BBQ for lunch. They are taking 8 residents this year (up from 6), and are interviewing quite a few people (3 days, about 30 per day, as well as all rotators during their rotation; so probably about 135 total).

Staff/Faculty/Chairman
In his presentation, Dr. Wright openly addressed the chairman change that happened at the beginning of last year. He said that Dr. Gelberman (the old chair, hand attending) reached the mandatory retirement age for WashU department chairs, so he had to step down, and Dr. O'Keefe (tumor) was hired from Rochester (where he was the former chair). Although he was courted for a number of jobs during his tenure, Dr. Gelberman elected to stay for his entire career, and is now focused on his clinical practice, resident education and research. However, his role in the day-to-day activities of the program is quite limited. I heard that the faculty were very loyal to Dr. Gelberman, but when a new chair was hired, a number of the faculty took jobs elsewhere (spine attendings Lenke, Riew, Lehman to Columbia, shoulder attending Galatz to Mount Sinai as chair, and I think trauma attending Gardner to Stanford as vice chair). Residents said they have been very happy with Dr. O'Keefe's leadership, and the department has hired 10 new faculty over the past two years, including Dr. Gupta, a field leader in spine who was previously at UC Davis. Their faculty is stacked across the board, with 3+ attendings in all fields. Dr. Wright takes all of the resident input very seriously, and with the move to 8 residents next year, they redesigned the entire schedule to give residents longer blocks with exposure to each service as a junior and senior. Dr. Wright also helped implement night float to help the program get into compliance with the 80 hour workweek. Another great thing is that a portion of the attending compensation is tied to their feedback scores from residents, so they actually have incentive to teach instead of purely focusing on efficiency in the OR. Overall, it seems like Dr. Wright runs the show for the residents, and Dr. O'Keefe works more in the background. Dr. Wright is very personable, talkative, and energetic. He reminds me of a smooth talking salesman, with a Midwest accent; if you gave him an opportunity, he could pitch anything. Dr. O'Keefe is a bit quieter, more reserved, and humble, but he is very accomplished and well respected within the ortho community.

Didactics/Teaching
Didactics is spaced out throughout the week. They have an hour of conference on Tuesday, Wednesday, and Thursday, with subspecialty conferences held on Mondays and/or Fridays. There is no dedicated academic day, and the residents said this keeps the didactics interesting and refreshing. Every single didactic activity is attending-led, and is generally interactive, with attendings asking the residents questions and bumping it up class-by-class as they got into the finer details of the case. I thought that the indications conference during interview day was impressive. While they don't teach to the OITE, residents typically perform very well. For each rotation, Dr. Wright had the residents and faculty create 150-200 pages of required reading with the most important textbook and journal articles for that specialty. It is specific to the PGY year as well, so the junior sports and senior sports readings are different to emphasize the basics versus the more advanced topics.

Operating Experience
The residents get a lot of experience in the OR here. All of the services are busy, as they are the major academic medical center in the region. They rotate on trauma during PGY1, PGY2, PGY3 and PGY5. The intern holds the pager for most of the day, seeing consults and putting out fires on the floor, while the other residents are in the OR. On Fridays, the intern and the PGY2 switch spots, so the intern gets 1 day in the OR per week. Their clinical rotations are mainly at Barnes-Jewish (the main hospital), with VA rotations as a PGY3 and PGY5 (10 minutes away), Shriner's for peds as a PGY3 (5 mins away), and a mix of days in Chesterfield (20 mins away) for rotations with primarily outpatient surgeries (hand, sports, F/A). Residents get the chance to see all the services by the end of their PGY3 year, and then do the rotation again during their PGY4 or PGY5 year (including tumor and F/A). They have a dedicated shoulder & elbow rotation in addition to general sports rotation. Some services are 1-on-1 mentorships (hand, F/A, sports, S/E, tumor, spine), with others using a team approach (trauma, peds, VA, recon). Double scrubbing is rare here, except on occasion in trauma, recon, and spine, where the PGY5 or the fellow walks the intern or PGY2 through the case. Most attendings run 2 rooms, with a fellow in 1 room and a resident in the other. The volume is high enough and they have uncovered cases so they were able to add 2 more residents for the upcoming year. I had heard that PGY2 was heavy on the floor work/consults, but was told on interview day that the PGY2 now spends most of their time in the OR, as they have hired a bunch of NP/PA help over the last few years. Residents said that even though Lenke and Riew were big names in spine, their cases were so complex that residents often didn't get to do much with them. With their departure, Dr. Wright has revamped the spine rotation with Dr. Gupta and a junior spine attending, and residents think it is actually better than before.

Clinic Experience
Residents spend 1 or 2 days in clinic depending on the service. Dr. Wright emphasized that he makes sure the residents spend enough time in clinic so they know how to work up and indicate their patients. There is a resident-run clinic once a week for most services, where the fellow is in charge of running the clinic and then staffing the indicated cases. Many services also have private office hours, where the resident typically will usually see the new patients, and then present the plans to the attending. The attendings are a mixed bag in terms of allowing residents to dictate, write notes, and enter billing codes. They have a bunch of different EMR's (one for labs, another for orders, another for clinic notes), which I was told can be a bit of a nuisance to deal with; however, they are transitioning to Epic for everything over the next 2-3 years.

Research Opportunities
Research here is among the best in the country. They are ranked 1 or 2 in NIH funding, and have a number of researchers with R01 grants. They just hired a basic science guy from Duke who has 5 (count that, five) R01 grants to his name. A lot of the research here is basic science, with biomechanics and tissue engineering being most popular. However, with such a large faculty, there are plenty of opportunities to work on clinical and outcomes research. They are collecting patient-reported outcomes for every patient, and will be growing their cost effectiveness and quality of care research moving forward. There are dedicated research blocks during PGY2 and PGY4, and residents are required to submit 1 project for publication by graduation. Many of the residents do more, but they said it is not forced on them by Dr. Wright or any of the faculty. Around half of the residents go into academics. During the interview day, I felt like the faculty had a lot of thoughtful commentary and questions about my research background, much more insightful than the "tell me about this project" that I got on many of my other interviews.

Residents
The majority of the residents are from the Midwest, with a few East Coast transplants. Nobody currently is from the West Coast, but there have been some in the past. They collectively struck me as very professional, mild-mannered, and friendly. Definitely had a Midwest vibe, generally easygoing and less intense than the Northeast personalities I'm used to. A number of churchgoers, which is not surprising for the Midwest. About 70% are married, but the residents made a point to show us that they have a lot of organized events to spend time with each other outside of work. The personality of the typical resident was described by one resident as "a bit nerdy, but in a good way", and I would tend to agree. Definitely not much of a bro feel, with quite a few girls (7 of 30). Everyone was really friendly, and seemed like they were a generally cohesive group. I did not get the stuffy or distant feel among the residents that some Orthogate reviewers have hinted at in years past.

Lifestyle
You will work hard at this program, but they try to keep it within 80 hours. This doesn't happen typically on trauma and joints, but it balances out on rotations with a lot of elective surgery like hand, sports and shoulder. Their trauma service is busy, but not crazy busy like some places (i.e. no OR running 24 hours a day). Joints can have 2 rooms going with 10 to 12 booked cases and operating until 10pm. They had enough uncovered cases that they will be adding 2 more residents for next year, but it is still a little unclear how this will impact the workload for everyone. If anything, it should make it a little easier. They have night float during PGY2 year, which is spaced out in 2-week rotating intervals with research to keep the residents fresh. The pager is busy at night, but not crazy busy, with an average of 10 to 12 consults in the evening/overnight. During the winter, you might even get an hour or two of sleep. There is a separate call pool for the peds hospital that is staffed by the PGY2 and PGY3's on the easier rotations (sports, hand, etc.). Interns help with the consults/floor on trauma (except for January, during surgical skills month), and there are mid-level providers to help with floor scut during the day. Overall, residents said they spend a lot of time in the hospital, but still have some free time to pursue outside interests.

Location/Housing
St. Louis is very inexpensive and accessible. Many of the residents live in the Central West End neighborhood near the hospital, and rent 1-bedroom apartments in new buildings that cost around $1000 per month. Most of the rotations are at the main hospital, with the VA and Chesterfield outpatient offices all within 20 minutes drive. Car is a must for St. Louis, although there is a light rail you can take from the hospital to downtown (for sporting events) or to the airport. Parking is free and plentiful for the residents at the hospital garage. There is stuff to do in St. Louis, including pro sports games, golfing in the park (right outside the hospital), live music, and brewery tours. St. Louis isn't a party town, but I got the sense that the residents were low-key, small-town people who liked the accessibility and easiness of St. Louis.

Limitations
The department is still in a bit of a transition state, and it's unclear how the expansion from 6 to 8 residents will impact the resident experience. More of a focus on basic science research here, which is not my area of interest. St. Louis is far away from family and friends, and is in a remote area of the country, far away from an ocean or major metropolitan area. Furthermore, there is some civil unrest in some of the communities of greater St. Louis. Residents seemed a little bit on the nerdy side, and were mostly from the Midwest. Dr. Yamaguchi, a famous shoulder attending, is not operating much currently due to a shoulder injury, which is obviously a lost learning experience. A car is required, although the sites aren't terribly far apart.

Conclusion
One of the most balanced residency programs in the country. I knew WashU's reputation was top-notch, but left interview day even more impressed than I was expecting. They have a well-rounded surgical experience, great research opportunities, solid didactics, and a distinguished faculty. While there has been some transition, the program is continuing to build, and prides itself on being one of the best. For someone who likes the Midwest or doesn't care about location, this is a definite tier 1 program. However, I didn't love St. Louis, and it will be towards the top of my tier 2 programs.

Albany

Interview Experience
This interview starts late, around 9am, so you can sleep in a little. The day started with a brief overview from Dr. Uhl, who serves as chairman and PD. Then everyone was split into 4 groups, split between interviews, a presentation from Dr. Uhl and Dr. Mulligan (associate PD), lunch, and a tour with the residents. Each group was assigned a couple of residents, so there were plenty of opportunities to ask questions and learn about the program. Everyone had 3 individual interviews for 10 minutes each. These were among the harder interviews I had, with ethical and/or clinical questions mixed in with generic CV questions in each room. The residents said that each faculty member is assigned specific questions by Dr. Uhl to help standardize the interview process. The residents have lobbied against the questions, because they think it takes away from normal conversation, but Dr. Uhl likes them, so have stayed. They only have 1 interview day, with about 60 applicants. They usually take 1 or 2 Albany students each year for the 5 spots.

Staff/Faculty/Chairman
Dr. Uhl (hand and upper extremity) serves as both the chairman and PD for the program. Residents say that he is a visible leader and is present at all academic activities. Furthermore, he mentors the junior residents to make sure they are keeping up with the workload and are starting to think about their future. Dr. Uhl is a big guy, and he has a jolly, jovial personality. The residents said they love operating with him on the hand rotation as a PGY4. Dr. Mulligan (hand) is a little bit younger and serves as the associate PD. He grew up in Albany and stayed for medical school and residency, so he is very pro-Albany and is invested in resident education. In the OR, he can be hard on residents, and he admitted this during his presentation, but he said that he wants to get the most out every resident's potential. Nearly all of the faculty are in private practice, but the academic affiliation allows them to teach, and they enjoy working with residents. The attendings are spread out across the hospital sites, including AMC, the VA (across the street from AMC), Ellis Hospital in Schenectady (20 minute drive), and St. Peter's (in Albany, 10 min drive). They currently have no dedicated peds attending, and go to Shriner's Hospital in Springfield, MA (1 hour away) for a peds block during their PGY4 (or PGY3?) year. They have a few attendings in each subspecialty, although only 1 tumor attending that they work with as a PGY3. They have 2 incoming attendings who were Albany residents last year and are currently in fellowship: F/A and Trauma. The F/A resident was a very productive researcher and will be the director of research upon his return.

Didactics/Teaching
There are conferences on Wednesday and Friday, with grand rounds Thursday and a dedicated lecture time every Friday (I think). The residents did not talk much about the didactics, but said that they do not teach towards the OITE. However, they have a 100% pass rate on part 1 of the ABOS boards, and learning is geared towards clinical application. They have journal club once per month at a local restaurant, which is run by Dr. Phelan, a well-read private practice sports and trauma attending. The residents are expected to read on their own, which is manageable during PGY3 through PGY5 but very difficult as a PGY2. Overall, this isn't a place that emphasizes book knowledge, and the learning is focused on the bread and butter of orthopaedic techniques and management.

Operating Experience
The residents here spoke highly of their operative experience. They spend the majority of their PGY3 through PGY5 years in the OR as first-assist. The way that the residency is set up, the PGY1's and PGY2's spend most of their time on consults and floor work for the trauma and general orthopaedic services, then the senior years are all operative. As a PGY1 and PGY2, you will get some opportunities to scrub, but usually this is as second-assist on trauma and general orthopaedics rotations. There will be some first-assist opportunities, and responsibility is graduated. As PGY3, you spend half of the year on general orthopaedics rotations as well as tumor. Trauma is for PGY1, PGY2, and PGY5, and the trauma service is very busy. They have 6 operating rooms at AMC, and these are very busy, especially with trauma during the summer. The volume at the VA is fairly low, and they have a new Bone and Joint surgicenter in Albany, where residents do elective cases on their subspecialty rotations as a PGY4 and PGY5.

Clinic Experience
Some attendings acknowledged that the residents don't get into the clinic as much as they would like. The OR's are often busy, and residents often are pulled from clinic to do cases. The clinic for AMC is all done at the Bone and Joint Center. The clinics are all private practice patients, and there is no resident-run clinic. However, residents said that they get a ton of clinic experience at the VA and St. Peter's Hospital, so they were not concerned about their clinic skills.

Research Opportunities
This has classically been a weakness of the program, but they are actively trying to grow their research profile. They recently hired a research director, who is a former Albany resident who published more than 25 articles during residency. They don't have any research assistants or dedicated labs currently, but there are opportunities to work on biomechanics projects with the nearby Rensslaer Polytechnic Institute. Not much in terms of outcomes research currently, but attendings are open to collaborating on any type of project. Residents have a 10-week research block during their PGY3 year, and they are required to submit at least 1 project to AAOS and 1 paper to a journal. However, the clinical schedule as a senior resident is conducive to doing research if that is a priority for you.

Residents
They take 5 per year, which was increased from 4 per year in 2011. Male-dominated, with only 2 girls. About half are married. I thought that the residents were a friendly, down to earth group. They joked around with each other quite a bit and seemed happy with their training and lifestyle. Residents said that they mostly hang out the people with their class, but that everybody gets along and knows each other. Most of the residents go into private practice, with an occasional person going into academics. Everyone does fellowships, and hand/sports seem to be the most popular.

Lifestyle
Both Dr. Uhl and the residents were up front about the PGY2 year being arguably the worst in the country. They have a night float system, where the PGY2's cover the consults and floor work for the entire trauma and general orthopaedic services at AMC. There are 20 weeks on trauma and 10 weeks on night float at AMC. They have a huge catchment area of most of New York State outside of metro NYC, so the juniors are getting killed with consults day and night. Call for PGY3 through PGY5 is from home, operative only. Morning trauma rounds at AMC (100+ patients) are done entirely by the interns and PGY2's. They get into the hospital around 3:30am for most of the year. However, as a senior, you can get in at 7am, and only round on the critical patients on your service. Weekend call again is taken by the PGY2's, with one resident taking a 24-hour on Friday and 12-hour on Sunday AM and another taking 24-hour Saturday, with the night float resident coming in on Sunday PM. The weekend call for the seniors works out to around one weekend per month. There are also opportunities to moonlight at St. Peter's Hospital starting as a PGY3 once you have finished the rotation there, with the caveat that you need to score at least 40th percentile on your OITE.

Location/Housing
Albany is a small city, very affordable and accessible. Residents have the option to buy or rent locally, and nearly all of the hospital sites are close to each other. A car is a requirement to get around Albany, but there is no issue with parking, and traffic is light. Not a ton to do in the city of Albany, but residents said there are a lot of gastropubs to eat at. There is some minor league hockey and college basketball in town, and there are plenty of outdoor options with the mountains close by. Saratoga is close, and is a fun place to go during the summer. As a senior, with the light weekend schedule, you can make trips into NYC, Boston, or Montreal, all of which are a few hours by car or train. The salaries are actually on par with many metro NYC programs, but you get a lot more bang for your buck in Albany. Moonlighting at St. Peter's is also a great way to make additional money as a senior.

Limitations
PGY2 year sounds like hell. Rotation in Springfield for peds is not ideal. No dedicated subspecialty-specific rotations on hand, sports and joints until PGY4, which might make it hard to decide on a subspecialty. There is great trauma and general ortho here, but maybe a little bit too much for my liking. Not a ton of research going on, and as a resident you have to push the project along. The joints exposure and clinic experiences are a bit on the lighter side. Less emphasis on book knowledge. Albany as a city doesn't have a ton to do. Even though the easiness of the senior years sound appealing, not even rounding on your own patients seems a bit lazy.

Conclusion
A solid community program. You will learn how to operate and take care of the bread and butter patients. It a blue-collar, work hard place for PGY1 and PGY2, with PGY2 being especially brutal, but PGY3 through PGY5 are on par with a gentleman's program. During these years, you can get in a 6 or 7am and leave by the early afternoon (like 3 or 4pm). It is great if you have a family or want time to dedicate to extracurricular interests. However, I did not sense much interest or emphasis by the residents in academic pursuits or research. They liked that they got crushed as a junior, then could cruise as a senior. Not the best fit for me in that regard, and will be lower end of my tier 3 spectrum.

Rutgers - Robert Wood Johnson (RWJ)

Interview Experience
The pre-interview social was bowling. Interview day started at 7am, but your interview schedule was created according to who showed up first that morning. So if you wanted to leave early, you were advised to show up early. I came around 6:45am, and ended up with one of the last slots. It was also frustrating, in that the interview end time was listed as “between 1pm and 5pm”, so getting transportation out of New Brunswick was last minute. Anyways, on the interview day, there was a grand rounds consisting of two complicated cases that were presented by one of the chief residents. The chief occasionally picked on his juniors to answer some reasonable pimp questions. Then the chairman, Dr. Gatt (who also serves as the PD) gave an overview presentation of the program. The resident selection chair (essentially the co-PD), Dr. Coyle, also gave a few comments about the structure of the day. There was a tour, as well as 4x12-minute interviews with 2 faculty in each room. The interviews were very laid back, and were mostly small talk about non-medicine topics including sports and my hobbies. Lunch was from a local Italian restaurant, and was among the best I had during interview season. Not sure how many they interview, my day had about 25 and they have 3 days. They usually take 1 or 2 RWJ students every year.

Staff/Faculty/Chairman
Dr. Gatt (sports) serves as the chairman and the PD. His personality is a bit on the dry side, but he was very friendly and engaging. Has a bit of a businessman feel to him. The residents and rotating medical students said that he is relatively hands-off in the residency, and lets the residents work issues up the chain of command. However, residents said that he is open to feedback, and they like him as their leader. Dr. Coyle (hand), heads the selection committee, and he is a funny guy. Old-school guy, doesn't have much of a filter on his conversation, with a lot of swearing and some off-color jokes. The entire faculty is volunteer, since ortho at RWJ is a private group that uses the hospital facilities. This was pitched as a strength, since the faculty doesn't need residents for their practice but they are dedicated to teaching. In addition, most of the attendings stay at RWJ forever, and are not looking to move up the academic food chain. Subspecialty-wise, they only have 2 joints guys and currently lack F/A and tumor attendings. They rotate through MSK in NYC for tumor as a PGY4. There are a lot of sports and hand attendings on the faculty.

Didactics/Teaching
I think that Thursday morning is the formal didactic curriculum. The teaching is a mixture of resident- and attending-led lectures as well as grand rounds, which are often case presentations by chief residents. The residents perform well on the OITE, with scores typically in the 70th to 90th percentiles. During the fall, each resident is assigned to a cadaver in the medical school during the school’s MSK block. Residents said they use the cadaver to work on approaches, soft tissue releases, etc., and they also have opportunities to teach the medical students. There is also morning report every day at 6am, where the residents from all of the services at University Hospital will go over the previous day/night's consults.

Operating Experience
Touted as a strength of the program. The experience is split between University Hospital (an academic center) and St. Peter's Hospital (a community hospital), which also located in New Brunswick. The residents get into the ortho trauma OR for 3 months as an intern, and have ample opportunities to operate. There are no fellows, and double scrubbing is rare, as there are usually more cases to cover than there are residents. Sports, hand, and trauma are the busiest services, but joints and peds are fairly busy as well. The volume here isn't crazy busy, but with only 3 residents, there are more than enough cases to go around. University Hospital is a level 1 trauma center, and can get quite busy in the summer. They are weak in F/A, without a dedicated attending. However, they are looking to hire one in the near future. They have an outpatient surgical center in town that is doing same-day total joints, and their joints volume is projected to grow significantly in the coming years.

Clinic Experience
There is a resident run clinic once per week on Thursday afternoon, where residents from all services at UH will see all of the community/general orthopaedic complaints. There is a diverse patient population in New Brunswick, and this clinic is mainly for the uninsured and underinsured patients. Speaking Spanish is a big plus for this clinic. An attending is in charge of staffing this clinic, and pre-operative/operative cases are presented to them, but otherwise it’s completely resident-driven. Depending on the service, there is also usually 1 additional day of clinic with the attending in their private office. Residents are encouraged to see the patients on their own and formulate a plan before presenting it to the attending. Their EMR is Eclipsys, not the easiest to use, but not the worst either.

Research Opportunities
This is a weak point of the program, but one that Dr. Gatt said they are working to grow. Residents are required to submit one paper for publication by graduation, and there is a 6-week research rotation during the PGY4 year. Most of the research is basic science sports medicine tissue engineering done by Dr. Gatt and the PhD lab guy, Dr. Dunn. However, they have started working on some database and clinical outcomes projects, and would like to study the economic and clinical implications within their same-day total joint replacement facility. Most of the residents go into private practice, so research is usually just a checkbox to get into fellowship, but occasionally a resident will prioritize research and be productive. Attendings are interested, but there aren't many resources available to facilitate the projects. There is support for travel if you present at a conference.

Residents
The program currently has 19 residents, with 3 interns and 4 in the other classes. The cutback to 3 per year is permanent, as they are no longer rotating at the Jersey Shore Medical Center (45 minute drive from New Brunswick), which has merged with the Seton Hall system. Dr. Gatt said that the resident experience will not be changing, since all of the services at JSMC were duplicative of UH and St. Peter's, and one less resident per year will allow the core experiences to remain the same. The only difference is that the length of rotation blocks will grow from 3 to 4 months. The residents themselves seemed like an easy-going, fun group. Only 2 girls in the program, so a little bit of a bro feel. They joked around a lot with each other, with a lot of sarcastic humor, although at times their dynamic was a bit weird. Many of them spend time together outside of work, and some even go on vacation with each other. Another thing that stood out was that despite many residents being present at the interview day, they mostly talked to each other and didn't seem that interested in engaging the applicants. Overall, nice group, just didn't develop much of a rapport with them.

Lifestyle
Fairly good lifestyle. Since the structure is privademic, many of the surgical days are finished at a reasonable hour and turnover time is above average. Trauma can be tough, especially during the summer, but this is expected for a level 1 trauma center. They don't have enough residents for a night float system, so call works out to q4 or q5 for the juniors. They recently started enforcing post-call days, so residents who have a rough night can go home. There will be nights on call where you get to sleep, especially during the winter. Resident morale seemed fairly high. There were some minor dissatisfactions about administrative disorganization, but overall they enjoyed their experience.

Location/Housing
Residents are distributed among the city of New Brunswick and the New Jersey suburbs. A 1-bedroom in a high-rise can go for $1000 to $1500, with options to rent/buy a small house in the burbs if you have family. Fairly evenly spaced between NYC and Philly (about an hour to both), so you could theoretically live in between and split a commute with a significant other. A car is required to live in this area of the country, but parking is plentiful at the hospital, and the two hospital sites are only 10 minutes away from each other. With Jersey Shore out of the rotation pool, there isn't much commuting anymore.

Limitations
Small program, with only 2 rotation sites. Research is limited, and most residents go into private practice. Fellowship placement over the last few years had a few standouts, but on the whole was average. No dedicated F/A rotation, and joints volume is currently on the low side. No night float means you have call fairly frequently. Location is in suburbia and a car is required. Did not have a great vibe with the residents, and was not particularly impressed by the grand rounds.

Conclusion
A solid community program in the suburbs. Good operative experience, with solid trauma exposure and strong sports and hand rotations. I didn't hear much about the tumor rotation at MSK, but it is the world's premier oncology institution, and you get to live in NYC for those 8 weeks. I don’t think this program has any glaring weaknesses, but it just wasn’t a good fit for me. Will be on the lower end of my tier 3.

Johns Hopkins

Interview Experience
Day started late by interview standards (8am), with breakfast and some presentations by Dr. Laporte (PD), Dr. Ficke (chairman), and a pair of residents. There were 3 interviews for 30 minutes each, with 2 interviewers in each room (1 attending + 1 researcher/resident). The interviews were among the hardest I had, with a lot of pre-planned, specific questions about my CV, as well as a number of behavioral and personality questions. With the 30-minute format, it was fairly intense, and many of the interviewers were hard to read (I heard this from other interviewees as well). However, no pimping or skills activities. There was also a 30-minute group interview with half of the interviewees where we got to ask questions to the chairman and PD. Day finished with a hospital tour, buffet lunch at Dinosaur BBQ (awesome meal), and a bus tour of the nice areas of Baltimore. They interview 50 applicants for 5 spots.

Staff/Faculty/Chairman
Dr. Ficke (F/A, trauma) has been chair for the past 2 years. Before he was hired, the department didn't have a chair for a few years (like 2 or 3), and a bunch of the faculty left. However, they hired Dr. Ficke from the Army Medical Center in Texas, and the department has seen tremendous turnaround under his watch. He has been working to increase resources for the department, including facilities (new musculoskeletal institute under construction, more dedicated clinic space, turning Bayview Hospital into total joints center of excellence), residency funding (plan to add 6th resident next year, funding from NIH for 1 resident to pursue a research year if they want), and faculty (hired 10 new faculty in the last two years, most notably in joints and tumor where they were weak). Dr. Ficke definitely has a military vibe (in a good way), as he is very direct, humble, and honest. The residents spoke highly of his leadership, work ethic, and vision for the department. Dr. Laporte (hand), is the PD, and she is super friendly and personable, although her presentation at the start of the interview day seemed a bit dry. She knew all of our applications from memory, which was definitely impressive. The residents meet with her regularly, and she is very open and responsive to feedback to improve the program. She used to be a resident at Hopkins, and the residents said this helps her relate to the issues they bring up. As far as the rest of the faculty, they have good coverage across all subspecialties, with a number of field leaders in peds and spine.

Didactics/Teaching
The didactics curriculum is Thursday from 7am to 12pm, with grand rounds followed by 3 hours of attending-led lectures and an hour of resident-led activities (i.e. OITE review, administrative housekeeping). During the summer, they have operative skills and/or anatomy sessions in lieu of lectures. They also have monthly journal club at attending homes with catered dinner and drinks. There is at least one specialty-specific conference per week. In the mornings, they have morning report (aka "trauma board") for residents at Hopkins hospital, where they go over the previous night's consults with an attending.

Operating Experience
Touted as a strength of the program. While the volume isn't super high, they only have 5 fellows (will be 6 fellows next year with the start of their joints fellowship), and attendings usually run two rooms so there isn't much competition for cases. In fact, Dr. Ficke said that they have enough uncovered rooms that they are applying to add a 6th resident next year. Residents said that they are rarely double scrubbed, except for the occasional trauma case (where the senior is typically allowed to teach the junior) or complex spine or peds case (where fellow does the hard parts and takes resident through the easier parts). Hopkins is a level 1 trauma center and Bayview is level 2, so there is a robust experience of bread and butter trauma cases, especially during the summer. The complex/exotic open and pelvis traumas in town are usually taken to the nearby Shock Trauma Center, but there is plenty of trauma case volume at Hopkins, including high-energy fractures from gunshots, car accidents, and struck pedestrians. While there has been turnover with joints and tumor faculty, residents going into these fields said they have received a lot of hands-on experience in the OR, and the attendings are dedicated to teaching. The sports experience was shoulder-heavy in the past, but they have now split it into two rotations, one with shoulder as a PGY3 and the other with general sports as a PGY2. Peds and spine are very busy services, although residents said there are a lot of complex cases, where they don’t get to do as much. They have added a community spine rotation for additional spine experience. The residents go to Union Memorial (15 minute drive) for F/A, which they said is a great hands-on experience. One area that is light on OR volume is hand, but the residents said you can do an additional month on hand as a PGY3 during your research/elective time.

Clinic Experience
Usually once per week during trauma, and twice per week otherwise. Experiences are attending-dependent, but usually the residents are responsible for seeing the patient, coming up with a plan, and dictating the note. They have Epic in the clinic, which is easy to use. Some attendings make an effort to help residents appreciate particular physical exam findings.

Research Opportunities
There are a lot of resources for research here. Residents are required to submit at least 1 manuscript for publication by graduation, but many do more. They have research/elective rotations for 10 weeks each in PGY3 and PGY4, where you can work on your projects, do a clinical subspecialty rotation at an away hospital, do an international elective, or do some mix of everything. In recent classes, about 50% have gone into academics, which is up from 25% in prior years. From talking to some of the residents, they can do as much or as little research as they want, with a few residents regularly presenting at conferences (fully supported by department as long as it's a different project each time). There is also the option for a research year at Hopkins (fully funded by NIH grant), which you can apply for at the end of the PGY2 year to take between the PGY2 and PGY3 years. The program stressed that the year is optional for the residents, and it doesn't go to a lottery system if nobody applies for it (like it does at Case Western and Maimonides). Nobody applied for it last year, so they don’t have a research resident this year. Their research portfolio is fairly diverse, with a mix of basic science and clinical research. Not a ton of biomechanics, but that's not important to me. There is some cost and quality research, not a ton, but they are growing this area and want to collaborate with the Hopkins schools of public health and business. Overall, great research resources available, although I wouldn't say this is a prevailing theme of the residency.

Residents
5 per year, so 25 total. Very diverse group of residents, with a collection of "bros, nerds, and girly girls" (verbatim from a resident). The residents spoke to the sense of community that they have with each other despite their diverse backgrounds and personalities. They were all very low-key, friendly, and down-to-earth. While I didn't get quite the same level of energy and fun from the residents at other programs, I feel confident that any type of person could fit into this group (can't say that for some places), me included.

Lifestyle
Definitely a hard-working, blue-collar program. On trauma, where you rotate as a PGY1, PGY2 and PGY5, rounding for the juniors starts at 4:30am, and you usually don't leave until late at night. Peds and spine are also really busy, and you can regularly log >100 hours per week. However, sports and F/A are reasonable and hand is light. For call, it works out to q5 or q6 for the juniors, with post-call days. They do have a night float rotation for PGY2's, but the resident is so busy with floor pages that they don't help much with ER consults. The overnight call can be rough, with double-digit pages regularly, and >20 not unheard of. They have the only level 1 peds trauma center in Maryland, so they get crushed with peds consults daily. Senior call is from home, and Bayview consults are handled by PA's (I think), with the on-call junior coming in only for something deemed urgent/emergent. They have hired a number of PA's over the past year to help with discharges and floor work during the day. They are looking to add another PA to help at night. The residents get plenty of perks, including lead and loupes, meal money while they're on call, and support for travel to research conferences. A few of the residents mentioned that the program had some “hints of malignancy" 5-10 years ago, but that has completely disappeared and it is now a very collegial and pleasant place to work.

Location/Housing
Baltimore has its good and bad parts. The hospital itself is in a bad, but not horrible, part of town. There are housing projects across the street from the hospital, and they have security guards posted on every street corner. Residents said that they have never felt unsafe while they were at work, but the concept of safety does come up regularly. One resident said his phone was stolen one day on the way to work. However, while there are a lot of bad parts of Baltimore, the residents saw this as a strength, in that they had an opportunity to help the community. They talked a lot about patient diversity, in that they treat international royalty, gang members, and homeless people within the same day. On the bus tour, we got to see the inner harbor area, which is about 10 minutes drive from the hospital campus. Many residents live here, and housing is affordable, even in new apartment complexes with parking and water views. The area is very walkable, has many restaurants and shops, as well as grocery and department stores. Other neighborhoods on the outskirts of the city have a more suburban feel, and real estate is cheap enough that you could buy a house and pay a mortgage on your resident's salary. A car is essential to live in Baltimore, but all of the hospital sites are within 10 to 15 minutes driving of each other. Some residents with spouses who work in DC will live in Columbia, Maryland, which is about halfway between DC and Baltimore.

Limitations
Baltimore is not the most desirable place to live, and the area around the hospital has some safety concerns. It is unsettling to think about driving at night, and having your car break down in a bad area. There was also some civil unrest in Baltimore last year, although this seems to have resolved. The residency program was also in a bit of turmoil and transition just a few years ago, and while the leadership has stabilized, I still feel like the program is still in the process of rebuilding its identity. The call schedule and work hours can be tough, and residents said that the ortho department isn't as respected within the hospital because every single Hopkins department is world-renowned. I heard complaints about inefficiencies of the university hospital, and room turnover can be as slow as 90 minutes. The operative experience on hand is light, although most other subspecialties are well-covered. Heavy doses of peds and spine, which I am not particularly interested in. Volume isn't as high as some places, although the quality of learning and hands-on experience seem great. Requirement for a car is a negative for me, although the driving is fairly limited.

Conclusion
At its core, this is a blue collar program. However, they have all the benefits of a big academic center, with renowned faculty and abundant research resources. The program is on an upward trajectory, and has new leadership with a drive to create the best department and residency experience possible. I was impressed with the hands-on clinical training, resident-focused structure of the program, and research resources including dedicated elective time. However, the residents I met, while quite friendly and engaging, seemed a bit nerdy and occasionally weird. They really tried to sell the city of Baltimore on interview day, but it is not a desirable place to live. This program exceeded my expectations on interview day, and will be an upper tier 2 for me.