Matching in Orthopaedics

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Matching in Orthopaedics

• Evidence and Opinions
• Cameron T Atkinson
• VMSIV
• Co-Chair, Vanderbilt Orthopaedic Interest Group

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Orthopaedics

• Treatment of disorders and injuries of
  extremities, spine, and associated structures
• 1 year of general surgery internship followed by
  4 years of orthopaedic training
• 8 Subspecialities
• One of the 5 most competitive specialties as
  defined by the National Residency Matching
  Program (excludes early-match specialties)

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2007 NRMP Match Data

• 616 Offered Positions with 876 Applicants
• 1.4 Applicants per Position
• 80 of U.S. Seniors Matched in 2007
• For Matched Applicants
• Mean Contiguous Ranks 11
• Median Step 1 Score 234 (75th percentile 245)
• Mean number of research experiences 2.6
• Mean number of abstracts, pubs, etc 3.0
• Percentage who are AOA members 31

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Rank List

• Obvious trend across specialities and in
  orthopaedics
• Rank More Improve Chances

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2007 NRMP Match Data

• 616 Offered Positions with 876 Applicants
• 1.4 Applicants per Position
• 80 of U.S. Seniors Matched in 2007
• For Matched Applicants
• Mean Contiguous Ranks 11
• Median Step 1 Score 234 (75th percentile 245)
• Mean number of research experiences 2.6
• Mean number of abstracts, pubs, etc 3.0
• Percentage who are AOA members 31

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Orthopaedics

• Treatment of disorders and injuries of
  extremities, spine, and associated structures
• 1 year of general surgery internship followed by
  4 years of orthopaedic training
• 8 Subspecialities
• One of the 5 most competitive specialties as
  defined by the National Residency Matching
  Program (excludes early-match specialties)

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USMLE Part I

• Mean for Matched Applicants is 234
• BUT

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What They Look For

• Article published in Bulletin of the Hospital of
  Joint Diseases in 2002-03 by Bernstein et al.
• Identical 26 item questionnaires sent to 96
  applicants at NYU-HJD and 156 orthopaedic
  residency program directors
• Separate supplement sent to program directors
• 91 of 96 (93) of applicants and 109 of 156 (70)
  of program directors responded

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What They Look For

• Rotation at Directors Institution 7.88
• USMLE Part I Score 7.78
• Rank in Medical School 7.77
• Formality Politeness at Interview 7.55
• Personal Appearance of Candidate 7.35
• Performance on Ethical Questions at Interview -
  7.11

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What WE THINK They Look For

• Applicant Ranking of Selection Criteria
• 4. Away Rotation 7.51
• 2. USMLE Part I Score 7.61
• 3. Rank in Medical School 7.55
• 5. Formality/Politeness at interview 7.44
• 9. Personal Appearance of Candidate 6.63
• 10. Performance on Ethical Questions 6.51
• 1. Letter of Rec from Orthopaedic Surgeon 8.60
• 7 on the Program Directors List

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What They Look For

• Most important aspect of Letter of Rec
• 34- The letter is overwhelming positive
• 54- The letter is written by someone I know
• Primary Purpose of Personal Statement
• 32- To gain insight into ability to communicate
• 43- To learn more about personal interests

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What They Look For

• 99 of Program Directors use the interview to get
  to know the applicant
• AOA Status
• Evenly distributed but 30 evaluate applicants
  regardless of AOA status

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What They Look For

• AOA
• Inferior to NRMP data
• Away Rotations
• 56 of residents over last 3 years who rotated
• 66 of programs with 50 of matched residents
  over last 3 years who rotated

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What They Look For

• Every program directors favorite line on
  interview day
• You are all on an equal playing field.
• BUT
• Only 22 of program directors stated that
  candidates are considered equal once selected for
  an interview

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Gender and Race

• Does it Matter?
• 2001 JBJS Article No gender bias in initial
  application review by faculty members
• Nonscientific paper published in CORR in 1999
  notes the improved matching of women and
  African-Americans at Johns Hopkins while the
  chairman had a commitment to diversity
• My Opinion What Can Brown Do For You?

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Intermission for Questions
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What to Look For
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Timeline

• PAY ATTENTION FIRST AND SECOND YEAR!
• USMLE Part I
• 3rd Year Clerkships
• March of VMSIII Setting up aways, talking with
  colleagues in class, etc
• Sub-Internship
• Away Rotations or Away Internships (AIs)
• ERAS opens July 1. Applications can be submitted
  Sept 1.
• Interviews
• Magic Number 11
• Thank Yous
• Ranked 24 out of 26 in Bernstein article with
  mean importance score of 3.26, just behind
  Candidate has an undergrad engineering major

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Timeline

• Phone Calls
• You may or may not get calls from programs saying
  how much they like you. Dont be discouraged if
  you dont get any!
• Only say Youre my 1 once.
• Beware the guarantee
• Rank List
• Important decisions
• Its ok to be a slut/man-whore.
• Multiple programs can believe theyre in the
  running.
• BUT only say Youre my 1 to one program.
• MATCH DAY

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Fourth Year

• July (or August) for Vanderbilt Orthopaedic
  Sub-internship
• Tumor, Trauma, Peds and Hand are the most popular
  services
• Aways in August-October.
• Only allowed three clinical months in a given
  field.
• Schedules do not match up well. May have to cut
  short a research month or use one of your two
  vacation months to get it all scheduled.

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Step 2 When and Why

• Pay now or pay later
• Data is clear Take it earlier and do better
• Do poorly and it will hurt your application
• Conventional Wisdom
• Take it before your aways if your USMLE Step I
  score is not ideal

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But whats ideal?

• Mean for Matched Applicants is 234
• BUT

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Step 2 When and Why

• Pay now or pay later
• Data is clear Take it earlier and do better
• Do poorly and it will hurt your application
• Conventional Wisdom
• Take it before your aways if your USMLE Step I
  score is not what you want it to be
• Otherwise take it between late January and late
  April

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Away Rotations / Sub-Internships

• Are they necessary?  No.
• Are they important? Yes.
• Choose Wisely
• 1 Factor as stated by program directors in
  selecting a candidate for their residencies
• Opportunity to shine
• Where?
• Some places only interview rotators
• Some geographic regions (i.e. the West) need a
  reason to believe youll actually consider going
  out there
• Explore multiple options
• Dont put all your eggs in one basket or prepare
  to be disappointed.

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Away Rotations / Sub-Internships
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The Application

• Curriculum Vitae makes ERAS a breeze
• Spend time on the Personal Statement
• Where?
• Geography
• Reputation
• Community vs. Academic
• Talk to your academic advisor
• Strength of Application
• How many?
• Unless geography is a serious concern, apply far,
  deep and wide.

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What to Do

• 1st and 2nd Years Go study something.
• And get involved in some orthopaedic research
• 3rd Years Go study something.
• And start seriously thinking about what programs
  at which youd be happy matching
• Set up those aways!
• Talk to 4th Years
• Talk to your fellow 3rd Years
• 4th Years
• Match
• Go out and make some bad decisions

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References

• Bernstein AD, Jazrawi LM, Elbeshbeshy B, Della
  Valle CJ, Zuckerman JD. An analysis of
  orthopaedic residency selection criteria. Bull
  Hosp Jt Dis. 2002-200361(1-2)49-57.
• Bernstein AD, Jazrawi LM, Elbeshbeshy B, Della
  Valle CJ, Zuckerman JD. Orthopaedic
  resident-selection criteria. J Bone Joint Surg
  Am. 2002 Nov84-A(11)2090-6. 3
• Sanfilippo JA, Sharkey PF, Parvizi J. Criteria
  used by medical students to rank orthopedic
  surgery residency programs. Am J Orthop. 2006
  Nov35(11)512-4.
• Thomas CL. African Americans and women in
  orthopaedic residency. The Johns Hopkins
  experience. Clin Orthop Relat Res. 1999
  May(362)65-71.
• Scherl SA, Lively N, Simon MA. Initial review of
  Electronic Residency Application Service charts
  by orthopaedic residency faculty members. Does
  applicant gender matter? J Bone Joint Surg Am.
  2001 Jan83-A(1)65-70.
• National Resident Matching Program and
  Association of American Medical Colleges.
  Charting Outcomes in the Match. Characteristics
  of Applicants Who Matched to Their Preferred
  Specialty in the 2007 NRMP Main Residency Match.
  2nd Edition. August 2007. Available Online.

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Questions, Concerns, Applause?