My Residency Reviews

Rutgers - NJMS (Newark)

Interview Experience
Arrived by 8:30am, with 6x10-minute interviews, a brief video presentation on the residency, and a campus tour with an intern and a PGY2 resident. Each interview room had 1 faculty member and 1 chief resident, including the room with the PD. The chairman did not make an appearance. The tour was the only opportunity to speak with the residents on interview day. The department was business as usual for the most part, so all of the residents except for the chiefs were busy with their normal responsibilities. Compared to some programs, where the program makes many residents available on interview day, this was a little underwhelming. Interviews were conversational and friendly. In one room I had to take out a jenga block, another I talked about an interesting case I saw during my subI's. They interview ~72 for 6 spots, so fairly good odds. Take a mix every year of 1 to 3 NJMS students, 1 or 2 rotators, and 1 or 2 non-rotators.

Staff/Faculty/Chairman
The PD is Dr. Berberian (foot and ankle). He is very involved with the residents and cares about their education experience. He gave all of the applicants his cell phone number, and said we can call him at any time with questions. The residents and the rotating medical students spoke very highly of Dr. Berberian, who went to medical school and did his residency at NJMS. The chairman, Dr. Benevenia (tumor), interacts very little with the residents. He sits on a number of committees at NJMS, so he has been able to get some assets for the program (bioskills lab, call rooms, access to new clinic facilities). However, outside of the tumor rotations as a PGY2 and PGY4, you rarely see him. As for the rest of the faculty, they have representation in every subspecialty, and are especially strong in trauma and tumor (3 attendings). They only have 1 hand attending currently, but another will be starting later this year.

Didactics/Teaching
Formal didactics are on Thursday mornings. It is a 3 hour session, broken into hour-long components: first, each class breaks up and reviews some readings with an attending; then there are case/topic presentations; and finally there is a formal lecture. Last year, Dr. Berberian didn't think that the residents were reading enough, so he created an oral quiz contest, where residents are split up into teams and each resident is asked 1 question per week based on the assigned reading. At the end, the winning team of residents and the individual resident with the most correct answers each get $1,000 bonus in educational money. Last year was the first year they did it, and it has become very competitive, with resident book knowledge increasing significantly. However, residents admitted that book knowledge has never been a priority of this program. You will have all of the core knowledge, and there is 100% pass rate on ABOS part 1 for the last 20 years, but OITE scores are not viewed as being important.

Operating Experience
Emphasized as a strength of the program. You will leave this residency comfortable with trauma and all of the bread and butter orthopaedic procedures. University Hospital in Newark is the home base, where you will spend more than 50% of your time as a resident. It is a level 1 trauma center, and a very busy one. Peds and tumor are also very busy services at UH. On trauma, the operative experience is back loaded, however, and double scrubbing is common according to the rotators. There is also a trauma fellow who will compete for the complex cases. At UH, the sports, spine and joints experiences are weak. Hand (Ahmed) and F/A (Berberian) at UH are hand-on experiences for the residents, but relatively low volume. Rotations at outside hospitals give juniors and seniors complementary experiences, including the VA (20 min drive, good joints), Hackensack (30 min), Overlook (30 min), Newark Beth Israel (10 min, many junior attendings are moving here as they recently inherited 6 OR's), Manhattan Beth Israel (good joints), and Monmouth (1.5 hours away, apartment for residents by hospital). Most of these ancillary sites are privademic and have good hours and limited call with good operative experience.

Clinic Experience
There is a resident-run clinic at UH, where the residents are often the only doctors seeing the patient. Juniors run management plans by their seniors, but they have the freedom to indicate patients for surgery as long as they run it by an attending. The patient population is underserved, so clinic can be busy, and juniors who are on light services are often sent to the clinic to provide an extra set of hands. There are also private offices at UH for the attendings private patients, and residents will also see the patients and come up with their plans, and then present to the attending. Trauma has clinic once per week, peds is more like three times per week.

Research Opportunities
There is an 8-week protected research block during the PGY3 year, and each resident is required to submit a paper for publication as a graduation requirement. However, research is not a focus of the program, and residents cited this as an attractive part of the program for them. They said you can do as much or as little research as you want, with most residents opting for minimal involvement. That said, one of the PGY3's is quite interested in research and published 3 papers this year. However, he was noted to be the exception, not the rule. There is some research support here, and they maintain an active biomechanics and tissue engineering lab with 2 affiliated PhD faculty members. There is a public health institute at the medical school, and it seemed like collaborations between departments are possible if you seek them out.

Residents
6 per year. No research track. There are only 2 females in the program, and both are chiefs this year. About half of the residents are married. I get the vibes that the residents are a bunch of hardworking, blue-collar guys, who are battle-hardened from working in a poorly-functioning hospital system with an underserved patient population. I would describe the residents as very bro-y, talk a lot about sports, swear a lot, and joke around with each other. There seems to be great camaraderie among the residents, and some of them do hang out with each other outside of work. I heard rumors that historically the residents were malignant, and the residents addressed this directly during the day, and said that this was definitely true in the past, but no longer the case. Morning report can still get pretty aggressive, and seniors and attendings like to put the juniors on the spot, but it is supposedly a lot more benign than it used to be.

Lifestyle
You will work hard at this program. Hours on trauma can be long, especially in the summer, where you will be logging 100+ hours regardless of your PGY year. Some of the other busy UH services like tumor and peds can be long hours as well. However, most of the ancillary sites, as well as the lower volume subspecialties at UH (hand, F/A, spine) are much lighter on the hours, definitely below 80. They have adopted a night float system, where you take 2 months straight of nights as a PGY2. This is really challenging, as the ER is busy at all hours of the night, and there is no back-up available. However, once you finish this you don't have any more nights except for weekend 24-hour call about 1x/month. The interns on spine have buddy call during the day to get themselves ready for nights. The day pager is held by a junior on the service that is light for that particular day.

Location/Housing
Newark on the whole is a rough city, and all of the residents live in surrounding areas, with about 1/3 in Hoboken or Jersey City, 1/3 in Manhattan, and 1/3 in New Jersey suburbs. The hospital isn't easily accessible by public transportation, and there are a lot of ancillary hospital sites, so a car is a requirement. However, parking in Manhattan, Hoboken and Jersey City can be a pain in addition to being expensive. Manhattan is obviously an expensive place to live, Hoboken and Jersey City are slightly less, and the suburbs obviously the most affordable and are where most of the residents with kids live.

Limitations
Less subspecialty exposure than I would like, especially in sports and joints. Only 1 hand attending currently, although that may be changing in the near future. Limited operative experience and double scrubbing as a junior on the UH trauma service. Car is required and there is a lot of driving to ancillary hospital sites, including treks to Manhattan and Monmouth (on the Jersey Shore). Chairman has limited involvement with the residents and the program. Book knowledge and research are not emphasized.

Conclusion
Solid program. I think this is a community program at its core, where you will come out well-versed in the bread and butter of orthopaedics, will be comfortable taking call, and will have a good foundation of orthopaedic skills to take with you to fellowship. That said, while there is a medical school affiliated with the program, it isn’t very academic here. Most of the graduates go into community practice, or will work at a private practice with academic ties. The location in the NY metro area is close to family and friends, which is a plus. However, Newark isn't a desirable place to be, and residents said that they go to work then leave the city as soon as they’re done. Make no mistake about it, this is a solid program, and the PD Dr. Berberian is a stand up guy. However, it is on the lower end of the tier 3 spectrum for me.

Tufts

Interview Experience
Arrive at 7am, welcome from the chairman (Dr. Cassidy) and faculty, followed by 2x30-minute interviews with 2 faculty members in each room. The interviews were spaced out by an hour or two, during which time you could speak with residents, faculty, and Dr. Cassidy, as well as take a resident-led tour. They keep the interviews long on purpose, because they think they can get a better feel for the applicant's personality over 30 minutes instead the 5 or 10 minute speed interviews that are commonplace. Laid back conversational interviews, nothing tricky or weird. I think they interview around 80 applicants for 4 spots. They actually don't have many Tufts students in their residency, and they take a mix of rotators and non-rotators.

Staff/Faculty/Chairman
Dr. Cassidy (hand and upper extremity) serves as both the chairman and the PD. Residents describe him as intimidating and business-like, but a great resident advocate. He is generally hands-off in day-to-day resident matters, and allows the residents to work their issues up the food chain to the chiefs before getting involved. However, residents say that he is very approachable and is always trying to create the best residency experience possible for them. He mingled with all the applicants on interview day, and seemed like a humble, cerebral, genuine, down to earth guy. Dr. Braun (I think) serves as the assistant PD to Dr. Cassidy, and he has slowly been gaining responsibilities over the last few years, with the plan that he will eventually take over full responsibilities as PD. The rest of the faculty is spread out over their 3 network hospitals - University, Newton-Wellesley, and New England Baptist. Most of the attendings at NWH and the Baptist are privademic, in that the patients have private insurance, the hospitals have very few inpatients, there is a lot of PA support, but they have residents with them in the OR. Well-represented in subspecialties, especially joints, sports, spine and hand, with only 1 F/A and 1 tumor. They have 1 traumatologist at University Hospital, and it became a level 1 trauma center in 2012, so this area of the faculty may expand in the coming years.

Didactics/Teaching
The residents are split across 3 different hospitals, and each hospital has its own didactics curriculum. They don't have a formal lecture series where all 20 of the residents come to TUMC each week. The only exception is that interns and PGY-2's from NWH and the Baptist come to the fracture conference at TUMC every Monday. The residents stood by this format, and said that all of the lectures are attending-led at each site, with the exception of chief-led basic science lectures on Wednesday morning at TUMC. They also have anatomy labs with fresh frozen cadavers during the year.

Operating Experience
Touted as the biggest strength of the program. The joints experience at the Baptist is incredible, as the volume of both primary and revisions is really high. At NWH, they have a general/community orthopaedics experience, where residents get bread and butter orthopaedics and hand (as a PGY2). Residents also rotate at Rhode Island Hospital as a PGY4, where they are in a room with one of the Brown superchiefs (PGY6's) and get a robust experience of simple and complex trauma cases. At RIH, the experience is hands on, same as the Tufts sites. Double scrubbing at Tufts is very rare, except for the occasional complex revision case at the Baptist with a joints fellow. There is a hand fellow at TUMC who works closely with Dr. Cassidy, but on the Dr. Cassidy OR days for the PGY4, he runs two rooms and you are 1-on-1 with him. At TUMC, they utilize a mentorship program, where you spend a few weeks with each attending on that service, do clinic with them, and operate with them. At NWH and the Baptist, you are basically in the OR for the entire day. Even as an intern and PGY2, you are almost always the first assist, with PA's scrubbed in for additional hands on big cases when needed. The residents said that there is a good balance of autonomy and teaching, especially when you are a junior.

Clinic Experience
The bulk of clinic experience is at TUMC, where you attend clinic with your assigned mentor on that service. Clinic in this setting is 2 or 3 times per week depending on the service. At NWH and the Baptist, you are in the OR most of the time, and usually will spend 0.5-1 day in the clinic. The residents spoke highly of their clinic experience, and said that even for the private patients, the attendings let you see the patient, formulate a plan, and then present.

Research Opportunities
As much or as little as you want to. There is a combined F/A and research block during PGY3, where you operate 3 days/week and do research for the other 2 days. The program is not known for its research, and most residents go into private practice, but attendings are open to collaborations. They have a little bit of biomechanics, but most of the research is clinical. The Baptist has a lot of joints patients with long-term follow-up data, and they also have some support staff to help with stats and IRB's. Dr. Cassidy said during interview day that he would like to grow the research aspect of the program/department over the next few years. They are limited resource-wise, however, so this may be a slow process. They will sponsor your travel to research conferences if you are presenting.

Residents
4 per year. The camaraderie among the residents was emphasized as a strength of the program, and since it is on the smaller end of residency programs, all of the residents work with and know each other. The program personality is on the more “bro” side of the spectrum, but there are 5 female residents who fit in seamlessly. Many of the residents hang out with each other outside of work as well. They enjoy the perks of living in Boston and take advantage of them when they can.

Lifestyle
This is a hard-working program, especially when you are at TUMC. With only 20 residents who are spread thin (usually 7 at TUMC, 5 at NWH, 5 at Baptist, 1 at Brown, 2 interns on gen surg), call at TUMC is covered by the PGY2 floor resident during the day, then a PGY2 or PGY3 at night. They don't have post-call days, so 36-hour shifts are commonplace. Residents said that it sucks but is just a part of life and getting through the program. Life as the floor resident is brutal when you are on call, since you end up holding the pager for 36 hours straight. TUMC is now a level 1 trauma center, so the amount of trauma/consults has increased steadily over the last few years, although this is generally seen as a plus because you get some additional trauma exposure. Outside of TUMC, there is minimal call. At NWH, the ER will call the attending directly, and the attending will only call in the resident if there is something urgent that they need to see or get ready for the OR. I don't think that the Baptist even has an ER, so there isn't any call there.

Location/Housing
Boston is a great place to work and live. Good diversity, food, sports, nightlife. The residents live in Boston, the surrounding neighborhoods (Cambridge, Brookline, South Boston), or the suburbs. The day starts at 5:30am at TUMC, so a car is a must since the train doesn't start running until 6am. The Baptist is ~15 minutes from TUMC and NWH is ~25 minutes from TUMC, so there will be driving, but parking at NWH/Baptist is free and TUMC is a subsidized garage (~$100/month). Boston is on the expensive side of places to live, especially if you want to live in Boston proper.

Limitations
Residents are fairly spread out, and didactics are separate for each site. Trauma exposure is okay, and you will see some trauma at NWH and on subspecialty rotations (i.e. distal radius on hand) but you only have formal trauma rotations as a PGY4 (at Brown) and PGY5 (at TUMC in their newly-minted trauma room). Plus as a PGY4, you have to live in Providence for 3 months. There aren't any post-call days, and you will work >100 hours as a junior at TUMC. Light on research, and most residents go into private practice. Minimal perks for the residents, as the hospital is short on capital. Tumor and F/A only have 1 attending, and you rotate through each of these services only once, during third year. Boston is fairly expensive, you need a car, and there is a bit of driving between the sites.

Conclusion
While Tufts is a well-known academic medical center, I would characterize this program as more community than academic. You get an awesome operative experience, especially in joints, which is hands-on from the very beginning. You get to learn orthopaedics at a number of different settings (academic at TUMC, community at NWH, with the Baptist as sort of a hybrid). However, research is not a focus of the department, the residency is on the smaller side, and the trauma exposure is less than I would like. This is very solid program, and will be in the mid-tier 2 for me.

Thomas Jefferson

Interview Experience
The hospital and residency pride themselves on efficiency, and the interview day was no exception. The day started at 7am and was done by 11am. They make the rank list after the interviews conclude, and said that they would be done by lunch. There was 1 hour of individual interviews in a 3x20-minute format with a faculty member +/- a chief resident in each room. Very conversational and laid-back, with a lot of questions about my research interests. In one room, I was asked questions while fitting a pile of 3D acetabular cups into reconstructed pelvis models. There was also a 20-minute group interview with Dr. Vaccaro (the chairman) and Dr. Purcill (the PD), where you gave a fun fact about yourself. The day concluded with a tour and a resident presentation. There was a social the night before, which was rumored to be among the best on the interview trail, and it did not disappoint. It was on the top floor of a downtown skyscraper, with good food and drinks. All of the chief residents knew my application from memory, which I thought was pretty impressive. They interview 50 rotators and 30 non-rotators for 6 residents per year, and usually take 4 or 5 rotators and 1 or 2 non-rotators. In recent years, they have taken a lot of Jeff students (4 of 6 last year, 5 of 6 the year before), but the residents said that they have brought this up as a concern to the faculty and that the program is actively trying to diversify its resident pool.

Staff/Faculty/Chairman
Dr. Vaccaro (spine) was named the new chair last year, when Dr. Albert left to become surgeon-in-chief at HSS. Since the Rothman Institute is a private group with an academic affiliation to Jeff, he was selected internally by the other orthopaedic faculty, unlike most hospitals where the department chairs each cast a vote. He is the CEO of the group, so he is clearly business-savvy, and he projected the slick business executive image during interview day. Very direct, concise, articulate, and focused on efficiency. In the group applicant interview, he was relaxed, told a few jokes, and shot the shit with us. The residents spoke highly of his leadership, and pointed to the fact that 0 faculty left after the regime change. Dr. Purcill (joints) is the PD. He also has the business executive feel, although he seems a little quieter and more calculated than Dr. Vaccaro. The residents said he is approachable and is very responsive to their feedback, and pointed to last year's change in the peds rotation schedule (from 6 months straight at DuPont during PGY3, with a lot of nonop management -- to 2 months at Shriner's during PGY2, with mostly complex operative cases, and then 4 months during PGY3 at DuPont). This change was in response to resident complaints about the DuPont experience. While on this topic, the residents are also lobbying to change a month of the PGY5 spine rotation to an open elective. As for the rest of the faculty, they have big names in literally every subspecialty. Their trauma faculty is small, but that is a product of having a privademic program with no rotations at public hospitals. Dr. Jerry Williams (shoulder/elbow) is on the presidential succession line at AAOS, and a number of other faculty are high up in the subspecialty group leadership food chains. Residents said that the structure of the program/hospital is such that they contact attendings directly, and there is minimal red tape. Again, it's all about efficiency.

Didactics/Teaching
They have 2 hours of lecture on Monday from 5 to 7pm, then 1 hour of lecture Friday morning from 6 to 7am followed by grand rounds from 7 to 8am. All lectures are attending-led, and lectures run on a 2-year cycle. There is also journal club once per month, where an attending will host a catered dinner at their house and residents will present and discuss the assigned articles. Most subspecialty rotations also have their own monthly journal club. There are also some cadaver/anatomy labs during the year. They don't have formal OITE review, but the residents said they have enough free time to study and do practice questions.

Operating Experience
Huge strength of the program. They have massive operative volume in every subspecialty, so you will get tons of reps for both routine and exotic cases. As an intern and PGY2, you do quite a bit of floor work, but your operative months are hands on. The juniors (intern/PGY2) are often double scrubbed with the PGY5/fellow, who will walk them through the case while the attending watches and/or bounces between rooms. This is done on purpose, so that the junior learns how to operate. However, the learning is hands-on, and the seniors have enough operative reps that they are focused on teaching. By PGY-3, you are given your own room with the attending, and you will never be competing for cases with the fellow. On many rotations, medical students don't even scrub in because they are considered to be an inefficiency in the surgical production. This rubbed a few rotators I talked to the wrong way, as they felt like they had no opportunity to showcase their skills or personality. Joints and hand are arguably the busiest services here. Many of the joints attendings will do 10 to 12 cases per day, but since the privademic model emphasizes efficiency, they will start around 8am and routinely finish by 2 or 3pm. One of the foot and ankle attendings does 20 cases per day twice a week, but he wants to be done by 5pm. They can do so much volume for a few reasons. First, the room turnover time is unbelievable, routinely 3 or 4 minutes at Rothman sites and 10 minutes at Jefferson. Second, they have a ton of ancillary staff support to keep the cases moving along. Third, there are a lot of expectations on residents to operate correctly, and some attendings can have low tolerance for mistakes. This may be a little stressful, but it forces you to get good at operating. Attendings acknowledged that some residents are better/quicker than others, so they will tailor their expectations and level of instruction to the individual resident. They also spend a few months at Bryn Mawr hospital (~30 min drive) as a junior and senior, where they get reps in more of a community setting with a lot of bread and butter orthopaedic cases across different subspecialties and a mix of hot and cold trauma. Residents say that they routinely get 1 or 2 operative cases per call shift. For peds, the operative experience at DuPont is light, with an operative-heavy PGY2 rotation at Shriner's.

Clinic Experience
For most blocks, you spend 3 days in the OR and 2 days in clinic. With the mentorship model, most of the attendings will have you see the patient yourself, then present your impression and plan for workup and management. Most of the residents do all of the documentation, and attendings teach residents how to dictate with an emphasis on key words for billing purposes, how to use billing codes, and how to run the clinic efficiently.

Research Opportunities
Every resident is expected to do research. There are a ton of resources at your disposal, including a "research sweatshop" as one resident described it, where there are >20 dedicated ortho support staff who help with IRB's, stats, lit review, manuscript submission, grant writing, etc. If you want a list of all of the distal radius fractures, what implant was used, and how much each one cost, someone will pull the data and send you a report within a few days. If you want access to a large insurance database for a research project, they will work to get you access ASAP, no questions asked. Most of the research is clinical, with not much basic science. The focus is on outcomes, cost efficiency, and business modeling. This is very relevant to the private Rothman Institute group, since they are always looking for ways to increase efficiency. They have become a leader in orthopaedics in this area because of the overhaul of the entire healthcare system with bundled payment reform and a focus on quality measures. The chairman and a number of other attendings have MBA's, and their biostatistician has advanced knowledge of economic modeling. They are developing a "business of orthopaedics" curriculum in collaboration with Temple business school, which they have identified as an area of under-education among orthopaedic surgeons and physicians as a whole. Overall, amazing research enterprise.

Residents
They take 6 per year, so 30 total, with 25 male and 5 female. Around 50% are married, a couple with kids. There is definitely camaraderie among the residents, especially within each class, and they are an energetic and fun bunch. They drink beers and watch sports outside of work, and most of them live nearby each other. I got a bit of a county-club feel from the residents, as most of them were in good shape, well-dressed, and clean shaven. Definitely not a fit for everyone, but I felt like I would fit in fine.

Lifestyle
This is a gentleman's program. You operate a ton, but since most surgeries are elective, and you don't work in a city/county hospital, you will almost never work >80 hours. Rounding usually starts around 5am and you are done when surgery or clinic is over, which is usually in the early afternoon. Some of the seniors said on certain rotations they regularly leave the hospital around 2 or 3pm. Clinic usually runs until 5pm. You do night float as a PGY2, which can be busy. You take weekend call for two weekends per month (with two golden weekends), although they often utilize 12-hour shifts instead of 24. Getting back to efficiency, the attendings can't afford to have the residents dragging in the OR or clinic, so there is no overnight call during the week. At Bryn Mawr, call works out to q4, I forgot to ask how post-call works here. There are a lot of perks for the residents, including research travel grants, money for lead/loupes, fleeces, book money, etc. Overall, very lifestyle-friendly, as you will have time when you get home to do research, read about your cases, exercise, hang with your family, make dinner, etc.

Location/Housing
Philadelphia has all of the amenities of a modern city, but is much more affordable than nearby NYC, DC, and Boston. Rent is reasonable and you can live comfortably in an apartment near the hospital in Center City. There is plenty of good food, beer, and sports to keep you entertained on days off. Public transit is generally good, although you will need a car for this program. Most of the PGY1/2 rotations are at the main Jeff hospital (except for the Bryn Mawr rotations), but starting with PGY3, you will need to drive to the ancillary Rothman sites (ranging from 20-40 minutes away) as well as DuPont in Delaware (40 minutes away). However, this is usually a reverse commute in the morning, and since the hours are good, the afternoon commute home is fine. Parking in the Jeff garage is subsidized by the hospital, and parking at the other sites is usually free.

Limitations
There is limited trauma exposure here. You will see some community fracture cases at Bryn Mawr, and their traumatologist at Jeff is really busy (rotate with him as a PGY4 or PGY5, I forget), so residents say that they feel comfortable taking primary call at a community hospital. However, without a city/county hospital, you do lose some of the daily grind of residency. Also, while this program is very team-based, it is rarely with other residents, and you largely function as a cog within the Rothman surgical team (attending, fellow, NP, PA, surgical team). Residents are spread out across different sites, and there is quite a bit of driving for this program, with a car as a requirement. With a huge faculty (not sure of exact number, but easily >50), you have a lot of different learning opportunities, but you may not get to work with everyone or build long-standing relationships. The predominance of Jefferson medical school graduates in the residency is also a negative, although this may be changing.

Conclusion
Amazing operative experience and research opportunities. Lifestyle-friendly program, with good work hours and sufficient time for research and your personal life. Top notch fellowships for all the residents (Shock Trauma, HSS tumor, HSS joints, etc.). Big names in every subspecialty, with stable leadership at the top. The lack of hot trauma is a bit of a negative, but it is a trade-off for logging a huge amount of cases in elective surgery. Philly isn't as alluring as NYC or SF, but it is a very affordable and fun alternative. The business-focus and privademic nature of this program definitely makes it different from the other programs I have interviewed at. For some people (but not me), I think this program is a tough "fit" because it has a very unique structure and identity. Overall, I think this program is in the conversation for the best residency in the county. Tier 1 for me.

Johns Hopkins

Interview Experience
Day started late by interview standards (8am), with breakfast and some presentations by Dr. Laporte (PD), Dr. Ficke (chairman), and a pair of residents. There were 3 interviews for 30 minutes each, with 2 interviewers in each room (1 attending + 1 researcher/resident). The interviews were among the hardest I had, with a lot of pre-planned, specific questions about my CV, as well as a number of behavioral and personality questions. With the 30-minute format, it was fairly intense, and many of the interviewers were hard to read (I heard this from other interviewees as well). However, no pimping or skills activities. There was also a 30-minute group interview with half of the interviewees where we got to ask questions to the chairman and PD. Day finished with a hospital tour, buffet lunch at Dinosaur BBQ (awesome meal), and a bus tour of the nice areas of Baltimore. They interview 50 applicants for 5 spots.

Staff/Faculty/Chairman
Dr. Ficke (F/A, trauma) has been chair for the past 2 years. Before he was hired, the department didn't have a chair for a few years (like 2 or 3), and a bunch of the faculty left. However, they hired Dr. Ficke from the Army Medical Center in Texas, and the department has seen tremendous turnaround under his watch. He has been working to increase resources for the department, including facilities (new musculoskeletal institute under construction, more dedicated clinic space, turning Bayview Hospital into total joints center of excellence), residency funding (plan to add 6th resident next year, funding from NIH for 1 resident to pursue a research year if they want), and faculty (hired 10 new faculty in the last two years, most notably in joints and tumor where they were weak). Dr. Ficke definitely has a military vibe (in a good way), as he is very direct, humble, and honest. The residents spoke highly of his leadership, work ethic, and vision for the department. Dr. Laporte (hand), is the PD, and she is super friendly and personable, although her presentation at the start of the interview day seemed a bit dry. She knew all of our applications from memory, which was definitely impressive. The residents meet with her regularly, and she is very open and responsive to feedback to improve the program. She used to be a resident at Hopkins, and the residents said this helps her relate to the issues they bring up. As far as the rest of the faculty, they have good coverage across all subspecialties, with a number of field leaders in peds and spine.

Didactics/Teaching
The didactics curriculum is Thursday from 7am to 12pm, with grand rounds followed by 3 hours of attending-led lectures and an hour of resident-led activities (i.e. OITE review, administrative housekeeping). During the summer, they have operative skills and/or anatomy sessions in lieu of lectures. They also have monthly journal club at attending homes with catered dinner and drinks. There is at least one specialty-specific conference per week. In the mornings, they have morning report (aka "trauma board") for residents at Hopkins hospital, where they go over the previous night's consults with an attending.

Operating Experience
Touted as a strength of the program. While the volume isn't super high, they only have 5 fellows (will be 6 fellows next year with the start of their joints fellowship), and attendings usually run two rooms so there isn't much competition for cases. In fact, Dr. Ficke said that they have enough uncovered rooms that they are applying to add a 6th resident next year. Residents said that they are rarely double scrubbed, except for the occasional trauma case (where the senior is typically allowed to teach the junior) or complex spine or peds case (where fellow does the hard parts and takes resident through the easier parts). Hopkins is a level 1 trauma center and Bayview is level 2, so there is a robust experience of bread and butter trauma cases, especially during the summer. The complex/exotic open and pelvis traumas in town are usually taken to the nearby Shock Trauma Center, but there is plenty of trauma case volume at Hopkins, including high-energy fractures from gunshots, car accidents, and struck pedestrians. While there has been turnover with joints and tumor faculty, residents going into these fields said they have received a lot of hands-on experience in the OR, and the attendings are dedicated to teaching. The sports experience was shoulder-heavy in the past, but they have now split it into two rotations, one with shoulder as a PGY3 and the other with general sports as a PGY2. Peds and spine are very busy services, although residents said there are a lot of complex cases, where they don’t get to do as much. They have added a community spine rotation for additional spine experience. The residents go to Union Memorial (15 minute drive) for F/A, which they said is a great hands-on experience. One area that is light on OR volume is hand, but the residents said you can do an additional month on hand as a PGY3 during your research/elective time.

Clinic Experience
Usually once per week during trauma, and twice per week otherwise. Experiences are attending-dependent, but usually the residents are responsible for seeing the patient, coming up with a plan, and dictating the note. They have Epic in the clinic, which is easy to use. Some attendings make an effort to help residents appreciate particular physical exam findings.

Research Opportunities
There are a lot of resources for research here. Residents are required to submit at least 1 manuscript for publication by graduation, but many do more. They have research/elective rotations for 10 weeks each in PGY3 and PGY4, where you can work on your projects, do a clinical subspecialty rotation at an away hospital, do an international elective, or do some mix of everything. In recent classes, about 50% have gone into academics, which is up from 25% in prior years. From talking to some of the residents, they can do as much or as little research as they want, with a few residents regularly presenting at conferences (fully supported by department as long as it's a different project each time). There is also the option for a research year at Hopkins (fully funded by NIH grant), which you can apply for at the end of the PGY2 year to take between the PGY2 and PGY3 years. The program stressed that the year is optional for the residents, and it doesn't go to a lottery system if nobody applies for it (like it does at Case Western and Maimonides). Nobody applied for it last year, so they don’t have a research resident this year. Their research portfolio is fairly diverse, with a mix of basic science and clinical research. Not a ton of biomechanics, but that's not important to me. There is some cost and quality research, not a ton, but they are growing this area and want to collaborate with the Hopkins schools of public health and business. Overall, great research resources available, although I wouldn't say this is a prevailing theme of the residency.

Residents
5 per year, so 25 total. Very diverse group of residents, with a collection of "bros, nerds, and girly girls" (verbatim from a resident). The residents spoke to the sense of community that they have with each other despite their diverse backgrounds and personalities. They were all very low-key, friendly, and down-to-earth. While I didn't get quite the same level of energy and fun from the residents at other programs, I feel confident that any type of person could fit into this group (can't say that for some places), me included.

Lifestyle
Definitely a hard-working, blue-collar program. On trauma, where you rotate as a PGY1, PGY2 and PGY5, rounding for the juniors starts at 4:30am, and you usually don't leave until late at night. Peds and spine are also really busy, and you can regularly log >100 hours per week. However, sports and F/A are reasonable and hand is light. For call, it works out to q5 or q6 for the juniors, with post-call days. They do have a night float rotation for PGY2's, but the resident is so busy with floor pages that they don't help much with ER consults. The overnight call can be rough, with double-digit pages regularly, and >20 not unheard of. They have the only level 1 peds trauma center in Maryland, so they get crushed with peds consults daily. Senior call is from home, and Bayview consults are handled by PA's (I think), with the on-call junior coming in only for something deemed urgent/emergent. They have hired a number of PA's over the past year to help with discharges and floor work during the day. They are looking to add another PA to help at night. The residents get plenty of perks, including lead and loupes, meal money while they're on call, and support for travel to research conferences. A few of the residents mentioned that the program had some “hints of malignancy" 5-10 years ago, but that has completely disappeared and it is now a very collegial and pleasant place to work.

Location/Housing
Baltimore has its good and bad parts. The hospital itself is in a bad, but not horrible, part of town. There are housing projects across the street from the hospital, and they have security guards posted on every street corner. Residents said that they have never felt unsafe while they were at work, but the concept of safety does come up regularly. One resident said his phone was stolen one day on the way to work. However, while there are a lot of bad parts of Baltimore, the residents saw this as a strength, in that they had an opportunity to help the community. They talked a lot about patient diversity, in that they treat international royalty, gang members, and homeless people within the same day. On the bus tour, we got to see the inner harbor area, which is about 10 minutes drive from the hospital campus. Many residents live here, and housing is affordable, even in new apartment complexes with parking and water views. The area is very walkable, has many restaurants and shops, as well as grocery and department stores. Other neighborhoods on the outskirts of the city have a more suburban feel, and real estate is cheap enough that you could buy a house and pay a mortgage on your resident's salary. A car is essential to live in Baltimore, but all of the hospital sites are within 10 to 15 minutes driving of each other. Some residents with spouses who work in DC will live in Columbia, Maryland, which is about halfway between DC and Baltimore.

Limitations
Baltimore is not the most desirable place to live, and the area around the hospital has some safety concerns. It is unsettling to think about driving at night, and having your car break down in a bad area. There was also some civil unrest in Baltimore last year, although this seems to have resolved. The residency program was also in a bit of turmoil and transition just a few years ago, and while the leadership has stabilized, I still feel like the program is still in the process of rebuilding its identity. The call schedule and work hours can be tough, and residents said that the ortho department isn't as respected within the hospital because every single Hopkins department is world-renowned. I heard complaints about inefficiencies of the university hospital, and room turnover can be as slow as 90 minutes. The operative experience on hand is light, although most other subspecialties are well-covered. Heavy doses of peds and spine, which I am not particularly interested in. Volume isn't as high as some places, although the quality of learning and hands-on experience seem great. Requirement for a car is a negative for me, although the driving is fairly limited.

Conclusion
At its core, this is a blue collar program. However, they have all the benefits of a big academic center, with renowned faculty and abundant research resources. The program is on an upward trajectory, and has new leadership with a drive to create the best department and residency experience possible. I was impressed with the hands-on clinical training, resident-focused structure of the program, and research resources including dedicated elective time. However, the residents I met, while quite friendly and engaging, seemed a bit nerdy and occasionally weird. They really tried to sell the city of Baltimore on interview day, but it is not a desirable place to live. This program exceeded my expectations on interview day, and will be an upper tier 2 for me.

Rutgers - Robert Wood Johnson (RWJ)

Interview Experience
The pre-interview social was bowling. Interview day started at 7am, but your interview schedule was created according to who showed up first that morning. So if you wanted to leave early, you were advised to show up early. I came around 6:45am, and ended up with one of the last slots. It was also frustrating, in that the interview end time was listed as “between 1pm and 5pm”, so getting transportation out of New Brunswick was last minute. Anyways, on the interview day, there was a grand rounds consisting of two complicated cases that were presented by one of the chief residents. The chief occasionally picked on his juniors to answer some reasonable pimp questions. Then the chairman, Dr. Gatt (who also serves as the PD) gave an overview presentation of the program. The resident selection chair (essentially the co-PD), Dr. Coyle, also gave a few comments about the structure of the day. There was a tour, as well as 4x12-minute interviews with 2 faculty in each room. The interviews were very laid back, and were mostly small talk about non-medicine topics including sports and my hobbies. Lunch was from a local Italian restaurant, and was among the best I had during interview season. Not sure how many they interview, my day had about 25 and they have 3 days. They usually take 1 or 2 RWJ students every year.

Staff/Faculty/Chairman
Dr. Gatt (sports) serves as the chairman and the PD. His personality is a bit on the dry side, but he was very friendly and engaging. Has a bit of a businessman feel to him. The residents and rotating medical students said that he is relatively hands-off in the residency, and lets the residents work issues up the chain of command. However, residents said that he is open to feedback, and they like him as their leader. Dr. Coyle (hand), heads the selection committee, and he is a funny guy. Old-school guy, doesn't have much of a filter on his conversation, with a lot of swearing and some off-color jokes. The entire faculty is volunteer, since ortho at RWJ is a private group that uses the hospital facilities. This was pitched as a strength, since the faculty doesn't need residents for their practice but they are dedicated to teaching. In addition, most of the attendings stay at RWJ forever, and are not looking to move up the academic food chain. Subspecialty-wise, they only have 2 joints guys and currently lack F/A and tumor attendings. They rotate through MSK in NYC for tumor as a PGY4. There are a lot of sports and hand attendings on the faculty.

Didactics/Teaching
I think that Thursday morning is the formal didactic curriculum. The teaching is a mixture of resident- and attending-led lectures as well as grand rounds, which are often case presentations by chief residents. The residents perform well on the OITE, with scores typically in the 70th to 90th percentiles. During the fall, each resident is assigned to a cadaver in the medical school during the school’s MSK block. Residents said they use the cadaver to work on approaches, soft tissue releases, etc., and they also have opportunities to teach the medical students. There is also morning report every day at 6am, where the residents from all of the services at University Hospital will go over the previous day/night's consults.

Operating Experience
Touted as a strength of the program. The experience is split between University Hospital (an academic center) and St. Peter's Hospital (a community hospital), which also located in New Brunswick. The residents get into the ortho trauma OR for 3 months as an intern, and have ample opportunities to operate. There are no fellows, and double scrubbing is rare, as there are usually more cases to cover than there are residents. Sports, hand, and trauma are the busiest services, but joints and peds are fairly busy as well. The volume here isn't crazy busy, but with only 3 residents, there are more than enough cases to go around. University Hospital is a level 1 trauma center, and can get quite busy in the summer. They are weak in F/A, without a dedicated attending. However, they are looking to hire one in the near future. They have an outpatient surgical center in town that is doing same-day total joints, and their joints volume is projected to grow significantly in the coming years.

Clinic Experience
There is a resident run clinic once per week on Thursday afternoon, where residents from all services at UH will see all of the community/general orthopaedic complaints. There is a diverse patient population in New Brunswick, and this clinic is mainly for the uninsured and underinsured patients. Speaking Spanish is a big plus for this clinic. An attending is in charge of staffing this clinic, and pre-operative/operative cases are presented to them, but otherwise it’s completely resident-driven. Depending on the service, there is also usually 1 additional day of clinic with the attending in their private office. Residents are encouraged to see the patients on their own and formulate a plan before presenting it to the attending. Their EMR is Eclipsys, not the easiest to use, but not the worst either.

Research Opportunities
This is a weak point of the program, but one that Dr. Gatt said they are working to grow. Residents are required to submit one paper for publication by graduation, and there is a 6-week research rotation during the PGY4 year. Most of the research is basic science sports medicine tissue engineering done by Dr. Gatt and the PhD lab guy, Dr. Dunn. However, they have started working on some database and clinical outcomes projects, and would like to study the economic and clinical implications within their same-day total joint replacement facility. Most of the residents go into private practice, so research is usually just a checkbox to get into fellowship, but occasionally a resident will prioritize research and be productive. Attendings are interested, but there aren't many resources available to facilitate the projects. There is support for travel if you present at a conference.

Residents
The program currently has 19 residents, with 3 interns and 4 in the other classes. The cutback to 3 per year is permanent, as they are no longer rotating at the Jersey Shore Medical Center (45 minute drive from New Brunswick), which has merged with the Seton Hall system. Dr. Gatt said that the resident experience will not be changing, since all of the services at JSMC were duplicative of UH and St. Peter's, and one less resident per year will allow the core experiences to remain the same. The only difference is that the length of rotation blocks will grow from 3 to 4 months. The residents themselves seemed like an easy-going, fun group. Only 2 girls in the program, so a little bit of a bro feel. They joked around a lot with each other, with a lot of sarcastic humor, although at times their dynamic was a bit weird. Many of them spend time together outside of work, and some even go on vacation with each other. Another thing that stood out was that despite many residents being present at the interview day, they mostly talked to each other and didn't seem that interested in engaging the applicants. Overall, nice group, just didn't develop much of a rapport with them.

Lifestyle
Fairly good lifestyle. Since the structure is privademic, many of the surgical days are finished at a reasonable hour and turnover time is above average. Trauma can be tough, especially during the summer, but this is expected for a level 1 trauma center. They don't have enough residents for a night float system, so call works out to q4 or q5 for the juniors. They recently started enforcing post-call days, so residents who have a rough night can go home. There will be nights on call where you get to sleep, especially during the winter. Resident morale seemed fairly high. There were some minor dissatisfactions about administrative disorganization, but overall they enjoyed their experience.

Location/Housing
Residents are distributed among the city of New Brunswick and the New Jersey suburbs. A 1-bedroom in a high-rise can go for $1000 to $1500, with options to rent/buy a small house in the burbs if you have family. Fairly evenly spaced between NYC and Philly (about an hour to both), so you could theoretically live in between and split a commute with a significant other. A car is required to live in this area of the country, but parking is plentiful at the hospital, and the two hospital sites are only 10 minutes away from each other. With Jersey Shore out of the rotation pool, there isn't much commuting anymore.

Limitations
Small program, with only 2 rotation sites. Research is limited, and most residents go into private practice. Fellowship placement over the last few years had a few standouts, but on the whole was average. No dedicated F/A rotation, and joints volume is currently on the low side. No night float means you have call fairly frequently. Location is in suburbia and a car is required. Did not have a great vibe with the residents, and was not particularly impressed by the grand rounds.

Conclusion
A solid community program in the suburbs. Good operative experience, with solid trauma exposure and strong sports and hand rotations. I didn't hear much about the tumor rotation at MSK, but it is the world's premier oncology institution, and you get to live in NYC for those 8 weeks. I don’t think this program has any glaring weaknesses, but it just wasn’t a good fit for me. Will be on the lower end of my tier 3.

Albany

Interview Experience
This interview starts late, around 9am, so you can sleep in a little. The day started with a brief overview from Dr. Uhl, who serves as chairman and PD. Then everyone was split into 4 groups, split between interviews, a presentation from Dr. Uhl and Dr. Mulligan (associate PD), lunch, and a tour with the residents. Each group was assigned a couple of residents, so there were plenty of opportunities to ask questions and learn about the program. Everyone had 3 individual interviews for 10 minutes each. These were among the harder interviews I had, with ethical and/or clinical questions mixed in with generic CV questions in each room. The residents said that each faculty member is assigned specific questions by Dr. Uhl to help standardize the interview process. The residents have lobbied against the questions, because they think it takes away from normal conversation, but Dr. Uhl likes them, so have stayed. They only have 1 interview day, with about 60 applicants. They usually take 1 or 2 Albany students each year for the 5 spots.

Staff/Faculty/Chairman
Dr. Uhl (hand and upper extremity) serves as both the chairman and PD for the program. Residents say that he is a visible leader and is present at all academic activities. Furthermore, he mentors the junior residents to make sure they are keeping up with the workload and are starting to think about their future. Dr. Uhl is a big guy, and he has a jolly, jovial personality. The residents said they love operating with him on the hand rotation as a PGY4. Dr. Mulligan (hand) is a little bit younger and serves as the associate PD. He grew up in Albany and stayed for medical school and residency, so he is very pro-Albany and is invested in resident education. In the OR, he can be hard on residents, and he admitted this during his presentation, but he said that he wants to get the most out every resident's potential. Nearly all of the faculty are in private practice, but the academic affiliation allows them to teach, and they enjoy working with residents. The attendings are spread out across the hospital sites, including AMC, the VA (across the street from AMC), Ellis Hospital in Schenectady (20 minute drive), and St. Peter's (in Albany, 10 min drive). They currently have no dedicated peds attending, and go to Shriner's Hospital in Springfield, MA (1 hour away) for a peds block during their PGY4 (or PGY3?) year. They have a few attendings in each subspecialty, although only 1 tumor attending that they work with as a PGY3. They have 2 incoming attendings who were Albany residents last year and are currently in fellowship: F/A and Trauma. The F/A resident was a very productive researcher and will be the director of research upon his return.

Didactics/Teaching
There are conferences on Wednesday and Friday, with grand rounds Thursday and a dedicated lecture time every Friday (I think). The residents did not talk much about the didactics, but said that they do not teach towards the OITE. However, they have a 100% pass rate on part 1 of the ABOS boards, and learning is geared towards clinical application. They have journal club once per month at a local restaurant, which is run by Dr. Phelan, a well-read private practice sports and trauma attending. The residents are expected to read on their own, which is manageable during PGY3 through PGY5 but very difficult as a PGY2. Overall, this isn't a place that emphasizes book knowledge, and the learning is focused on the bread and butter of orthopaedic techniques and management.

Operating Experience
The residents here spoke highly of their operative experience. They spend the majority of their PGY3 through PGY5 years in the OR as first-assist. The way that the residency is set up, the PGY1's and PGY2's spend most of their time on consults and floor work for the trauma and general orthopaedic services, then the senior years are all operative. As a PGY1 and PGY2, you will get some opportunities to scrub, but usually this is as second-assist on trauma and general orthopaedics rotations. There will be some first-assist opportunities, and responsibility is graduated. As PGY3, you spend half of the year on general orthopaedics rotations as well as tumor. Trauma is for PGY1, PGY2, and PGY5, and the trauma service is very busy. They have 6 operating rooms at AMC, and these are very busy, especially with trauma during the summer. The volume at the VA is fairly low, and they have a new Bone and Joint surgicenter in Albany, where residents do elective cases on their subspecialty rotations as a PGY4 and PGY5.

Clinic Experience
Some attendings acknowledged that the residents don't get into the clinic as much as they would like. The OR's are often busy, and residents often are pulled from clinic to do cases. The clinic for AMC is all done at the Bone and Joint Center. The clinics are all private practice patients, and there is no resident-run clinic. However, residents said that they get a ton of clinic experience at the VA and St. Peter's Hospital, so they were not concerned about their clinic skills.

Research Opportunities
This has classically been a weakness of the program, but they are actively trying to grow their research profile. They recently hired a research director, who is a former Albany resident who published more than 25 articles during residency. They don't have any research assistants or dedicated labs currently, but there are opportunities to work on biomechanics projects with the nearby Rensslaer Polytechnic Institute. Not much in terms of outcomes research currently, but attendings are open to collaborating on any type of project. Residents have a 10-week research block during their PGY3 year, and they are required to submit at least 1 project to AAOS and 1 paper to a journal. However, the clinical schedule as a senior resident is conducive to doing research if that is a priority for you.

Residents
They take 5 per year, which was increased from 4 per year in 2011. Male-dominated, with only 2 girls. About half are married. I thought that the residents were a friendly, down to earth group. They joked around with each other quite a bit and seemed happy with their training and lifestyle. Residents said that they mostly hang out the people with their class, but that everybody gets along and knows each other. Most of the residents go into private practice, with an occasional person going into academics. Everyone does fellowships, and hand/sports seem to be the most popular.

Lifestyle
Both Dr. Uhl and the residents were up front about the PGY2 year being arguably the worst in the country. They have a night float system, where the PGY2's cover the consults and floor work for the entire trauma and general orthopaedic services at AMC. There are 20 weeks on trauma and 10 weeks on night float at AMC. They have a huge catchment area of most of New York State outside of metro NYC, so the juniors are getting killed with consults day and night. Call for PGY3 through PGY5 is from home, operative only. Morning trauma rounds at AMC (100+ patients) are done entirely by the interns and PGY2's. They get into the hospital around 3:30am for most of the year. However, as a senior, you can get in at 7am, and only round on the critical patients on your service. Weekend call again is taken by the PGY2's, with one resident taking a 24-hour on Friday and 12-hour on Sunday AM and another taking 24-hour Saturday, with the night float resident coming in on Sunday PM. The weekend call for the seniors works out to around one weekend per month. There are also opportunities to moonlight at St. Peter's Hospital starting as a PGY3 once you have finished the rotation there, with the caveat that you need to score at least 40th percentile on your OITE.

Location/Housing
Albany is a small city, very affordable and accessible. Residents have the option to buy or rent locally, and nearly all of the hospital sites are close to each other. A car is a requirement to get around Albany, but there is no issue with parking, and traffic is light. Not a ton to do in the city of Albany, but residents said there are a lot of gastropubs to eat at. There is some minor league hockey and college basketball in town, and there are plenty of outdoor options with the mountains close by. Saratoga is close, and is a fun place to go during the summer. As a senior, with the light weekend schedule, you can make trips into NYC, Boston, or Montreal, all of which are a few hours by car or train. The salaries are actually on par with many metro NYC programs, but you get a lot more bang for your buck in Albany. Moonlighting at St. Peter's is also a great way to make additional money as a senior.

Limitations
PGY2 year sounds like hell. Rotation in Springfield for peds is not ideal. No dedicated subspecialty-specific rotations on hand, sports and joints until PGY4, which might make it hard to decide on a subspecialty. There is great trauma and general ortho here, but maybe a little bit too much for my liking. Not a ton of research going on, and as a resident you have to push the project along. The joints exposure and clinic experiences are a bit on the lighter side. Less emphasis on book knowledge. Albany as a city doesn't have a ton to do. Even though the easiness of the senior years sound appealing, not even rounding on your own patients seems a bit lazy.

Conclusion
A solid community program. You will learn how to operate and take care of the bread and butter patients. It a blue-collar, work hard place for PGY1 and PGY2, with PGY2 being especially brutal, but PGY3 through PGY5 are on par with a gentleman's program. During these years, you can get in a 6 or 7am and leave by the early afternoon (like 3 or 4pm). It is great if you have a family or want time to dedicate to extracurricular interests. However, I did not sense much interest or emphasis by the residents in academic pursuits or research. They liked that they got crushed as a junior, then could cruise as a senior. Not the best fit for me in that regard, and will be lower end of my tier 3 spectrum.