Welcome to our tutor interview series! In the upcoming months, we will be interviewing some of our tutors about their experiences with residency. We’ll be asking the questions many of our students are interested to know about some of the most popular and sought after residency programs and areas of study. You can look forward to insight about the residency application process, the decision making that goes into choosing a specialty, the importance of USMLE scores, and more! So, without further delay, meet this week’s interviewees and Elite Medical Prep tutors Dr. Danielle Marshall and Dr. Emily Wichern
Briefly explain why and when you chose to pursue Orthopedics for your desired medical specialty?
Dr. Wichern: I did not fully decide to pursue Orthopedics until somewhere towards the middle/end of my third year. I had completed one elective rotation in Orthopedics at the VA Hospital, and although I enjoyed it immensely, I knew that the VA Hospital operative schedule was much lighter than that of your average Orthopedic Trauma service. So, I elected to do a second rotation in Orthopedic Trauma at one of Indianapolis’ two Level 1 Trauma Centers, just to confirm that I enjoyed Orthopedics enough to make the overnight call and long hours worth it. I was more than sold on the specialty after my second rotation. I chose to pursue Orthopedics for several reasons. One, I love surgery. Pretty early on I had decided that I wanted to pursue a surgical specialty because I enjoy the surgical environment and the somewhat immediate gratification that surgery offers. Two, I love that Orthopedics is a very goal-directed specialty. Whether the patient has a tibia fracture or end-stage osteoarthritis of the knee, the goal is always to restore that patient’s quality of life by allowing him or her to use their leg again. I enjoy being a part of a patient’s life in this way, helping the patient get back to doing what he or she loves. Three, I love the inter-professional nature of Orthopedics. Orthopedic surgeons work with professionals in many different fields including Radiology, Plastic Surgery, Physical Therapy, and Occupational Therapy, not to mention Physician Assistants and Nurse Practitioners. And lastly, I love that Orthopedic Surgery is a very diverse and dynamic specialty. There are numerous fellowship opportunities that allow further specialization after residency in Hand Surgery, Foot and Ankle Surgery, Orthopedic Trauma Surgery, and Total Joint Arthroplasty to name a few.
Dr. Marshall: I began medical school knowing I wanted to enter into a surgical subspecialty, but I originally was interested in plastic surgery—it offered a blend of significant surgical skill and creativity. However, during the summer after my first year of medical school, I applied to a plethora of surgical research scholarships and was selected for an orthopedic research fellowship. I learned that orthopedic surgery aptly fit many of my goals in a medical career, providing definitive solutions to specific patient conditions that dramatically improved quality of life. I was drawn to the patients, who were diverse and motivated, and to the field, which involved constant teamwork to choreograph the appropriate surgical treatment. I found myself enamored with this culture of camaraderie and teamwork I witnessed in orthopedic surgery.
Furthermore, I became fascinated by the scope of orthopedics. From scrubbing a brachial plexus reconstruction to repairing a THA periprosthetic fracture, I became captivated with the orthopedic surgeon’s ability to navigate variable anatomy and anticipate the biomechanical implications that would occur with each surgical modification. In the OR, the pace was fast and efficient, and I found myself quickly adapting to the tempo and style of this surgery.
As a woman entering medical school, I had never considered a career in orthopedic surgery—I always thought it was a prerequisite to have torn your ACL as a college athlete to enter into this specialty. But after early exposure and female mentorship in the field, I found orthopedic surgery was a natural fit for my strengths. Additionally, it encompassed the qualities I desired in a career: hands-on interventions, team-based solutions, and the opportunity to impact patients’ lives.
How important do you believe the USMLE Step 1 and Step 2 CK were in your application to this specialty?
Dr. Wichern: Unfortunately, due to the fact that so many medical schools are now Pass/Fail in the first two years, the importance of the USMLE Step 1 score cannot be overlooked. Orthopedic Surgery has become a highly competitive specialty simply because there are many more students who choose to apply to Orthopedic Residency than there are spots available (755 positions in 2019). I did not take USMLE Step 2 CK until after I had submitted my ERAS application in September, and that did not greatly affect the number of interviews I was offered. However, I recommend that all students interested in pursuing Orthopedics take USMLE Step 2 CK earlier rather than later. More and more programs will not consider your application complete until your USMLE Step 2 CK score is available, which can mean missing out on interview offers. Plus, if you take USMLE Step 2 CK earlier and do better than you did on Step 1, it can only help your application! If your USMLE Step 1 score is not what you had hoped it would be, do not fret! Although Step 1 is an important benchmark in a student’s medical career, there are other application factors that are just as important. Participating in research, performing well on away rotations, and having strong letters of recommendation are all extremely important aspects of a competitive application for Orthopedics.
Dr. Marshall: I echo Emily’s thoughts—the importance of Step 1 and Step 2 CK cannot be overstated. A study by Michael Mont at the Cleveland Clinic in 2018 demonstrated that Step 2 CK and Step 1 scores were the 2nd and 3rd most significantly application factors that most correlated with interview offers for orthopedic surgery residency applicants (p<0.001). Many programs will screen out applicants who score <240 on their Step 1, and competitive programs are even beginning to screen out applicants with a score of <245. Not to mention, the average Step 1 and Step 2 CK score of orthopedic applicants in 2018 was 248 and 255, respectively. With this knowledge, it is an unfortunate but vital part of the residency application.
What did you find to be important (e.g. USMLE scores, prior rotations, letters of rec, research, etc) in getting interviews at the programs you were interested in?
Dr. Wichern: Personally, I think that letters of recommendation, third-year clerkship grades, and research are the three most important features of a competitive application for orthopedic surgery, in that order. I naively underestimated the importance of letters of recommendation early on in this process and having gone through the application and interview process, I can now confidently say that letters of recommendation are the single most important piece of your application. Of course it is great to have letters of recommendation from well-known surgeons in Orthopedics; however, I would argue that it is much more important to have very detailed, very complimentary letters of recommendation from faculty members who know you personally and are willing to “go to bat” for you, in a sense. I have never read my letters of recommendation, but I had several interviewers comment on the strength of my letters in interviews, and that was unexpected. In addition, I think third-year clerkship grades and research experience are valued highly, but different programs may emphasize one or the other. Research heavy residency programs are oftentimes most interested in interviewing candidates with solid research backgrounds and multiple publications, while smaller programs more likely valued Honors in third-year clerkships as a marker of a good team player and a hard worker.
Dr. Marshall: Strong USMLE scores and strong third-year clerkship grades are prerequisites to match into orthopedics these days. Most competitive applicants have these statistics already, so the next question is what is important to distinguish you amongst the all-stars? As Emily emphasized, it often comes down to (1) who you know, (2) what research you did, and (3) your compelling story. First, letters of recommendation in orthopedics and in many other specialties (eg, emergency med) are increasingly being “standardized.” This means writers are asked to rate you quantitatively on a scale from “top 50% of class” to “rank to match.” Having a strong longitudinal relationship with an orthopedic surgeon that you can trust will rate you highly and is willing to put in a good word about you with their friends at top programs is extremely helpful. Remember, orthopedic surgery is a small specialty, and connections DO matter. Secondly, with more and more students obtaining high USMLE Step scores and Alpha Omega Alpha membership (the fourth year honors society), research is a way of demonstrating your interest in the field and your ability to balance clinical and research responsibilities while getting papers published. I also strongly believe it is one of the best ways to naturally form a relationship with physicians who can ultimately write you a letter. Last, having a compelling reason why you are the best candidate when it comes time to interview cannot be overstated. If you get the interview, it is your job to prove that you will be a reliable, effective team player that will bring something unique to the residency.
What was your impression of the interview experience for Orthopedics applicants?
Dr. Wichern: Overall, I found the interview experience to be a lot of fun! Orthopedic surgery programs interview MUCH later than the majority of specialties, which was hard to stomach initially. I did not receive the bulk of my interview offers until early to mid-November, while many of my colleagues applying to other specialties were already starting to wrap up on their interview trails. The interviews themselves were almost always laid back, with interviewers asking some of the standard questions, “Why did you choose orthopedics?” “What was your favorite orthopedic case that you scrubbed into?” “Why did you apply to our program?” etc. The majority of interviewers also asked more personalized questions about my research or my volunteer experiences. That said, my biggest piece of advice for prospective applicants is to know your application in and out! I speak Spanish, and I had listed “Advanced Spanish” on my application, so it should not have been a surprise when one interviewer started asking me questions in Spanish, but I was a little taken aback. Everything you write is fair game, so do oversell yourself unless you can back it up!
Dr. Marshall: The interview experience is filled with emotions—fear, anxiety, excitement, hope. Prior to interviewing, I recommend preparing some standard question responses, including situational questions like, “what do you consider your biggest failure/success?” or “tell me about a time you overcame a challenge.” Preparation will help you feel calmer during early interviews. As the interview invites begin to roll in, make sure to schedule you interview as soon as possible, as most programs offer more spots than there are interviews. In 2018, response time to interview invites was 12 minutes after receipt of an invite. But what if you are in the OR when you receive the email? Many people have a second or third person added to their email account that can serve as a “back up” when these emails come in.
So what happens if you don’t get an interview with a program you were really interested in? My suggestion is to write a “love letter” to that program telling them why you are particularly excited about them, especially if you do not have ties to the area. I would only do this for programs you are strongly interested in, but I know countless people who have gotten interviews simply by showing a little extra enthusiasm.
When you get to the interview, do not be surprised if there is a skills lab. Many programs are beginning to integrate a skills portion into their interviewing process. It is less about performing the skill perfectly, and more about remaining calm, thoughtful, and maintaining safety precautions at all times. There also may be a knowledge room, where you are walked through a case and asked questions along the way. The key is to not speculate—acknowledge when you do not know the answer. Admitting you don’t know the answer does not make you look dumb, it shows humility and your ability to recognize your limitations (which will be important when you begin performing surgeries on real patients).
Last, make sure to be evaluating programs as you interview. This may sound obvious, but often candidates can get so wrapped up in their performance that they forget to judge the program. Throughout the interview process, you will be told programs are looking for a “good fit.” So, evaluate your fit in these programs—can you spend 80 hours per week with the residents and staff you are meeting?
Now that you’ve matched, what advice might you give to other potential applicants? Please address also include advice for students who may be applying from Osteopathic medical schools, Caribbean medical schools, and non-Caribbean foreign medical graduates.
Dr. Wichern: This is a tough question to answer succinctly because I feel like I have so much advice for potential orthopedic applicants. If I had to give one piece of advice, however, it would be to find a mentor as soon as you decide Orthopedics is for you! Mentorship in medicine is so crucial, and in Orthopedics especially, having a faculty mentor can help strengthen your application by providing opportunities to get involved with research, giving advice when planning away rotations, and eventually (hopefully) writing a letter of recommendation on your behalf. My other piece of advice would be to look at your application from top to bottom and be honest with yourself about what your weaker areas might be. If it’s research, then send some emails at your home institution and try to get involved with some Orthopedic research as soon as possible so at the very least you have another research experience to list, even if it does not lead to a publication before ERAS submission. If it is your USMLE Step 1 score, then work hard to improve your application by taking USMLE Step 2 CK early and knock it out of the park! If it is your third-year clerkship grades, then consider doing 3 away rotations at programs you are most interested in matching at and work your tail off for 3 months to showcase your work ethic! Those are only a few examples, but I think it is important to be able to do the introspection necessary to improve your application and give yourself the best shot to stand out against other applicants.
Dr. Marshall: Emily highlighted some great advice about finding a mentor that will advocate for you and filling in the blanks in your application. My additional advice would be to keep an open mind throughout the process, particularly for those who may have deficiencies in their application (eg, low Step 1 score, limited research, average clerkship grades, foreign applicants). By this, I mean be open to all types of programs in different locations to keep your options open. If you do have strong preferences in location or program type, you need to honestly evaluate your competitiveness and decide whether you are willing to live for five years in Omaha, Nebraska (sorry for those Nebraskans) to be an orthopedic surgeon. The truth is, no matter where you train, in the end, you will be an orthopedic surgeon.
Additionally, many bemoan taking an additional year to conduct research to buff up their resume. Let me remind everyone that you have already done 4 years of undergraduate, 4 years of medical school, have 5 years of orthopedic training, and most likely another 1 year of fellowship. This is a long journey, but it does not have to be a race. Take the time you need to put yourself in the best position to match because believe me, you only want to go through the process once!
We hope you enjoyed our first residency interview post! As always, do not hesitate to reach out to us with any further questions.