Orthopaedic Surgery Residency Applicants Research Articles

Peer-Reviewed Publications by Successfully Matched Orthopedic Surgery Residency Applicants in the 2022-2023 Match.

The Orthopaedic Surgery Match is highly competitive, with more applicants than residency spots. With the Step 1 Exam moving to a pass/fail result, residency programs and applicants have fewer objective data to determine applicants' relative competitiveness. Through this study, we sought to provide the mean number of accepted publications on PubMed a successfully matched orthopedic surgery applicant has by the time of submission of their application. Orthopedic surgery residency programs participating in the National Resident Matching Program were identified by their ranking on the Doximity Residency Navigator. Each program's intern class and their medical schools were identified. Their names were searched in PubMed and Scopus and articles with their name and affiliations were recorded. In total, 877 orthopedic surgery interns published a mean of 3.30±5.27 articles each on PubMed. They were first or second author on 1.44±2.58, and 1.96±3.89 publications were related to orthopedic surgery. There were no statistical differences between degree, sex, or residency program rank from the Doximity Residency Navigator. The mean number of publications from a successful applicant was approximately 3. There was a great range in the number of publications, and 27.3% of successful applicants did not have a single publication. Future applicants and programs can use this number to gauge relative research output. [Orthopedics. 202x;4x(x):xx-xx.].

Evaluating the 2023 Standardized Letter of Recommendation Form in Applications to Orthopaedic Surgery Residency.

Successfully matching into orthopaedic surgery residency is a challenging endeavor due to the limited number of available positions. Implementation of the Standard Letter of Recommendation (SLOR) in 2017 was intended to allow better comparisons between applicants; however, the form suffered from notable rank inflation ultimately requiring introduction of an updated SLOR for the 2023 to 2024 application cycle. The purpose of this study was to evaluate whether the 2023 SLOR improves on deficiencies of the 2017 SLOR. Applications submitted to our institution during the 2023 to 2024 orthopaedic surgery residency application cycle were analyzed. Applicant objective metrics were collected, including US Medical Licensing Exam scores, clerkship grades, AΩA status, and research productivity. Scores for each domain of the 2023 SLOR forms were recorded. Mean scores were calculated for each question, and cumulative scores per SLOR were determined. Intraclass correlation coefficients were determined per applicant and evaluator. The Spearman rank correlation coefficient was calculated for comparison of SLOR cumulative scores and objective metrics. Three hundred sixty-eight applications were reviewed, and 743 2023 SLORs were submitted in conjunction with these applications. Most of the 2023 SLORs (n = 399, 53.70%) had cumulative scores placing applicants in at least the 90th percentile. Furthermore, 267 evaluators (72.36%) consistently gave scores of 99s and 10s for each question. Intraclass correlation coefficients were rated as fair to moderate agreement between evaluators for each applicant. Objective applicant metrics did not meaningfully correlate with SLOR cumulative scores. The 2023 SLOR demonstrated notable rank inflation with only 22.7% of applicants receiving a score of less than 7 on any domain. By contrast, 69.9% of applicants received a score of "rare, perfect gem" on at least one domain of the form. We encourage the American Orthopaedic Association Council of Orthopaedic Residency Director to continue to improve the form and provide guidance to residency program leadership on proper use of the grading system.

The Impact of Diversity, Equity, and Inclusion Scholarships for Acting Interns on the Diversity of Orthopaedic Surgery Residency Programs

Background Improving diversity, equity, and inclusion (DEI) in orthopaedic surgery is a priority as statistics continue to demonstrate it as the least diverse surgical subspecialty. DEI scholarships for Acting Interns have been recently developed to recruit more diverse candidates. Objective To determine the impact of DEI scholarships on the orthopaedic surgery residency application process. Design An anonymous survey was distributed to program directors at ACGME accredited orthopaedic residencies that offered DEI scholarships for visiting medical students. The survey inquired about factors involved in scholarship implementation, source of funding, number of scholarship applications received, factors considered in selecting recipients, number of DEI scholarships awarded, program results in the 2023 Match, demographics of incoming first-year residents, and program directors’ observations following implementation. Results Of the 49 programs with known DEI scholarships, 16 (32.7%) completed the survey. During the 2023 Match cycle, respondents matched an average of 5 residents (SD 0.5, Range 3 – 8) consisting of 36.7% female (SD 31.7%, Range 0 – 100%) and 36.9 (SD 28.2%, Range 0 – 100%) underrepresented minority (URM) residents. Following scholarship implementation, most program directors (56.2%) observed a rise in URM student rotators with an associated 18.8% increase in the number of URM residents. Additionally, 18.8% of programs claimed that scholarship recipients either matched at their program or another orthopaedic residency program. Respondents reported that 68.8% (SD 41.5%, Range 0 – 100%) of scholarship recipients received an invitation to interview at the awarding program. Of the three programs (18.8%) that claimed recipients matched at their program, two (13.3%) reported they matched one DEI scholar, while the other (6.7%) stated that five DEI scholars matched into their program. Conclusion DEI scholarships may be an effective strategy for promoting diversity in orthopaedics. However, longitudinal data and increased institutional GME funding are required to increase the proportion of orthopaedic residency programs that offer these scholarships for visiting students.

Let's Take a Look at the Tape: The Impact of ERAS Video Prompts on Interview Offerings for Orthopaedic Surgery Residency Applicants: A Prospective Observational Study.

Matching into an orthopaedic surgery residency consistently reinforces a competitive landscape, challenging the applicants and programs. A group of orthopaedic surgery residency programs implemented video prompts asking applicants to respond to a standardized question by video recording. Assessing the impact of this video on the decision to offer an interview can help guide programs and applicants through the interview process. Twenty residency applications to one institution requiring video prompts were randomly selected and deidentified. Thirteen experienced faculty from various orthopaedic surgery programs served as applicant reviewers. The reviewers evaluated the electronic residency application service (ERAS) application and determined whether they would grant the applicant an interview ("no," "maybe," or "yes") before and after watching the video prompt. The reviewer also scored the impact of the applicant's dress, facial presentation, and video background distractions on their evaluation of the video. Multivariable logistic regressions were conducted using a group of applicants where interview status was not impacted by the video compared with the group of applicants where the interview status changed after video review. An alpha value of 0.05 was used to define significance. The video prompt impacted the decision to offer an interview 29.3% of the time; 15.8% were switched from "yes" or "maybe" to "no" and 13.5% were switched from "no" or "maybe" to "yes." For the positively impacted applicants, facial presentation score was significantly higher (P = 0.005). No recorded variables were associated with decreased chance of interview. Video prompts impacted the decision to offer interviews to orthopaedic surgery applicants approximately one-third of the time, with a similar number of applicants being positively and negatively impacted. Facial presentation score was associated with increased chance of interview, and no variables were associated with decreased chance of interview. Thus, the answer to the videos presumably negatively impacted applicants.

Who Bears the Burden? Understanding the Socioeconomic Patterns of Educational Debt in Orthopaedic Surgery Residency Candidates.

Educational debt is commonly observed among applicants to orthopaedic surgery residency programs; however, an understanding of the debt burden among minority and nonminority applicants is not well established. Thus, this study aimed to fill these knowledge gaps by examining the extent of and factors shaping educational debt among orthopaedic surgery applicants. (1) What is the educational debt burden among orthopaedic surgery residency applicants? (2) After controlling for relevant confounding variables, what factors are independently associated with increasing levels of educational debt? (3) After controlling for relevant confounding variables, are individuals classified as an underrepresented minority or those with educational debt and socioeconomic disadvantage less likely to match in orthopaedic surgery? A retrospective evaluation of orthopaedic surgery residency application data from the American Association of Medical Colleges was analyzed from 2011 to 2021. The American Association of Medical Colleges database was selected because every residency applicant must register and apply through the American Association of Medical Colleges. Therefore, these data exist for every residency applicant, and the sample was comprehensive. Self-reported data including premedical, medical, and total educational debt burden as well as classification as socioeconomically disadvantaged and application fee waiver use were collected. Applicants were dichotomously categorized as an underrepresented minority or a not underrepresented minority based upon self-identified race and ethnicity. Monetary values were reported in USD and inflation-adjusted to 2021 using the Consumer Price Index. We performed t-tests and chi-square tests for continuous and categorical variables, respectively. Significance was considered at p < 0.05. In all, 12,112 applicants were available in the initial cohort, and 67% (8170 of 12,112) of applicants with complete data were included from 2011 to 2021 in the final study cohort. Of these, 18% (1510 of 8170) were women, 14% (1114 of 8170) were classified as underrepresented minorities, and 8% (643 of 8170) were classified as socioeconomically disadvantaged. Sixty-one percent (4969 of 8170) of applicants reported receiving at least one scholarship, 34% (2746 of 8170) had premedical school debt, and 72% (5909 of 8170) had any educational debt including medical school. Among all applicants, the median (IQR) educational debt was USD 197,000 (25,000 to 288,000). Among those with scholarships, the median amount was USD 25,000 (9000 to 86,000). After controlling for the potentially confounding variables of gender and socioeconomic disadvantage, classification as an underrepresented minority applicant was independently associated with higher scholarship amounts than applicants characterized as not underrepresented minorities (β = USD 20,908 [95% confidence interval (CI) 15,395 to 26,422]; p < 0.001), whereas underrepresented minority classification was not independently associated with a difference in total educational debt (β = USD 3719 [95% CI -6458 to 13,895]; p = 0.47). After controlling for the potentially confounding variables of gender and classification as an underrepresented minority, socioeconomic disadvantage was independently associated with higher scholarship amounts (β = USD 20,341 [95% CI 13,300 to 27,382]; p < 0.001) and higher total educational debt (β = USD 66,162 [95% CI 53,318 to 79,006]; p < 0.001) than applicants not classified as socioeconomically disadvantaged. After controlling for the potentially confounding variables of gender and classification as an underrepresented minority, socioeconomic disadvantage was independently associated with decreased match rates (OR 0.62 [95% CI 0.52 to 0.74]; p < 0.001). These findings underscore the need for comprehensive scholarship initiatives to ensure equitable financial accessibility for applicants from all backgrounds. In the future, orthopaedic surgery may benefit from research comparing the effectiveness of various initiatives aiming to improve fairness in the burden of debt among applicants to orthopaedic surgery residency programs.

103 Parental Occupation and Orthopaedic Surgery Residency Applicants: Implications on Educational Debt, Scholarships, Medical School Ranking, and Resulting Match Rates

OBJECTIVES/GOALS: Parental SES may influence the trajectory of students applying to orthopaedic surgery residency, perpetuating opportunistic disparities. Thus, we sought to examine the relationship between parental occupation/education and applicant match rate, education financing, and medical school background. METHODS/STUDY POPULATION: Data from the Association of American Medical Colleges (AAMC) documented parental occupation and education levels of 10,697 orthopedics applicants from 2011 to 2021. Parental occupations were categorized into physician vs non-physician, healthcare vs non-healthcare, working class vs non-working class, and STEMM (Science, Technology, Engineering, Mathematics, Medicine) vs non-STEMM. Parental education levels spanned from no college degree to doctorate degrees and were used as a proxy for SES. Outcomes analyzed included match success, premedical and medical school debt, total educational debt, scholarships, and representation from top 40 research medical schools as determined by NIH funding. RESULTS/ANTICIPATED RESULTS: Physician parent applicants (20.1%) had better match rates (75.5% vs. 73.5%), lower debts, lesser scholarships, and higher top 40 school representation. Healthcare parent applicants (37.0%) had similar match rates, less debt and scholarships. Working class parent applicants (6.0%) had more debt and scholarships. STEMM parent applicants (48.6%) had higher match rates, lesser debts and scholarships, and higher top 40 representation. Applicants with parents without college degrees had lower match rates (68.6% vs 74.5%), more debt and scholarships. Doctorate parent applicants had better match success (75.9% vs 72.9%), lesser debts, and higher top 40 school representation (34.9% vs 29.6%). DISCUSSION/SIGNIFICANCE: Parental SES was associated with substantial variation in applicant financial burden and educational pedigree. Notably, applicants with parents lacking degrees had lower match rates, underscoring the need for supportive strategies to ensure equitable opportunities for aspiring orthopaedic surgeons.

Analysis of variability and trends in medical school clerkship grades

BackgroundMedical school clerkship grades are used to evaluate orthopedic surgery residency applicants, however, high interinstitutional variability in grade distribution calls into question the utility of clerkship grades when evaluating applicants from different medical schools. This study aims to evaluate the variability in grade distribution among medical schools and look for trends in grade distribution over recent years. MethodsApplications submitted to Rush University's orthopedic surgery residency program from 2015, 2019, and 2022 were collected from the Electronic Residency Application Service. Applications from the top 100 schools according to the 2023–2024 U.S. News and World Report Research Rankings were reviewed. The percentage of “honors” grades awarded by medical schools for the surgery and internal medicine clerkships were extracted from applicants' Medical Student Performance Evaluation letters. ResultsThe median percentage of honors given in 2022 was 36.0 % (range 10.0–82.0) for the surgery clerkship and 33.0 % (range 6.7–80.0) for the internal medicine clerkship. Honors were given 6.6 % more in the surgery clerkship in 2022 compared to 2015. There was a negative correlation between a higher (worse) U.S. News and World Report research ranking and the percentage of honors awarded in 2022 for the surgery and internal medicine clerkships. ConclusionThere is substantial interinstitutional variability in the rate that medical schools award an “honors” grade with evidence of grade inflation in the surgery clerkship. Residency programs using clerkship grades to compare applicants should do so cautiously provided the variability demonstrated in this study.

The Impact of Signaling on the 2022 to 2023 Orthopaedic Residency Application Cycle: A Survey of Incoming Residents.

During the 2022 to 2023 orthopaedic surgery residency application cycle, "signaling" was added, allowing applicants to communicate strong interest to 30 programs of their choosing. This study's purpose was to evaluate signaling's impact on the 2022 to 2023 application cycle. A cross-sectional survey was distributed to applicants who applied to a single residency program. We evaluated how many interviews the average applicant received, what proportion of interviews came from programs they had signaled, and what percentage of applicants matched at a program they had signaled. We stratified data by American Orthopaedic Association status, United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, research items, sex, and race. This survey was distributed to 611 applicants, with 124 (20.3%) responding to the survey. Ninety-five respondents (76.6%) matched. The percentage of applicant interviews that came from signaled programs was 78.7%. Ninety-one percent of matched applicants matched at a program they signaled. Sixty-three percent of matched applicants performed an away rotation at their matched programs. Forty-five percent of applicants felt that signaling incentivized reducing the programs they applied to, and applicants gave signaling a high favorability rating of 4/5. Applicants with Alpha Omega Alpha status received more interviews per application (0.18 ± 0.11 vs. 0.10 ± 0.10, p < 0.001) and more interviews from programs they did not signal (74% of interviews from signaled programs vs. 90% of interviews from signaled programs, p < 0.001). Higher Step 1 and Step 2 scores were associated with more interviews per application (Step 1: 0.16 ± 0.12 vs. 0.12 ± 0.08, p = 0.032) (Step 2: 0.16 ± 0.11 vs. 0.12 ± 0.09, p = 0.032). Orthopaedic residency applicants received most of their interviews from programs that they signaled, with an overwhelming majority matching at signaled program. Alpha Omega Alpha status and high USMLE scores were associated with more interviews granted per application, regardless of signaling status. Signaling seems to be a favorable option for orthopaedic applicants. Data from future application cycles will help further evaluate signaling's impact on the orthopaedic match.

Letter to the Editor: Does "Hoarding" Impact Interview Distribution Among Orthopaedic Surgery Residency Applicants? A Modeling Study Based on a Large Database.

Letter to the Editor: Does "Hoarding" Impact Interview Distribution Among Orthopaedic Surgery Residency Applicants? A Modeling Study Based on a Large Database.

Analysis of Research Productivity of Orthopedic Surgery Residency Applicants.

Background Orthopedic surgery has become an increasingly competitive specialty. With a pass-fail Step 1, an even greater emphasis on research has been placed to allow candidates to better distinguish themselves. This study analyzes the scholarly activity of accepted orthopedic residency applicants during medical school, assessing what factors, including the novel altmetric attention score, may be associated with greater research productivity. Methods A list of orthopedic residency programs was obtained from the Electronic Residency Application Service (ERAS). A total of 688 orthopedic residents from 180 programs who matriculated in 2020 from allopathic medical schools were identified.Resident demographic information and bibliometric data (total publications, orthopedic-related publications, h-index, and altmetric score)of publications published from July 1, 2016, toSeptember 1, 2020, were collected. Descriptive statistics were calculated. Kruskal-Wallis tests analyzed the association between medical school characteristics and research productivity using Stata® 17.0 (StataCorpLLC, College Station, Texas). Results Postgraduate-Year-3 orthopedic residents (N=688) published 2,600 articles during medical school, averaging 3.8 articles per resident. The residents from a top 25 medical school for research had publication counts, altmetric scores, and h-indices, on average, that were higher than those from non-top 25 medical schools for research. Over 150 residents had no publications, and ~10 residents had more than 30 publications. Conclusions The results illustrate that medical school research status influences the research productivity of applicants. Also, given the average number of publications, most research listed on applications are abstracts and presentations. Utilization of the altmetric score may not yet be the best way of examining research experience because orthopedic applicants do not appear to use social networks for academic research.

Perceptions of Preference Signaling in Orthopaedic Surgery: A Survey of Applicants and Program Directors.

To improve transparency between candidates and training programs, a preference signaling program (PSP) was implemented before the 2022 to 2023 orthopaedic surgery match. The PSP allows applicants to 'signal' up to 30 programs, informing the program of the applicant's particular interest in interviewing for their available position(s). This study reports the perspectives of orthopaedic surgery residency applicants and program directors (PDs) on the effects of preference signaling on the orthopaedic match. Electronic surveys were distributed to PDs and applicants. Almost all programs participated in the PSP (90%), and most of the applicants (97.6%) used 25 to 30 of their allotted preference signals. Most of the applicants (67.2%) thought that their likelihood of obtaining an interview was improved at 'signaled' programs but decreased at programs without a 'signal' designation (85.3%). Both applicants and PDs considered preference signaling to be one of the three most important factors for interview selection, along with Step 2 CK score and letters of recommendation. The applicants did not think that their likelihood of matching would improve with fewer allotted signaling tokens (35.2%), and 55.2% of PDs believed 21 to 30 tokens were optimal. Preference signaling is highly regarded by applicants and PDs. Signaling a program will likely improve an applicant's chance to interview. The optimal number of signaling tokens remains unknown, although both groups favored a larger allotment of tokens than has been seen in other specialties. Universal guidelines and recommendations for applicants and PDs would improve the utility of preference signaling.

Editor's Spotlight/Take 5: Does "Hoarding" Impact Interview Distribution Among Orthopaedic Surgery Residency Applicants? A Modeling Study Based on a Large Database.

Editor's Spotlight/Take 5: Does "Hoarding" Impact Interview Distribution Among Orthopaedic Surgery Residency Applicants? A Modeling Study Based on a Large Database.

Does "Hoarding" Impact Interview Distribution Among Orthopaedic Surgery Residency Applicants? A Modeling Study Based on a Large Database.

"Interview hoarding" is commonly used to refer to the concentration of interview offers among a small number of high-performing residency applicants. Theoretically, if the same applicants interview at every program, fewer rank lists will be submitted than open residency positions, leading to a "match crisis" with unfilled positions after the match. There are no published studies we are aware of that describe the observed distribution of residency interview offers among orthopaedic surgery applicants or the potential impact of "hoarding" on that distribution. We examined the distribution of interview invitations extended to orthopaedic surgery residency applicants in the 2020 to 2021 and 2021 to 2022 application cycles. The change in the shape of the interview invitation distribution was the primary outcome for two central questions: (1) Does the interview offer distribution curve among orthopaedic surgery applicants change meaningfully from baseline with implementation of an interview cap (Model 1)? (2) What is the impact on the distribution of invitations with a reduction in the number of applicants in the field (Model 2)? This was a retrospective study of orthopaedic surgery interview invitations extended to applicants via the Thalamus interview management program during the 2020 to 2021 and 2021 to 2022 residency application cycles. The Thalamus database was chosen because it contains data on interview invitations for orthopaedic surgery residency positions and has the largest market share in orthopaedics compared with similar databases. Thalamus data represent 1565 applicants and 53 residency programs (90% and 25% of the national total, respectively) in 2021 to 2022 and 993 applicants and 46 programs (77% and 23%, respectively) in 2020 to 2021. It has been shown to contain a representative sample of orthopaedic residency programs. An interview cap (Model 1) was simulated by removing excess interviews held by applicants above the 75th and 95th percentiles, which were chosen to represent a formal cap and an informal cap, respectively. A reduction in the size of the applicant pool was similarly modeled by randomly removing 5% and 25% of applicants, chosen to simulate informal and formal application requirements, respectively. In both models, the excess interviews were redistributed among the remaining applicants. Applicants received a mean of 1.8 ± 2.2 Thalamus interview invitations in 2020 to 2021 and 1.7 ± 2.4 invitations in 2021 to 2022, with no change to the overall distribution curve. A total of 39% (606 of 1565) of applicants received no Thalamus interview invitations in 2021 to 2022, 75% (1176 of 1565) received two or fewer, and < 1% (14 of 1565) of applicants received 10 or more invitations. Redistributing excess interviews held by the top 5% of applicants resulted in 2% (61 of 2651) of interviews being redistributed (Model 1). Removing 5% of the total applicant pool resulted in a redistribution of 3% (87 of 2651) of the interview invitations (Model 2). Orthopaedic surgery interview data demonstrated an expected uneven distribution of interview invitations, with a small proportion of highly competitive applicants receiving a higher number of interview offers as well as a large group of applicants receiving no interview invitations in Thalamus. Concerns that "hoarding" would lead to a crisis resulting in many unmatched residency positions seemed unfounded, given the excess of applicants relative to positions and the minimal change in the distribution of interviews in the cap model. Medical students applying to orthopaedic residency should seek individual advising to improve their individual odds of matching, while understanding that interview hoarding does not seem to alter the distribution of interviews. Program directors and medical students' advisors should be cognizant that a small proportion of applicants are broadly interviewed and may benefit from steps taken to ensure applicants have genuine interest in the program.

Assessing Gender Differences in Technical Skills and Confidence in Orthopaedic Surgery Residency Applicants.

Variations in confidence for procedural skills have been demonstrated when comparing male and female medical students in surgical training. This study investigates whether differences in technical skill and self-reported confidence exist between male and female medical students applying to orthopaedic residency. All medical students (2017 to 2020) invited to interview at a single orthopaedic residency program were prospectively evaluated on their technical skills and self-reported confidence. Objective evaluation of technical skill included scores for a suturing task as evaluated by faculty graders. Self-reported confidence in technical skills was assessed before and after completing the assigned task. Scores for male and female students were compared by age, self-identified race/ethnicity, number of publications at the time of application, athletic background, and US Medical Licensing Examination Step 1 score. Two hundred sixteen medical students were interviewed, of which 73% were male (n = 158). No gender differences were observed in suture task technical skill scores or mean difference in simultaneous visual task scores. The mean change from pre-task and post-task self-reported confidence scores was similar between sexes. Although female students trended toward lower post-task self-reported confidence scores compared with male students, this did not achieve statistical significance. Lower self-reported confidence was associated with a higher US Medical Licensing Examination score and with attending a private medical school. No difference in technical skill or confidence was found between male and female applicants to a single orthopaedic surgery residency program. Female applicants trended toward self-reporting lower confidence than male applicants in post-task evaluations. Differences in confidence have been shown previously in surgical trainees, which may suggest that differences in skill and confidence may develop during residency training.

Decoding the Signals: An Analysis of Preference Signaling in the 2023 Orthopaedic Surgery Residency Match.

While previously used in other specialties, the preference signaling program (PSP) was implemented in the 2022 to 2023 orthopaedic surgery residency application process for the first time. The PSP allowed for 30 signaling tokens to be sent by applicants to programs of their choice to indicate particular interest in a program. It remains unknown how the PSP affects applicants and programs in the orthopaedic surgery residency match. Thus, this study's purpose was to assess the utility of preference signaling within the orthopaedic surgery residency application process in its inaugural year of use. An anonymous electronic survey was emailed to all orthopaedic surgery residency applicants who applied to the authors' institution during the 2022 to 2023 application cycle. The survey was sent after match lists were submitted and closed before the release of match results. The survey collected information regarding applicant demographics, preference signaling habits, and attitude toward preference signaling. The survey was completed by 101 applicants. Applicants applied to a mean of 90 programs (range: 10-197) and received an average of 12 interview invitations (range: 0-39). Applicants almost uniformly used all 30 signals, with nearly two-thirds signaling their home programs (65%, 49/76), and nearly all applicants sending signals to programs at which they performed away rotations (95.7%, 88/92). Applicants received a mean of 9 invitations from programs they signaled, compared with 2 invitations from programs they did not signal. Applicants were significantly more likely to receive an interview invite at a program they signaled than one they did not (p < 0.01). Overall, 57% of applicants (57/101) found the PSP to be helpful, whereas 28% (28/101) found it to be unhelpful, and 16% (16/101) had a neutral opinion. This study reports that the PSP in the 2022 to 2023 orthopaedic surgery match was an effective method of expressing interest in a program because applicants were significantly more likely to receive interview invites to signaled programs. More than half of respondents felt PSP to be helpful; however, the effect on application numbers is still unclear. III.

Differences in the Academic Attributes of Matched and Unmatched Orthopaedic Surgery Residency Applicants are Narrowing.

Applicant data from the National Resident Matching Program from 2016 to 2022 were analyzed. The number of matched and unmatched US allopathic senior orthopaedic applicants relative to the number of available positions was used to determine respective match rates. Performance metrics and applicant characteristics were compared by match status. Trends were compared with those of previous analysis from 2006 to 2014. The number of applicants increased from 863 in 2016 to 1,068 in 2022. The match rate decreased from 75% in 2016 to 66% in 2022 (p < 0.0001). Matched applicants had a higher number of contiguous ranks (12.3 vs. 6.5; p < 0.001), United States Medical Licensing Examination (USMLE) Step-1 score (248 vs. 240; p < 0.001), USMLE Step-2 score (255 vs. 247; p < 0.001), Alpha Omega Alpha (AOA) membership (38% vs. 13%; p < 0.001), and enrollment at a top 40 National Institutes of Health (NIH)-funded medical school (34% vs. 24%, p < 0.001). Compared with 2006 to 2014 data, a smaller percentage of matched applicants were enrolled in a top 40 NIH-funded medical school (34% vs. 37%, p = 0.013). The mean differences in USMLE Step-1 score (16 vs. 8.25 points, p < 0.001) and USMLE Step-2 score (16 vs. 8.25 points, p = 0.002) in favor of matched applicants nearly halved compared with that in 2006 to 2014. In addition, there was no longer a significant difference in the number of research products (abstracts, presentations, posters, and publications) between matched and unmatched applicants (p = 0.309). Differences in the academic attributes of matched and unmatched orthopaedic surgery applicants have become less profound over time, making it increasingly difficult to predict a successful match based on USMLE Step scores, AOA membership, research productivity, and medical school research reputation. Future studies should evaluate differences in subjective metrics (e.g., away rotation and interview performance and letters of recommendation) by match status.

Postmatch perceptions of virtual interviews among orthopaedic surgery program directors and candidates: results of an online survey

Background: Interviews are considered fundamental to the residency application. Universal implementation of virtual interviews (VIs) caused substantial modifications to the 2020/2021 residency application cycle. Previous work elucidated the expectations and perceptions of candidates and program directors (PDs) prior to the match. The authors aimed to assess whether the match results affected perceptions of VIs. Methods: An online survey was distributed to candidates and PDs of the 2020/2021 orthopaedic surgery residency application cycle. Questions assessed match results, the perceived impact of VIs, and interview format preferences for upcoming application cycles. Results: Responses included 39 PDs (20% response rate) and 71 candidates (14% response rate). PDs in the sample reported filling all positions. Of the 71 candidates, 19 went unmatched. Candidates had significantly higher prematch expectations of the impact of VIs than PDs (P=0.039). PDs reported significantly different changes in perception of VIs after the match compared with candidates, with more positive views of VIs reported (P=0.009). Compared with matched candidates, unmatched candidates expressed significantly greater dissatisfaction with the match result (P&lt;0.001). Conclusions: PDs reported higher satisfaction with VIs than expected after the match compared with prematch expectations. Candidates’ opinions of VIs postmatch were polarized. Unmatched candidates expressed a high level of dissatisfaction with the match and overwhelmingly felt VIs negatively affected their chances of matching. A large majority of PDs and matched candidates were satisfied with the outcomes of the match and VIs; nevertheless, this did not confer broad support for continuing VIs in the future. Level of Evidence: Level IV

Preference-Signaling During the Orthopaedic Surgery Residency Application Process.

The orthopaedic surgery residency selection process has grown more competitive over recent years, with programs receiving an unprecedented number of applications. As an effort to target applications to programs of interest, the American Orthopaedic Association has announced the introduction of a formal preference-signaling program into the 2022 to 2023 orthopaedic surgery residency selection cycle. This system will allow applicants to assign "signals" to a total of 30 programs. The purpose of this article was to (1) discuss implications of the new preference-signaling program, (2) introduce the framework of the "strategic signaling spear" for applicants to conceptualize the power of all methods of preference-signaling to improve their odds of matching, and (3) describe the role of strong mentorship at all stages of the residency application process.

Evaluating Databases With Orthopaedic Surgery Residency Program Information.

Orthopaedic surgery residency applicants submit more applications than ever before. While this issue is multifactorial, increased information and transparency regarding residency programs are important. This study aimed to evaluate the completeness and variability of the information that is currently available regarding orthopaedic residency programs on two publicly available databases, the Fellowship and Residency Electronic Interactive Database (FREIDA) and the newly created Orthopaedic Residency Information Network (ORIN). Orthopaedic surgery residency programs were identified and evaluated using FREIDA and ORIN on September 11, 2021. Information on the FRIEDA and ORIN databases were evaluated in the following categories: program overview, the residency application, and education information. Univariate statistical analysis was performed on the data. Of the 194 programs that participated in the FREIDA database, over 48% failed to include basic program information including resident demographics and key application information including USMLE Step requirements. Of the 141 programs that participated in the ORIN database, most the programs did not report USMLE Step median and cutoff scores and clerkship grades. Depending on the database and type of information, factors including the program's National Institutes of Health funding, reputation, size, and type were associated with the availability of information. This study showed that while most orthopaedic surgery residency programs participate in FREIDA and ORIN, the information included was highly variable and incomplete for nearly all programs. Improving the completeness of information in these databases has the potential to allow students to make more informed application decisions.

Variation in core clerkship grading reported on the Medical Student Performance Evaluation (MSPE) for orthopaedic surgery applicants: a retrospective review

Purpose: To understand the variation in number and verbiage in grading schemes during third-year core clerkships for orthopaedic surgery residency applicants. Methods: Applications to a single institution’s orthopaedic surgery residency program during the 2017-2018 match cycle were reviewed. Data extracted from the Medical Student Performance Evaluation (MSPE) included medical school name, number of core clerkships, grade options/tiers, and % grade distribution in clerkships. Applicant data collected included Step 1 Score, Step 2 Clinical Knowledge (CK) Score, Alpha Omega Alpha (AOA) membership status, clerkship grades, and medical school rank. Results: A total of 858 applications from 211 medical schools were reviewed. Further analysis was performed on 142 schools, representing 721 students, that reported grading distributions. The number of grade tiers varied from two to 11, with three (26.1%), 4 (43.7%), and five (20.4%) tiered grading systems being the most common. One-hundred unique verbiages were identified to describe grading amongst all schools. Schools ranked in the top 25 distributed honors more often than schools ranked outside the top 25 (P&lt;0.001). The median for the average percentage of honors distributed by a school was 32.3%, with a total range of 2.4 to 72.6%. A significant relationship between applicant match success and medical school grading practices could not be determined (P=0.054). Conclusions: Significant differences in assigned grades by medical schools for third-year core clerkships were found. Therefore, students’ core clerkship grades should be reviewed in the context of the grade distributions at their medical schools. Level of Evidence: Level IV.