Getting into an orthopedic residency as an intern is so much harder than getting accepted as a student!  Whether or not it’s fair, there is a stigma associated with going unmatched that many programs will not overlook.  With that said, it can be done!  Here are some answers to frequently asked questions on traditional rotating internships (TRI’s). 

Who should do a TRI?

If you can’t see yourself as anything other than an orthopedic surgeon, this may be a good option.  A TRI will allow you to not only improve your application for orthopedics but also to spend time exploring other specialties and getting yourself out of tunnel-vision mode.  A typical TRI curriculum will include exposure to internal medicine, family medicine, emergency medicine, general surgery, and electives.  

It’s very important to look critically at your application and identify your weaknesses.  Talk with your mentors about their thoughts on what went wrong.  This can be intimidating and painful but so important.  If your biggest issue was low board scores, a TRI may not address that deficit and it may be a good idea to balance your efforts at getting into orthopedic surgery with discovering another specialty that you can feel excited about.

How do I choose a TRI?

Not all TRI’s are created the equal.  Picking the right program can make or break your experience.  Sadly, in the busy orthopedic world, out of sight is out of mind.  If you fall off the radar and people forget who you are, you will have a very hard time convincing programs to take a chance on you.   The best TRI’s will allow you to have exposure to the ortho world and time to explore your other options.  Here are the top three factors to look for when choosing a program:

1. Electives

The more electives the better.  Give the program extra points if they allow you to do these electives at outside facilities.  This way, you can do away rotations at different programs and make sure people remember who you are.  If you did poorly on your away rotations as a student, this is your chance to show off how the new and improved you.  Be sure to think about your alternate specialty too when making your elective schedule. You may find that your experience as an intern – rather than a student – more engaging and a better representation of what practicing that specialty is like.

Being clear about your intentions of matching into a competitive specialty when interviewing with the program director can set the tone for the upcoming year.  Be sure to ask that your electives be scheduled during audition season before you sign the contract. Most TRI coordinators will schedule the upcoming year soon after they finalize the roster.   You can set up the specifics of the rotation (program, specialty, etc) later but once they’ve created the block schedules for the year it can be tricky to change it.

2. Reasonable schedule

Applying, networking, and studying orthopedics in your spare time is a lot of work.  So, you’ll need a program with a lot of spare time.  Look for one with minimal call and reasonable work hours.  

3. Location, location, location

The program’s proximity to an orthopedic residency is also very important.  If a program is within reasonable driving distance, you can drop in on didactics or other educational events like grand rounds or journal club.  This will add to your foundation of orthopedic knowledge  – never stop learning! – and also make networking with residents and attendings easier.

There are certain advantages to picking a TRI with an associated ortho program.  You will theoretically have better access to their didactics and will theoretically be more on top of your ortho knowledge. (everything is theoretical because now that you’re an intern, patients actually rely on you and they take first priority).  If the hospital is a reasonable size, you can also build your reputation while on other rotations by being available to do favors for shared patients in the ER or on IM, liking rolling out splints, writing missing prescriptions, or helping with dressing changes on the weekends, etc.  However, the downside of being so available is being so available.  It can be emotionally exhausting to be at attention all the time.  Whereas away rotations are limited to four weeks, you will have approximately 8 months between the start of your internship and upcoming match day.   Be sure to weigh factors 1 and 2 as well when looking at a TRI at an ortho programs base hospital.

How do I find out information about these programs?

The best people to ask for the “lifestyle” TRI’s are your dermatology, PMR, anesthesia, ophthalmology buddies.  Get their lists but run them through your criteria as well.  Use the AOA opportunities website to search for internships.  Contact the program coordinators for more details about the curriculum.

What was your experience like?

I did my traditional rotating internship at the PCOM/Crozer-Keystone Health System internship at Delaware County Memorial Hospital, affectionately known as Delco.

 Although it was not the official PCOM base hospital, it was loosely affiliated.  Two residents rotated through every couple of months, which let me get to know several of the residents.  I also spent extra time keeping up with the weekly assigned readings and going to PCOM’s weekly didactics whenever my schedule permitted.  Walking into the back of the room at the first didactic meeting, I was honestly a little embarrassed to see the residents I had interviewed with the year before.  I was still smarting from not matching and felt a little awkward about approaching the residents. But as soon as I realized that my bruised ego was only holding me back, I jumped at every opportunity to interact with the residents and attendings.  It was definitely in my head and I got used to telling everyone that I hadn’t matched but I intended to this year.  

This mindset helped me gain the confidence I needed to really establish and develop mentorships.  Functioning as a newly minted doctor made me more… mature, which I think came across on my away rotations.  The curriculum allowed me three out rotations, which I used to spend time at the other PCOM hospitals and also rotating with a program that I didn’t experience as a student.  

 I also did an elective in anesthesia early in the year.  It was a specialty that I had only been indirectly exposed to during third and fourth year.  They were always very friendly but I had never seriously considered it as an option.  Once I gave it a fair shot, I was surprised by how much I enjoyed it.  There were so many practice setups that I knew nothing about and eventually I could begin to see myself carving out a fulfilling career in that field.  With the support of my anesthesia mentors, I submitted some applications for anesthesia and even did pretty well on my interviews.  When push came to shove, I chose orthopedics but I realized that we have so many options as doctors!

What other questions do you have about internships?  Please comment below or send us a note!