Residency Review Thread 2015-2016

Med School: Texas
Boards: Step 1: mid 240s Step 2: mid 260s (July 4th year)
Rank: Top 5%
AOA: Yes - Junior
Preclinicals: All A's
Clinicals: All Honors
Ortho: All Honors or pass on pass/fail scale
Aways: (Home + 2 aways – one in TX, the other in Northeast at a big name program)
Research: A couple ortho publications, one first author
Extracurriculars: Intramurals, typical volunteering

What I was looking for in a Program (I developed this list after doing my away rotations): Strong early operative experience, emphasis on resident autonomy, good didactics/good OITE performance, research opportunities without research being the major focus, and a level 1 trauma center with a strong trauma emphasis. Also I preferred to live in Texas since its home and my family is here, etc.

How many Programs:
Applied to: 62
Offered Interviews: 14
Attended: 10 (Due to scheduling conflicts) These included a few "top 10" places in the northeast that have been thoroughly reviewed in previous posts. After rotating I knew that I wanted to stay in Texas, so my reviews are of Texas programs in two tiers in alphabetical order:

Tier 1:
Baylor (Houston): A no-nonsense, blue collar residency program with great operative experience that produces strong surgeons. They have great case volume and have cases scheduled throughout the night most nights for the resident on call. Oftentimes the 3rd year residents would do the entire case with minimal supervision (although the attending was around to help if needed and they schedule the cases based on what the resident was comfortable with). Some viewed this as a negative, but it provides great autonomy for the residents. One difference from other blue collar programs on the list is that the operating starts a little later here (3rd) year with more clinic and floor based work the first two years. Baylor utilizes the level 1 county hospital, Ben Taub, which gives them a great number of cases and variety. They emphasized that in a city the size of Houston that there should be many more level 1 trauma centers that the two that are there now. This translates to tons of cases. Didactics seemed good. Residents here were close and very personable. The residents are also good teachers and provided students with the opportunity to do quite a bit in the ED. Research is not a huge emphasis at this program, however, opportunities are available for residents who seek them out. There is not any protected research time here. Overall a blue collar program with great operative experience and resident autonomy. Because of the call set up the autonomy that residents have here is the highest that I encountered on the trail.

John Peter Smith (Fort Worth, TX): This is a work hard, down to earth program that produces outstanding surgeons. Residents here get great early operative experience. Most of the interns had been to the OR and put in IM nails, etc. The R2s do the full case (with supervision from faculty/upper levels) with most procedures. The interns carry the pager here during the day so that the R2s can just focus on operating which was a plus. OITE scores were emphasized here during the interview and the residents do very well (70-90th percentile every year). Research is not emphasized here, although many residents end up publishing multiple papers during their 5 years. Of note they do provide protected research time 3rd year (a few months) where residents have the opportunity to work on as much or little as they want. JPS is a level 1 trauma center with great variety. There are no fellows, plastics residents, or neurosurgery residents to compete for cases. Because of this the residents have a great breadth of experience with common and more complicated cases (e.g. pelvic fractures). The program director and faculty are attuned to resident's concerns and changes are made every year to improve the program. Foot and ankle is probably the biggest subspecialty weakness here. JPS has a podiatry program that shares the foot and ankle cases with orthopaedics. During the interview they addressed this and stated that changes were being made to bolster foot and ankle. Additionally a new medical school is being built in Fort Worth at TCU which they said will add to the research opportunities, funding, etc. Overall a blue collar program with great operative experience, resident autonomy, and resident education. This was the most well-rounded program that I encountered on the trail.

UT San Antonio: This program has a great tradition with names like Rockwood, Green, Wilkins, and Heckman. This program is blue collar and the surgeons coming out of here don't need fellowships. Operative experience is great, with residents getting into the operating room early with good autonomy (especially at the VA). There is also a rotation with a guy who trained in plastics were you get to run your own room as an R1 which was distinctive. Residents here have good didactics run by the upper levels and attendings that prepare them well for OITEs. Research opportunities are available, but not a major emphasis for the program. Of note there is protected research time (4 months total) in the R2 and R4 years that can be used to work on as many projects as the resident wants. UTSA utilizes a variety of hospitals including University Hospital which is a level 1 trauma center. The program director is attentive to the residents’ suggestions and they make changes here to improve the program every year. Biggest weakness is probably pediatrics because they lost a contract with their children's hospital for political reasons, however, this is being addressed and they have recently hired some new pediatric faculty. Overall this is a blue collar program with great trauma, early operative experience, and well-rounded education. This program had the most big names and storied history of all the programs that I interviewed at in Texas.

Tier 2:
UT Southwestern (Dallas): As blue collar as it gets. Still has a few big names and residents here get outstanding operative experience. Interns get to do some cases (especially foot and ankle) and the R2s are doing full cases all year (with supervision from residents/faculty). One drawback was that R2s have to carry the pager sometimes which seemed to pull them away from the OR. OITE scores are not an emphasis here and didactics seemed like a weakness. Research was surprisingly not an emphasis here and takes a lot of effort on the residents part to get publications. Many residents have multiple publications by the time they graduate though. Parkland is a level 1 trauma center where the residents see everything. There is a trauma fellow, but there are so many cases that the residents get a great case load for both bread and butter as well as more complicated cases. They just hired a new chairman so changes are coming to the program. Foot and ankle was probably the biggest weakness of the program, however, this won't be for long as the new chairman is a foot and ankle specialist. The new Parkland Hospital, where the majority of the training occurs, was built last year and is state of the art. Pediatrics is also a big strength here with the affiliation to Texas Scottish Rite Hospital for Children. As far as drawbacks, the culture here was a bit different than at some of the other places I interviewed. The residents are very close and getting into this program is mostly based on what residents think of you (I was told this explicitly by the interim chairman during my interview). This along with meeting a few faculty and residents who seemed pretty arrogant rubbed me the wrong way. I have heard others describe this program as "malignant," although I wouldn't go quite that far. Overall a blue collar program with great trauma and case load. In my tier 2 because of the culture and it didn't seem as well rounded. Lots of operative experience at the expense of didactics, etc.

Houston Methodist: A white collar program that is graduating their first class of residents this year. Residents start operating pretty early and R2s play a large role in the cases. Teaching model is one on one with an attending. Trauma rotation occurs with UT Houston and is strong, just not as long as most of the blue collar programs. Didactics and research are emphasized here and the program director has an impressive research lab with tons of PhDs. The residents have lots of publications and most start research their first year. This was the least structured program that I interviewed at with residents following the schedule of their attending (e.g. if the attending is off, you are off). There is a lot of free time that you can use to operate with other surgeons, do research, or watch Netflix. This was a negative for me although what I saw as a lack of structure the residents there viewed as a great opportunity to pursue research etc. Overall a relatively new white collar program with great research opportunities and one on one teaching model. In my tier 2 because I was looking for a bit more structure and an emphasis on trauma.

Texas Tech (Lubbock): A blue collar/community program where a fellowship is not required. Level 1 trauma center with a good exposure to each specialty. The residents get to operate early and seemed very confident. Didactics were average. Research is not emphasized here; however, they are pushing to do more resident research. One negative for me was that the pediatrics rotation was off site (Fort Worth) and required moving there for 4 months during residency. Some of the residents viewed this as a positive and they do provide a fully furnished apartment for this rotation. Lubbock was surprisingly nice, however not quite nice enough for me to spend 5 years there. Overall a blue collar/community program that provides good operative experience.

NOT RANKED: None

Matched at: #1

Advice for future applicants: With as competitive as things are in orthopaedics, matching into an orthopaedic residency program requires many factors. To get your foot in the door for an interview you have to have good scores, grades, and letters of recommendation. High quality research in any field can go a long way but cannot take the place of these. Get involved in orthopaedics research early with a mentor who publishes frequently and has a track record of working with students. Away rotations are a great way to show a program that you are a good fit, but you have to be on your game since it really is a one month long job interview.

Interviews are offered with a great regional bias. Unless you have an impeccable record, it will be tough to count on any individual programs outside of your med school’s region to provide an interview, unless you rotate there or grew up there. In my experience away rotations do not open up regions for interviews, just a possible interview at that program. This process can seem very random at times and probably is to some extent. Rotate wisely, apply broadly, and hope for the best.

Rank programs thoughtfully. There is a tendency to be focused on rankings like those on Doximity which can give you a good idea of the relative prestige of a program, however, these are mostly based on the power of a program’s research machine and not things like surgical training which really matters and is difficult to quantify. Research is important in getting fellowships and starting a career in academics, but you don’t have to go to a research powerhouse to gain these skills. You just need some personal motivation and a mentor who is willing to guide you through the process and help you to become self-sufficient. Also be aware of programs that provide prestige and research experience at the expense of operative experience (e.g. having to watch fellows and attendings do the majority of cases until late in residency) and autonomy in the OR. No amount of research experience can make up for a lack of technical skills and confidence in the OR (which requires hands on experience and opportunities to be the primary decision maker). If your main goal in life is to publish 50 papers per month you should probably be getting a PhD instead of applying for an ortho residency.

Due to the ACGME requirements pretty much any orthopaedic program can train you to be a competent surgeon. Most programs in the country have produced both leaders in the field and folks you probably wouldn’t want to emulate. Although your residency program is an important stepping stone, ultimately the quality of surgeon/researcher/leader you become is based on you as an individual and not where you train.

Hoping more people can post some of their reviews!

I found this helpful as I was applying last year, so happy to contribute some short reviews from what I remember.
(**Edited to add some information about rotating at these programs. Would have been helpful to know this a year ago)

Med School: Northeast
Boards: Step 1: 259 Step 2: 256 (before applying)
AOA: Yes
Preclinicals: Pass/Fail curriculum
Clinicals: Mix of Honors and High-Pass
Ortho: Honors
Aways: 2 aways in the Southeast
Research: NIH funded research year between MS3-4. About 8 publications, plus a number of abstracts.
Extracurriculars: Nothing special.

What I was looking for in a Program: Nice place to live, well rounded training with busy trauma experience, "resident centered" vs. fellow centered, and happy residents.

How many Programs
Applied to: 33
Offered Interviews: 20
Attended: 12

I was impressed by all the programs I visited, so I'll just say a few brief things about the places I interviewed. Would have been happy anywhere, but some were better fits than others. Alphabetically listed.

Brown - Busy community style program with the mandatory "super chief" year. Nice group of residents who seem to get solid training. I got the impression that you graduate a better surgeon after 6 years, but you also graduate in 6 years... Have to decide whether that's something you want. "Resident centered"
Rotation: Didn't get a good sense for the rotator experience.

CMC - Great private/academic blend with CMC and OrthoCarolina. Operative heavy trauma rotations at CMC with 1-on-1 training at OrthoCarolina on all rotations other than trauma, peds, tumor. Charlotte is very affordable and a nice city. Very happy and friendly group of residents. A program that is very much on the rise when talking to others, if it isn't already there. "Resident centered"
Rotation: 4 each month. About 50% invited back for interviews.

Duke - Do you like second looks? I felt pressured to come back for a mini-rotation in January if I wanted to be seriously considered for their rank list. I was impressed by the competency based curriculum that Dr. Alman is driving, and they put a lot of time into the interview day. Not the busiest trauma experience from what I could gather, with UNC down the road and Duke not having a burn unit. Ship you to Atlanta for 6 months as a 4 for peds (major downside for me). "Resident centered"
Rotation: Not really sure about the rotation. Don't have to do a second look if you rotated, I believe.

Emory - Extremely busy trauma program that is investing in it's research infrastructure. Their young faculty hires are all big on research, and they are trying to tap into Grady as a resource. Lots of single guys. Bad traffic. Didactics are only 2 days a week (one night, one morning). Definitely would come out of here extremely well trained. "Resident centered"
Rotation: Lots of rotators. About 60 total, and they are all interviewed during rotation. Only 30-40 non-rotators are interviewed.

HSS - Very happy residents, in what felt like a pretty cushy program. It's a certain kind of residency experience... Hard to beat the elective volume here for joints and sports, even with the 50+ fellows. Subsidized living walking distance from the hospital. Short white coats until you're a chief. Wasn't the experience I was looking for. "Fellow centered"
Rotation: All on one service. About 100 rotators from what I was told, and ~30-35 are invited back for the interview day. Sounded like a really relaxed rotation, never work on the weekends.

Michigan - Solid mid-west program with well developed research. Happy residents, affordable living. Not the busiest trauma or call experience, because you're in Ann Arbor and don't have a big city population. "Resident centered"
Rotation: Not really sure...

Penn - Beautiful new facilities and aggressive chairman who has been driving the program forward. 2 research residents. Busy trauma and great operative training. Hard working group. "Resident centered"
Rotation: Not really sure...

Rochester - Very well rounded clinical and academic program, with some big NIH dollars going to their msk center for research. Busy trauma experience. Very affordable. Happy residents. "Resident centered"
Rotation: 5 each month. 100% invited back for interviews.

Rush - Similar style of training to HSS. Heavy elective volume and light call. Travel for trauma as a 4, 80 miles away. Very happy residents. "Fellow centered"
Rotation: Lots of rotators, not sure how many. Separate interview day for rotators in early January, so I think everyone is interviewed(?).

Utah - Certainly made their case for best program west of the rockies. Impressive health care system at the U of U, with a beautiful setting in SLC. Extremely happy residents who seem satisfied with the training. Probably the nicest social event of the trail, hosted by Dr. Aoki at his house with all the residents and a few dozen attendings. "Resident centered", with a bit of a fellow presence on some services.
Rotation: Not sure how many each month, but only ~50% invited back for interviews.

Vanderbilt - Impressive place in a fun city. Definitely a busy program and they turn out great surgeons. Residents got along really well and seemed happy. "Resident centered"
Rotation: Around 8 each month. Probably about 1/3 invited back for interviews.

Yale - More bow ties than I saw at any other programs. Not the busiest program, but residents seemed to really enjoy their experience and they have a pretty sweet compensation package (>10k/year more than some other programs). Chairman is stepping down.
Rotation: Not sure.

Matched at: #1

Advice for future applicants:
Be honest with yourself when deciding what you want out of your residency experience. Away rotations are a good chance to see different style programs up close - it's hard to tell from an interview day what the experience at a place is really like. Enjoy the process and trust that it'll work out the way it's meant to.

Anyone else out there want to add some reviews? Pretty quiet forum compared to years of the past. This forum is extremely helpful for future applicants because there are very little resources to help you decide which programs to apply to. If you know someone who recently matched, encourage them to post on here!

Since the time for new ortho interns nears (well new interns around the nation), I was hoping there would be some others who could post their thoughts and reviews so others like me can obtain some info. Anything is appreciated!

Med School: not NIH top 25
Boards: Step 1: 259 Step 2: 262 (July)
Rank: top 25%
AOA: nope
Preclinicals: A's and B's
Clinicals: A's and B's
Ortho: Pass (P/F)
Aways: 2
Research: nothing special. 2 minor ortho projects. 1 non-ortho publication
Extracurriculars: former D1 football player

What I was looking for in a Program: Location (should be important to everyone) and operative experience. For operative experience I valued things like having exposure to a big high volume county hospital and a VA. I wanted a high volume trauma program because I am a firm believer that trauma is where you learn how to operate and get your bread and butter ortho (fracture fixation). Early operative experience as a 2 and autonomy as a chief were big for me as well. I definitely believe chiefs should be walking 2s and 3s through cases and get to run a room on their own. Doing a fellowship should be for marketing purposes, not because I need an extra year of training. Also, the fewer fellows around the better (fellows eat from the same plate).

How many Programs:
Applied to: 72
Offered Interviews: 19
Attended:12

Tiers are stupid. People have different priorities and location preferences. Some people want to build a big academic resume, others just want to operate. Some people want to be around big academic names, others want attendings who are invested in training good surgeons. In no particular order, some of my favorites...

UT Southwestern: blue-collar hard working program. Parkland is one of the busiest trauma centers in the country. The 2nd year residents here get crushed, but they are better for it and get to live a better life as an upper level resident. The absolute strength of the program is the experience on Trauma as a 2 where the expectation is that they are doing the cases skin to skin. Obviously they'll just be assisting the attending on tabs or bad pilons and plateaus, but overall it’s really a great operating experience. The other services are probably more average in their operative experience, but the foundation they get in trauma as a 2 is great to build on. Other perks of the program are a big VA, fantastic Peds experience at Scottish Rite, and an optional 3 month rotation in England as a chief where they function as an attending across the pond. Culturally, super bro-heavy complete with full bench and squat rack in the call room. Very tight knit group that gets pizza together every Monday night and does brunch on Sundays. Academically, they don’t care much about OITE scores and the didactics are much more focused on operative technique than OITE type questions. Also, they didn’t really honor protected didactics time. However, they just hired a new chairman who may bring a more academic focus. Overall, a really solid operative experience with a great trauma experience. Super rotator heavy.

Duke: Overall a well balanced program. More academic than most of the programs I seriously considered, but operating and teaching were still the focus of the program, not research. Trauma volume is adequate but definitely not huge. A more graduated operative experience than the Texas programs, but chiefs were still quite good, especially on joints. The sports and joints rotations are very strong, and they do a great job of not letting fellows get in the way on those rotations. A very good VA experience is probably what sets Duke apart from other programs of similar academic prestige. The volume and autonomy at the VA were great. On peds, I liked seeing a pedi spine 10 level fusion where the attending let the 4 do her entire side without interfering. Sports is very strong with great attendings and great relationship with industry (Friday morning cadaver labs for the junior residents to practice rotator cuff repairs, etc). Culturally, a big focus on teaching, from both residents and attendings. The only downside to this was a little bit of hand-holding for the 1s and 2s seeing consults, but overall very positive environment. Big on tradition which I liked. Academics are fitting of Duke, but I was happy that research was not the focus of the program in the slightest. Residents were a nice group with lots of former college athletes.

UT San Antonio: Criminally underrated program, especially given it’s the home of Rockwood, Green, Morrey, Heckman, Wilkins, DeLee, and Wirth. Big, high volume county hospital with tons of high velocity polytrauma. Residents spend a total of 13 months on trauma over their 5 years, so they basically graduate with a mini trauma fellowship relative to most programs. Operate at night far more than most programs. They have an interesting trauma team set-up, which makes life tough on trauma (q3, even as a 5) but very nice when not on trauma for good balance overall. Strong VA experience as well that provides good bread and butter experience. Have a cool experience as an intern where they spend 2 of their “non-ortho” months doing plastics with a ortho-plastics guy where they function as a chief in the OR and get to do a ton, including nerve repairs, flaps, tendon repairs, skin grafts, etc. Strong shoulder and elbow experience, as you would expect at the House that Rockwood Built. Culturally, blue collar program with down-to-earth, family-oriented residents. Research hasn’t been a big focus, but the chairman and the PD are increasing the resources in that capacity. Academics were fine but nothing special. Several new young faculty members have been hired and seem to be popular with the residents. Overall just a really great program that doesn’t get its due on orthogate.

Campbell Clinic: big-time name with a blue collar atmosphere and good “ortho dudes.” Great trauma and expectations of resident autonomy. 24 on/24 off schedule when you’re at the Med is obviously grueling, but a good mix of private practice on non-trauma rotations. Rotators I talked to were impressed with operative autonomy and surgical skills. All residents and rotators indicated that Dr. Throckmorton is an awesome PD. Biggest negative is the amount of driving between sites.

JPS: super solid program with great operative experience and really happy residents. Chiefs had huge case numbers, and from talking to rotators, those numbers don’t seem inflated with BS. Despite being a trauma heavy Texas program, they had some really impressive OITE scores to brag about too. Dr. Wagner was one of my favorite PD’s I met. Ft Worth is an awesome city and is quite affordable. Overall this is really an underrated program that everybody who interviewed there loved.

Vanderbilt: really solid program top to bottom. Seems to have maintained the “work hard and operate” mentality even though it’s a fancy academic name. Good blend of public, private, and VA experience. Big consult volume with a huge draw area. Only knock I have against them is that they interview very few of their rotators, which just seemed weird. The rotators I did talk to were impressed with the residents operative autonomy and surgical skills though. Also, Nashville is an amazing city, but fairly expensive. Would be an awesome place to be a single guy.

Texas A&M - Scott & White: well-rounded, blue collar Texas program. Not in a big city but the catch area is huge so the trauma volume is on par with most big city programs. Also, Baylor-Scott&White is the largest hospital system in Texas so they have a massive referral base for their private practice stuff. This place and Duke had the faculty who seemed most invested in teaching their residents. Culturally, super tight-knit, family oriented feel. Almost all residents are married and most with kids. Residents all seemed really happy. Seemed to put a huge premium on fit during interview process. Rotators I talked to were impressed with the operative autonomy and surgical skills, with chiefs usually running own room or walking junior through the case. No fellows, which is great. Being in Temple is probably a negative if you're single, but a positive if you're married +/- kids because it's so cheap.

NOT RANKED: None. If you don't rank a program you interview at then I hope you don’t match.

Matched at: a good program

Advice for future applicants:
Take everything you read on here with a big pinch of salt. I don’t think the average poster on here is indicative of the average ortho applicant, and certainly not indicative of the applicants from the South and Texas. It’s really easy to get caught up in “prestigious” names, but I promise you that the name of the program does not produce a better surgeon, and, from what I gathered, often the fancier name has a more delayed operating experience. Talk to every resident, fellow, and young attending you encounter about their experiences as medical students, residents, and fellows. Their thoughts will be a lot more accurate than what you read on here. Ultimately, you’ll be happiest if you make your rank list based on what feels right to you, not based on doximity rankings.