I’ll admit it.  I can be a little competitive and when I was looking for rotation programs I wanted to go to the “best”.  However, there are several problems with that blanket “best” program approach.

First, the reputation of quality programs are in their very nature quite subjective.  It makes logical sense that good operative experience is important in training surgeons.  But it becomes incredibly difficult to accurately decipher which programs have better operative experience.  Is it the numbers of cases?  Is the amount of attending coaching?  Is it early autonomy?  The truth is that all of these factors matter, which makes creating a general ranking system really hard.

Second, with the cyclical nature of residencies, reputations can quickly become outdated.  With residents and chiefs changing roles annually, the tone of a program can change just as quickly.  The academic intensity instilled by one year’s chiefs can be quickly lost by the following year’s class and vice versa.

Lastly, is the biggest factor.  Everyone has different preferences.  The best program for one person may not be the best program for another.  It all goes back to the Greek maxim:

Which, for those of you who haven’t mastered Greek yet, means “know theyself.”  So how do you find the best programs for you?

Here are five factors to keep in mind when making your top 10 programs.

1. Location, location, location

Where do you want to live for the next five years of your life?  Your program will ask a lot of you and the reality is that you won’t have much time to recharge when you’re off duty.  This means that picking surroundings that are conducive to efficiently maintaining sanity and mental clarity is really important.  It will preserve a lot of mental energy if you can step out of the hospital into an environment that energizes you rather than drains you.

What are your hobbies and stress relievers? Do you like the outdoors?  Nightlife? Mowing your lawn?  What are your stressors?  Do you hate driving in traffic?  We have had a lifetime of practicing delayed satisfaction but don’t fool yourself into thinking that you will perform better if you just suck it up for a couple more years.  You will be better able to retain information, think creatively, and empathize if you are well rested and fulfilled.

If you have a family, their happiness is very important.  Not just later in life when you’re an attending but now.  Remember that when it’s all said and done, you’re probably doing this for them.  What each family needs is different but understand that you will be spending a lot of time away from them.  Consider if it’s worthwhile to do your training near relatives who can help with the kids periodically or in a city where your spouse has a fulfilling career or an awesome community to plug into.  For those of you married to other doctors, you’ll need to coordinate two residencies which can sometimes be difficult in smaller towns or start developing those long distance relationship skills.

Check out the interactive map in our osteopathic orthopedic residency directory to search by location.

2. Board score expectations

Orthopedics is only getting more competitive and many programs have board score requirements.  If you were in the 99th percentile, disregard this section.  For the rest of us, this will automatically exclude you from certain programs.  For DO’s, check the directory for each program’s COMLEX policy.  The rationale behind board score requirements is that your past performance on standardized tests will likely predict your future performance.  Standardized tests will keep popping up for the remainder of your career.  A program may not want to risk investing resources in someone who will have issues passing board examinations.  The average USMLE step 1 score of applicants who matched into an ACGME orthopedic residency in 2016 was 247.  Unfortunately that data is not available for the osteopathic orthopedic match.  If you did poorly (COMLEX <600, USMLE <235), take your Step2/Level2 sooner rather than later and DO BETTER.  Easier said than done but this will show the program (and yourself) that you can conquer standardized tests.

3. Exposure to subspecialties/Fellowship

As a third year medical student, I didn’t yet know enough about subspecialties to have a preference, but some of you have known that you were going to be a pediatric reconstructive orthopedic surgeon since you were in middle school.  If you have an idea of what you would like to pursue, look for a program that has good exposure to that subspecialty as well as a good match rate into fellowships.  If you don’t have any idea but want to keep your options open, look for a program with a good match rate and track record of alumni who have graduated from good fellowships.  

4. Program Size

Big programs with lots of residents inherently feel different than smaller programs with fewer residents.  Do you do better in more anonymous learning environments or do you thrive in smaller groups?  In the same way, working in a large academic center feels very different than being based in a small community hospital.  Reflect on which environment was more conducive to your learning style during your clinical rotations.  Did you like working in a hospital where everyone knew you after a month? Or does that give you the creeps?  

5.  Numbers

The caveat to this last factor is that you should first and foremost consider which program would be the best learning and developmental environment for you.  Also keep in mind that this is not a poker game where the cards are shuffled and dealt off the top so think of this as counting cards.  Not everyone comes in with the same numbers, accomplishments, strengths and this strategy will not mask your flaws.  With that in mind, if you feel like an underdog that needs a statistical advantage, compare the number of student rotators to number of interviewees granted to number of residency spots filled.  In the residency report, you can find whether or not a program requires rotations.  If yes, look at how many students rotated there.  From there, how many were interviewed?  For how many spots?  You get the idea.  

It may seem daunting to narrow your choices down to ten programs right off the bat but for better or worse, it’s an inevitable part of the application process.  Browse our directory and read a little about each program.  Peruse the program websites.  Take it to the next level and reach out to the program coordinators, residents, or program directors with questions.  Most coordinators start to schedule rotations for the “audition” season in January or February.  Make a list of your top ten programs and start booking ASAP!