When you start getting down to the last few, it gets really hard to pick those last few. Some are it's about untapped talent, others a great voice, and still others there is something special, the it factor. You may disagree with some of that Randy, Simon, and Paula choices, but they do have experience. They see something. Sometimes I disagree and others I have to agree. They have been choosing contestants for years and know what works.

So many residency applicants and even residents what to know what we use to select candidates. Rumors spread from person to person. There are whispers about USMLE cutoffs, AOA, and clinical grades. "TELL ME WHAT SCORE I NEED TO GET INTO ORTHOPAEDIC SURGERY," they scream. Well I can tell you one thing, I don't know. You may say, "well then what good are you, someone has to know." Well, maybe there are programs that do have cutoffs, but for my program, not so much. What I can tell you is that if you have a below average score, the likelihood of you getting into any competitive residency is less than if you have a high score. That's common sense isn't it. So then what is important? EVERYTHING.

Everything is important. We are interviewing people with names, not 240 or 205. So what about these "people" is important. I personally think there are several things we have to look at an applicant.

USMLE
Ok, yes I said it, the F**K*N USMLE. I think this is one of the things we most look at to help us evaluate how you do relative to you peers nationally. But, that being said, I don't feel it should be done by the strict number. I think it should be used like a blood pressure or cholesterol. There are numbers that are low that may put you on a little medication, but won't kill you; and then there are others that make you start pulling out the defibrillator.

Now, how can you salvage a bad score. It is hard to do, but possible. If you have a bad score, you need to take step II early as possible and rock it. This will show us that maybe your lower score was a fluke. Most people tend to score around the same score each time, within 10 points.

CLINICAL GRADES
I think this is more important as a measure of you abilities as a physician. Now you ask, "what do I need do? What grades do I need to get?" The best grades you can get.

Now clinical grades are more like trying to compare college football teams from different conferences. Some are strong conferences (SEC, Big Ten), and others weak (WAC). So it is difficult to interpret their competition. The assumption is made that the stronger conferences get more "quality wins" than the weaker. But, if you are undefeated, maybe you should go to the championship game. So, regardless of were you are, honors is better than pass. If you are in a very competitive school (proven but the %honors and school), a high pass may be just as good. If you are Boise State, maybe you will have your chance.

The most important honors are those in Surgery and Orthopaedics. I can tell you if you DO NOT honor orthopaedics, we will question your application.

MEDICAL SCHOOL
This is your conference. Presumably, you have stronger competition. So you get points for Doing well in undergrad and getting into a good school.


RESEARCH
Research is something that more academic programs look at to see if you have aptitude to do research. The most important research is published or presented research. I see a lot of applications that have research on the application, but it was a project done over several months in their 3 year of medical school. That appears as a desperate effort to pad your application. So that time is better spent working on another area of your application. Research that stands out is done over time (meaning may be a year or two), started early in medical school, that results in a publication, presentation, or poster. But, if you are interested in research please pursue it.

RECOMMENDATIONS
These tend to be more important in the interview. It helps us to see how others view you. If we know the person writing the letter, it is a plus.

AOA
Varies from school to school and is more tied to clinical grades.

LEADERSHIP POSITIONS
Elected leadership positions in college and medical school are helpful at assessing your personality and ability to be like by others. It doe not say if you are a good or bad leader, just that you may have the aptitude and/or the drive to lead. That says a lot about charisma.

THE OTHER (IT FACTOR)
Do you have it? Well, this is something I can't quantify. It may be you had a previous job, or some special volunteer position. May be a pro athlete or actor. May be you organized a mission to Haiti. It is something that makes you different from everyone else, and it's not because you or a family member have an orthopaedic surgery, or because you played sports, or because you are a team player. It is, hmmm, I i don't know, but i know it when I see IT.

IF WE KNOW YOU
This is easy. A known is ALWAYS better than a unknown. That is why people like to have rotators (from inside or out , because it is like a month long interview. It allows us to see your personality, the good and bad traits, your work ethic, and you knowledge base. It also allow us to see if you fit in with the other residents.

So, those are most of the factors. Not one thing is going to get you into a orthopaedic spot. Not one specific number is going to get you in to a program. But, the better you do in all of the categories, the better chance you have.

ORTHOPAEDIC RESIDENCY: The attending perspective.  A blog specifically for medical students interested in orthopaedics and orthopaedic residents. It is orthopaedic residency from the attending's perspective.