My Residency Reviews

Washington (UW)

Interview Experience
The pre-interview social was unique. It was held on Dr. Hanel's (the PD’s) houseboat in Seattle Harbor. You literally have to walk onto a dock to get to his front door. All of the applicants in attendance get a few minutes of facetime with Dr. Hanel as well as the residents who came (only 2 per class, which I was told is because the boat has a weight limit). The interview day itself was split into AM and PM groups. The day started with a presentation by Dr. Chansky (chairman), followed by a presentation by Dr. Hanel (the PD). Interviews ran for the next few hours, with 5 total rooms for 15 minutes each. Two of the rooms were individual meetings with Chansky and Hanel, which were designed for the applicants to ask them questions about the program. Chansky and Hanel said they don't have that much input into the rank list, and wanted it to be a low stress environment. The other 3 rooms were panel-style, with 4 or 5 interviewers per room sitting on one side of a banquet table and you sitting on the other. These were among the most formal interviews I have experienced, and many of the questions were complex and designed to make you think. Not too many bread and butter questions like “tell me about yourself”, “why ortho”, etc. The interviews were a bit on the stressful side, and were definitely harder than I was used to, but at no point did I feel uncomfortable in the room. However, what was somewhat off-setting was that few of the interviewers showed any emotion, instead maintaining poker faces and/or staring at their computers. This made it difficult, if not impossible, to gauge their interest in your responses and figure out if you should keep talking or move on to the next question. From talking to the other applicants, they had similar experiences. Day ended with a "tour", aka a trip to a local Seattle brewery. In the evening, they had a second social event with at a local restaurant. Buffet-style food and beer and an opportunity to hang out with the residents and applicants. They have the second social because Seattle is a far trip for anyone outside of Washington, so they want to give the applicants some activities while they are there. They interview around 75 for 8 spots (around 15 UW students, 30 rotators, and 30 non-rotators).

Staff/Faculty/Chairman
Dr. Chansky (joints/tumor) is the new chairman, and he is the 3rd chair in the last 5 years. Dr. Matsen was their longtime chair, but stepped down a few years ago to focus on his research and his clinical practice on the shoulder/elbow service at UW. They chose Dr. Chapman (spine) to take over for Dr. Matsen, but Chapman’s tenure was cut short by a poor fit and a legal problem, and he ultimately left UW for a private practice. Dr. Chansky was chosen as the next chair after a long search, and he has been on the UW faculty for over 20 years. He has a heavy Boston accent and he seems like a friendly, blue-collar type of leader. The residents say that he is very pro-resident, and is very approachable. Dr. Hanel (hand) is the long-time PD. While his personality is a bit quirky, he is very outgoing and nice. The residents say that he can be a bit intimidating, and he is very much a solutions guy, as in if you go to him with a problem, you better also come to him with proposed solution. I got hints from some residents that he is a bit entrenched in his ways, and is somewhat resistant to change, but that he can be responsive to resident feedback if someone makes a good case for a change. He will likely retire within the next few years, so there likely will be new residency director during my training. The remainder of the faculty is fairly balanced, with their biggest strengths in trauma, hand and shoulder/elbow. The joints service lost quite a few faculty over recent years, but is turning nearby the Northwest Hospital into a center for excellence and is aggressively making new faculty hires. The faculty is around 70 or 80, but they are spread out across Harborview, UW, and Children's Hospital.

Didactics/Teaching
The majority of their didactics come when they are at Harborview. They have weekly fracture conference, where the PGY2's on trauma will go through all of the major consults and cases from the previous week. There is a lot of pimping here, and it can get aggressive at times. Some rotators said that while the sessions were highly educational, it can be somewhat of an anxious environment. However, residents finish PGY2 with a huge fund of knowledge on orthopaedic trauma. At Harborview, they also have attending-led lectures on various topics, and the interns have an interactive anatomy teaching session with an attending every week on Friday. They also have grand rounds on Wednesday. Other services have monthly journal clubs and an occasional teaching session. Performance on the OITE is emphasized here, and they scored in the 90th percentile as a program last year. However, most of the preparation is self-directed. They are in the process of designing a core reading curriculum for each rotation block.

Operating Experience
The operative experience here is good, but it is definitely back loaded. As an intern, you spend 4 months on orthopaedic trauma floors, and 2 months on peds ortho floors. The PGY2 year is 4 months of trauma consults at Harborview, and although you technically assigned to 1 OR day per week, typically you can’t go because you are swamped with consults. One of the PGY2's told me that they did about 10 cases on trauma all year. As a junior, however, the other services do seem to have solid operative experiences. They use a mentorship model, and you do each rotation as both a junior and a senior. They spend 6 months straight as a PGY3 at Seattle Children's Hospital, and they are split into mini-teams, with each resident covering a subset of attendings there. There is a lot of autonomy at the VA, and the PGY4 on service gets to run their own room. There is 6 months of trauma as a PGY5, where you get your own room and run the gamut of simple and complex operative trauma cases. They see every sort of fracture imaginable, since they cover all of the high-grade trauma for the states of Washington, Idaho, Alaska, Montana and Wyoming. The residents said that they have heard from past graduates that the operative experience ends up as being above average. However, you have to be okay with the back-loaded nature of it. The juniors don't do a ton here, and there are fellows on a number of the services (specifically, trauma, shoulder/elbow and F/A).

Clinic Experience
The clinic experience here is good. The residents function relatively independently. They are given an opportunity to see patients themselves, come up with a plan, and write notes. It's usually 3 days in the OR and 2 days in clinic for most services, although as the intern/PGY2 on trauma you will be in-and-out of clinic taking care of floors and consults. They do not have a resident-run clinic.

Research Opportunities
They have a lot of research resources available to the residents, although the projects are generally resident-driven. It is a mixed bag in terms of resident research productivity, with some publishing a few articles per year and others fulfilling the minimum requirement of 1 submittable project. They don't have a dedicated research block, and instead have 1-day per week during the entire PGY3 year. It is protected for research, but some of the residents use it for scrubbing on additional cases if they don't care about doing research. Only the shoulder/elbow service has a dedicated research coordinator to help with administrative work. Dr. Leopold (joints), is the editor of CORR, and is a great resource to bounce ideas off of. They have one attending working on cost and quality research (Dr. Davidson), and Dr. Chansky mentioned that he is in the process of hiring 2 PhD health economists/epidemiologists to build the outcomes-based research arm of the department. Most of the resident research here is clinical, with not much basic science/biomechanics (partly due to the fact that they only get 1 day/week instead of a few weeks/months straight). They support travel to present at research conferences.

Residents
Overall, a very laid-back and friendly group. Many of them have West Coast ties, although some do not. The Pacific Northwest is awesome for outdoor activities, and many of them are big into hiking, climbing, skiing, etc. They have 8 residents per year, so there is a bit of variety in resident personality, but I would say that they have a generally nerdy feel. Not too many bros here, at least among the residents I met. The residents emphasize that they are a fairly tight-knit group, especially within classes, and have each other's backs in the hospital. Despite the program's size, it seemed like all of the residents knew each other. The dynamic between classes here is less hierarchical than programs of similar sizes, and that's generally what I have seen with the West Coast programs. The most popular fellowships here at joints, sports, and hand, with very few going into trauma.

Lifestyle
This is a blue-collar program, and you will work hard for every year while you are here. They have placed an emphasis on staying within the 80-hour workweek, and have hired a number of mid-level providers over the past few years to help with floor work. The long hours during the trauma experiences in the summer and fall are unavoidable. Trauma has 3 teams at Harborview (red, blue, green), with an intern, PGY2, PGY5, and fellow on each, and the call during PGY2 works out to q3.5 with post-call days (the PGY2 on sports also takes some call). There are 4 PGY3's at Seattle Children's, and they take q5 call (residents at Madigan Army program help with call). The PGY3 also takes 5 weekend calls per month at Harborview. As a PGY5, there is a night float system at Harborview. This is designed so that chiefs aren't post-call, and the night float chief is there to take care of any operative night float cases for any of the 3 teams. Apparently this rotation is fairly easy since there aren't a ton of orthopaedic surgical emergencies anymore, and you can use your down time for research or other activities. While the trauma call here is difficult, you make up for it on many of the subspecialty services, where you may work 40 to 50 hours on services like hand, F/A and sports. Joints and the VA can be busy, but not Harborview busy.

Location/Housing
Seattle is an increasingly desirable place to live, and with the growing tech market here, it is really exploding in terms of population size and cost of living. The residents are fairly scattered around the different neighborhoods of Seattle, and rent here for a 1BR is typically in the high $1000's. If you are willing to live a bit further from the city, there are opportunities to buy. However, traffic in Seattle can be brutal. There is a single highway that runs through town (and this is the best way to get between all the Seattle hospitals), but it can get absolutely jammed during the day. The ortho program counters this by assigning residents to one site, with no cross coverage at other sites except for call. Parking is free at all sites (I believe), and a car is a requirement. Seattle has a lot of great features, including close proximity to the mountains and ocean, good food, and plenty of fun stuff to do. During the spring and summer months, the weather is awesome. During the fall and winter, it is cloudy and/or rainy almost every day. They get less rain volume than many other cities, but the frequency of rain is definitely higher here.

Limitations
The lifestyle here is definitely difficult here, with a lot of time spent on trauma with call and long hours. The amount of call during PGY3 year is above average for most programs. For PGY5's, you spend 6 months on trauma and even take night float, which is definitely suboptimal. Also, for all of the talk about the great trauma experience here, you don't get to operate on any trauma until your PGY5 year. I think that UW graduates can manage any type of complex trauma in the ER, but I would prefer to master the bread and butter trauma cases and get in the OR more as a junior on these cases. They are in the process of adding a community trauma experience as a PGY3 or PGY4, which I think is great, but I still would like to some basic operative trauma experience before that. I also think I would like to split up the peds exposure into 2 or 3 smaller blocks instead of the single 6-month-long experience as a PGY3. The didactics outside of trauma seem a bit underwhelming. Research support is limited, and while there are resources available to residents, it does not appear that research is quite as prominent among residents as I would have imagined. Seattle seems like a great place to live, although I'm not huge into the outdoors scene and would prefer to see some sunshine during the winter months. While they have stable leadership at the moment, the program went through some transitions recently, and could have more in the future. Dr. Hanel may be retiring in the next few years, and Dr. Chansky is still getting settled into his new role. Residents are on the nerdy side and I didn't get much of a bro-friendly feel.

Conclusion
This is a well-rounded academic orthopaedic program. They get good trauma exposure with balance in the subspecialties. Big name faculty in many of the fields. There is no area of true weakness here, but you have to be ready as a resident to work hard. This program has a number of minor individual limitations, and collectively they add up to make it a tough fit for me. I think UW residents get excellent training experiences, and would be happy to go here, but I think that the program has a lot of missed potential. Mid-tier 2 for me.

NYU

Interview Experience
Social was held at a bar in lower Manhattan. There was a smattering of residents from each class, although I don't think any interns were in attendance. Attendings were present for the first hour, with the PD and chairman making rounds and greeting the applicants. The venue was a bit on the loud side, and was quite crowded, especially when the attendings were there. NYU is a formal program, and I would actually recommend wearing a tie as an applicant to the social. I heard Dr. Zuckerman (the chairman) making some remarks about it, so it’s better to play it safe. Overall, there were ample opportunities to speak with residents and get a feel for the program. This is a huge program (62 residents total), so it is impossible to meet everybody, but I would say between the social and interview day, you got to interact with 20 to 25 of them. The interview day itself started early, at 6:30am, with a sample didactic lecture from Dr. Zuckerman to the residents. Dr. Egol (PD) then gave an overview of the program, followed by a presentation by one of the executive chief residents. The applicant group was then split in half, with some applicants going on a tour and the rest heading upstairs for interviews. It was 7 rooms for ~10 minutes each, with 2 faculty per room for 6 rooms and the 3 executive chief residents in the 7th room. In the resident room, you got to putt into a golf hole. The other rooms were mostly general conversation, with typically 1-2 "hard" questions (ethical, behavioral interviewing). In the room with Dr. Strauss (assistant PD), he asked pop culture trivia questions rapid fire for the last 30 seconds of the interview. After the interviews, I had about an hour to hang out in the boardroom with 5 of the residents and talk about the program. Then, a different group of residents came to take us on a bus tour, with some walking around each of their Manhattan facilities. The tour was admittedly a bit on the long side, and I could live without going inside the buildings. The day ended with lunch at their uptown clinic. They interview 84 for 12 spots, with 2 being 6-year research positions. Starting with this year's incoming class, they have 1 NYU student who matched directly into the residency as a pre-med, and who went to NYU medical school for only 3 years. Therefore, applicants this year are competing for 11 spots instead of 12. The program may be expanding to 14 residents within the next few years, since the hospital system recently acquired two hospitals in Brooklyn, expanded their surgery center, and is building a huge addition to the private Tisch Hospital. Residents may start rotating at those sites in the future, so the manpower definitely seems like it is indicated. However, this year's class will remain at 12 residents.

Staff/Faculty/Chairman
As a preface, NYU is a huge program, the largest in the country at 12 residents per year (tied with Harvard and Mayo). The faculty has around 100 attendings. As such, it is very hierarchical here, and as a resident you work your way up the chain of command. The chairman is Dr. Zuckerman (shoulder/joints). He is a past president of the AAOS and has been at the helm for the last ~15 years. Under his leadership, the department has seen tremendous growth and increase in name recognition. He has a suave businessman vibe to him, seems very cool and collected, and is always making witty one-liner jokes. He comes to the Wednesday morning lectures every week, and is the face of the program, but he has limited involvement in the day-to-day activities of the residency. You don't rotate on his service until your PGY5 joints rotation, and while he knows every resident's name and biographical background, you typically don't develop much of a relationship with him until you become a senior resident. Dr. Egol (trauma) is the PD, and has been in that position for the last ~10 years. He keeps tabs on the residents, but again, since NYU is so large, you won't get to know him on a personal level until you are a senior resident. You rotate on his service as a PGY3, and he shows a lot of tough love, but he is very dedicated to teaching and always prioritizes the needs of the residents over the fellows. He can seem a little intimidating at times, but he cares a lot about the residents and the quality of the program. Dr. Strauss (sports) is the assistant PD. He graduated from NYU in 2009, and is energetic, friendly, and quite interactive with the residents. The faculty leadership holds an annual "resident gripe session" at a bar at the end of the year, where the residents from each class talk about their issues with each rotation. If an attending isn't letting the residents do enough, they reserve the right to pull resident coverage and tell the attending to hire a PA (this has actually happened in the past). If you have a serious personal issue, you can contact Dr. Egol directly and I have been told he is very accommodating. For more routine complaints, it typically funnels up through the chain of command and eventually up to the 3 executive chief residents (aka super chiefs), who have close relationships with Egol and Zuckerman. The faculty here is huge, with 100 attendings spread across 4 hospitals. They have ~20 attendings each for joints, sports, and spine, ~10 trauma and hand, ~5 hand, 3 F/A, but only 1 tumor. Despite the huge faculty, there are 3-4 core teaching faculty for each rotation, and they try to structure it as a mentorship model as much as possible (e.g. if you are on hand, you mostly work with 2 attendings for the first month and the other 3 for the second month).

Didactics/Teaching
They have 3 hours of attending-led didactics every Wednesday morning. The time is protected for education for every resident, and they report to their clinical sites once the lectures are over. The lectures are fairly interactive, with many attendings using a case-base approach and then pimping the residents from each class with appropriate knowledge-level questions (e.g. juniors read the XR and give a differential, seniors discuss the management, surgical approach, and complications). This can be a little bit anxiety-provoking since you know you will get pimped a little bit each week, but the residents say it encourages them to read and prepare for the lectures. Most of the subspecialties have an additional 1 to 2 hours of conferences each week (i.e. indications conference, journal club), and they also have a general journal club for all the residents every month or two. They have started to create core reading lists for certain blocks, but this is still a work in progress. While there are a lot of educational activities built in here, it still involves a lot of self-directed learning and preparation. The residents here have a lot of clinical responsibilities, so reading can be difficult on certain blocks (i.e. Bellevue, Jamaica, joints). This is also a good spot to mention that there are a lot of opportunities to teach medical students during splinting and sawbones sessions (they get 90 rotators per year and 40 MS1 students each summer), and you can also use 1 week of vacation for an international trip to Haiti.

Operating Experience
This a resident-focused program, and operative experience is prioritized here. The caseload is high with all of the hospitals that they cover, and the volume is only expected to increase with the recent growth in both facility number and size, which consequentially is creating a massive referral network to HJD for orthopaedic care. The residents here cover the two busiest Level 1 trauma centers in NYC (Bellevue in Manhattan and Jamaica in Queens), where the orthopaedic services are essentially resident-run. It is fairly common for the attendings to not scrub and let the residents fly in the OR. This is also the case at the Manhattan VA, where the residents get a lot of autonomy on bread and butter joints, sports, hand and trauma cases. HJD is their orthopaedics-only specialty hospital, and this is where the majority of the elective cases happen. The operative experience at HJD is attending-dependent, but generally the residents are actively participating in the case and not observing or holding hooks. They have some fellows on joints, spine, hand, and sports, but the caseload is high enough such that the residents are rarely double scrubbed, with residents given priority for scheduling the coverage for most of the cases. The Tisch Hospital is the NYU private hospital that is right next door to Bellevue, and a lot of the complex peds, joints and trauma cases happen here. They also have a surgery center in midtown with 8 OR's and fast room turnover (the turnover at Bellevue and HJD is slow, like 30-45 minutes, versus 10-15 minutes at the surgicenter). While there is quite a bit of floor work as a junior, you do get some opportunities to scrub on cases at the VA, HJD, and Jamaica. As a senior, you are basically all operative with some clinic mixed in, and many of the attendings will time you out and let you function as a junior attending if you know what you are doing.

Clinic Experience
Most of the clinics here are resident-run. There is a ton of autonomy in terms of seeing the patients, coming up with diagnosis and plan, and writing the note. In most of the clinics there will be one or two attendings that staff it, listening to presentations and making sure the plan is reasonable. Some services have a private clinic in the uptown offices, which involves a mix of shadowing and seeing patients. Residents said they don’t mind this, since it's a good place to learn some of the fine details of working up certain orthopaedic complaints from the attendings, and then applying that to your own patients in resident-run clinics later on. There is generally 1 to 2 days of clinic per week for most services. They have Epic EMR for all of the NYU sites, with QuadraMed (which is a bit clunky) at Bellevue, although Bellevue is supposed to be switching to Epic in the next few years. Clinic days can be busy, but you typically can get out of there by 5 or 6pm.

Research Opportunities
There is a strong research culture here, with a lot attendings who publish frequently and are field leaders in their subspecialty. Nearly all of the residents are involved in research, although their level of involvement is somewhat of a mixed bag. Some residents publish a ton, while others fulfill the minimum requirement of 3 papers (case report, original project, review article). Dr. Egol said during his presentation that the average resident has 10 to 12 submitted projects by the time they graduate. In addition, all residents must write a grant during their PGY3 year to graduate. They have their own PubMed indexed journal (HJD Bulletin), so all of your projects will get published somewhere. They do not have a dedicated research block, and some projects require the resident to drive the project to completion. However, this really depends on your mentor and research team. Some attendings have full-time and volunteer research staff that help with projects, with the attendings driving the projects to make sure they get done and published. They have a good mix of outcomes and basic science projects, with a large amount of stuff on quality, outcomes and cost effectiveness. There are 2 research residents per year who get a fully protected year between PGY2 and PGY3 to work on their projects (which are typically basic science).

Residents
This is a resident-run program, and I felt like despite the program’s size, it was a cohesive group with a similar type of team-player resident personality. They spend a lot of time with each other in the hospital, and the rotations are very team-based (i.e. at Bellevue there is an intern, 3 PGY3's, 2 PGY4's and 2 PGY5's). This program has a reputation for being a "bro" program (it is true that they have a weight room in the HJD OR and a 300-pound bench press club), and while I wouldn't say that is absolutely true across the board, it is definitely "bro-friendly" and has the feeling of a grown-up frat or sports team. The residents are definitely fun, energetic, they work hard, and they are battle-hardened from working in some difficult NYC hospitals. However, they are very collegial and help each other out. Again, it is very hierarchical here, so you need to respect the chain of command and know when to ask for help. A lot of the teaching is occurring from senior to junior, so you need to be able to work well in a team environment or else you will struggle to fit in. The program is so large, that you won't get to know everyone in the program on a close personal level. However, there is a ton of cohesion within each class, and all the residents gradually get to know each other across different classes. Fellowship choice varies from year to year, with a lot of joints, sports and hand. Residents said that even though some years multiple residents apply for the same subspecialty, there isn't that much competition amongst each other for fellowship spots, and they usually get their 1st or 2nd choice.

Lifestyle
This is definitely a work hard program. The hospitals aren't easy to work in (especially Bellevue and Jamaica), and the residents have a lot of responsibilities. As a junior, you can work 100+ hours on your trauma rotations, and most of this is floor (PGY1) and consults (PGY2/3). The call at both Jamaica (PGY2/3) and Bellevue (PGY3) is q3 with post-call days. Overnights can be busy but variable, with 8 to 10 consults on average, but bad nights could be up to 20 or 25. There is no night float here, which the residents said they prefer, since they have an entire post-call day to sleep and take care of other stuff during normal business hours. At Tisch, it's a Level 2 trauma center, so you are expected to take overnight call and then scrub the first case the next day before going home. As a PGY2 on certain services (peds, sports), you run I-Care at HJD, which is their all-ortho emergency room. You see some low-energy trauma and a lot of BS stuff (i.e. chronic back/knee pain), but you get to make a lot of your own decisions as a junior, with backup from the senior resident if you need it. This counts as your HJD "call", but it’s not too horrible, since I-Care closes at 10pm and you are typically out of there by ~11pm. The residents are paid among the best in the country (interns make 62K), and they have a lot of perks, including $10/day meal cards, $600 annual book fund, conference travel funds if you are presenting, and entry fees for intramural sports teams (they have a basketball team that plays in the city league, and had an ice hockey team a few years ago). In response to resident gripes about lack of moonlighting opportunities, the program recently set up moonlighting in I-Care on the weekends (as long as they score >50th percentile on OITE), where they make $100/hour and have fairly limited responsibilities. They get 4 1-week vacations spread across the year (a lot of programs give 3 weeks), which is nice. Interns have a month-long boot camp in July.

Location/Housing
Located on the lower east side of Manhattan, in the Gramercy/Kips Bay neighborhood. There is a ton to do, eat, and see in NYC, and all of the hospitals are clustered in a 20-block radius. The exception is Jamaica, which is a 20-minute drive from HJD. They have a shared car for the residents at Jamaica, which they pile into every morning from HJD. The on-call resident at Jamaica can take home an Uber the following morning and get reimbursed, or they can take the train back, which takes about an hour. The rent in the area around the hospital is expensive, with a 1BR running in the mid to high 2000's. There is limited subsidized resident housing, which is allocated based on a lottery system, with preference given to out-of-towners. Some residents live on the Upper East Side, where you can get a little more bang for your buck (a lot of married residents live here, especially those with children), and a few residents have lived in Brooklyn. None of the residents have a car here, as the public transit system is extensive and cabs/Ubers are everywhere.

Limitations
The schedule during the junior years is difficult, with quite a bit of call. All of the hospitals can be difficult to work in, with poor ancillary staffing and slow turnover time. The program is large, so you won't get a personalized experience with the PD and chairman as a junior resident. The hierarchy is necessary to allow this huge program to work, but there can be inefficiencies, and you are often at the mercy of your seniors. While research is emphasized, there is no dedicated research block to work on projects. The pimp-style of lectures force you to read, but can be unpleasant if you are on a tough block and haven't been able to prepare. They also don't get to rotate on F/A or tumor until PGY4 year, and they only get 2 months of hand as a PGY3. The trauma, joints, and sports are strong here, but you don’t spend much time on the other subspecialties. NYC is expensive, and you are often on your own for housing.

Conclusion
This program has a big-time academic reputation and is in a great location, but it is a blue-collar program at its core. I think this is a very balanced program, with good trauma, joints and general orthopaedics exposure. There is good diversity in the hospital sites, which include private, public, and VA. There are big name attendings scattered throughout the faculty, with plenty of resources for research. If you are willing to put in the work, this program has as many opportunities as any program in the country. Here you can make your own adventure, and if you want to focus on taking advantage of the available research, clinical, teaching, or extracurricular opportunities, you can do it. This program is also very resident-centric, and while there are a few fellows, they aren’t clashing with the residents because of the sheer size and case volume of the program. I think this program is in the conversation for best program in the country, tier 1 for me.

SUNY Downstate

Interview Experience
The social was held at a shuffleboard bar in Brooklyn. A little less than half of the residents showed up, with a mix across the different years. Got a chance to talk to a few of them about the program and living in Brooklyn. Unlike other socials, it wasn't nearly as loud or crowded here, which was a good thing. The interview day itself was fairly short. It started with an overview of the borough of Brooklyn and the history of the program from the former chair Dr. Gordon, followed by a presentation on the program from the current chair Dr. Urban, and finally a resident presentation. We moved downstairs for hot breakfast (among the best I've had on the interview trail), with 8x10 minute interviews with residents and faculty. Typically 2 interviewers per room, with the exception of Dr. Urban and Dr. Paulino (the PD) each having their own room. Mostly generic interview conversation, with a "tell me about an interesting case" in one room. Interviews concluded with lunch and some brief conversation with the residents in the break room.

Staff/Faculty/Chairman
Dr. Urban (sports) is the chairman. He was a medical student and resident at Downstate, and has been the chair here for the last 15 years. He has a businessman feel to him, and is a straight shooter. He was very direct with the applicants during his presentation and in his interview room. The program has had some ups and downs over the past decade, and they were placed on probation three years ago. Dr. Urban addressed this directly on interview day, and mentioned that they have worked diligently to correct the problems. One of the probation citations was for insufficient research output, and in response they hired a full-time research coordinator. This past year, they had 15 acceptances to the AAOS annual meeting and published ~10 manuscripts. The other probation citation was for insufficient full-time faculty, as they lost half of their faculty about 5 years ago due to financial restrictions due to New York State's budget woes. However, after the probation ruling, the orthopaedics department has received an infusion of resources from the state, and they have hired 5 new attendings over the past year (1 each in peds, trauma, spine, sports, and shoulder/elbow). In addition, they are looking to add one hand, one trauma, and one recon attending. Their core full-time faculty work out of University and Kings County Hospitals (which are across the street from each other), and they have 2 faculty in each subspecialty (except for 1 in F/A and tumor). They have a lot of volunteer faculty at their 5 affiliate hospitals (Lutheran, Brooklyn Hospital, Staten Island, Brookdale, Brooklyn VA). Most of the faculty are community-oriented, and don't publish much (outside of Dr. Paulino, their senior spine attending and PD; and Dr. Maheshwari, their joints/tumor attending). In regards to the structure of the program, Dr. Urban is relatively hands-off with the residents and leaves the day-to-day decisions to the chief residents and PD Dr. Paulino (spine), who is a big, burly, blue-collar guy. He was also a resident in the program, and the residents really like working with him.

Didactics/Teaching
They have formal didactics on Monday afternoon from 4-7pm. The lectures are a mix of resident- and attending-led, and rotate across the subspecialties. They often have guest lecturers who are past graduates from the program working in the community or are volunteer faculty at the affiliated hospital sites. They have grand rounds on Friday morning, where the chief residents will present the cases from the past week on their respective services and pick one case each for deeper discussion. On occasion, they will have a guest speaker for grand rounds. They also hold journal club once per month on Mondays in place of the lectures, hold OITE reviews in the fall, and there are occasional skills sessions for the junior residents in the anatomy lab. However, there is no dedicated surgical skills month for interns. They have a morning fracture conference every day, where all of the residents on different services at University/Kings County will show up (as well as 1-2 trauma attendings) and the PGY2 consult residents will present everything that came through the previous day or over the weekend. There is a lot of pimping here, and it can get aggressive at times, especially from senior residents to junior residents (although I heard it has become a lot more benign over the past few years). OITE performance is largely dependent on self-preparation, since the depth and quality of lectures is variable. Some residents perform very well, and others very poorly. The same goes for ABOS exams, with some scattered failures over the past few years.

Operating Experience
The residents get a lot of hands-on experience here, especially on the trauma service as a PGY4/5 at Kings County (the Brooklyn city/county hospital). There are no fellows here, and there is definitely a culture of letting the residents do the cases. The operative experience on the subspecialty services is a bit of a mixed bag, and often depends on the rapport you develop with the attendings. Spine and joints are relatively hands-off. There aren't a ton of tumor cases here, and they are mixed in during the joints rotation since the same attending does both subspecialties. There hasn’t traditionally been much shoulder and elbow here, but with the hiring of two new sports attendings, this should be improving. While there is a ton of volume in the hand clinic, the operative hand experience here is weak since the attendings are all part-time faculty. The operative experience at the other clinical sites is quite variable, and each site has a junior and senior running the general ortho service (except at Brooklyn Hospital, which is PGY3 only). The VA is fairly slow and you typically only can get 2 cases done in a day, although the residents are given a lot of autonomy with the joints and sports stuff they get there. Staten Island, Lutheran, and Brooklyn have a lot of bread and butter orthopaedics, with some low-energy trauma, sports, joints and hand cases. Residents do every subspecialty rotation at Downstate/Kings County as a junior and senior, and each subspecialty service covers both hospitals simultaneously. Overall, residents come out of here confident in all of the basics of orthopaedic surgery, although they don't get a ton of exposure to the complex subspecialty cases. Operative experience as a junior is variable, and often depends on the seniors you are paired with, as well as the rapport you develop with the attendings.

Clinic Experience
Most services have 2 days of clinic per week. The clinic at Kings County is essentially resident-run, with each resident taking a room and seeing the patients on their own, presenting to a senior resident or attending, and then writing the note. The clinics at Kings County can get busy, often with 70-80 patients in a day. The clinic at Downstate is a little less busy, with the attending seeing each individual patient after you present to them. Many of the patients in Brooklyn have serious unmanaged comorbidities (i.e. morbid obesity, diabetes, hypertension, CHF), problems with insurance/access to care, and poor follow-up, so there is a lot of non-operative management in clinic.

Research Opportunities
The research output has grown quite a bit over the past few years. They started the research coordinator position a few years ago, and these guys are highly motivated to publish because they are looking to bolster their residency application. They had 15 projects accepted to AAOS this year, and published ~10 manuscripts. Most of the research is biomechanics and database stuff. Not a ton of basic science here. If you get a presentation accepted at a major meeting they will sponsor your travel. While there are a decent amount of resources available here, the projects are still largely resident-driven. You need to submit 1 paper to graduate, and many residents just do that, although a few have published more. There are a lot of clinical responsibilities, especially as a junior, so it can be difficult to get stuff done if you aren't motivated. The attendings are always interested in research, but only a few have published more than a few articles.

Residents
They have 6 per year, so 30 total. The residents have a blue-collar, average guy feel, and they all seemed relatively friendly and knew each other. There are only 3 girls here, but they seemed to fit in well with the guys. There is a lot of cohesion within each individual class, although there is a bit of hierarchy and division across classes. I heard that it was a bit malignant in the past, especially in the morning fracture conference, but this does not seem to be the case anymore. Most residents go on to fellowships, with nearly all going into private practice. The sub-specialties selected most often are sports, hand and spine.

Lifestyle
The junior residents work hard here, but life is fairly easy for the seniors (with the exception of the 2 months on fracture during PGY4/5). Intern year is easy, even on the ortho rotations, with limited floor work. The PGY2's do 2x2 months (4 total) on fracture, where they have alternating weeks between nights and days. They work entirely on ER consults and floor work, with no operative time. They had a PA to help with Kings County floor work, but he recently left, so they are looking to hire a new one. The consult service can get busy, especially during the summer, and they are always on triple threat call, since there are no plastics or neurosurgery residents in the hospital to split up the hand and spine call. The PGY2 and PGY3 residents split up the weekend call (Friday night, Saturday all-day, and Sunday day) at the various hospitals they cover. Seniors have home call, which is operative only, and very few cases go in the middle of the night here. There is also weekday call at some of the other hospitals, but it is fairly light since none are major trauma centers. Not a ton of perks (i.e. no meal money, lead, loupes, books), but I think they get a educational allowance of ~$250 per year.

Location/Housing
Brooklyn is a cool place to live. Great diversity, lots of stuff to do, places to eat, craft beer to drink. It is a city/borough of neighborhoods, and there are a lot of different places you can live. Many residents live in Park Slope brownstone apartments, and some of the seniors live in lower Manhattan near Wall Street. There are also a couple of residents who live on Long Island and commute in every day. Rent is lower in Brooklyn than Manhattan (low $2000s for 1BR in a good neighborhood), although the salary is only marginally higher than programs outside of NYC. A car is needed here, since the different hospital sites are spread out and most are not easily accessible by subway. Theoretically, you could take public transit to most of the hospitals if you are willing to invest a ton of time into commuting, although Staten Island Hospital is only reachable by an hour-long bus ride from downtown Manhattan.

Limitations
The program was on probation a few years ago, and remains "accredited with warning". Many of the cited issues have been resolved, but the program is still in rebuilding mode. The full-time faculty is ~10 attendings, and they only have 1 or 2 attendings on many services, which is small for a 30 resident program. In addition, there isn't a dedicated tumor block, and the operative hand and F/A experiences are weak (the F/A block is only 3 days per week, with the junior cross covering sports and the senior having research time). While they get a lot of exposure to the bread and butter orthopaedic cases, and get some weird complex pathology from the immigrant and uninsured populations (e.g. massive osteosarcomas or adults with untreated DDH), the case volume here is fairly low. I also would like to have some dedicated operative trauma experience as a junior, but it is back loaded to the PGY4/5 years here. Research is growing, but most of the residents seem to have limited interest in academics. The Brooklyn hospitals are run very inefficiently, with the residents needing to do a lot of the floor scut (i.e. drawing labs, transporting patients, helping with X-rays), and cases constantly delayed by slow room turnover (45-60 minutes on average). Despite being in NYC, you need a car to get between the different hospitals and parking can be difficult (no subsidized parking except for Staten Island and VA). The residents are also spread out across the different sites, so you don't see many of your colleagues for extended periods of time.

Conclusion
Solid community program in a solid location. You will get a strong operative experience in trauma and the bread and butter subspecialty procedures, and have opportunities to train in a variety of different hospital settings (VA, private, public). They have above-average research here for a community-type program, although you do need to take the initiative to get it done. Brooklyn is a fun place to live, although it can be expensive and you need a car to get to the different hospital sites. The core faculty is small, but is growing. The program was on probation just a few years ago, but has rebounded nicely, and seems overall to be on the upswing. This program will be tier 3 for me, since it has a number of limitations and I am seeking more of an academic atmosphere.

North Shore - LIJ (Northwell Health)

Interview Experience
There was a massive blizzard in New York during their interview weekend, so the pre-interview social was cancelled. They still held interviews on Saturday and Sunday, with a fairly solid turnout by applicants (about 45 of 60 made it). Not sure if they decided to have a make-up day or Skype interviews for the stranded applicants. The interview day was somewhat makeshift since everybody was arriving at different times, but overall it was still fairly organized all things considered. There were 5 rooms, each for 10 minutes, which were panel-style with 3-5 faculty each. The rooms were themed, and the theme was the only topic of conversation in the room (compared to other programs, where the room had a few themed questions but also had some general small talk). There were 2 knowledge rooms: the first had 3 brief cases where you were asked to read the X-ray and answer a few simple questions about diagnosis and management. The other room was a single case, where you were asked to read the X-ray and then talk about that topic more in depth. I didn't know a ton about the topic, but I was able to reasonably move through it. I think this is the challenge with knowledge rooms, in that the knowledge base of medical students is fairly limited and is completely dependent on the smattering of services you rotated on. The attendings were still nice about these pimp-style rooms, and I feel like they just wanted to see we had a grasp on some of the basics of orthopaedic management. There was an ethics room with a complex scenario, a research room, and a chairman's/general questions room. There was some down time between interviews to speak with the residents in the boardroom. They had lunch and then Dr. Sgaglione (chairman) and Dr. Lane (PD) made some remarks about the program.

Staff/Faculty/Chairman
Dr. Sgaglione (sports) is the chairman. He is a very personable, friendly guy, and is fairly well known in the academic community (past president of AANA). The department has grown a lot in the past few years, and he has overseen the hiring of 10+ full-time faculty members. The PD is Dr. Lane (hand), who was in private practice for 20+ years before joining the faculty 5 years ago. He has overseen a number of changes to the program, which were all in response to resident feedback, including the creation of a night float system at LIJ hospital. Since LIJ used to be affiliated with HSS, a lot of the faculty here are HSS-trained. They have multiple attendings in every subspecialty, with the exception of 1 tumor attending. They go to Memorial Sloan Kettering during the PGY4 year for 6 weeks for a formal tumor rotation. They are strongest in joints, sports and hand.

Didactics/Teaching
They have formal didactics for 2 hours on Wednesday morning, with attending-led lectures on various topics. The residents said that the lectures are good, and have improved significantly over the past few years with the addition of new faculty members with expertise in different areas. On Wednesday afternoon, the residents typically have bioskills (they have a massive new lab/sim center) or anatomy sessions. There is also a single lecture on Thursday mornings from an attending.

Operating Experience
The residents get extensive operative experience. There are more cases than the residents can cover, and they have PA's and NP's to cover the floor work during the day. The residents are almost always single-scrubbed on cases with the attending (with the exception of some trauma cases where the senior walks the junior through), and even the interns spend the majority of their ortho months in the OR. They split their entire residency between North Shore and LIJ hospitals (about a mile apart), aside from the 6 weeks at MSK as a PGY4. Most of the residents at each hospital are on the general orthopaedics service, which covers most of the trauma, recon, spine, and tumor cases at each hospital. As a PGY2/3/4/5, there is an ambulatory rotation, which mostly covers hand, sports, and F/A. There are no dedicated blocks for the subspecialty services (with the exception of hand as a PGY2/4 and tumor as PGY4), and you may be covering different types of cases each day of the week. There is generally a good amount of autonomy in the OR, and you get to operate a lot. The North Shore Hospital is their Level 1 trauma center, and while the volume isn't crazy busy, you will get a lot of the bread and butter trauma cases.

Clinic Experience
There is a resident-run clinic on Wednesday morning from 9am to noon. They hold clinic at both North Shore and LIJ hospitals, and each clinic is staffed by an attending. You get a lot of autonomy in clinic for the short time you are there. On Wednesday afternoons, if there aren't any educational activities scheduled, and there aren't any cases to cover in the OR, you get farmed out to various attendings' office hours. The hospital system has its own EMR, which can be a bit clunky, but is manageable once you get the hang of it.

Research Opportunities
The program has historically been community-focused, with limited research resources and productivity. Over the past few years, with the creation of Hofstra medical school, the growth of the orthopaedics department, and the increase in the size of the hospital system, the research has grown. They have a number of full-time research faculty (3 or 4 I think), with a lot of work in cartilage regeneration and biomechanics. There isn't a ton of outcomes research yet, but they have invested resources into creating their own data collection system. In addition, the North Shore-LIJ system became Northwell Health this year, and they have enough hospitals now throughout New York that they created their own health insurance network. There will be opportunities for a lot of research down the road, but it will likely be a few years before this is really booming. Not many of the clinical faculty are publishing regularly here, since they are basically private practice surgeons, but they will support projects if residents are interested in putting in the work. There is dedicated time for research during the PGY3 and PGY4 years.

Residents
Nice group of guys. Had a little bit of a blue-collar feel to them, not particularly "bro" though in my opinion. Only 4 per year, so they all get to work with each other and know each other. They are spread out across the two hospital sites, and are dispersed housing-wise across Long Island, but they said that it isn't too hard to spend time together outside of work. Most of the residents here do fellowships and go into private practice. A number of them have ties to the New York area.

Lifestyle
As a junior, there is quite a bit of call here. At LIJ, you have 2 months on night float as a PGY2 and 1 month as a PGY3. At North Shore, call for the PGY2 and PGY3's is q2 24-hour with post-call days. The pager isn't crazy busy during the day, but consults can add up, and you are also handling all of the floor pages overnight. The seniors are home backup call, and their lives seem fairly reasonable. This residency also has the highest intern salary in the country ($69K), so you have plenty of money to spend on educational and recreational items. They don't have any additional perks, but they will sponsor you if you present research at a major conference.

Location/Housing
The hospitals are located on the western part of Long Island, about a 45-minute drive from Manhattan and 30 minutes from Brooklyn and Queens. Some residents live in Manhattan and the outer boroughs, while others live near the hospital or in suburbs in eastern Long Island. You need a car here to get around, and the highways can get jammed with traffic during rush hours. The area near the hospital is entirely suburban, but the city isn't too far away and the beaches on eastern Long Island are great during the summer. Rent isn't quite as high as the city, and you have sufficient salary to comfortably cover your housing and transportation costs.

Limitations
I don't love the structure of the rotations, with residents placed on general orthopaedics and covering a wide range of orthopaedic subspecialties. This makes it difficult to learn in depth about a particular subspecialty, since you are constantly bouncing between them each day. While North Shore is a Level 1 trauma center, its volume isn't that high and it doesn't get much high-energy trauma. The call schedule is fairly difficult, and I would prefer a program a little bit larger than 4 residents per year. The research is solid for a community-type program, but it is mostly basic science and is lacking in the type of clinical research that I want to pursue. The suburban location is also a negative for me, and I don't love the idea of living in Brooklyn and driving 30-45 minutes every day to work. There is very little clinic here, which I think is a negative, as indicating and managing patients is just as important as becoming a skilled technician in the OR.

Conclusion
Solid community program that will only continue to improve over the next few years. You will get a strong operative experience here, and will get in the OR early and often. The research opportunities are growing, and with the hiring of more faculty and acquisition of more hospitals, the academics should continue to improve. This program has some limitations, but for me the biggest one is the location. I don't think there's that much of a difference between the training here and some of the other community-type NYC area programs. Given the suburban location and the lighter trauma experience here, it will be a tier 3 for me.

UPenn

Interview Experience
Social was held in a private room at the Penn Inn. The attire was “business professional”, meaning that you were expected to wear a suit. They make it no secret that this is a formal program, starting with the dress code. All the residents were clean shaven, and this is a requirement for residents. At the social there was plenty of space to speak with residents and attendings, with ample food and drinks to go around. The chair Dr. Levin made a brief speech in the middle of the event to welcome the applicants and talk about how they invested the resources for this venue instead of the foyer in the hospital because of resident feedback from past years. Afterwards, the residents walked the applicants to a local bar, where they had reserved a private room and we got to speak with them in a bit of a less formal setting. Interview day was broken up into AM and PM sessions. The day started with a 30-minute presentation by Dr. Levin about the program, followed by 5 minutes from Dr. Israelite (the PD). The applicants were subdivided into different groups for interviews, a resident presentation, and a tour. There was an hour of interviews, with 6 rooms for 8 minutes each. There were 4 rooms with 2-3 faculty each, a resident room, and the chairman’s room. We did not meet or interact individually with the PD Dr. Israelite, which I found to be a little bit odd, although the two associate PD’s (Dr. Mehta and Dr. Ahn) were among faculty interviewing applicants. Two of the rooms had themes (letters of recommendation and research), and there were a couple of “tell me about a time when…” questions, but no clinical or ethical questions. In the resident room, they asked me to suggest a Pandora station and tell a joke. The resident presentation was fairly straight forward, and the tour was fairly long and probably unnecessary. They hold interviews towards the end of the season, so I had already seen a ton of trauma bays, clinic rooms, and research labs. On the flip side, I will say that there was a nice view of Philadelphia from the helipad on top of the trauma center.

Staff/Faculty/Chairman
Dr. Levin (hand/plastics) is the chair. He was at Duke for 25 years before taking the chair position at Penn 7 years ago. He has a unique background, in that he is double board certified in orthopaedics and plastic surgery. He has a dual appointment to the faculty of both departments, and his clinical rotation is actually referred to as “orthoplastics”. He does so many flaps for the trauma service that he is a member of both the trauma and hand divisions within orthopaedics. He is very well known and connected within the orthopaedics community, and he goes to bat for his residents when it comes time to get them fellowships and jobs. The fellowship match list is phenomenal, and I have been told he asks you at the beginning of your PGY4 year what fellowship you want, and then he gets on the phone and gets the fellowship for you. While he seems like a great guy to have in your corner, he runs a very tight ship at Penn. All of the residents and fellows are required to wear suits and be clean-shaven while they are on his service or at an event where he will be present. Residents take every consult with a smile, and can be disciplined if they are reported as not acting “professionally”. Apparently the medicine and ER services are very influential at Penn, and they are very quick to file complaints about the residents on different consult services, so this definitely adds a stress level to daily work. From what I hear, the residency is quite hierarchical and rigid, with Dr. Levin calling the shots. That said, Dr. Levin is definitely ambitious for making the residency first-class, and is always looking for ways to make it better. He has feedback sessions with residents from each class, decides what can and needs to be changed, and then asks the PD Dr. Israelite (joints) to design and implement the changes. Dr. Israelite seems like a happy-go-lucky guy, with a dry sense of humor, who makes a lot of jokes. He has more day-to-day interaction with the residents, although it still seems like Dr. Levin is the primary decision maker for the residency program. There are also two associate PD’s, Dr. Mehta (trauma) and Dr. Ahn (trauma), who are quite involved in resident education and are the primary teachers during the trauma blocks. Otherwise, their faculty has made a lot of hires since Dr. Levin took over. About 10 years ago, they lost a lot of faculty to Thomas Jefferson, so it has taken some time to rebuild the departments. They have 5 faculty in trauma, 7 in joints, 5 in hand, and 4 in joints, which are probably their strongest departments. They have 1 tumor and 3 F/A (2 of which are new hires), and they have 2 spine (with 2 more new hires starting soon). There are also 20 affiliated peds attendings at CHOP, although they are not full-time faculty.

Didactics/Teaching
Didactics have traditionally been a weakness here, according to some residents I spoke with. They have 1-hour morning conferences 4 to 5 times per week, with an additional 2 hours of lecture and 2 hours of bioskills or anatomy lab on Thursday morning. Most lectures are resident-led, and moderated by 1 or more attendings to make sure the residents are learning the salient points. However, some residents noted that they would like more attending-led lectures, and that they often miss conferences because of work on the floor or cases to cover in the OR. Dr. Levin recently hired some additional NP/PA’s to help with floor work and cover the resident responsibilities during Thursday morning so that everyone can go to didactics, but education is still difficult, especially for the juniors. They have a month-long intern boot camp, but no dedicated OITE preparation.

Operating Experience
Generally a hands-on experience here. As a junior, you will get in the OR as a PGY2 at the VA and CHOP, but the trauma is backloaded into your senior years, with a single 6.5 week block on trauma as a PGY3, PGY4 and PGY5. There is a lot of volume and autonomy here, with PGY3 and PGY5 in one room and a PGY4 in the other room. The attendings, especially on trauma and at the VA, will let the residents fly if they come prepared and generally know what they are doing. The subspecialty rotations are set up like a mentorship model, so you get graduated responsibility during the rotation, although some attendings are more hands-on than others. I heard this is especially the case on joints and hand, with a mixed bag on sports and peds. They don’t have many fellows here, and they have good volume, so there isn’t much double scrubbing. At CHOP, there are quite a few fellows, but there is high volume and they parse out the cases at the start of the week, so the residents get to scrub on mostly basic cases and a few advanced ones. The residents said the spine, tumor and F/A experiences are decent, and will be improving with the hiring of new faculty. They do each rotation as both a junior and a senior, with the exception of a single F/A block as a PGY3. They also have a community orthopaedics rotation about an hour drive away, which they do as a PGY5.

Clinic Experience
They spend 2 or 3 days in clinic depending on the rotation. These are all private clinics, and they do not have a resident-run or free clinic at any of the sites. They are given a good amount of autonomy in the clinics though, seeing the patients, presenting to the attending, and writing the note. They are making the transition to Epic from their old EMR, which will be complete by the end of next year. The residents spoke highly of their clinic experience, and felt that it was among the most educational parts of their training. When there are extra cases in the OR where resident coverage is needed, they have PA’s who can help cover the clinics.

Research Opportunities
They take two residents per year for the 6-year research track, which is a dedicated year between PGY2/3 to work in the basic science, biomechanics, or tissue engineering labs. They have invested a lot of resources in infrastructure and full-time PhD faculty to staff the labs, and there is a lot of high quality work coming out of there. Most of the residents not in the research track, however, are involved with outcomes research. The joints and trauma attendings are the highest volume for publishing, and residents can get involved if they show interest. They don’t have a dedicated research block, so you have to find time to work on research during the lighter blocks like sports and hand. Some of the residents graduate with double-digit publications, but many do not. It is really what you want to make of it. They have some support staff to help with IRB filings and data collection, and have some affiliated biostatisticians to help with methods. They will support travel to present at conferences.

Residents
They take 8 per year, which includes the 2 research residents on the 6-year track. They seemed like a hard-working, blue-collar group, and a bit on the nerdy side. They take pride in their hard work, and according to some rotators, they are always staying late because it is expected of them and not necessarily because they feel compelled to stay to learn and help out. They are a fairly diverse group, with a number of female residents, married residents, and residents with children. Fairly hierarchical structure here, and it seems like there is good cohesion within the class, but less outside of it. I got the feeling that a lot of the residents were tired and run down, and although they expressed enthusiasm about the quality of their training, I didn’t feel like they were as fun as some of the other resident groups I have been around. It may be that the program selects for these types of people, or the program just tires them out over the years. That said, I didn’t get the sense that it was a bad or malignant work environment.

Lifestyle
Blue-collar feel here, and you will work a lot. The trauma blocks are difficult every year here. The interns are slammed with floor work on the general surgery and orthopaedic services, where they are in charge of trauma, joints, and general ortho patients. The PGY2 year has 3 months on trauma, with a combination of day/night float. They are so busy taking care of consults as a PGY2 that there is no OR time for them. The rest of PGY2 is a bit better, with decent hours and some opportunities to get into the OR, especially at the VA. The trauma rotation is 6.5 weeks for the PGY3/4/5 years, and these guys are literally at the hospital for 100 to 110 of the 120 possible hours between Monday morning and Friday night. Each trauma attending works in 24 hour shifts, and the attendings like to operate and teach for the entire time. However, the residents have to stay at the hospital when the attendings switch over in the morning, so you never go home. It sounds like a miserable existence, and Dr. Levin talked about possibly changing the structure, but the residents actually lobbied to keep it because they felt like they learned a ton. Outside of trauma and joints (80-100 hour weeks but not as insane as trauma), the other senior rotations have better hours with time for basic activities of daily life and research. Since they have night float as PGY2, the call schedule works out to q8 for the PGY2 and PGY3’s covering the orthopaedic services at the 3 different hospitals (sometimes you need to drive from hospital to hospital to see consults or floor stuff), with a separate ~q4 call pool for the residents at CHOP. The seniors have home call, but often the primary trauma team stays at the hospital and handles all the cases, so the call team just needs to get the case teed up. Overall, this is among the worst lifestyle programs that I have seen.

Location/Housing
The hospitals are located the University City area of Philadelphia, which is located by the main campus of all of the UPenn undergrad and graduate schools. Most of the residents live in Center City, which is a long walk (~20 to 30 minutes) or short drive (5 to 10 minutes) away from the hospitals. All of the clinical rotations except for the PGY5 community rotation (45-60 minute drive) are within 10 minutes of each other and within the city limits of Philadelphia. The rent is very reasonable, and you can live in a decent sized place for a lower rent than nearby NYC, DC or Boston. They have some clinics located in the suburbs, and combined with the fact that you have to travel between different hospitals while on call, you absolutely need a car to be a resident at this program. Philadelphia has all of the amenities of a modern city, with plenty of good food, beer, and entertainment. The residents seem to spend some time with each other outside of work when they have the time to.

Limitations
The lifestyle here seems pretty brutal, especially as a junior and as a senior on trauma. I am not afraid of working hard and getting my hands dirty, but it seems a little extreme here. They didn’t seem to hide the fact that they are over work hours, and I got the feeling they were kind of proud of it. It seemed like the residents were tired and I didn’t get a sense that it was particularly fun to work here. I heard from a home rotator that one of the interns is leaving, since he felt like the program was too tough; while this is probably more related to the person than the program, it still raises concerns about the work environment. The didactics here are mediocre, and there doesn’t appear to be a ton of time for research. The availability of a research block certainly would be nice. I don’t mind the formality here, but it seems like Dr. Levin really runs a rigid hierarchical system. Philadelphia is a solid location, but it’s not as fun as NYC, and I would need a car.

Conclusion
A blue-collar program with a great name to back it up. You will work hard as a resident here, but you will come out well-trained with a good pedigree and will match at the fellowship of your choice. Despite its shortcomings, I think this is one of the premier programs in the country, but you have to be okay with long work hours, high expectations, and a formal, high-stakes work environment. Unlike many other programs, orthopaedics is not the most influential department in the hospital, and you are constantly under a microscope as a resident and are expected to perform. The academic reputation here is great, and they have good basic science labs, but the clinical research seems to still be developing. While this is arguably a tier 1 program, I am going to put it at the top of my tier 2, as I just didn’t get the sense it would be as fun to work here for 5 years as some of the other places I interviewed.

No offense bro, but if you actually believe 1/2 of the things you wrote here then you were guzzling some ...s e r i o u s... kool aid while interviewing. UPenn a "blue collar" program? Rush operative experience top notch? Did you even talk to rotators? I know at least a dozen rotators whose experiences contradict much of what is written here about various programs.

While we appreciate your efforts in typing this up, readers should be aware that these reviews contain a lot of hyperbole and very little critical analysis.