My Residency Reviews

WashU (St. Louis)

Interview Experience
Solid day, and it was memorable for its early start time. Met a resident in the hotel lobby at 5:45AM, then walked over to the hospital for a brief welcome from the chairman (Dr. O'Keefe) and an overview of the program from the PD (Dr. Rick Wright). Dr. Wright was very comprehensive in his presentation and sold the program well. He had slides prepared to answer all of the typical applicant questions (e.g. any changes coming, how are residents/faculty evaluated, resident/fellow dynamic). He used a lot of numbers to quantify the case volume and research output from the program, and mentioned the Doximity rankings multiple times. After the presentation, half of the applicants interviewed, and the other half went on a tour. There were a lot of interviews here, I think 8x20 minutes, with 2-3 interviewers in each room. I had heard there was X-ray interpretation in previous years, but this was not the case for me. Conversational interviews, mostly about my CV, hobbies, and research interests. No ethical, clinical, or weird questions. In the committee room (chairman, PD, chief resident), Dr. Wright did most of the talking, while Dr. O'Keefe occasionally chimed in. It seemed like as far as the residency goes, Dr. Wright is the face of the program. The day finished with an indications conference (applicants watched while 2 attendings and 5 residents went through some hand and joints cases. Was definitely impressed with the level of interactive teaching here), as well as a tour of the hospital and some authentic St. Louis BBQ for lunch. They are taking 8 residents this year (up from 6), and are interviewing quite a few people (3 days, about 30 per day, as well as all rotators during their rotation; so probably about 135 total).

Staff/Faculty/Chairman
In his presentation, Dr. Wright openly addressed the chairman change that happened at the beginning of last year. He said that Dr. Gelberman (the old chair, hand attending) reached the mandatory retirement age for WashU department chairs, so he had to step down, and Dr. O'Keefe (tumor) was hired from Rochester (where he was the former chair). Although he was courted for a number of jobs during his tenure, Dr. Gelberman elected to stay for his entire career, and is now focused on his clinical practice, resident education and research. However, his role in the day-to-day activities of the program is quite limited. I heard that the faculty were very loyal to Dr. Gelberman, but when a new chair was hired, a number of the faculty took jobs elsewhere (spine attendings Lenke, Riew, Lehman to Columbia, shoulder attending Galatz to Mount Sinai as chair, and I think trauma attending Gardner to Stanford as vice chair). Residents said they have been very happy with Dr. O'Keefe's leadership, and the department has hired 10 new faculty over the past two years, including Dr. Gupta, a field leader in spine who was previously at UC Davis. Their faculty is stacked across the board, with 3+ attendings in all fields. Dr. Wright takes all of the resident input very seriously, and with the move to 8 residents next year, they redesigned the entire schedule to give residents longer blocks with exposure to each service as a junior and senior. Dr. Wright also helped implement night float to help the program get into compliance with the 80 hour workweek. Another great thing is that a portion of the attending compensation is tied to their feedback scores from residents, so they actually have incentive to teach instead of purely focusing on efficiency in the OR. Overall, it seems like Dr. Wright runs the show for the residents, and Dr. O'Keefe works more in the background. Dr. Wright is very personable, talkative, and energetic. He reminds me of a smooth talking salesman, with a Midwest accent; if you gave him an opportunity, he could pitch anything. Dr. O'Keefe is a bit quieter, more reserved, and humble, but he is very accomplished and well respected within the ortho community.

Didactics/Teaching
Didactics is spaced out throughout the week. They have an hour of conference on Tuesday, Wednesday, and Thursday, with subspecialty conferences held on Mondays and/or Fridays. There is no dedicated academic day, and the residents said this keeps the didactics interesting and refreshing. Every single didactic activity is attending-led, and is generally interactive, with attendings asking the residents questions and bumping it up class-by-class as they got into the finer details of the case. I thought that the indications conference during interview day was impressive. While they don't teach to the OITE, residents typically perform very well. For each rotation, Dr. Wright had the residents and faculty create 150-200 pages of required reading with the most important textbook and journal articles for that specialty. It is specific to the PGY year as well, so the junior sports and senior sports readings are different to emphasize the basics versus the more advanced topics.

Operating Experience
The residents get a lot of experience in the OR here. All of the services are busy, as they are the major academic medical center in the region. They rotate on trauma during PGY1, PGY2, PGY3 and PGY5. The intern holds the pager for most of the day, seeing consults and putting out fires on the floor, while the other residents are in the OR. On Fridays, the intern and the PGY2 switch spots, so the intern gets 1 day in the OR per week. Their clinical rotations are mainly at Barnes-Jewish (the main hospital), with VA rotations as a PGY3 and PGY5 (10 minutes away), Shriner's for peds as a PGY3 (5 mins away), and a mix of days in Chesterfield (20 mins away) for rotations with primarily outpatient surgeries (hand, sports, F/A). Residents get the chance to see all the services by the end of their PGY3 year, and then do the rotation again during their PGY4 or PGY5 year (including tumor and F/A). They have a dedicated shoulder & elbow rotation in addition to general sports rotation. Some services are 1-on-1 mentorships (hand, F/A, sports, S/E, tumor, spine), with others using a team approach (trauma, peds, VA, recon). Double scrubbing is rare here, except on occasion in trauma, recon, and spine, where the PGY5 or the fellow walks the intern or PGY2 through the case. Most attendings run 2 rooms, with a fellow in 1 room and a resident in the other. The volume is high enough and they have uncovered cases so they were able to add 2 more residents for the upcoming year. I had heard that PGY2 was heavy on the floor work/consults, but was told on interview day that the PGY2 now spends most of their time in the OR, as they have hired a bunch of NP/PA help over the last few years. Residents said that even though Lenke and Riew were big names in spine, their cases were so complex that residents often didn't get to do much with them. With their departure, Dr. Wright has revamped the spine rotation with Dr. Gupta and a junior spine attending, and residents think it is actually better than before.

Clinic Experience
Residents spend 1 or 2 days in clinic depending on the service. Dr. Wright emphasized that he makes sure the residents spend enough time in clinic so they know how to work up and indicate their patients. There is a resident-run clinic once a week for most services, where the fellow is in charge of running the clinic and then staffing the indicated cases. Many services also have private office hours, where the resident typically will usually see the new patients, and then present the plans to the attending. The attendings are a mixed bag in terms of allowing residents to dictate, write notes, and enter billing codes. They have a bunch of different EMR's (one for labs, another for orders, another for clinic notes), which I was told can be a bit of a nuisance to deal with; however, they are transitioning to Epic for everything over the next 2-3 years.

Research Opportunities
Research here is among the best in the country. They are ranked 1 or 2 in NIH funding, and have a number of researchers with R01 grants. They just hired a basic science guy from Duke who has 5 (count that, five) R01 grants to his name. A lot of the research here is basic science, with biomechanics and tissue engineering being most popular. However, with such a large faculty, there are plenty of opportunities to work on clinical and outcomes research. They are collecting patient-reported outcomes for every patient, and will be growing their cost effectiveness and quality of care research moving forward. There are dedicated research blocks during PGY2 and PGY4, and residents are required to submit 1 project for publication by graduation. Many of the residents do more, but they said it is not forced on them by Dr. Wright or any of the faculty. Around half of the residents go into academics. During the interview day, I felt like the faculty had a lot of thoughtful commentary and questions about my research background, much more insightful than the "tell me about this project" that I got on many of my other interviews.

Residents
The majority of the residents are from the Midwest, with a few East Coast transplants. Nobody currently is from the West Coast, but there have been some in the past. They collectively struck me as very professional, mild-mannered, and friendly. Definitely had a Midwest vibe, generally easygoing and less intense than the Northeast personalities I'm used to. A number of churchgoers, which is not surprising for the Midwest. About 70% are married, but the residents made a point to show us that they have a lot of organized events to spend time with each other outside of work. The personality of the typical resident was described by one resident as "a bit nerdy, but in a good way", and I would tend to agree. Definitely not much of a bro feel, with quite a few girls (7 of 30). Everyone was really friendly, and seemed like they were a generally cohesive group. I did not get the stuffy or distant feel among the residents that some Orthogate reviewers have hinted at in years past.

Lifestyle
You will work hard at this program, but they try to keep it within 80 hours. This doesn't happen typically on trauma and joints, but it balances out on rotations with a lot of elective surgery like hand, sports and shoulder. Their trauma service is busy, but not crazy busy like some places (i.e. no OR running 24 hours a day). Joints can have 2 rooms going with 10 to 12 booked cases and operating until 10pm. They had enough uncovered cases that they will be adding 2 more residents for next year, but it is still a little unclear how this will impact the workload for everyone. If anything, it should make it a little easier. They have night float during PGY2 year, which is spaced out in 2-week rotating intervals with research to keep the residents fresh. The pager is busy at night, but not crazy busy, with an average of 10 to 12 consults in the evening/overnight. During the winter, you might even get an hour or two of sleep. There is a separate call pool for the peds hospital that is staffed by the PGY2 and PGY3's on the easier rotations (sports, hand, etc.). Interns help with the consults/floor on trauma (except for January, during surgical skills month), and there are mid-level providers to help with floor scut during the day. Overall, residents said they spend a lot of time in the hospital, but still have some free time to pursue outside interests.

Location/Housing
St. Louis is very inexpensive and accessible. Many of the residents live in the Central West End neighborhood near the hospital, and rent 1-bedroom apartments in new buildings that cost around $1000 per month. Most of the rotations are at the main hospital, with the VA and Chesterfield outpatient offices all within 20 minutes drive. Car is a must for St. Louis, although there is a light rail you can take from the hospital to downtown (for sporting events) or to the airport. Parking is free and plentiful for the residents at the hospital garage. There is stuff to do in St. Louis, including pro sports games, golfing in the park (right outside the hospital), live music, and brewery tours. St. Louis isn't a party town, but I got the sense that the residents were low-key, small-town people who liked the accessibility and easiness of St. Louis.

Limitations
The department is still in a bit of a transition state, and it's unclear how the expansion from 6 to 8 residents will impact the resident experience. More of a focus on basic science research here, which is not my area of interest. St. Louis is far away from family and friends, and is in a remote area of the country, far away from an ocean or major metropolitan area. Furthermore, there is some civil unrest in some of the communities of greater St. Louis. Residents seemed a little bit on the nerdy side, and were mostly from the Midwest. Dr. Yamaguchi, a famous shoulder attending, is not operating much currently due to a shoulder injury, which is obviously a lost learning experience. A car is required, although the sites aren't terribly far apart.

Conclusion
One of the most balanced residency programs in the country. I knew WashU's reputation was top-notch, but left interview day even more impressed than I was expecting. They have a well-rounded surgical experience, great research opportunities, solid didactics, and a distinguished faculty. While there has been some transition, the program is continuing to build, and prides itself on being one of the best. For someone who likes the Midwest or doesn't care about location, this is a definite tier 1 program. However, I didn't love St. Louis, and it will be towards the top of my tier 2 programs.

Rush

Interview Experience
Pre-interview social was held at a local steakhouse. It was a sit down dinner with a phenomenal spread: steaks, chicken and salmon served family style. The residents rotated at the different tables, and there was a good turnout (around 15 to 20 of the 25 residents, apparently everyone who could go attended). The interview day started at 7am with grand rounds, followed by a welcome from Dr. Jacobs (chairman) and a PowerPoint from Dr. Kogan (PD). Faculty then left the room and there was a PowerPoint from one of the chief residents, which included slides addressing common Orthogate rumors (i.e. too many fellows, not enough trauma). Starting at 9am, everyone had 5 interviews of 10 minutes each. Each room had 2 interviewers, with 4 faculty rooms and 1 resident room. The interviews were generally laid back and conversational, although 1 room had you perform a physical task: solving a block puzzle, suturing, or drilling. The interviews were spread out over the entire day (from 9am to 5pm), so there was a lot of waiting around in between interviews, with the time designated to ask residents questions, take a tour, or just speak to other applicants. I think it would have been a lot more efficient to have applicants grouped into 1 hour blocks for interviews, with another group touring, another speaking with residents, another listening to a PowerPoint. Lunch was held from noon to 1pm in the faculty club restaurant, which also had a nice spread. The day was over by 5pm. Overall, a solid experience and I felt like I got a good feel for the residents and the program. They interview 35 non-rotators and around 35 rotators. They typically take 3 rotators and 2 non-rotators. According to some residents, they rank a lot of the non-rotators high in hopes of getting a couple of them, so rotating doesn't wind up helping you that much.

Staff/Faculty/Chairman
Dr. Jacobs (joints) is the chairman, and he has been at Rush since his joints fellowship in the late 80s. He was president of the AAOS a few years ago, and is extremely well connected and well liked in the ortho community. This helps immensely with fellowship placement and politics within the Rush system. The residents said that he travels a lot (to meetings, conferences, and courses), so he isn't that involved in the day-to-day residency activities, but he is very responsive to resident issues and wants to make sure that the attendings are dedicated to teaching the residents. Dr. Kogan (peds) is the PD, and she took over from Dr. Levine (joints) at the beginning of last year. According to the residents, Dr. Levine was a great advocate, but he was frequently embroiled in battles with administrators. The change in leadership has been seen a positive development, as Dr. Levine remains involved with the resident education but has less administrative duties. The resident dynamic with Dr. Kogan was described as being "motherly", and she has focused on improving intern skills workshops, developing a formal mentorship model between junior and senior residents, and meeting with class representatives each month to discuss concerns and ways to improve the program. The program as a whole is very responsive to resident feedback: for example, they pulled residents out of the Cook County PGY4 trauma rotation because it was felt to be overcrowded (with 2 Northwestern seniors and a senior from a DO program). Dr. Jacobs/Kogan also reserve the right to pull coverage from attendings who aren't letting the residents operate enough. As for the rest of the faculty, there is a mix of established names and younger, up-and-coming talents. Aside from Dr. Jacobs and Dr. Rosenberg (both joints), most of the attendings are in their late 30s to mid 50s. Next year, 3 of the subspecialty group presidents will be from Rush. The faculty is in the 30 to 40 range, so not huge, but not small either. The joints, sports, and spine departments are probably the strongest in the program, with hand, tumor and F/A being smaller but still high-volume. They only have 1 dedicated peds attending (Kogan), and residents go to Shriner's for additional peds exposure during the PGY4 year. They don't have an in-house traumatologist either, but there may be one starting next year, and they would create a new rotation with 1 of the senior residents to get them some additional trauma exposure.

Didactics/Teaching
The bulk of the academics are on Monday night. From 5 to 6pm, there are surgical skills labs for interns, with an optional sports conference for the seniors. Then, there are either lectures or anatomy labs (with hardware to perform relevant fracture repairs) from 6 to 8pm. The lectures are led by a resident and moderated by an attending. On Wednesday morning from 7 to 8am, there are department grand rounds, typically with a faculty speaker. Thursday morning from 6:30 to 7am, there is a short lecture that rotates between tumor faculty, peds faculty, and trauma residents. Friday morning from 6:30 to 7am, there is a service specific conference. Overall, the residents said they feel they get adequate book learning, and they typically perform well on the OITE, although there is no dedicated OITE prep here.

Operating Experience
This is clearly a selling point of the program. Rush (aka Midwest) orthopaedics is a privademic program, and the operative experience is structured as a mentorship model, with residents from each year spending a given number of weeks on that attending's service. They have a high-volume practice, so despite the large number of fellows on sports, joints, and spine, double scrubbing is rare. The only times it typically happens are with PGY1's and PGY2's with spine or joints fellows or with a senior on trauma at Cook County. Junior residents felt that the fellows actually enhance the learning experience, because they let you do the approach and some of the easier parts of the case, without the pressure of having the attending in the room. For hand and F/A, there is only 1 fellow, so you barely even interact with them. The attendings almost always run 2 rooms, with one room for the fellow and the other for the resident. Most of the time, the resident room is bread and butter cases for that subspecialty (primary total joint, knee scope, ACL, carpal tunnel, etc.), but if the senior is interested in that field they can negotiate with the fellow on more interesting cases. The residents said that the responsibility is graduated, as in the attendings won't let you use the saw/drill until you can properly place the retractors, or harvest the ACL graft until you have mastered the diagnostic knee scope; however, they said they feel like they get good autonomy in the OR, and rarely feel that they are watching the attending work. If the attending is not letting the resident do enough, they can speak with the PD and resident coverage for that attending can be pulled, since cases at Rush still go uncovered and are staffed by surgical PA's. There are some additional rotation sites, including ortho trauma at Rockford for 10 weeks each during PGY4 and PGY5 (1.5 hours drive away, live in on-site apartment), peds at Shriners for 10 weeks as PGY4 (20 minutes away), and ortho trauma at Cook County for 2 months as PGY1 and 10 weeks as PGY2 (10 minute walk from Rush). Despite the distance, the Rockford rotation is among the highest regarded experiences by the Rush residents. You basically show up and operate for 6 to 10 hours a day, every day, with focus on trauma, but opportunities to scrub on subspecialty cases of your choosing. I didn't hear much about Shriner's, but it is a renowned peds hospital with lots of complex deformity and CP cases. Cook County is mostly floor/consults as PGY1, with PGY2 spending some time in the OR. It can get crowded with all the residents at County, but there are still ample opportunities to get in reps on the junior-level cases like hip fx, distal radius, tibial nail, ankle fx. However, the trauma here is fairly back-loaded as a whole, with the operative-heavy Rockford rotations coming as a senior. One nice thing about the rotation schedule is that you get to work on each rotation as a junior and senior, with different mentors each time, giving you sufficient exposure to make a fellowship choice and master the basics of that field.

Clinic Experience
Typically 2 days in clinic and 3 days in the OR, with some exceptions (peds and spine have 3 clinic days). The clinics are all private patients, but the residents said they nearly always get to see the patients and come up with their own diagnosis and management plan. There is resident-run clinic at Cook County for the few months you're there as a junior, but there is currently no resident-run Rush clinic. They have discussed the idea of a general ortho resident-run clinic, but there are some issues with faculty staffing and liability, so it isn't happening anytime soon. The facilities are fantastic, and the clinics are run efficiently. Usually you get to dictate notes, although this can be attending-dependent. Often there is free lunch courtesy of the attendings. They use Epic in the main Rush hospital, but a different EMR for the private clinic. You can't access it the clinic EMR remotely, making ER consults during home call a nuisance patients of the private clinic.

Research Opportunities
This is a huge strength of the program. During the morning PowerPoint, they flashed a slide that residents have more than 500 cumulative publications. Many of the faculty have dedicated medical students and research staff, and there are a ton of national and institutional datasets to perform clinical outcomes research. Clinic patients complete outcome questionnaires at every follow-up visit, so there is a ton of data at your fingertips if you have an idea. There are a few attendings working on cost-effectiveness and quality projects (Dr. Singh, a spine attending is quite involved), and given their privademic model, that sort of research is becoming more relevant to the program. They have 9 PhD basic science researchers, although I'm not particularly interested in this area of research, but it is there if you want it. The sports fellows are required to publish 12 articles each during their 1-year fellowship, so if you are interested in sports and are willing to help them, you can get your name on a ton of projects over the course of residency. Joints and spine are also very active in the publication arena. There is also a 10-week dedicated research block during PGY3 year that you can use to work on projects. You get full support to present at national meetings (AAOS or the major subspecialty group meetings).

Residents
They have 5 per year, so 25 total. The residents seemed like a fun and cohesive group. Very down-to-earth, joked with each other, and it looked like they all got along. There is definitely a lot of intra-class cohesion, with a little bit less inter-class interaction, but this wasn't absolute by any means. This is partly due to the setup of the program, since the mentorship model has you typically on your own for most of the week. However, the program does have some aspects of team-based work, since each service has a junior and a senior (who work together on conferences, rounds, etc.). The program was described as "bro-friendly", with quite a few hard-working, hard-playing bros in the junior classes. I heard that the current seniors have a different vibe, and are a little more nerdy, but that they still get along well with everyone. Many of the residents have Midwest ties, but not everyone. About 80% are in a long-term relationship, and about 50% are married, but most the married residents still find time to hang out with each other. Fellowship matches are fantastic every year, at big name places, with sports being most popular. Everyone does a fellowship, but it is about a 50/50 split for academics and community ortho; some residents opt not to do much research, and plunge straight into private practice after their fellowship.

Lifestyle
This is a lifestyle-friendly program aside from the PGY2 year. As a PGY2, there is q4 home call with no post-call days, so you will be tired and overworked all year. Cook County as a PGY2 has night float calls as well. As a PGY3, you take a single Friday call every 5 weeks. Then backup call for operative cases as PGY4 and 5. However, since Rush is a Level 2 trauma center, it is rare to have cases go in the middle of the night. Mostly, for the resident holding the pager, it is returning pages on floor patients and seeing some low-energy trauma consults (ankle fx, hand/foot pus, distal radius fx). However, when you aren't on call, the hours are fantastic. The day rarely goes longer than 5am to 5pm, and many times is done by 2 or 3pm. This is one of the advantages of the privademic model, since they are interested in efficiency and have quick turnover time (15 minutes on average). This gives you the opportunities to scrub on plenty of operative cases, but have time to go home to exercise, work on research, hang with family, make dinner, read for cases, etc. There isn't a ton of driving for this program, although living in Rockford for 4 months as a senior is a negative. However, it's only 1.5 hours from Chicago, so you can come back to the city for the weekends because Rockford has PA's to cover the call pager. This program also has a ton of perks: you get $5000 to spend as you please during residency, and that is in addition to lead and loupes. There's meal money while you're on call, and they give you an additional $1000 travel stipend to academic conferences that you don't even present at. Parking is free at all hospital sites. Overall, a very cushy program, and residents said that the perks make their day-to-day that much more enjoyable.

Location/Housing
Chicago is a very solid location. It has all the amenities and attractions of a large city, including tons of bars and restaurants, a good public transportation system, accessible airports, a good sports culture, and a beach/boating scene at Lake Michigan. There are a lot of different neighborhoods to live in, with rental prices much cheaper than NYC, typically mid 1000’s for a nice 1 bedroom in an older building in a nice neighborhood. Everyone in Chicago has a car, and with early hours at the hospitals, ancillary sites (Shriner's, and there is also a private clinic 20 minutes from Rush), and the fact that the area around Rush isn't super residential, you can’t survive on public transit. However, parking is free at the Rush sites, and traffic isn't that bad outside of downtown. The winters can be brutally cold and windy in Chicago, but there isn't a ton of snow. The residents definitely take advantage of the city's offerings, especially with their favorable call schedules, and they cited the city as one of the biggest attractions of the program. This is also a good spot to mention the AAOS headquarters, which is located in Rosemont, Illinois, about 45 minutes outside of the city. They frequently have courses for residents and attendings, and you can volunteer to help with a course and sit in on all of the lectures and observe the labs. Definitely an underrated perk of the Chicago-area residency programs.

Limitations
This program is relatively light on the trauma and general orthopaedics rotations, with the majority of the trauma operative experience back loaded into the PGY4-5 years. I spoke with some senior residents about this, they all said they felt comfortable with the amount of trauma they see, and feel comfortable taking primary call. However, I think there is something to be said for getting trauma reps in as a younger resident, as this is where you get a lot of autonomy and can master the fundamental techniques of orthopaedics (using a drill, plating, making cuts) that you can apply to other subspecialties. As a corollary to that, Rush doesn't give you a blue-collar experience, where you are left to grind a little bit and get comfortable when shit hits the fan. Furthermore, some rotators said that on days where cases were running behind schedule, the attending just did the entire case, and the resident was watching. PGY2 year is hard everywhere, but it seems fairly brutal here, and the lack of post-call days is definitely a negative. The home call system at Rush is tough, since you will be up most of the night answering floor pages and seeing consults without a post-call day. Chicago is a relatively desirable location, but it is far away from my family and friends, and the winters are tough. Resident-led lectures are a negative, as attending-led would be better, especially with so many field leaders in the department. They also have a fairly weak peds experience at Rush, and going to Shriner's isn't great either because the cases are so complex. It would be nice to have more bread and butter peds exposure. There isn't a ton of driving here, but there is some, and living in Rockford as a senior resident kind of sucks.

Conclusion
This program sits in the academic sweet spot. Renowned field leaders, a diverse subspecialty operative experience, and high volume so that fellow encroachment is quite limited. For the "no trauma" reputation that Rush sometimes gets in the rumor mill, there seems to be a good amount of trauma exposure (8 weeks PGY1, 10 weeks PGY2, 10 weeks PGY4, 10 weeks PGY5), and they may eventually be adding another trauma block at Rush with an incoming faculty member. The research opportunities are abundant, and the favorable lifestyle and work hours permits the residents to work on plenty of projects. The fellowship match list is great. Chicago is a fun city to live and work in, and is affordable on a resident's salary. I got a good vibe from the residents, and felt like I would definitely fit in. Lots of perks makes life enjoyable, the call schedule from PGY2 aside. I was really impressed here, and I think it is in the conversation for one of the best programs in the country. It will be tier 1 for me.

Albert Einstein-Montefiore

Interview Experience
The social was held at a bar in Manhattan the night before. It was really loud, and the resident turnout was so-so, maybe 5 or 6 residents total for ~30 applicants. Many of the residents were talking with each other, and didn't make as much of an effort to speak with the applicants as I would have liked. They got a couple games of flip cup going later on in the evening, which was fun, but a little less professional than I was accustomed to seeing at the other socials. The applicants were split into morning and afternoon sessions. It is a relatively short day, with the morning session running from 6:45-10:30am. I know some people who did the morning session at Einstein and the afternoon session at Mount Sinai, or visa versa. The day started with some breakfast (the bagels were actually good for a change) and a welcome by Dr. Cobelli (chairman) and a "why Montefiore" PowerPoint by Dr. Levy (PD). The interviews themselves were 4 rooms by 10 minutes, with 2 interviewers per room, with 6 faculty and 2 chiefs among the interviewers. The questions were a mix of the generic "tell me about yourself" and "tell me about your research", but also some more serious questions like "why would you come here?" and "why should we take you?". None of the interviews ever felt uncomfortable, but the questions were a bit pointed at times, and there wasn't much small talk. After the interviews, there was a chance to speak with a group of 5 residents about the program, followed by a tour of their new outpatient center. That was it, short and sweet.

Staff/Faculty/Chairman
Dr. Cobelli (joints) is the chairman. He is relatively hands off in the residency, but has played a big role in the growth of the department, including the development of a joint replacement center, a new outpatient ambulatory surgery center, and hiring of new faculty. Dr. Levy (sports) is the PD, and he is an eccentric guy. He wears thick pink-rimmed glasses and went on some short, albeit amusing and informational, tangents during his presentation. According to the residents, he is very open to resident feedback and meets with the chiefs every two weeks to go over the concerns from all class levels at the various sites. During the interview, he talked about how he wants to structure the program’s leadership like the military, where he gets a steady stream of real-time info from his senior residents (aka his “boots on the ground”). The residents said that he makes as many improvements as he can within reason, as the hospital system is still limited in terms of staffing, funding, and system-wide inefficiencies. The entire faculty is spread across 3 main campuses, all within a 10-minute drive of each other. There are about 35 faculty members, with approximately 10 joints, 4 hand, 5 sports, 4 peds, 3 tumor, 2 spine, 1 F/A, and the rest trauma/general at Jacobi (the Bronx city/county hospital). They recently hired Dr. Otsuka from NYU as their peds chief, and they also hired a junior spine attending to replace 2 of the senior spine surgeons they lost last year (who went to NYMC and LIJ). The faculty is generally interested in teaching, but at the same time give the residents a lot autonomy to run the orthopaedic services at each respective hospital.

Didactics/Teaching
They have formal didactics once per week on Friday afternoon (I think). The lectures are completely resident-led, and attendings occasionally show up. They have grand rounds once per week in the morning as well. The residents are often busy with clinical responsibilities and don't always make it to didactics. They have had some scattered poor performances on the OITE and ABOS board exam failures over the last few years, which were said to be related more to the residents themselves than the education in the program. The didactics have been improving over the last few years, and one of the PGY4's is already working on changes for next year's curriculum. They have a surgical skills lab that is tool-based (instead of anatomy-based), and the juniors say this has helped them get comfortable with drills, saws, etc.

Operating Experience
This is a blue-collar program, and you will come out of here knowing how to operate. The interns spend most of their ortho blocks taking care of floor work, and the PGY2's split time fairly evenly between operating and taking consults. However, from PGY3 through 5, the residents are operating all the time. Jacobi is mostly trauma with some general orthopaedics sprinkled in, and it is a rotation for 2 months in PGY1, 2 months in PGY2, 4 months each in PGY3 or 4, and 2 months in PGY5. They typically have 2 trauma rooms running, with the 5 in one room and the 3/4 in the other. There is a focus on resident autonomy here, and if the resident is comfortable with the case, the attending will let them go skin to skin. The interns spend 2 months each on ortho at the Weiler (mostly consults and general ortho stuff) and Moses (joints and general ortho), with PGY2's spending 2 months at Moses on general and 2 months at Moses on joints. The PGY3/4 structure is a single 24-month cycle, with 4 months on peds, 4 months sports (combined with research), 2 months tumor, 2 months F/A, 2 months Weiler joints, 2 months spine, 2 months peds/spine, and 2 months hand, in addition to the 4 months at Jacobi trauma. PGY5 is 2 months sports/joints combined, 4 months on general at Weiler, 2 months on general at Moses, and 2 months on peds, in addition to the 2 months at Jacobi trauma. The joints experience here is excellent, with peds very busy as well. Spine is a little bit slow with the loss of faculty, but it should be picking up in the next year or two with new hires. There are only 2 fellows here (1 joints and 1 peds), so the seniors are almost never double scrubbed, although PGY2's and an occasional PGY3 can be double scrubbed with a senior on big trauma or joints cases. The opening of the new ambulatory surgery center has helped with room turnover (10 minutes), and leads to higher daily case volume than the old community hospital setup for elective cases. The joints center at Moses is also much more efficient, and a few of the attendings (but not all of them) will run 2 rooms and slam in 6 to 8 joints a day. A few of the rotators I spoke with said that the technical skills of the Einstein seniors were among the best they saw during their ortho experiences, and they are very well-trained with bread and butter orthopaedics.

Clinic Experience
Residents typically spend only 0.5 to 1 day per week in clinic, with some of the usual exceptions (peds, spine). At Jacobi, the clinic is entirely resident-run, and is usually 2 to 3 days per week for the juniors and 1 to 2 days for the seniors. Even as a junior in clinic, you are making your own diagnoses and management plans, and then presenting complex or operative cases to the senior residents (attending is available by phone if you need him). The subspecialty clinics with the private patients are still characterized by a lot of autonomy, although you will present these patients to the attendings directly. Some private clinics go uncovered by residents because they are needed in the OR/floor, so PA/NP's help cover those clinics.

Research Opportunities
The research is "there if you want it", as one resident put it. You are required to present a research idea during your PGY3 year, and then use the research block and PGY4 year to get a publication submitted by your PGY5 year. Most of the residents don't do any more research than the minimum requirement, although they have an occasional resident who will pump out a bunch of publications and podiums. They recently hired 2 research coordinators to help grow the research branch of the department, and there are medical students from Einstein who are interested in getting involved, but overall if you want to do research here you have to drive your own projects from start to finish. There are limited resources for your utilization, most notably funding, staff and sources of data. The extensive time commitments to providing clinical care, especially as a junior resident, make it hard to find time to work on meaningful research projects. Dr. Otsuka, who was recently hired from NYU, is trying to increase the research culture, but it likely will be a slow process over the next few years.

Residents
The residents were a fairly close-knit group. The culture has changed over the past few years, from a hierarchical environment where the seniors rode the juniors hard, to a much friendlier, collegial atmosphere. The residents joked a lot with each other, and busted each other’s balls like typical New Yorkers do. The Bronx can be a grueling place to work, with a difficult hospital system and patient population to navigate, so you will be battle-hardened, but I didn't sense that the residents were jaded or had lost faith in what they were doing. In fact, it seemed like quite the opposite. They said that they all work hard, but at the end of the day, they feel good about the difference they are able to make in the community. Nearly all of the residents do a fellowship and go into private practice, with sports and joints being the most popular. Many of the senior residents are married and some have kids, but they try to find time to hang out outside of work. Many have NY area ties and will hang out with their med school or college friends or their family. A mix of personalities, with some nerds, some girly girls, a couple bros, and a lot of regular guys. The program has around 25% women.

Lifestyle
You work hard in this program. The residents are vital to the daily functioning of both Jacobi and Montefiore, as these hospitals are understaffed and inefficient. As an intern and a PGY2, you will regularly work over 80 hours. It is very tiring, but you learn a lot and provide needed care to the community. You spend 2 months on the Jacobi night float system as a PGY2, and they recently eliminated night float for covering the Moses floor and Weiler ER, in favor of q4/5 call system for PGY2's with post-call days. The intern takes noon to midnight call once per week, with PGY3's and 4's on backup home call. PGY5 is only for operative emergencies, and they rarely ever have to come in. The lifestyle for PGY3 to PGY5 is generally pretty good, especially on the ambulatory services like sports and hand.

Location/Housing
The hospital sites are spread across 3 sites in the Bronx, which are about 10 minutes apart from each other. The public transportation in this area of town is spotty, so every resident in the program has a car. Many of the junior residents live in the hospital housing, which is cheap, only $700 per month for a 1 bedroom. Other residents live in nicer areas of the Bronx for low $1000's in rent, while many of the seniors live in the Upper East and Upper West sides of Manhattan (usually 20 minute drive to the hospital, low $2000's for rent). If you are willing to spend (and commute), you can live pretty much anywhere in NYC. However, given the long hours and lower salary for juniors (no housing stipend like some of the Manhattan programs), it typically doesn't happen until the senior years. There is tons of food and culture throughout NYC, and within the Bronx, there is the zoo, botanical gardens, Yankee stadium, and Arthur Avenue (Little Italy of the Bronx, great food).

Limitations
There is a lot of floor work for junior residents, a lot of which is scut like social work and discharges, patient transport, drawing labs, etc. The operative experience in the junior years is less than other programs, and the occasional double scrubbing for juniors is suboptimal. Jacobi is a difficult place to work, with minimal ancillary staff and tons of inefficiencies. Resident-led lectures are a big minus, compounded by the fact that residents often don't even get to go to lecture. The lack of interest and resources for research would make it fairly difficult to launch a successful academic career from here. Furthermore, there is a ton of general ortho and trauma, with only 1 experience on each subspecialty. You can typically work out your schedule to have your target fellowship rotation during the 3rd year, but this may not always happen if the field is popular among your co-residents (like sports or joints). Work hours are brutal for juniors, with little time to pursue research or extracurricular interests. Even though clinic sucks, I would like more than 1 day per week, especially as a senior, and I would like more attending supervision to make sure I am indicating the right cases. The Bronx has some nice areas, and you can live in Manhattan, but the requirement for a car and the cost of living in NYC are definitely negatives. I also thought the residents were nice, but didn't get as much of a "bro-friendly" feel as I was hoping for.

Conclusion
A blue-collar community-type program in NYC. You will be a skilled technician in taking trauma call and will be well versed in the bread and butter of joints, sports, hand and peds. There are a number of limitations for this program, but they are reasonable trade-offs for the strong clinical experience and the location. Furthermore, the trauma, joints and tumor experiences are strong compared to many programs nationally. You need to be independent and tenacious to thrive in this program, and it will push you outside of your comfort zone. This may be a tier 3 for some people, but it is on lower end of my tier 2 spectrum because of location.

Mount Sinai

Interview Experience
Social the night before was held in a private room at a bar on the Upper East Side. Great resident turnout and there were abundant appetizers to eat. Wasn't too loud and I got an opportunity to talk with a number of residents from different classes. The interview day was split into two separate groups, AM and PM. They interview 50 applicants for 4 spots, and they do not interview many rotators. That said, their intern class had 4/4 rotate, with the PGY2 and PGY3 classes having 2/4 rotators each. The day started with a brief welcome from Dr. Galatz (their new chair) and Dr. Parsons (PD). There was a 30-minute presentation by the chief resident on the program, followed by 6x10-minute interviews with multiple faculty in each room. On the interview schedule, the rooms were labeled as themed (clinical, ethical, general), but there were almost no knowledge or ethical questions at all. The interviews were mostly about my application, my letters, and what I was looking for in a program. There was a bioskills room, which involved a styrofoam ball, a K-wire, and a mini C-arm. The interviewers in that room asked everyone to talk about what they were thinking as they worked through the task. From my conversations with other applicants, I think performance was a mixed bag during my day. Many of the current residents said that they failed during their interview days, so I think that the problem solving and reasoning are most important. Furthermore, when you consider that it was one room out of 6, mediocre performance in bioskills is only worth a minor component of your overall interview score. After interviews, there was a brief tour, and the entire day ended up lasting for about 4 hours.

Staff/Faculty/Chairman
Dr. Galatz (shoulder/elbow) is the new chair. She came from WashU in St. Louis and just started in September. The residents said that she is very visible in the program and has made an effort to get to know all the residents. Residents described her at somewhat "motherly" in her approach to the residency, but also said she has business-savvy vibes and projects an image of a corporate CEO. This is in contrast to the prior chair, Dr. Flatow (shoulder/elbow attending, who runs the entire St. Luke's hospital), who was not that involved in resident education. The administrative duties of the program are handled by the chief resident (1 of the PGY5’s), and in many regards this resident is the de facto PD, running the day-to-day activities of the residency program. He meets with Dr. Galatz and the PD Dr. Parsons (also shoulder/elbow) at least once weekly to air concerns about the program. Dr. Parsons himself was a resident of the program, and has been on faculty for 10 years. He is intricately involved with the didactics, and gives lectures himself at least once per week. He is a big believer in pimping as a form of teaching, and while he sets high expectations for his residents, he was noted to be approachable and friendly. The big news on this interview was that Mount Sinai recently acquired St. Luke's/Roosevelt Hospital, and created the Mount Sinai Hospital Network. After next year, the St. Luke's ortho residency (3 residents per year) will be merged into the Mount Sinai residency (currently 4 residents per year) into a 7 resident per year program under the Mount Sinai name. This also means that the faculty will be combined, with certain services being integrated at 1 clinical site (except for joints, which will be at both sites). The Sinai faculty is strongest in hand and spine, and with the merger, shoulder and elbow will be expanded to the point that it will get its own rotation. Hand at St. Luke's is also really strong (with the renowned CV Starr fellowship), and the hand experience figures to get even better for the residents at Sinai. The joints experience is robust here as well, as it is at most Manhattan programs. They have 1 F/A attending and 1 tumor attending currently, although they both have high-volume practices. Dr. Galatz said she plans to hire 15-20 additional faculty over the next 5 years, and wants to add a mix of established names and young up-and-comers.

Didactics/Teaching
There are didactics every day, with 1 hour of attending-led lecture on Mon/Tues/Thur/Fri and 2 hours on Wed (resident-led fracture conference followed by grand rounds). Interns also have 3 additional hours of interactive lecture with the chief resident with assigned reading for each topic. Following Dr. Parsons' style, there is a lot of pimping in every lecture, from attending-to-resident and senior-to-junior resident. I had heard rumors from rotators that the pimping was extremely aggressive, and that they were scared shitless during their rotations. However, according to the residents, although the pimping was borderline malignant a few years ago, it was toned down a lot and now is utilized as a teaching style to make sure the residents are keeping up with their reading and building their knowledge base. Junior residents said that at no point have they felt uncomfortable, and that they are driven to read because they don't want to look bad in front of the other residents and their attendings. It is a reasonable expectation, since this residency is lifestyle-friendly and there is ample time to read for lectures and cases. The anatomy labs in the summer are also another source for pimping, and here the expectations are very high for knowledge, and you may get an earful if you don't know your approaches cold. With all of the focus on didactics, the residents perform well on the OITE as well as their boards. They have around 30 PA's to cover clinical responsibilities and their academic time is protected, so they never miss it. As a PGY2, it can be hard to read when you’re on some of the busy services, and you will inevitably have a few poor pimping performances, but overall the didactics are a definite strength of this program.

Operating Experience
As alluded to earlier, they have a ton of PA help with the floor, and the majority of time is spent in the OR, even as a PGY2. The rotations are service-based, but there are typically only 2 residents on the service, so it functions basically as a mentorship model, where you work with a few attendings for each rotation. You rotate on each service as a junior and senior resident, although the sites and order of these rotations will be changing with the residency merger in two years (when I would be a PGY2). Because of the high faculty to resident ratio, residents are almost never double scrubbed, and PA's are assigned to cover cases that residents can't cover. They have a few spine fellows, but there are 10 spine attendings, with more than enough volume to go around. Many of the other services have 1-2 fellows, but there is enough volume that double scrubbing with fellows isn't common. The trauma experience is at Elmhurst Hospital, which is the county/city hospital in Queens and is a Level 1 trauma center. You rotate there as an intern, PGY2 and PGY3, with the PGY3 acting as the chief of the service. The other Sinai surgical residents (ie gen surg, vascular, plastics) do an Elmhurst ortho rotation, so as an intern you act as the “chief” intern and see the ER consults while they help with floor work. The PGY2's and PGY3's spend their time in the OR with the 2 Sinai trauma fellows. They have a q4 24-hour call system (2 residents, 2 fellows) with 3 residents splitting up the OR and 1 being post call. During PGY4, there is also a trauma rotation at Westchester Hospital, where you spend the entire day in the OR on complex polytrauma cases. With the merger, they will also go to Memorial Sloan Kettering as a PGY3 (or PGY4, cant remember) for tumor, with another tumor rotation at Sinai as a PGY2 (or PGY3?). They will also go to DuPont Hospital in Wilmington, Delaware for the complex peds experience as a PGY4, with another Sinai peds rotation as a junior. Overall, the operative experience here seems good and generally hands-on, although it can be attending-dependent (but this is typically the case everywhere).

Clinic Experience
There is typically 1.5 days in clinic per week, with private office hours for your subspecialty service on Wednesday after lectures, and an entirely resident-led clinic on Tuesday afternoon. This clinic is very unique, in that you keep your patients over time. If you see an ER consult as a PGY2, you can have the patient to follow-up in your personal clinic. Many of the new patient referrals for Medicaid are sent here, and specific subspecialty complaints are typically sent to the resident on that service (i.e., hand issue is referred to the junior on hand). You then book your own clinic patients, and choose an attending to do the case with. Clinic operative cases take priority over your subspecialty rotation, and they will get PA's to cover your rotation cases while you take care of the clinic case. Residents also refer patients between each other – for example, if a patient has a complex hand issue, you can send it to the senior resident that is planning to go into hand. Overall, it is a very unique experience. All of the clinic rooms have EMR (I think Epic, but didn't ask), and the clinic is relatively efficient. You are given a lot of autonomy in coming up with your diagnosis and plan, and usually get to write the notes and enter billing codes.

Research Opportunities
There are a lot of opportunities for research here, although resident interest and commitment can vary. The residents collectively were authors on ~70 papers last year. Podium presentations are fully funded by the department, and you don't have to take vacation to attend and present (due to PA coverage). There is 1 dedicated PhD basic science researcher, and 1 of the chief residents also has an NIH grant and runs his own basic science lab. Most of the research is clinical outcomes stuff, and there is a spine attending who specializes in cost effectiveness research. A number of residents have worked with him and then apply their acquired skills to the subspecialty they are most interested in. The lifestyle here is good, so you have ample time to work on research projects if you want. There is a dedicated research block during PGY3, and you are required to have 1 publishable project by graduation. However, many residents do more, and their chief resident (the one with the NIH grant) has put out ~40 of his own papers during residency. Their spine and hand groups are the most active in terms of research productivity, with a few highly-published shoulder/elbow attendings as well (Galatz, Flatow). They have some departmental research staff to help with stats and IRB's.

Residents
With 4 per year (the PGY4 and PGY5 classes have 3 residents), they are a tight-knit group. After morning rounds, they have breakfast (might I mention it’s free) and then they attend lectures, so they wind up spending a lot of time with each other. Contrary to many other programs, it actually seems like there was a lot of camaraderie across the different classes, maybe since the program is among the smaller ones I interviewed at. They have quite a few girls and a few bros, with some other personality types scattered in. Most of them had ties or reasons to be in NYC, and they were energetic, fun city folk that enjoy the hustle and bustle of the city. However, the lifestyle is good here, and they said they all value their lives outside of medicine. The majority of the residents are in serious relationships, and the program is good about giving time off for family-related and personal issues. Many of the residents go into private practice, although there are plenty of opportunities to get into academics if you desire. The seniors said they have no problems getting into the fellowships of their choice.

Lifestyle
As mentioned previously, there is a ton of PA help here, and the program is very lifestyle-friendly. The PA's cover the floor during the day take primary call for the overnight consults at Sinai (a Level 2 trauma center), so as a PGY2 and PGY3 at Sinai you are taking q5-6 home call. The PGY2's take q3/4 24-hour call on Saturdays (the only night with no PA on call), and the PGY3's take 12-hour Sunday day call. At Elmhurst, there is no call for the interns, with 24-hour rotating q4 call with post-call days for the PGY2, PGY3 and the 2 fellows. The PGY4 and PGY5's take a week straight of backup call, but this is for operative emergencies, and they almost never come in. The juniors on home call get a post-call day if they have to go into the hospital after 1am, and apparently this only happens 3 to 5 times during the entire 2 years of PGY2 and PGY3 home call. With their call system, you get most of your weekends off, and your rotation hours are typically 5 or 6am until 4 or 5pm. There are a lot of perks in this program, including free breakfast, $1000ish for educational purposes every year, an additional $700 per year to attend educational courses, full travel expense coverage for national meetings, and 1 educational course/conference every year (i.e. AO Basic as PGY2, Miller's review as PGY4, AAOS as PGY5) in addition to the courses you choose to attend using your course funds. The PGY2 year is supposed to be the hardest, but it is fairly easy outside of the busy rotations (Elmhurst, spine, joints). There is a department-provided car to drive up to Westchester for the PGY4 trauma rotation (30 minutes away). I believe that there will also be a department-provided apartment in Wilmington for the DuPont rotation.

Location/Housing
Located in the Upper East Side of Manhattan, which is a relatively quiet part of town by Central Park. NYC sells itself, with great food, culture, and activities. In this program, you also have the time and money to enjoy it. They have highly subsidized resident housing (studios if you're by yourself, 1BR for couples, 2BR with roommate) with rents in the low to mid $1000s. The buildings are located close to the hospital, have a doorman, and are fairly spacious. A few residents live in other areas of town, but about 75% of them live in the resident housing. As mentioned, there is a car to drive to Westchester and a shuttle to Elmhurst. There also is a shuttle between the different Mount Sinai campuses, which will be useful in the future to get from morning lectures to clinical rotations at the St. Luke's campus.

Limitations
The pending integration with the St. Luke's residency program is definitely a source of uncertainty, as it is unclear how the core experiences will change for the residents. While the faculty and residents were adamant that the program will stay the same, and that they will simply be expanding in the size of the residents and faculty (and making new hires), the program will clearly be in a state of transition during the course of my education over the next 5 years. I also think that the type of resident at St. Luke's is much different from Mount Sinai, and the addition of 3 St. Luke's residents to my class and each of the 3 senior classes above me is a bit unsettling. Dr. Galatz is apparently sitting on the interviews for St. Luke's residents this year, but I still think the applicant pools are very different for each program. The core knowledge and experiences I imagine will be much different for the existing St. Luke's residents, and while I don't think it will be a huge problem, I would prefer some continuity of my seniors from intern year onward. Another limitation is the away rotation at DuPont in Delaware, although this does help augment their relatively weak peds experience at Sinai. While you get a taste of trauma call at Elmhurst, the call here is really light and you don't the blue-collar experience that can be valuable to get comfortable with running an orthopaedic service. Elmhurst also seems like it is a much less busy city hospital compared to Bellevue in Manhattan and Kings County in Brooklyn. While the chair seems to have a great vision for the program, the fact that Dr. Galatz is new gives the program another element of transition and growing pains. I also don't know how I feel about having lectures and reading for every single day, and the constant flow of pimp-style learning seems like it might be unnecessarily anxiety provoking. I didn't get quite as much of a "bro-friendly" feel from the program as I would have liked, but the residents were a fun group I could see myself fitting in with.

Conclusion
A lifestyle-friendly academic program, with a well-rounded operative experience, unique clinic experience, and solid research opportunities. The program has a ton of perks, so the residents have a great work-life balance and can enjoy the benefits of living in NYC. The program is in a state of transition, with a new chair and a pending department/residency merger with St. Luke's. While in the long run I think this will be a net positive and will enhance the residency experience and the academic reputation of Sinai, I do have some reservations. It is quite possible that the product that was advertised on interview day may not be the product that exists in a few years. That said, I think this is an excellent academic program in a great location, and many of the negative reviews about Sinai on Orthogate are no longer applicable. This program definitely exceeded my expectations and will be at the top of my tier 2.

Maimonides

Interview Experience
The pre-interview social was held in a private room at a pub in Brooklyn. There were booths to sit down and talk to the residents, and they kept the pitchers of beer flowing. You could order food off the menu, and overall it was a good time. Good resident turnout, with an appearance by the PD, Dr. Razi. Residents were very casual here, with many in t-shirts and one even in sweatpants. The social was on the later side of ones I have had, running from 7:30 to 10pm. The interview day was split into separate AM and PM sessions. After a brief presentation by the chairman Dr. Choueka, which included some generic video clips, we were subdivided into two groups, either interview or tour. The interview rooms were 6x10 minutes, and each room had a theme. There was a knowledge room, an ethics room, a behavioral interviewing room, a research room, the chairman's room, and a random room (tell me how you make your PB&J sandwiches). The questions made the interview day generally refreshing and everyone was very friendly and engaging. The tour was generic, with a walk-through of the hospital wards, ER, research lab, and simulation center. The facilities were actually pretty unimpressive, with an old city hospital feel. The new Bone and Joint Center (where the interviews were held) was actually really nice, and they have some private clinic and outpatient surgeries there, but most of the residency is spent at the main hospital.

Staff/Faculty/Chairman
The chairman Dr. Choueka (hand and upper extremity) seems really nice, and he is very interested in the well-being of the residents. When he took over about 10 years ago, the program had some issues, and he has steadily worked to make improvements each year. He is more of an ideas guy, with the PD Dr. Razi (spine) figuring out how to implement the ideas. They are relatively responsive to resident feedback, and the residents fill out surveys after each rotation. Even as the boss, Dr. Choueka seems like a blue-collar orthopaedic surgeon. I liked Dr. Razi as well, and he is quite friendly and is always smiling. The full-time faculty is fairly small, probably on the order of 10 to 15 attendings, with a few additional private practice surgeons serving as volunteer faculty. They have 1 or 2 surgeons for each subspecialty, with hand and general ortho (and a ton of hip fractures) as their busiest services. They recently lost their hotshot tumor attending to LIJ, and they do not have a full-time spine attending (most of the spine rotation is spent with neurosurgeons). They recently added a young trauma attending, and they will be transitioning from Level 2 to Level 1 trauma center over the next few years. Dr. Razi said they may also apply for a 4th resident spot within the next few years.

Didactics/Teaching
They have an hour-long fracture conference on Mondays, with presentations followed by pimping from the new trauma attending. On Fridays, they have ~2 hours of didactics that is a mix of attending and resident-led lectures on selected topics. Residents are also required to complete the OrthoBullets OITE curriculum, with assigned reading and questions. Performance on the OITE is really important here, and the residents typically do well because their didactics are geared towards it. Pass rates on the boards have been 100% over the last 5 years.

Operating Experience
Attending-dependent according to the residents, with some attendings being quite grabby and others letting them fly. Residents double scrub on joints and hip fracture cases, since they don't have ancillary staff to help with retracting and holding the leg. The entire PGY1 year is spent on floor work, and PGY2's split time between consults and the OR. They have quite a bit of general orthopaedics each year at Maimo and Lutheran Hospital (also in Brooklyn, about 15 minute drive). Lutheran is a level 1 trauma center, but not a super busy one. The residents also go to Hartford for peds as a PGY4, and Shock Trauma for general surgery trauma as a PGY1. The sports, F/A, tumor rotations are mentorship-based. The spine experience is with neurosurgeons, and is a lot of non-op stuff. Hand with Dr. Choueka is among the best rotations. The operative experience at Lutheran is fairly hands-on compared to Maimo.

Clinic Experience
They have resident-run clinic three times per week. However, it is typically covered by 1 junior and 1 senior from services that aren't busy that day. Some subspecialties (but not all) have private clinic office hours as well during the week. For each resident, it works out to about 2 days of clinic per week. The residents said they enjoyed the autonomy of clinic, but weren't overly enthusiastic about the constant commitment to staffing it every day.

Research Opportunities
Of the 3 residents per year, 1 is required to take a research year between PGY2 and PGY3. This is not decided until the middle of the PGY2 year, and if nobody volunteers to do it, the decision is left to a coin flip. They have a research lab with a full-time research coordinator, and most of the projects are biomechanics. Dr. Razi is also on the faculty at NYU, and they often collaborate with NYU and Mount Sinai on projects where Maimo is lacking the facilities or field expertise on a particular topic. The research resident typically gets at least 1 presentation or paper from the research year, but there isn't a ton of push for productivity from the leadership. The research resident also takes call once per week at Maimo and gets $400 for the shift, which helps to supplement income. Overall, research is not a focus here, and the residents did not express much interest in academic pursuits.

Residents
With only 3 per year, they are a tight-knit group. They know each other well, and spend time together outside of work when they can. Felt like a blue-collar group, and didn't get any bro vibes from them. They were very casual in the social, seemed like they had fun, but they weren't particularly academic, and they didn't seem that passionate about their training. Most do a fellowship, and sports and hand seem to be the most popular. Nearly all of them go into private practice.

Lifestyle
One of my interviewers said this is a gentleman's program, and I would agree. They rarely work 80 hours (except for junior general ortho rotations at Maimo), and rounds never start earlier than 6am. The Lutheran rotations are mostly just operating, with most of the floor work handled by PA's and NP's. The call schedule works out to about q4 to q5, and it is split between the 3 PGY2's and the 1 PGY3 at Maimo and the research resident. They have power weekends, with Friday night call, Saturday off, then Sunday all day. They have post-call days, and the program is good about sending residents home. There is plenty of free time to enjoy Brooklyn and NYC, and many of the residents seemed like they placed a premium on maintaining their social life.

Location/Housing
The hospital is located in the southern part of Brooklyn. Most of the residents live in the brownstones of nearby Park Slope and downtown Brooklyn, although it is feasible to live in lower Manhattan. There is no subsidized housing for residents. The subway runs near the hospital, but with a number of different hospital sites and early hours, all of the residents have a car. Parking at the hospital is street-based, and it can get dicey in the mornings. The cost of living in Brooklyn is relatively high, but is definitely more affordable than Manhattan. Brooklyn has plenty to do, including great food, bars, sporting events, diversity, etc.

Limitations
The trauma experience here is light for a community program. They do a ton of hip fractures and bread and butter subspecialty cases, but the services don't seem that busy and the volume is fairly low. Working with neurosurgeons on spine is suboptimal, and many of the other subspecialties have 1 attending, so there isn't much diversity in teaching style. The Lutheran rotation is their only Level 1 experience, but the hospital was recently acquired by NYU, and Maimo residents may be kicked out within the next few years. Similarly, the Maimo hospital was bought by North Shore-LIJ system last year, and while we received assurances that the program isn't going to be absorbed, there may be changes to the department and the hospital within the next few years. Maimo is turning into a Level 1 trauma center, but it's unclear how long this will take and what the final product will be. The requirement for 1 research resident in each class is a huge negative, as you might get stuck doing a 6th year of residency. Furthermore, there isn't a strong research focus here, and the resources to do projects are limited. Going to Hartford for peds and Baltimore for general surgery trauma are also undesirable. I didn't get a strong sense of program pride from the residents.

Conclusion
This program has an "identity crisis", as one resident put it. They have a research resident, but otherwise don't have much of a focus on research. They are a community program at their core, but the trauma is much lighter than most of the community programs that I have seen. This program is lifestyle-friendly with a good location, and you will graduate as a competent orthopaedic surgeon, but I feel like there is a ton of untapped potential here. This is at the lower end of my tier 3.

Brown

Interview Experience
Pre-interview social was held at a gastropub in downtown Providence, with some decent food and plenty of space to speak with the residents. The resident turnout was pretty good, with around half of them in attendance. There are quite a few senior residents who have children, and I think they were among the absent. The interview day was split into AM and PM sessions, with the morning starting at 6am. There was an introduction and overview of the program from the PD, Dr. Eberson, followed by a few remarks from the interim chair, Dr. Ackerman. The longtime chair, Dr. Erhlich, will be retiring within the next few weeks and was not in attendance. The interview day was structured with 4 faculty interviews and 2 group sessions with the PGY5 and PGY6 classes (as in, 4-5 applicants met with some of residents in that class). There was a research interview that was a bit odd, with one of their senior attendings grilling me about how I would design a basic science study. Otherwise, the interviews were conversational and laid back. At lunch, a representative from each subspecialty department gave an overview of their specific rotations and research projects. The day concluded with a tour of their basic science laboratory facility, which I could have done without.

Staff/Faculty/Chairman
The longtime chair, Dr. Erhlich, announced his plans to retire about a year and a half ago, and they have been conducting a nationwide search to find his replacement. They are down to two finalists, who are each currently in contract negotiations with the hospital. The new chair should be announced within the next few weeks, with an absolute deadline of April 1. Dr. Ackerman (hand) is the internal candidate, and is the favorite to get the job. He is president of the hand society, is well known and respected in the orthopaedics community, and has been on the faculty at Brown for over 20 years. The external candidate is a prominent sports attending from the West Coast. Dr. Ackerman had an opportunity to speak to all the applicants during the start of the interview day, and he said that regardless of who is hired, it will be a good environment for the residents, as both he and the other candidate are passionate about teaching. The faculty aren't expected to leave with the chairman change, as Brown orthopaedics is a privademic model, and the majority of them have been at Brown for decades. The PD is Dr. Eberson (peds/spine), who took over last year for Dr. DiGiovanni, who left to head the F/A department at Harvard. Eberson was a resident at Brown himself, and he is very pro-resident. He is a friendly, enthusiastic guy, and he talks really fast, but I definitely liked his energy. In the short time he has been there, he has made a number of resident-suggested changes. For example, the general surgery months of intern year were historically brutal, and he swapped out two months of general surgery (aka lots of floor scut) for a month each of radiology and anesthesia. He established both junior-to-senior resident and faculty-to-resident mentorship systems, and he also made adjustments to the didactic curriculum in response to resident feedback. The faculty is a mix of old and young, with a lot of established names and some up-and-comers. They are strongest in hand and trauma, with solid peds, spine, joints and sports, but only 1 faculty each on F/A and tumor. Dr. Froehlich (joints) is the assistant PD, and he is responsible for supervising the resident experience at the Miriam Hospital's joint replacement center.

Didactics/Teaching
They have 30-minute lectures in the morning on Mon/Tues/Thurs/Fri, which are subspecialty topic-based and usually attending-led. This is followed by 30+ minutes of fracture conference, where the residents go over their consults with the attendings and superchiefs (PGY6 residents). They have dedicated OITE review lectures during the summer and early fall, where they will walk through various textbook chapters. Dr. Eberson mentioned that they are developing reading lists for each rotation of the highest yield materials for that block. Some residents mentioned they would like to model it after WashU, where there is a packet of papers and textbook chapters that are specific to the year and the rotation (i.e. junior vs. senior joints rotation). They also have journal club and tumor board each once per month. Most of the subspecialty services have a few additional didactic sessions every week. The residents I spoke with said they felt the didactics were generally good, and that Dr. Eberson is working to make them even better.

Operating Experience
This is definitely sold as a strength of the program. The core of the operative experience is trauma, and you spend time on trauma as a 1/2/3/5/6. The intern year is floor work, the PGY2 year is consults, the PGY3 year is purely operative, and the PGY5 year is running the service and operating. The PGY6 year is obviously unique here, and it is considered a mini-trauma fellowship (but not board-certified fellowship), where you will act as a junior attending with your own patients, run your own clinic, and take primary q6 trauma call. The residents noted that there is a huge jump in operative skill between PGY5 and PGY6, as you are taking on complex cases, although you do have backup from the trauma attendings when you need it. On other services, the PGY1 spends 2 months on hand with their junior hand attending, and it is a 1-on-1-mentorship model. There is good operative autonomy on the VA rotations as a PGY3 and PGY5, where you will run the orthopaedic service and take care of mostly joints and sports issues. They get 4 months doing primary joints at the Miriam Hospital as a PGY2, and then get joints again as a PGY3 (or PGY4, don’t remember) and PGY5, with the PGY5 doing a lot of the complex revision cases. Their F/A rotation comes as a PGY4, and tumor comes as a PGY5. They have sports as a PGY3 and PGY4, with a separate shoulder and elbow rotation as a PGY4. Otherwise, everything else is done as both a junior and a senior. As mentioned, every rotation outside of trauma utilizes the mentorship model. The residents felt that they had good autonomy, with graduated responsibility in the OR. However, as with most places, the level of autonomy can be attending dependent, and the residents said there are a few attendings that let them do a little less than they would like. The operative sports experience is apparently not the greatest, and the F/A attending is fairly new and still building his practice.

Clinic Experience
The clinic experience here is fairly robust. Dr. Eberson and a number of the faculty emphasized during the interview day that knowing when to indicate patients is more important than knowing how to do the procedure. To this point, they have indications conference every week for every service. Clinic is typically 2 days per week, with some services having it 3 days per week. There is also a resident run weekly longitudinal clinic that you attend from PGY2 through PGY5. The only other program with something like that I know of is Mount Sinai. You see uninsured patients in clinic, and will retain them over the duration of your residency, from the initial workup to nonoperative treatment to surgery and postoperative care. There is an attending that staffs the clinic at all times, and if you book a clinic case for surgery, you will scrub on that case regardless of the service you are on. The residents are given a lot of autonomy in the service-specific clinics, where you will see the patient and present to the attending. There is very little shadowing in clinic, although it can happen with a few attendings. Overall, the clinic experience is definitely above average here. As a PGY6, you run your own clinic with your own patients, and learn how to bill and code your encounters.

Research Opportunities
Research is definitely a focus of the interview day and the residency. They have 2 months of dedicated research time as both a PGY4 and PGY5. During the PGY6 year, you also have a decent amount of free time to work on research if you want to. The bulk of the research here is basic science, and they have ~10 PhD researchers in the department working on a combination of biomechanics, tissue engineering, and genetics projects. Dr. Terek, their tumor attending, has an NIH grant for his lab work on chemotherapy resistance in osteosarcomas. They have some clinical outcomes research, which is headed by Dr. Owens (sports), who was recently hired from the military and has 200+ publications. Some of the attendings work on cost and quality committees, but Brown doesn't have much in the form of internal databases or faculty with experience in these fields. The faculty is very enthusiastic about research, although it is generally resident-driven. They fully support conference presentations if you get something accepted. The residents collectively published ~40 papers last year.

Residents
They were a laid-back, down-to-earth group. They had a bit of a blue-collar feel, even though it was an academic environment. Not very "bro-y", with little bit of a nerdy vibe, but everyone seemed cool. There is only 1 girl in the entire program, which apparently was not intentional, as there were ~5 girls in the program consistently up until a few years ago. Nearly all of the residents are married, and many have kids. Most do not have Rhode Island ties, so they are generally a tight-knit group, get along well, and spend a lot of time with each other.

Lifestyle
With all of the trauma rotations, the lifestyle is definitely more difficult than average here. The intern year used to be fairly miserable, but it has improved a lot in recent years with less general surgery. They also hired a couple of PA's over the past few years to help with floor work and discharges on each service (which was done to help residents maximize time in clinic and OR). The interns spend 2 months on trauma taking care of the floor work, with the PGY2's doing 4 trauma months split between days and night float. The PGY2's also take all of the weekend call, which I think is set up into power weekends (Friday night/Sunday day for one resident and Saturday 24 for the other). The pager is busy here, and they can get 25-30 consults each night. The PGY3 is on home call, but with all the volume of consults, they spend the first quarter/half of the year in-house. The PGY5 is on operative backup call. The call for PGY6 is ~q6, with the trauma attendings available by phone for questions, or in-person if needed for a case. It is worth mentioning that the PGY6's are technically graduates of the program, and do not spend time on any of the other services outside of trauma. However, if they are interested in a particular area, they can negotiate for relevant trauma cases among each other (i.e., interested in hand, do a lot of upper extremity trauma). The salary for PGY6 is around $110K (listed as 150 on the website, but this was back when they had 5 PGY6 residents per year). The fellowship is not board-accredited, and everybody does a separate fellowship afterwards. The hours on the non-trauma subspecialty services are supposed to be pretty good, since it is essentially private practice and built for efficiency.

Location/Housing
Providence is a small but very livable city. There is a great food and beer scene here. It is about 30 minutes south to the beaches, an hour north to Boston and 3 hours west to New York. The residents are spread out around the city, but you have the option to live in a modern apartment building downtown, an older building in one of the Providence neighborhoods, or a house in the suburbs. The housing is affordable on a resident salary, somewhere in the low 1000s for a 1BR. While a car is a requirement here, all of the hospital sites are within a 10-minute drive of each other, and there is very little traffic here. Parking is free at all of the hospital sites.

Limitations
The PGY6 year is definitely a big factor here. The opportunity cost of a year of my life as well as the lost salary of delaying being an attending are definitely negatives from my perspective. While there are a lot of potential gains from the extra year, I think you can get sufficiently good at trauma during the 5-year experience at many programs. It also feels a bit like exploitation for cheap and easy labor, since none of the faculty attendings there take trauma call, you generate a ton of money for the hospital, and you are paid at 40% of a junior-level attending's salary. The other big concern is the uncertain chairman situation. Even though the potential candidates sound great, there is still the unknown of how they will fit into the program, the changes they might make, and a potential exodus of faculty who don't fit in with them. Smaller limitations include the F/A and tumor experiences that are delayed until PGY4/5 years, the general lack of clinical outcomes research, and the lack of a "bro-friendly" resident feel. I also would like a strong sports experience if possible, and I didn't hear a ton about sports during my interview.

Conclusion
Overall, a very well balanced program. They get a great foundation in trauma, there is very limited encroachment by fellows (around 5 total, all on non-trauma services, and with the mentorship model, you rarely interact with them), and they have a solid experience in all of the subspecialties. Providence is a very livable city, the residents seemed like a great group of guys, and they have a strong academic reputation with resources available for research. My big issue with the program here is the sixth year. While I think it has some unique advantages, it is hard to bring myself to commit to an extra year of my life to residency. I think trauma is important, and I want to be good at it, but I don't plan to go into trauma and I think that I can get the necessary trauma experience and surgical skills from a 5-year program. I think that if Brown turned itself into a 5-year program, it would be among the most desirable programs in the country. However, they have no plans to change, and all of the residents there stand by the value of the 6th year. It is definitely a hard place to rank, but I think it will be in the middle of my tier 2.