“Look at every path closely and deliberately, then ask ourselves this crucial question: Does this path have a heart? If it does, then the path is good. If it doesn't, it is of no use.” ~Carlos Castaneda

Sunday, January 28, 2007

Do I have a chance getting into an orthopaedic residency?

The first question I would like to put out there is:

Do I have a chance getting into an orthopaedic residency?

I personally think this is a very important question. It is a reality check. And this is something that you have to look at without kid gloves. You can ask you parents and friends (unless they are in the field and honest), because that's like asking you mother if she thinks you are pretty/hansom. You need to be brutally honest with yourself and get someone else to review you application who will be honest as well.

Lets look at what "relatively" objective measures you have in your application that will help you get into the door.

This is definitely an area that gets a lot of press. Do programs have cutoffs and what are they? etc. Realize this is the only objective measurement that everyone has in common. So, most programs (I can not speak for all) use it in some way, shape or form, to get the numbers of applications down to a reasonable number to review for interview. Every program is different in this initial process. Some do have absolute cutoffs, some relative cutoffs, and others no cutoffs. It depends on the number of applications to the program. If you have 500 applicants, probably more like absolute cutoffs; if only 150, may be relative cutoffs. Regardless, the test will be used in someway, and you will need to do well on it.

This is were honesty and reality comes into play. If you score low (say 200-215 ave is now around 215), please be realistic. You are probably not going to one of the top 10 programs unless are able to pull some strings.

This is something that differs from university to university. Some schools are very liberal with the honors, and others not. Regardless, 2 rotations you need concentrate on getting honors in are surgery and orthopaedics. Now, we can be lenient on the surgery honors, but if you don't honor orthopaedics, you are definitely a tougher sell.

This may be considered by some, but the elections for AOA are not always complete when the applications come out. So it is difficult to use as an evaluation tool for every applicant. It does in general correlate with the number of honors at most institutions.

This is kind of hit or miss for me personally. Some applicants decide late, so should they take a year off and do research; find a project to tag on; do a month rotation. I think if you do research, you genuinely need to look as if you want to do research. Get a publication out of it, etc. I have review may applications were the research was kind of half ass, done so they can check that box off on the application. If you decide late to go into ortho, I feel it is better to concentrate on you strengths and make contacts who will be an advocate for you. If that means you end up doing research, fine. Make it look real though.

These need to be strong recommendations with key words. Words or statements like:
1. will be ranked high at our institution
2. we are actively recruiting for our program
3. one of the top students we have had this year; (or even better) on of the top students we have ever had.

Things that you don't want with you letter of recommendation.
1. you would not sign the waive to not be able to review you recommendation
2. a statement like " we tried to persuade him to go in to another less competitive area."

At most institutions, this does not get read until interview time. In general for most it is a none factor. Most of the statements say similar things like
1. the applicant or a family member had some interaction with an orthopaedic surgeon and that is what made them interested in it
2. the applicant was an athlete
3. the applicant likes to work with his/her hands
4. on a rotation, the application had an experience which shaped his/her decision.

so, for me, I read the statement and if I start to see this theme, no bonus points.

Now this personal statement can be a plus or a minus. It is tricky if you decide to go outside of the norm. If it is too artsy and you sound crazy, minus; if you are creative and interesting, plus. But this is tricky and I would only recommend this for the literary inclined.

In summary, most of these things are common sence. I don't think I am shedding a ton of light on the situation. The most important thing initially is to be realistic. If you don't have the numbers, you may need some other assistance, like an away rotation or people who can be advocates for you.

And is you are a good applicant (after being honest with yourself), you need to then ask yourself what makes you different. Something to set you apart, otherwise you all blend together.


The Balls said...

Brutal Honesty Please.

I'm in the middle of my class, step I 220, no research. Oh yeah, and I'm a DO student not particularly interested in living in ohio or michigan. I do expect to kick ass on step II if shelf scores are any predictor. I've received "honors" on the majority of my rotations. I'm not a softy, much more of a do'er than a classroom kinda guy, if taht makes any sense. I'm a former EMS guy who went to medschool w/the intention of doing ER. Just had an ortho rotation and enjoyed it exponentially more than other things. I could be happy doing ER, but I could be happier doing ortho. I'm kinda late to the game. Just need a little reality check, please.

Someonect said...

with your scores you would be a mid to low in the pack, you are also coming from a DO school. so if you apply, i would recommend you stay in the osteopathic system. there are some very good osteopathic programs. if you decide to go allopathic, do understand it will be a long road.

Anonymous said...

I am an MS III at a top rated US med school, and I came here solely to do ortho. But I did not do so well in my first two years and got a 218 on my step I. I have been doing research since before 1st year, with great dedication, but no publications yet (for various reasons unrelated to me). I think I am going to get good rec. from my PI and hopefully some “big name” colleagues of his.
I would be willing to go to any program, and would actually prefer to get out of the big metropolitan area.
Can you tell me something about the non-top 10 programs? How do I know which ones they are? Are they harsher on board scores to improve their image?
Also, anything on being a female applicant? (that is I cannot bench press my own weight).
Thank you for your time and dedication to students

Anonymous said...

this is interesting...220 on step I, but honors in the majority of rotations. I would think that the honors factor would make him/her much more competitive. Wouldn't you consider the 220 a negligible factor in this case?

Someonect said...

ANON#1: i can't believe i forgot to answer these questions. i apologize. to the first question about programs, there are a lot of good programs. take a look at orthogate and the orthogunner site to get an idea about different programs. as far as the board score number, it is used to decrease the list of applicants for interview without specifically looking at the application. female applicant can help your appoication because there are so few female applicants (<10%).

ANON#2: the USMLE number is a factor for programs who use a cut off to determine the people for interviews. i think the honors are more important, but if you can get passed the first screen, they don't come into play.

Anonymous said...

Thanks for the response. Do you know in general what step 1 score programs use as a cutoff?

Someonect said...

every program has their own guidelines. i don't know for sure. if your scores are in the 230's you should be relatively safe.

Anonymous said...

I scored a 202 and will be in the top of the 2nd quartile for my school. I have research and have done relatively well my 3rd year. Hypothetically, if I were to knock the step 2 out of the park (235-250s) would I even be given a chance to interview? Or should I consider another specialty altogether?

Samir Desai said...

Dr. Puryear has offered an excellent overview of the factors involved in the orthopaedic surgery residency selection process. The standard advice that low-scoring USMLE Step 1 applicants interested in ortho receive is to do well on the USMLE Step 2 CK.

This is obviously good advice but what I've found is that applicants generally don't have a solid understanding of the reasons that led to the low score. It's important to have someone objectively analyze your study skills, approach, and test-taking ability. By becoming well-informed of what's holding you back (and it's often more than one factor), you will be able to develop the "right" strategy for success.

I would definitely encourage low-scoring applicants to start with their school's academic advising office for an analysis.

Samir Desai, M.D.
Assistant Professor of Medicine
Baylor College of Medicine