Orthopedic Surgery Residency: Mending the Broken

The Best Orthopedic Surgery Residency Programs (US)

1. Harvard Medical School
2. Cornell Medical School
3. Mayo Medical School
4. University of Washington Medical School
5. Stanford Medical School

Are you applying for residency and want to know how to avoid residency application red flags? Watch this video:

The Best Orthopedic Surgery Residency Programs (Canada)

1. Memorial University Faculty of Medicine
2. Queen’s University School of Medicine
3. University of Toronto Faculty of Medicine
4. Northern Ontario School of Medicine
5. Cumming School of Medicine

What is an Orthopedic Surgery Residency?

In an orthopedic surgery residency, you learn about the various ways the entire musculoskeletal system can break down and how you can repair it, mostly through surgery. Despite it being a surgical specialty, you don’t need to take a general surgery residency before you enter. Neither do you need to do a transitional year residency. Most orthopedic surgery residency programs in the US and Canada are categorical, so you learn everything you need to learn about orthopedics within the program.

This usually means that the bulk of your rotations throughout the five years are dedicated solely to learning about various types of injuries affecting the musculoskeletal system and the surgical techniques to fix them. You don’t often pass through other departments or specialties mostly because the breadth of the musculoskeletal system is such that you need to focus solely on the various subspecialties within orthopedics, such as:

• Adult Reconstructive Surgery
• Pediatric Surgery
• Foot and Ankle Surgery
• Hand Surgery
• Orthopedic Oncology
• Shoulder and Elbow Surgery
• Trauma and Fracture Surgery
• Sports Medicine

These are just a few, but there are many more subspecialties that deal with knee and hip replacements, physical medicine and rehabilitation, rheumatology, and general orthopedics. These are the rotations you’ll have to do, but there are didactics as well.

Depending on the program, you usually divide time between observing surgeries, practicing your clinical and surgical skills, and learning from expert faculty and practicing orthopedic surgeons. You’ll also do Grand Rounds that bring in an invited guest or lecturer with experience in your field, or possibly, another, and learn from them about surgery fundamentals, anatomy, and new surgical techniques.  

What’s Involved in an Orthopedic Surgery Residency (US)

As we mentioned, orthopedic surgery residency programs in the US are mainly dedicated to learning the skills of a diagnostician and surgeon, which eliminates the need to do rotations in off-service specialties such as emergency medicine, radiology, or family medicine. Being a highly-trained surgeon requires hours upon hours of practice and education, which is why many programs forgo off-service rotations that are typical of other residency programs such as an internal medicine residency or a neurosurgery residency.

You’ll start doing rounds or rotations immediately, although some programs will put you through a surgery “boot camp” to get you up to speed on surgery fundamentals. You’ll do rotations throughout the various training sites associated with your program. If you want to incorporate other disciplines and sub-specialties into your program, try choosing a program that has a variety of clinical partners in different areas so you see more diverse cases and population groups.

The variety and scope of possible injuries you’ll deal with will be another highlight of your residency training. We mentioned some of the subspecialties that you can focus on later in your residency, but from the time you start you’ll be seeing and examining patients with basic fractures, and injuries that you can treat yourself, but under the supervision of a senior or chief resident.

As you progress through the program, you’ll have more responsibilities, and begin operating on patients that present with more serious and complicated issues, such as soft tissue tumors, spinal disorders, trauma and fracture, and reconstructive surgery. You’ll also do outpatient rotations in later years that can prepare you for administrative positions where you learn to manage clinic staff and scheduling.

Applying to an Orthopedic Surgery Residency (US) 

There are close to 200 different orthopedic surgery residency programs in the US offering a total of 900 positions. Last year, a little over 1400 applicants (US medical graduates, international medical graduates, and osteopathic graduates) applied to those orthopedic surgery residency positions, and were largely successful. However, US medical seniors fared the best, as they had a 75% match rate, while DO seniors had only a 7% match rate.

The application requirements to get into an orthopedic surgery residency are not dissimilar from other programs, and they are pretty standard:

• Medical student performance evaluation (MSPE)
• 3 to 4 letters of recommendation
• Orthopedic surgery residency personal statement
• Official transcripts
• USMLE Step 1 or USMLE Step 2 CK scores (program-dependent)

Now that we’ve dealt with the admissions requirements, what are some of the things you can do to get noticed by orthopedic residency program directors?

Well, aside from the admission requirements, residency directors want to see a few more things based on the successful applications of previous orthopedic surgery residents. Since surgery is such a technical art, residency directors want to see the tangible ways you’ve excelled or set yourself apart by, for example:

• Being a member of the Alpha Omega Alpha, a medical honors society in the US
• USMLE Score above 230
• Published research
• Previous experience working on a research project

How Orthopedic Surgery Residency Programs are Structured (US)

We’ve talked a lot about the way you progress through a five-year orthopedic surgery residency program, so we’ll only mention a few more points. The way electives are distributed is also something that depends on the program you are attending. You usually have to wait until the final years of your residency before you start taking one or two electives in either a related field or a subspecialty that we listed above.

The way research is integrated into your curriculum is also dependent on your program. Research is a vital component of any orthopedic surgery residency, and close to 93% of all orthopedic surgery residency applicants had some involvement in research before applying. But when, where and in what specific field of research you’ll work in is up to you.

As mentioned, some programs make a research project a required rotation during your residency, but others let you decide on what you want to do. You’ll have more time in the final two years of your residency to decide what you want to specialize in and whether you need to take a medical fellowship after your residency to increase your knowledge.

What’s Involved in an Orthopedic Surgery Residency (Canada)

An orthopedic surgery residency in Canada is maybe one of the few residency programs that mirror precisely what’s involved in an orthopedic surgery residency in the US. In both countries, the program typically lasts for five years. They’re both categorical and they’re both largely focused on the fineries of orthopedic surgery to the exclusion of other disciplines and off-service specialties. 

However, there are a few differences. The number of orthopedic surgery residency positions available in Canada is smaller than the US, and the make-up of the curriculum and your rotation schedule will also differ from programs in the US, but not by much. You’ll stick primarily to surgery-related rotations in similar subspecialties and have a few research projects and electives to complete.

But the way you progress through your residency will be based on the Competence by Design model, which most all residency programs have adopted as their new assessment model. The CBD model is the most glaring difference between the two countries, although some programs in the US use a similar model of testing competency through whether you can perform professional activities on your own, which is the basis of the Competence by Design model.

Applying to an Orthopedic Surgery Residency Program (Canada)

The number of orthopedic surgery residency positions in Canada has fallen from almost a decade ago. As of the last cycle, there were 52 positions available throughout the 17 medical schools in Canada. There was a total of 93 applicants from Canadian medical graduates, international and US graduates, making matching into these positions very competitive. You must submit all your application materials through CaRMS, such as:

• Residency CV
• Research resume
• CaRMS personal letter
• 3 or 4 letters of recommendation
• Official transcripts
• Medical student performance record

But what orthopedic surgery residency directors are looking for?

They want to see your interest in surgery, so that means taking a lot of your medical school electives in the various subspecialities involved in surgery, from general surgery to vascular or thoracic surgery. Again, as in the US, you should be able to point to previous research you did in the field, or talk about a research project that you would like to complete while a resident, as many programs in Canada make completing a research project a requirement, with the added caveat that it must be publishable.

How Orthopedic Surgery Residency Programs are Structured (Canada)

The various programs spread out through the country have a variety of different rotation schedules, curricula, and research requirements, but they all follow the Competence by Design model, meaning certain features of the curriculum may change to comply with the new model. For example, a lot of programs in Canada for surgical specialties host a “boot camp” lasting anywhere between 2 weeks to a month for you to get your feet wet in surgery.

You’ll learn basic surgery and orthopedic skills such as identifying different surgical implements and knowing their function, suturing, collecting and handling tissue specimens, how to cut through bone and applying casts. All surgery residents, as well as residents in other specialties with a surgical component, such as an OB/GYN residency must also take and pass the Surgical Foundations curriculum, which is in addition to the boot camp that some programs use, although not all of them use it.

But, as we mentioned earlier, a lot of orthopedic surgery residency programs in Canada make a research rotation a mandatory part of the residency, sometimes in the first year. Other programs leave it to the later years, but, regardless, you should go into a residency having some idea of what you want to research. You can prepare by attending academic conferences hosted by Canadian Orthopedic Association or any other surgery specialty to get an idea of the current state of orthopedic scholarship.

The academic portion of your training will also be different at each program. You’ll have a combination of residency conferences and in-class lectures and Grand Rounds to attend as part of your surgery training. The didactic parts of an orthopedic surgery residency are broken up throughout the year and you’ll attend half-days where you are in class then attend a clinic or observe a surgery in the OR.

How to Get into an Orthopedic Surgery Residency

Network and Get Yourself Noticed

You can do this in medical school in the run-up to applying. You should attend academic and professional surgical conferences where you can meet a lot of people associated with orthopedic surgery and surgery, in general. You can leverage these contacts into other opportunities and also demonstrate your passion for the field by learning as much as you can about it. At these conferences, use your interpersonal and communication skills to find out about research opportunities, surgeons and faculty who could possibly mentor you, and more experts who you can either shadow or ask for letters of recommendation.

Stand Out in Your Residency Interview

Getting a residency interview invite is a huge accomplishment in itself, but it’s only the first step to getting in, and you need to focus on how to give your best performance. In the US, you’ll typically have either a traditional one-on-one or panel interview. In Canada, you’ll either have to do an MMI or a traditional interview, so you need to prepare according to the format. You can read over traditional residency interview questions and orthopedic residency interview questions and formulate answers that you can refine over time (start preparing as soon as you get the invite). If you know you’ll do MMI, you can also read over MMI practice questions, but also get a sense of what’s current in orthopedics so you can answer questions about policy, ethics and the latest developments in orthopedic surgery.

Do Research and Get Published

The first part might be easier than the second, but while you are at these conferences, find surgeons and doctors who are currently doing research and ask them if you can be a part of their team. You might get a lot of rejections, but try anyway and if you do get someone to agree, then you’ll have more to show than someone who has not done any research. The ideal would be to get something into a medical journal and have your name published, but barring that having participated in research goes a long way to demonstrating your commitment.

Take Surgery Electives

Fortunately, general surgery is often a required rotation during your clerkship years in medical school, but as its required, all applicants will have the same base knowledge that you do. So, you should take as many surgical electives as possible in your final years of medical school, or even do a gap year before residency to pursue positions (paid or volunteer) where you devote a lot of time to learning about orthopedics and general surgery.

Get Great Letters of Recommendation

You should always ask for letters of recommendation from people who know you well, and not people who are solely well-regarded but know nothing about you. This is why attending conferences and doing research is so beneficial because it introduces you into the world of orthopedic surgery and gives you the opportunity to learn from the best. Additionally, after you’ve spent time with these experienced professionals, you can ask for a letter of recommendation that demonstrates your clinical skills, teamwork and leadership skills, your curiosity and enthusiasm for orthopedic surgery.

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To your success,

Your friends at BeMo

BeMo Academic Consulting

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