Orthopedic Residency Guide Javad Parvizi, Sean E Mazloom
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Editors Sean E Mazloom MD Resident, Department of Orthopedics University Hospitals Case Western Reserve Medical Center Cleveland, Ohio, USA Javad Parvizi MD FRCS Professor, Department of Orthopedic Surgery Jefferson Medical College, Thomas Jefferson University Vice Chairman of Research Rothman Institute Philadelphia, Pennsylvania, USA Foreword James J Purtill MD
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Orthopedic Residency Guide
First Edition: 2014
Printed at:
I want to dedicate this book to my wife and best friend, Golta, for her unconditional and beyond imagination love and support. From the day we met, you have brought true happiness and laughter to my life. You taught me to be free and most importantly you showed me how to appreciate the beauty of small things in life.
I also would like to thank our parents for all the sacrifices they have made for us and to all of those who have taught me how to be a better person.
—Sean E Mazloom
I want to dedicate this book to residents in orthopedics for their devotion, enthusiasm, and perseverance.
— Javad Parvizi
7Contributors 9Foreword
Applying for orthopedic surgery residency training is very compe-titive. There are many more applicants than training spots available. High job satisfaction for orthopedic surgeons, excellent remuneration, high patient treatment success rates, and good quality of life combine as driving forces to keep interest in this specialty keen. Applicants to orthopedic surgery residency are among the very best and most accomplished of graduating American medical students. In addition to outstanding grades, orthopedic surgery residency applicants have shown an escalation of USMLE scores and a proliferation of research.
The process for choosing orthopedic residents is complex. Medical students apply during the fourth year of medical school. Residency programs screen candidates, review some applications in depth, and interview candidates. Letters of recommendation, Dean's letters, and personal statements are read. Medical students often complete subinternship “audition rotations” in orthopedic surgery. Medical students participate in orthopedic research projects. There are occasional faculty phone calls on behalf of candidates, and existing residents are polled for their opinion. What emerges is a picture of the applicant that is employed by residency selection committees to rank candidates.
The depth and breadth of exposure to orthopedic surgery during medical school are varied. Not all medical schools require students to spend time on an orthopedic rotation. Many medical students have little opportunity for participation in orthopedic research. High-profile academic orthopedic surgeons are concentrated in only a few academic centers. Given these issues, some orthopedic surgery applicants may find challenges in producing an application that grabs attention with a robust academic profile.
Orthopedic department oversight from university administrations, the Accreditation Council for Graduate Medical Education (ACGME), the federal government as well as various non-governmental organizations has increased. Restrictions on resident 10work hourshave tightened. Case logs, milestone reporting, and surgical simulation skills training requirements have all been instituted in the last decade. Challenges such as these have increased the complexity of training orthopedic residents but offer the promise of making them better educated and prepared for practice.
Drs Mazloom and Parvizi have produced a book that highlights the important steps in the process from developing an interest in a career in orthopedic surgery to securing a position in orthopedic surgical training. The complete spectrum of issues are addressed and, taken as a whole, this work provides a formula for successful pursuit of this most rewarding medical specialty.
James J Purtill MD
Assistant Professor
Department of Orthopedic Surgery
Jefferson Medical College
Thomas Jefferson University
Rothman Institute
Philadelphia, Pennsylvania, USA
Orthopedic surgery continues to be one of the most sought after and popular surgical disciplines today. There is a multitude of reasons for the popularity of our discipline. Ability to “cure” patients of their condition, continued exciting advancements in the field and growth of the specialty, availability of variety of surgical procedures, dedication of the orthopedic surgeons to their discipline, and the fun loving nature of orthopedic surgeons are some of the reasons why medical school graduates seek orthopedics.
Because of this rising popularity, entry to orthopedic surgery has become very challenging in recent years. The quality of candidates applying to orthopedic has become ever more impressive. This book is written with the intention of outlining the strategies that candidates may employ in their mission to match into orthopedic surgery. The chapters are written by experts who have provided practical suggestions to candidates from all walks of life. We are certain candidates seeking admission to orthopedic surgery will find this book useful.
Sean E Mazloom
Javad Parvizi
I would like to express my sincere gratitude to many great individuals who helped us in writing this book. Without all your support, remarks and comments, we would not be able to have this book today.
Above all, I want to thank my wife, Golta, who has always inspired and encouraged me to achieve my goals in spite of all the time they have taken me away from her. I would also like to thank my entire family for their endless love throughout my life. An honorable mention goes to a great friend and mentor, Cyrus Rasouli, for all his support, guidance and encouragement in the past several years.
I would also like to greatly thank our editor and publisher M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India, for their continuous work and commitment to this project.
Last but not least, words are inadequate in offering my special thanks and gratitude to all the hard working residents and physician-scientists who continue to dedicate their lives to medicine and to caring for others.
Sean E Mazloom
Sean E Mazloom, Javad Parvizi
In the last few decades, orthopedic surgery has emerged to become one of the most exciting, robust, and rewarding fields in medicine. Not surprisingly, it has become one of the most desired and competitive residency programs in America and around the globe. To better understand the competitive nature of this field, we refer to the 2010 National Residency Matching Program (NRMP) report. Based on the results of the 2010 NRMP Orthopedic Surgery Program Directors Survey, programs in orthopedics received 457 applications on average, of which only 54% passed the initial screening and were reviewed in depth, while 46% were simply rejected. Of the remaining pool of applicants, 58 were interviewed for only four available residency positions, on average. In 2013, there were less than 0.7 orthopedic residency positions available for each applicant who listed an orthopedic surgery program as their preferred specialty on the rank list. Furthermore, according to the 2011 NRMP Charting Outcome of the Match, the US medical student seniors who matched into orthopedics had a mean United States Medical Licensing Examination (USMLE) Step 1 score of 240; 27.1% were Alpha Omega Alpha (AOA) members; and most were highly involved in research with a mean of 4.5 abstracts, presentations, and publications. This clearly, but 20not fully, illustrates the level of difficulty for gaining acceptance into an orthopedic residency.
Which factors contribute to the competitiveness of this field and what are the implications for interested candidates? Perhaps, it is only after fully understanding the competitive nature of this field that interested candidates can more realistically approach the challenges and plan accordingly. Several factors account for the exceedingly competitive nature of orthopedic residency programs. Foremost, orthopedic surgery by nature is an exciting, interesting, and robust field in medicine. The world of orthopedics, with its numerous fascinating surgical and nonsurgical approaches to musculoskeletal conditions and deformities, intrigues many people. The recent, increasing trend and engagement in evidence-based medicine and conducting quality basic science and clinical research has brought even more excitement and shone more light onto the science of orthopedics. This has translated into the introduction of novel techniques and instrument designs and more effective management of disorders, with the ultimate goal of improving the quality of patient care. The field of orthopedics has grown out of its infancy and become a giant field in medicine as a result of the exponential number of advancements and discoveries.
Additionally, most orthopedic procedures currently have some of the highest ratings for success and patient satisfaction among all types of surgical operations. This success has been made possible by a combination of excellent outcomes, relatively minimal complications, low morbidity and mortality, and long-lasting results. Besides the low complication rates, the recovery and functionality rates after orthopedic operations are remarkable in most cases. These factors ultimately equate to high patient satisfaction rates and the desire to seek various elective orthopedic procedures. For example, hip and knee arthroplasty operations have 21become two of the most successful and sought-after surgical procedures performed in the US today.
The demand for orthopedic surgeons will continue to rise dramatically in the next two decades, as the baby boomer generation ages. Because of advances in medical technology, we now live far longer than our ancestors did. Inevitably, the notion of longevity fosters the presumption of continued preserved health. However, in reality, medically-achieved longevity exposes our musculoskeletal system to greater wear and tear and a greater need for repair. Today, the elderly engage in a higher and more diverse level of recreational and outdoor activities, further necessitating a more functional and healthy musculoskeletal system. Consequently, the above factors have resulted in a greater demand for both elective and nonelective orthopedic procedures in the elderly population. Patients in their seventh or eighth decades of life more frequently elect to undergo arthroplasty procedures, once a rarity for patients in this age group.
Finally, global urbanization, most often a result of rapid, unplanned growth and global modernization, plays a role in the rising demand for orthopedic surgeons. As a consequence of urbanization, urban populations face greater health hazards than before. As an example, the overcrowding of cities puts people at increased risk of becoming involved in motor-vehicle-related accidents and sustaining injuries that necessitate orthopedic care. Similarly, continued suburbanization growth has been associated with increased poverty and limited access to specialty care such as orthopedics to those in need in many regions.
Despite the increasing demand for orthopedic surgeons, the number of orthopedic residency positions and subsequently, the number of orthopedic surgeons will not increase at nearly the same rate. For example, the number of orthopedic surgery positions in 2010 increased by a mere 6.25% from 5 years ago, while demand for orthopedic 22procedures such as arthroplasty have increased, and will continue to rise, much more drastically in the next two decades. In summary, a combination of supply and demand, and the exciting, rewarding nature of orthopedic surgery accounts for the popularity and competitive nature of this field.
As fields such as orthopedic surgery have become more competitive, residency programs have developed more stringent methods to compare and screen applicants. The USMLE board scores, AOA membership percentile, and research involvement for candidates who are matched into orthopedic surgery programs are the highest among all specialties.
As an interested candidate for orthopedic surgery, you may have many unanswered questions, such as: “What are the most important selection criteria for orthopedic surgery residency programs?”, “Am I competitive enough for this field, and what can I do to make myself more competitive?”, “Do I have a chance if I scored poorly in my USMLE Step 1?”, “How important is the role of research involvement?”, and many others. It is our goal for this book to answer questions you may have about applying for orthopedic surgery residency in the most detailed and comprehensive manner. This book will reveal the truth and secrets to a successful match in orthopedic surgery, which may also be applied to other competitive medical residency programs.
  1. National Resident Matching Program, Data Release and Research Committee: Results of the 2010 NRMP Program Director Survey. National Resident Matching Program, Washington, DC: 2010.
  1. National Resident Matching Program, Data Release and Research Committee: Results and Data. National Resident Matching Program, Washington, DC: 2013.23
  1. National Resident Matching Program, Data Release and Research Committee: Charting Outcomes in the Match. National Resident Matching Program, Washington, DC: 2011.
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