Fear. This is a common emotion that one feels while applying for an orthopedic residency position. Nothing is certain until you have the paper in hand saying that you have been accepted into a residency. This is the case unless you are the number one student in your class, have an Olympic medal, or have competed in professional athletics. (It sounds funny, but it is true). Is orthopedics really this competitive? Yes. Will it be getting easier in the foreseeable future? No. Why is orthopedics so popular? For those of us who have been around the field for a while, we feel it is the best field in medicine. Period. Students are attracted to the field for many reasons including: lifestyle, financial rewards, patient population, and the biomechanical principles related to orthopedic surgical procedures.

If you’re reading this, you want to know, "How can I get in?" Well, the best advice is: start early. (Like your first year of medical school.) This provides you with an opportunity to start research projects and make valuable contacts within the field. This will help to protect yourself if you don’t make AOA.

Getting an advisor is also good idea. Dr. Foster is the best advisor in the department. Unfortunately this is not a secret, and it is almost impossible for him to take on new students. Dr. Sledge is a new, young attending at HAC. His interests are spine, trauma, and total joint replacement. He is very excited about teaching, and he would be a good person to approach for advice. Dr. Schepsis is excellent but is extremely busy. He usually has 3 – 4 sports related research projects going on at any one time. Dr. Einhorn is the chairman of the department and is extremely busy at the present time. He is internationally renowned for his basic science research and is a strong proponent of student and resident education. If you have a strong background or interest in basic science (bench top) research, it may be wise to make an appointment with him. The department at BU is rapidly changing. By the time this is published, others may have joined the staff. A key thing to remember is that new or young attendings want and need to publish and can always use the help of a motivated student.

Grades in ortho are extremely important. If you honor everything, beautiful. We believe that the most important classes to honor are medicine, surgery, and your BU ortho elective. Other classes that are important are your surgical sub-I, anatomy, and pathology. If you don’t honor all of your classes, your ship is not sunk. There are still other ways to succeed.

Do well on the boards. At a minimum, you have to get over 200. Better yet, you should get over 220. If you want a reasonable amount of interviews, you need over 235.

AOA is helpful but not essential. You can still get a spot without it.

Research is very helpful if you are academically challenged. It gives you a chance to prove your interest in the field and allows the attendings to know you on a more in-depth and long-term basis. One option is to do your research while you are in medical school. Another option is to take some time off from school (1 to 2 years). If you get some strong publications off during this time, it can make you a much stronger candidate.

It is not imperative that your third year schedule be created in one specific manner. However, many people suggest that you do your medicine and surgery rotations early. The advantage to this schedule is that your surgery rotation is done early enough so that you can send your surgery grade to away-rotations that require it as part of their eligibility requirements. Second, it also allows you to get some fourth year rotations completed during your vacation block in the spring. Sign up to do an orthopedic elective during your surgery clerkship. It can either be done at the HAC or the ENC. We suggest that you use your third year vacation block to get some fourth year rotations completed in order to maximize the amount of orthopedic rotations you can do in your fourth year.

This is a gray area in the application process of orthopedics. If you did great on Step 1, you definitely do not need to take this exam until March. However, if you did poorly on Step 1 or even average, you may consider taking Step 2 in August. If you get a great score on Step 2, it probably can help you to get some more interviews. However, an average score on Step 1 (220 in the ortho world) with some honors and some research can still get you ten or more interviews. If you take Step 2 in August, you should schedule a vacation block around that time.

Everyone should do a fourth year orthopedic elective at BU (preferably, at the institution formally known as UH) and at least 2 away rotations. You should petition the promotions committee to have all three count for credit (which will equal extra vacation time). However, some of you will be DENIED and you will have to do one of these rotations during a fourth year vacation block.

When choosing away rotations you should be realistic. One elective should be at a program where you stand a legitimate shot at getting in. The other program can be a bit of a reach. It is a good idea to discuss these choices with your advisor. You should contact the places where you want to do your away rotations by February of your third year.

Other rotations that you may want to do early are neurology and radiology. These rotations may help to prepare you for your away rotations. If you really had a good rapport with the surgery attendings, you can also think about doing your surgical sub-I early (before September). Some candidates claim that a rotation with Dr. Menzoian is very helpful because it allows you to review a lot of your extremity anatomy. I (M.G.) did mine with Dr. Beazley and had a great time. So, the choice is a personal one.

There are two more things to keep in mind. One is that you should take a vacation block during late December and early January. This is when a majority of your interviews will be. Second, you should plan an easy rotation for late February / early March because this will give you plenty of time to study for the USMLE Step 2.

Letters of recommendation should be from attendings that know you well, especially orthopedic surgeons. Give them PLENTY of time to write your letters. Ask them to write your letter in June/July at the end of your third year.

Start writing your personal statement early; we suggest in June at the end of your third year. Write it several times. Try to focus on things that will not be in your C.V. (medical résumé) or application. Use your personal statement to separate you from the other candidates and to describe your goals. It is important NOT to include past athletic experiences (After benching 500 lbs. for the last five years, I knew ortho was for me.) or personal medical experience (After they repaired my ACL, I had to do ortho). Also do not use autobody talk, i.e. "I built this 1964 Porsche from the ground up when I was seven." Have your advisor go over it with you by August.

Most of the programs are on the ERAS system. Contact all of the programs you wish to apply to by May at the end of your third year by mail, even if they are on ERAS. This is important because some of these programs may have special forms to fill out, or they may still require a paper application. Program addresses can be obtained by using the Green Book or using the FRIEDA computer system. We recommend applying to programs in areas that you can tolerate living in for five years. We are not advocating that you apply to every program in the country, but apply to a lot of programs. The range of programs that the 1998 BU ortho candidates applied to was between 30 and 80. The weaker your grades, the more programs that you should apply to.

Apply to programs early! The Dartmouth application is due by September 1. Obtain your SATs, MCATs, and undergraduate transcripts. As scary as it may seem, some programs require these numbers. Some programs on the ERAS system require material that is not standardized for the ERAS program. They usually tell you to include these things as an additional letters of recommendation. We advise sending each unique addendum by mail. If you have a strong CV or publication, it may be helpful to send it by mail to all of the programs that you apply to. You may want to discuss this with your advisor. Some previous candidates advise calling each of the programs they applied to in order to confirm successful arrival of their application material. Some of the secretaries may get annoyed at this approach, so you have to decide what is best for yourself.

Follow up your interviews with thank you letters to the residency director and department chairman.

After your interviews, you need to decide what are your top choices. You should ask Dr. Einhorn to call your top choice. It is also a good idea to send a letter to your top program advising them that you will rank them number one. Dr. Culbert will also call a program for you. You may want him to call your number two program instead of your top choice. If Dr. Culbert knows you very, very well, this may be a good opportunity to take advantage of.

In the end, try the best that you can. Although trying to achieve all of these goals is quite daunting, if you don’t meet all of them, an ortho slot is still a possibility. In fact, we know of several people with board scores below 200, or those who have only had two interviews, and still matched. So, don’t get discouraged too quickly.

We wish you the best of luck in your endeavors.