Hey man, Just so you know where I'm coming from- Recently graduated, starting residency in Ortho this summer. The most important advice I think that anyone could give you at this point is for you to first decide how important orthopaedic surgery is to you for a career. If the answer is that you know this is what you want and that you'd only have career satisfaction through ortho, then you should do whatever it takes. If it's just a crush and you'd rather get moving with your life, get out of med school, and start residency, then maybe the path for you to ortho will not be worth it. This decision obviously affects the rest of YOUR life, so you need to do what's right for you. If the answer is that it's ortho or bust for you, read on. After perusing these forums for probably over a year now and thankfully reaching my goal, I believe the best bet to land an ortho residency in your position would be to postpone graduating med school and taking a research year IN ORTHO. This is my initial recommendation based on what the "ortho high ups" at your school said to you, and that personally I'd hate to not match and try re-matching. I'd rather do the "M5" route and attempt matching the first time around with a much stronger application. If you are able to land an official research position within your school, awesome; paid, even better. If not, you can still try to work closely with a faculty member with pull in the ortho world, such as your PD or chairman. Because you have little ortho-related ERAS material (LORs, research, rotation experience) to date, it makes much more sense for you to do an extra year in orthopaedics as opposed to a transitional year in general surgery. You also get the benefits of being a medical student while doing away rotations (malpractice insurance, time-off granted by your research advisor who wants to see you match ortho, etc). If you do gen surg, you will be a busy intern in the gen surg department (sounds awful to most ortho prospects..) and you may not even be granted the time (months) needed to do away rotations to better your chances in the next application cycle. You can also spend your elective time during M4 year doing ortho rotations before the research year even starts. With all of that being said, I do not think it's impossible for you to match ortho THIS year if you are able to obtain some ortho rotations in July, August, and September in time to get LORs. This would require the cooperation of your med school administration to allow you to back out of previously scheduled rotations. Ideally you should try to do the first one at your home institution and then a couple away rotations. I'd look for places that heavily favor rotators, because if you nail your rotation they will probably overlook the other weaker parts of your application. It would also help for you to post a Step 2 score of >245 sometime before the end of September (at the latest). Here is a link to some great advice regarding deciding to do a research year or start residency in transitional gen surg: by ArthroscopicSpine » Sun Jun 02, 2013 4:51 pm The Prelim vs. Research debate goes on every year. If you search through the forums for it you'll find plenty of reasons to do either. I successfully matched after not matching previously with a "non-competitive" application and i fully believe it was because of my research year. My reasons for doing a Research over a Prelim year are outlined in the following post: http://www.orthogate.org/forums/viewtopic.php?f=1&t=6141#p25332 Good luck man. This is a brutal process, but if it truly is ortho or bust you will be happy in the years and decades to come that you stuck with it.