ortho attending AMA

[OrthoTraumaMD]

@OrthoTraumaMD really appreciate your time,

Was just wondering about your perspective on some southern programs, beginning to plan away rotations and figured the more opinions I hear the better

Any thoughts on Campbell Clinic, Louisville, UT Houston? Leaning towards more of a blue collar program, more than happy to give up the lifestyle to get my ass kicked and operate. Any particular programs you can think of in your neck of the woods?

I'm not from the south, but I do have some familiarity with UT Houston. If you're looking for an ass-kicking, they'll give you plenty. They have a very robust trauma program (their trauma fellowship is the most sought after in the country), and a huge trauma center where the residents work a lot and operate a lot. As for the other two you mentioned, I'd ask that question over at orthogate, as I have no knowledge of them. Some other programs that have the same qualities you are looking for are HSS, Harvard, and Geisinger; places with lots of early operative experience.

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[OrthoTraumaMD]

@OrthoTraumaMD, once again, thank you for your time! I heard an attending talking about some residencies possibly moving toward 6 years due to residency work hour restrictions/ lower number of cases per year. Apparently a program or two already has 6 year tracks. What is your take on this, do you think it will become common?

Currently there is no major move to make 6 year required programs, and I do not think it will become common as long as work-hour restrictions are not decreased even more (currently the squeeze came from 16-hr max call for interns, but the rest has not changed in a while). One of the two programs you are talking about is Brown. Their 6th year (at least how I've heard it) is basically a fake trauma super-chief "fellowship," where you spend your time doing stuff the other attendings don't want to do, and yet are not accredited for anything related to trauma at the end. I do not recommend it. Five years of residency is more than enough. The other way to do 6 years (voluntary) is with a research year, which is a separate track from the 5-year match in most places with a separate rank list for that one spot. During those years, people typically do mostly research but have to take call as part of their clinical responsibility. Doing a year like that depends on how much you like/want research, and that year is also a time to relax a bit, and maybe even think about a family if the program is friendly to that.

 

[DrLeoSpacemanMD]

No idea. Never tried.
On a serious note, if any women (or smaller men) are reading this, sedation and technique (and in some cases, good assistants in the ER) trump brute force every time. I'm a slightly built woman, weigh 120 lbs, and there has never been a hip i wasn't able to reduce, even in patients three times my size. the bro stereotype doesn't apply to all of us.

This is a bit insulting to smaller men. But I will let it pass.
On a serious note, thanks for doing this.

 

[OrthoTraumaMD]

This is a bit insulting to smaller men. But I will let it pass.
On a serious note, thanks for doing this.

OK fair. I was thinking that smaller people (men and women) can't bench as much as larger people, but maybe I'm wrong.

 

[Status Sciaticus]

What type of applicants statistics get screened out typically? Step 1 hard cutoff?

I am trying to gauge if its possible for me to match into ortho with a 239 without taking a year to do research or something of the like.
I have 2 pubs related to DFO (2nd and 3rd) and currently in 1st quartile.

 

[Bancrofti]

What type of applicants statistics get screened out typically? Step 1 hard cutoff?

I am trying to gauge if its possible for me to match into ortho with a 239 without taking a year to do research or something of the like.
I have 2 pubs related to DFO (2nd and 3rd) and currently in 1st quartile.

hard cutoff at 240

 

[augeremt]

What type of applicants statistics get screened out typically? Step 1 hard cutoff?

I am trying to gauge if its possible for me to match into ortho with a 239 without taking a year to do research or something of the like.
I have 2 pubs related to DFO (2nd and 3rd) and currently in 1st quartile.

Depends on the program. For some it's as high as 250 and others have 210 as a minimum. Many programs don't have hard cutoffs at all. So it widely varies. Talk to your PD and/or chairman. They'll have the most accurate info on where to apply and which programs will automatically screen you out (most useful for planning aways).

 

[Status Sciaticus]

hard cutoff at 240

Im sure several wont since theres >100 matches with scores between 230-239.

Depends on the program. For some it's as high as 250 and others have 210 as a minimum. Many programs don't have hard cutoffs at all. So it widely varies. Talk to your PD and/or chairman. They'll have the most accurate info on where to apply and which programs will automatically screen you out (most useful for planning aways).

Thanks for the advice. Ill go ahead and do that.

 

[OrthoTraumaMD]

Depends on the program. For some it's as high as 250 and others have 210 as a minimum. Many programs don't have hard cutoffs at all. So it widely varies. Talk to your PD and/or chairman. They'll have the most accurate info on where to apply and which programs will automatically screen you out (most useful for planning aways).

Agreed. No hard cutoff for most places. My personal opinion about cutoffs is that they should not exist--scores aren't everything.

 

[Bancrofti]

Im sure several wont since theres >100 matches with scores between 230-239.

Thanks for the advice. Ill go ahead and do that.

my bad. meant to edit my post saying jk, but got sidetracked watching the game. It's definitely possible for you to match and IMO, I think the smarter thing to do is to just go about planning aways in a smarter fashion rather than reaching for top research programs. Of course, if your goal is to match at say, Rush, Mayo, Harvard, etc. then the research year will help you out significantly in securing interviews at those locations.

That being said, I'm currently coming to the end of the interview trail this year. I know quite a few people who got interviews at those programs who had minimal to no research. This whole process is a crapshoot. Unless there are a ton of people from your school applying, your third year grades suck, you have poor social skills, or there is absolutely nothing interesting about you, then I don't think a research year is necessary for a 239. Just choose aways wisely and kill them.
Edit: also take step 2 early and kill it

 

[Fundamentals]

Not a question about orthopedics specifically, but one about a field that i'm interested in and wondering how that relates to you as an orthopedic attending.

How do you find your interactions (if at all) with radiology and do you find them useful in your field? MSK radiology often has images that are purely restricted to the musculoskeletal system and often aren't a picture of several organs like chest/abdo imaging. Given that, as an orthopedic attending do you find that you just do your reads yourself and don't typically use the radiology report in your day-to-day work. What about in the trauma settings?

Thanks!

 

[OrthoTraumaMD]

Not a question about orthopedics specifically, but one about a field that i'm interested in and wondering how that relates to you as an orthopedic attending.

How do you find your interactions (if at all) with radiology and do you find them useful in your field? MSK radiology often has images that are purely restricted to the musculoskeletal system and often aren't a picture of several organs like chest/abdo imaging. Given that, as an orthopedic attending do you find that you just do your reads yourself and don't typically use the radiology report in your day-to-day work. What about in the trauma settings?

Thanks!

Interesting question. For most imaging (Xray and CT) I read my own studies, and review reports later to make sure the radiologist hasn't picked up something I didn't. Often, it's the other way around and I end up contacting the radiologist to tell him about a fracture he missed, or a screw in the joint etc, because I am specifically trained to look for those things. Many large centers have a dedicated MSK radiologist who often also does interventions like injections, and it's nice to have that relationship because you trust them to do the injection in the right place etc. In the setting of something more acute or serious, if I am not 100% sure, I often go up to Xray or CT or call the radiologist to discuss the study with them, tell them what I am looking for. This applies specifically to MRIs; some people are better at reading them than others, particularly sports orthopods since they do it all the time. As a trauma surgeon I am much more trained to read Xrays/CT than MRI, so I rely on radiology for that.

 

[BirdiePutt]

Thanks so much for taking the time to to this, @OrthoTraumaMD
Many of my questions have been answered above. Here are a few more I've was thinking of:

I'm currently a 4th year PharmD student and will start medical school in July at a private school (NIH funding in the top 40-50 range). I decided on medical school 3 years ago with my sights set on Ortho (any non-surgical specialty and I probably would have stayed in pharmacy). I've got a few publications under my belt in other areas (Oncology, neurosurgery) and I'm now working with my undergrad institution's ortho dept on some papers before I move for medical school.

1. A few subspecialties catch my eye but spine is a front runner. I am more inclined to end up in an academic setting as I'd love to incorporate some teaching in my life. How do you see residencies as they pertain to employment in an academic setting? Particularly if I'd like to live on the west coast (more competitive as you stated previously). What type of residencies should I look for if this is a goal of mine? Also, is there a solid resource for learning more about these residencies or is it primarily word of mouth?

2. Thoughts on ortho spine vs neurosurg spine in 15 years? One pushing another out?

3. I'll be within a reasonable distance of Rush which I've heard has a fairly research heavy ortho department. Would a summer (M1-M2) research experience be something worth pursuing here? Maybe with goals of research experience, networking, and potentially a letter of rec when the time comes? Or would staying at my home hospital provide the same benefit?

4. As you said, MSS education is lacking at a lot of schools. Did you supplement your learning on the side while in med school?

As a comment, I saw ~110 lb female ortho resident reduce a hip while I was on one of my PharmD rotations - +1 on technique > strength! Thx again - cheers

 

[OrthoTraumaMD]

Thanks so much for taking the time to to this, @OrthoTraumaMD
Many of my questions have been answered above. Here are a few more I've was thinking of:

I'm currently a 4th year PharmD student and will start medical school in July at a private school (NIH funding in the top 40-50 range). I decided on medical school 3 years ago with my sights set on Ortho (any non-surgical specialty and I probably would have stayed in pharmacy). I've got a few publications under my belt in other areas (Oncology, neurosurgery) and I'm now working with my undergrad institution's ortho dept on some papers before I move for medical school.

1. A few subspecialties catch my eye but spine is a front runner. I am more inclined to end up in an academic setting as I'd love to incorporate some teaching in my life. How do you see residencies as they pertain to employment in an academic setting? Particularly if I'd like to live on the west coast (more competitive as you stated previously). What type of residencies should I look for if this is a goal of mine? Also, is there a solid resource for learning more about these residencies or is it primarily word of mouth?

2. Thoughts on ortho spine vs neurosurg spine in 15 years? One pushing another out?

3. I'll be within a reasonable distance of Rush which I've heard has a fairly research heavy ortho department. Would a summer (M1-M2) research experience be something worth pursuing here? Maybe with goals of research experience, networking, and potentially a letter of rec when the time comes? Or would staying at my home hospital provide the same benefit?

4. As you said, MSS education is lacking at a lot of schools. Did you supplement your learning on the side while in med school?

As a comment, I saw ~110 lb female ortho resident reduce a hip while I was on one of my PharmD rotations - +1 on technique > strength! Thx again - cheers

1. I said this on another post, but fellowships are much more important than residencies in obtaining academic jobs, because they have a more vested interest in ensuring that all their graduates have good jobs. Spine has lots of prestige, if you can handle the patients (chronic pain etc)-- personally I never want to see another spine as long as I live. I think your goal should be to match wherever you can. If you want to stay on the West coast, look into any of the UC residencies, and also up in Seattle, preferably one in which there are few fellows, because they tend to take cases away from the residents. Ultimately, I think any residency will be able to train you well, and no one does spine these days without a fellowship-- so if you want an academic job later on, you will need to do a fellowship anyway. To learn about residencies, their own websites and OrthoGate are good resources-- otherwise it's pretty much word of mouth, as far as I know.

2. I was just talking about this with a neurosurg spine person. I think at this point, they are fairly equivalent. In the past, deformity correction was the purview of only ortho spine, but now they pretty much do the same thing. The only difference is whether the other stuff you do is bones or brains. People generally tend to like one over another. The surgeon I was talking to said that he wouldn't be surprised if eventually, spine became its own residency. And it makes sense-- within ortho, spine is very specialized, and most orthopods want nothing to do with it. It's a totally separate "spine call," and is not like trauma where most people participate.

3. Rush is a great and highly competitive program. It's always a good idea to do research in the summer; I did between my first and second year of med school, and it was great. Even if you don't have a great project, it will introduce you to the attendings and residents, and it's always good to have a leg up in a program like that. A letter from them would probably count for more. But I say this with a caveat-- it would need to be a great, or at least not an average letter. All too often I see applications with very short, obviously copied and pasted letters from great places, and applications with very strong personal letters from a not-so-great place. For me, the personal letter matters much more. But every interviewer is different.

4. Unfortunately, I did not supplement my learning of MSK while I was in med school; I wish I would have. One of my earlier posts has some book suggestions if you want to take a look.

 

[Allergic to Toradol]

Why did you choose to go into Ortho Trauma as opposed to becoming a general surgeon with a fellowship in trauma? I'm very interested in the acute surgical care residencies/fellowships and am curious as to why you chose one over the other. It is my understanding that general trauma surgeons are the "leader" of the acute surgical team and only call in ortho's if there is a significant and isolated ortho-specific injury/fx as opposed to the general trauma surgeon being in charge of basically everything else short of neuro. I would think that this sort of variety would be incredibly challenging, yet definitely exciting. One reason I am leaning the general route is just due to the fact that I think I would want to jump off of a bridge if I had to do the same 3-4 operations over and over all year as opposed to being able to do a whole lot of different disciplines via the trauma general surgeon route. I'm curious as to your thoughts/reasonings on this... and thanks for doing this!

 

[OrthoTraumaMD]

Why did you choose to go into Ortho Trauma as opposed to becoming a general surgeon with a fellowship in trauma? I'm very interested in the acute surgical care residencies/fellowships and am curious as to why you chose one over the other. It is my understanding that general trauma surgeons are the "leader" of the acute surgical team and only call in ortho's if there is a significant and isolated ortho-specific injury/fx as opposed to the general trauma surgeon being in charge of basically everything else short of neuro. I would think that this sort of variety would be incredibly challenging, yet definitely exciting. One reason I am leaning the general route is just due to the fact that I think I would want to jump off of a bridge if I had to do the same 3-4 operations over and over all year as opposed to being able to do a whole lot of different disciplines via the trauma general surgeon route. I'm curious as to your thoughts/reasonings on this... and thanks for doing this!

I answered this question on another post in this thread. https://forums.studentdoctor.net/posts/18508697

I'm not sure what you mean by "the same 3-4 operations." As an orthopaedic trauma surgeon, I do hundreds of different types of procedures, on almost every bone in the body (barring spine/sternum/skull/face/ribs) and even within that, no patient or fracture is ever the same. The orthopods who do total hips and knees all day, sure; that's pretty rote. But not me.
Also, general surgeons do not treat orthopaedic trauma, at all (unless you are in Europe, where some do). General surgeons only treat visceral injuries-- chest and abdomen. Musculoskeletal injury is entirely the purview of ortho.

 

[Allergic to Toradol]

I answered this question on another post in this thread. https://forums.studentdoctor.net/posts/18508697

I'm not sure what you mean by "the same 3-4 operations." As an orthopaedic trauma surgeon, I do hundreds of different types of procedures, on almost every bone in the body (barring spine/sternum/skull/face/ribs) and even within that, no patient or fracture is ever the same. The orthopods who do total hips and knees all day, sure; that's pretty rote. But not me.
Also, general surgeons do not treat orthopaedic trauma, at all (unless you are in Europe, where some do). General surgeons only treat visceral injuries-- chest and abdomen. Musculoskeletal injury is entirely the purview of ortho.

I appreciate you tagging that post. I skimmed through the thread looking for a similar question in an effort to avoid redundancy but I must have missed it. My apologies!

 

[OrthoTraumaMD]

I appreciate you tagging that post. I skimmed through the thread looking for a similar question in an effort to avoid redundancy but I must have missed it. My apologies!

No problem.

 

[Chillbo Baggins]

Do you use leaded eye protection, and, if so, when would you recommend getting them? Before away rotations? In intern year to see if the program will pay for them?

 

[OrthoTraumaMD]

Do you use leaded eye protection, and, if so, when would you recommend getting them? Before away rotations? In intern year to see if the program will pay for them?

Occasionally. I have yet to find a pair that is light and doesn't fog up. I think it is a good idea because over time, the radiation does contribute to risk of cataracts (though how much dosage is required to do that isn't set in stone). I would say that you should wait until you enter residency; many programs will use their funds to cover the cost of leaded glasses and loupes, or at the very least will give you a discount. I didn't get my glasses until I was well into residency.

 

[OrthoTraumaMD]

I have a question of my own for the students reading--- what can we as attendings do in the OR/clinic/in general to improve your learning experience? Keep in mind our time is limited and we have a million things to worry about, and some of us are more hesitant to give up the scalpel, but the vast majority of us want to contribute to your education.

 

[HereWeGo21]

I have a question of my own for the students reading--- what can we as attendings do in the OR/clinic/in general to improve your learning experience? Keep in mind our time is limited and we have a million things to worry about, and some of us are more hesitant to give up the scalpel, but the vast majority of us want to contribute to your education.

Thanks for asking! I think that's the most important part--that you're asking.

Please excuse us for our ignorance. I may be good at step 1-type stuff, but that doesn't matter much anymore. What matters now is often stuff like where to send stable trauma patients when beds are needed in the ICU but the SIMU is full--stuff like that. And I have no grasp of that, which often makes me useless and ignorant and bumbling. So please be understanding of stuff like that, and don't be easily exacerbated by what seem like stupid questions. Rather, try to help me learn the demands of residency--including but not limited to the book stuff.

Of course, the book stuff is what I'd rather learn about. So it'd be great to teach that, but be understanding of ignorance elsewhere.

 

[ChEMD]

Thanks for asking! I think that's the most important part--that you're asking.

Please excuse us for our ignorance. I may be good at step 1-type stuff, but that doesn't matter much anymore. What matters now is often stuff like where to send stable trauma patients when beds are needed in the ICU but the SIMU is full--stuff like that. And I have no grasp of that, which often makes me useless and ignorant and bumbling. So please be understanding of stuff like that, and don't be easily exacerbated by what seem like stupid questions. Rather, try to help me learn the demands of residency--including but not limited to the book stuff.

Of course, the book stuff is what I'd rather learn about. So it'd be great to teach that, but be understanding of ignorance elsewhere.

Just to briefly chime in, as a student, it's not your job to learn that type of stuff. One reason being that every hospital you work at will have different protocols to deal with it. It's also relatively pointless because students can't write the orders to get that stuff done anyways. So I'm sorry if your attendings are focusing on that stuff, but that's on them, not on you.


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[NWwildcat2013]

I have a question of my own for the students reading--- what can we as attendings do in the OR/clinic/in general to improve your learning experience? Keep in mind our time is limited and we have a million things to worry about, and some of us are more hesitant to give up the scalpel, but the vast majority of us want to contribute to your education.

If I am on a surgery rotation I'd like to be taught things that are generally applicable to all surgical fields. How to recognize post op infection, how to prevent DVTs, etc. I think more of the medical management of surgical patients is what is valuable for a rotating student. Im assuming we are talking about a surgery rotation rather than an away rotation? If not my bad, but hopefully my perspective is useful if ortho gets students rotating through during a GS rotation (happens at my school).

 

[OrthoTraumaMD]

Just to briefly chime in, as a student, it's not your job to learn that type of stuff. One reason being that every hospital you work at will have different protocols to deal with it. It's also relatively pointless because students can't write the orders to get that stuff done anyways. So I'm sorry if your attendings are focusing on that stuff, but that's on them, not on you.


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I agree. I'm not sure why an attending would focus on placement etc, particularly for students. That's usually the job of the chief residents to teach their juniors, the ins and outs of managing the service. Attendings should focus on the actual clinical/academic stuff.
That said, I will say that there IS actually such a thing as a stupid question, in one scenario-- where you didn't prepare for your case the next day, and ask something so rudimentary you might as well be announcing "I didn't care enough to prepare for this." Like scrubbing on an ankle and not knowing which bones are broken. That just drives me nuts. I had an attending who used to tell me, when I was a fellow, "Think before you say something, because everything you say can expose how dumb you are." (Maybe not the greatest advice for students, but sure as hell made me read more as a fellow!)

 

[OrthoTraumaMD]

If I am on a surgery rotation I'd like to be taught things that are generally applicable to all surgical fields. How to recognize post op infection, how to prevent DVTs, etc. I think more of the medical management of surgical patients is what is valuable for a rotating student. Im assuming we are talking about a surgery rotation rather than an away rotation? If not my bad, but hopefully my perspective is useful is ortho gets students during a GS rotation (happens at my school).

Yes, I understand. Certain things are applicable across surgical fields, though our literature may differ. So in my case, I will talk about DVT prevention as it specifically applies to ortho injuries, because that is the data I know... but much of that knowledge can translate in general -- as in, why does Coumadin take longer to become therapeutic, etc.

 

[Burla]

I have a question of my own for the students reading--- what can we as attendings do in the OR/clinic/in general to improve your learning experience? Keep in mind our time is limited and we have a million things to worry about, and some of us are more hesitant to give up the scalpel, but the vast majority of us want to contribute to your education.

The most engaged I've ever been in the OR is when a CT surgeon walked me through each step of the case. He told me what he was doing and why, what could go wrong with that step and how he would fix it, etc. Its the only time a surgeon has done that and I personally found it very helpful.

 

[Bancrofti]

I have a question of my own for the students reading--- what can we as attendings do in the OR/clinic/in general to improve your learning experience? Keep in mind our time is limited and we have a million things to worry about, and some of us are more hesitant to give up the scalpel, but the vast majority of us want to contribute to your education.

If you aren't letting students go, then you should make sure that you make a brief teaching point as frequently as possible. On one of my aways there is an attending who would try to take a minute whenever possible to give some teaching point. Taking 2 seconds to draw out a femoral neck before a case is about to start, ask where we're going to put the screws, ask my logic, etc. During a big case, if it was myself, her and a resident, she'd hold retractors so that I could be at a better vantage point along with the resident so that I could actually see. In clinic, going over radiographic findings, classification schemes, and physical exam maneuvers.

I think asking questions in a stepwise fashion is also great. It allows those of us who have studied that we care, while giving you an idea once we stumble on the level of Ortho knowledge that we could use help from someone your level of experience in understanding. So either taking the time to teach or for the average person if you put them in enough cases where they get to use a drill and do things besides suction, they're happy enough to the point where nothing else that happens on their rotation matters to them.

 

[OrthoTraumaMD]

If you aren't letting students go, then you should make sure that you make a brief teaching point as frequently as possible. On one of my aways there is an attending who would try to take a minute whenever possible to give some teaching point. Taking 2 seconds to draw out a femoral neck before a case is about to start, ask where we're going to put the screws, ask my logic, etc. During a big case, if it was myself, her and a resident, she'd hold retractors so that I could be at a better vantage point along with the resident so that I could actually see. In clinic, going over radiographic findings, classification schemes, and physical exam maneuvers.

I think asking questions in a stepwise fashion is also great. It allows those of us who have studied that we care, while giving you an idea once we stumble on the level of Ortho knowledge that we could use help from someone your level of experience in understanding. So either taking the time to teach or for the average person if you put them in enough cases where they get to use a drill and do things besides suction, they're happy enough to the point where nothing else that happens on their rotation matters to them.

Our of curiosity, what Ortho subspecialty was the attending you described in? The one who held the retractors? Some subspecialties lend themselves easier for attendings to take a "back seat" and let the resident/student fly.

 

[OrthoTraumaMD]

Also I've often wondered how students feel about being "pimped." I want to see how much students know, but I never know whether to ask some specific question ("what are the components of the syndesmosis?) or to go more general ("tell me what you know about the syndesmosis")...

 

[joker2400]

Also I've often wondered how students feel about being "pimped." I want to see how much students know, but I never know whether to ask some specific question ("what are the components of the syndesmosis?) or to go more general ("tell me what you know about the syndesmosis")...

I think a good mix is beneficial. General questions sometimes lead to good conversations that reach topics that you may not have with specific questions.

 

[Psai]

Also I've often wondered how students feel about being "pimped." I want to see how much students know, but I never know whether to ask some specific question ("what are the components of the syndesmosis?) or to go more general ("tell me what you know about the syndesmosis")...

As long as it feels educational and not like hey let me show u how dumb u are and im smart

 

[SurfingDoctor]

Also I've often wondered how students feel about being "pimped." I want to see how much students know, but I never know whether to ask some specific question ("what are the components of the syndesmosis?) or to go more general ("tell me what you know about the syndesmosis")...

I always start with broad questions to gauge general concepts... and more into specifics based on level of understanding and training.

Quite honestly, one should be expected to be asked questions. If one doesn't ask questions, one can never thoroughly a trainee level of understanding.

 

[Bancrofti]

Our of curiosity, what Ortho subspecialty was the attending you described in? The one who held the retractors? Some subspecialties lend themselves easier for attendings to take a "back seat" and let the resident/student fly.

Trauma. FWIW, the cases I was in were typically either myself, the attending, and a chief or myself, the attending, and a fellow. So I suppose her freedom level wouldn't have been as high if I was 2nd assist with a junior resident.

Also I've often wondered how students feel about being "pimped." I want to see how much students know, but I never know whether to ask some specific question ("what are the components of the syndesmosis?) or to go more general ("tell me what you know about the syndesmosis")...

The only students who don't like being pimped are the ones who don't prepare at all or just have weak personalities. I think where the animosity for pimping occurs is towards people who do it in a malignant fashion, i.e. clearly taking pleasure in asking you questions you don't know the answer to, continuously not taking the time to teach/elaborate if they ask something we don't know, or questioning our intelligence if we get a few questions wrong.

 

[failedatlife]

Do you look down upon those of us who want to go into surgical subspecialty but are inadequate at standardized exams? Do you notice a discrepancy between people you know scored very high on board exams and those who scored in the mediocre range?

 

[OrthoTraumaMD]

As long as it feels educational and not like hey let me show u how dumb u are and im smart

I think a good percentage of students who feel that way are projecting. Most attendings (at least orthopods I know) take no pleasure in making a student look dumb. Not to be an ass, but we know you're dumb, you're supposed to not know things--that's why you're there, to learn! Pointing out a student's lack of knowledge is idiotic-- it is like going "hey look at the homeless guy, he's homeless!" But of course, I'm sure there are some attendings out there who didn't get hugged enough as children and now they're sadistic. And that's sad. But most of us are not that way, or at least don't mean to be. I know I took many more things personally as a student than I do now. I think it's a type A personality thing, where you want to be responsible for your successes but that means also being very sensitive to failure or criticism.

 

[OrthoTraumaMD]

Trauma. FWIW, the cases I was in were typically either myself, the attending, and a chief or myself, the attending, and a fellow. So I suppose her freedom level wouldn't have been as high if I was 2nd assist with a junior resident.



The only students who don't like being pimped are the ones who don't prepare at all or just have weak personalities. I think where the animosity for pimping occurs is towards people who do it in a malignant fashion, i.e. clearly taking pleasure in asking you questions you don't know the answer to, continuously not taking the time to teach/elaborate if they ask something we don't know, or questioning our intelligence if we get a few questions wrong.

Agreed with your second statement.
Trauma huh? Are you sure it wasn't me?? would be funny if it were. There are only a handful of us, at least in academia--ten or 15 at best.

 

[GadRads]

It may not seem particularly obvious, but it appears we are still discriminating against women in medicine and corporate America, simply because they will (or plan to) have children or are feminine. It is also quite impressive that women in orthopedics have also bought into the male maschismo and discriminatory practices towards their own sex/gender. This is probably a case of group identity superseding gender identity.

You state that childbearing women are viewed as "risks" in ALL programs, yet we are all to accept prima facie that their "childbearing risk" wouldn't impact their match success rate? In any other instance, a prospective resident that is viewed as a "risk" is likely to not be as successful in the match. Yet somehow being a childbearing woman just doesn't matter, despite it being viewed as a risk by not few, but ALL programs. I am not convinced. Why do you all find sneaky and round-about ways to know the probability of a woman having a child during training if it is not important to you in some way?

There are women who don't want or value kids, and perhaps those who attain to surgery must have this personal value. However, there are plenty young female attendings and fellows who want a family with their own kids.

In any case, I think the culture is gradually changing as more women are entering the field. I wager that in 50 years, we will make accommodations for women in medicine/surgery who choose to have a family, and we won't find sneaky ways to judge them based on this rather important personal goal.

2A. I would not recommend pregnancy as a resident ... Just remember that when you are absent, everyone else has to pick up the slack. It will breed resentment, whether you like it or not, even in the nicest of people, if they have to keep covering you because you have to go to a doctor's appt.

2B. You are correct in saying that PDs cannot ask you about family plans during interviews, but I've done plenty of interviews and let me tell you, they have ways of figuring it out using more subtle questioning. And I've been asked directly in the past, when I've interviewed. Most people don't have a problem with answering because they don't care. One good way of scoping out if a program is family friendly is asking how many of the residents have families, and how many of them started families during residency.

All programs consider women of childbearing age to be a "risk," but it doesn't deter most of them from hiring women ... Most orthopods (male and female) associate that stuff with femininity and may subconsciously dismiss you as potentially being focused more on yourself/family/outside things than work.

 

[DNC127]

Anyone who takes time off from residency due to ANYTHING is a risk, including childbirth--because guess what, someone has to pick up the job you left behind. What I said was, if a program wanted to find out what someone's plans were, they could do it without asking the question directly. What they do with that info is up to them; and indeed, most programs don't care. Women are MORE, not less, likely to match into ortho because the specialty is currently geared toward diversity and attracting women. So yes, they will be more successful in the match than a male with the same credentials. What you call "buying into male machismo" is actually adopting a very simple rule: if you can't take the heat, get out of the kitchen. Women, like men, must be prepared for the rigors and sacrifices of a surgical residency. Giving them special concessions or accommodations is a disservice to those who have actually made those sacrifices, and a strain on those who have to do extra work as a result. you seem to be peddling an ideological argument that doesn't belong here.

Preach.

 

[GadRads]

Anyone who takes time off from residency due to ANYTHING is a risk, including childbirth--because guess what, someone has to pick up the job you left behind. Giving them special concessions or accommodations is a disservice to those who have actually made those sacrifices, and a strain on those who have to do extra work as a result. you seem to be peddling an ideological argument that doesn't belong here.

Many OBGYN programs manage to do fine with women who start families. And it happens to work at UC Davis' General Surgery program. http://www.reuters.com/article/us-pregnancy-residency-idUSKBN0FR25T20140722

I never knew a woman who chooses to have a child during residency means "not taking the heat?" That is ridiculous. As a dude, I have picked up the slack for co-residents for legitimate reasons, and I expect them to the same for me if indicated.

As I said earlier, the culture is changing in surgical training as more women are entering the field. OBGYN is more accommodating than it used to be in years past, and surgical programs will catch up ultimately. If we continued to espouse the patriarchal and machismo ideologies of the 1900's, you wouldn't have even been allowed into medical school in recent times.

 

[Status Sciaticus]

How much does AOA factor into ortho residency? Our AOA cutoff this year was 4.0...
Also, I spoke to my PD who mentioned that getting a 260+, honors on rotations with strong letters and an extra pub or two only gives me only 50% chance of matching due to a 239 S1. is it really that competitive to where a 10 point difference from the s1 average snubs out my chances?

What are your thoughts on academic practice settings vs. private practice in terms of ortho trauma and family balance?

 

[OrthoTraumaMD]

How much does AOA factor into ortho residency? Our AOA cutoff this year was 4.0...
Also, I spoke to my PD who mentioned that getting a 260+, honors on rotations with strong letters and an extra pub or two only gives me only 50% chance of matching due to a 239 S1. is it really that competitive to where a 10 point difference from the s1 average snubs out my chances?

What are your thoughts on academic practice settings vs. private practice in terms of ortho trauma and family balance?

AOA is secondary to step 1 and letters.

As for your matching likelihood, I try not to answer these because there are so many factors...but i will say that your PD's statement seems a bit overboard. If you have strong letters from orthopaedic surgeons, and honors on your Ortho rotations, you should be fine. A 239 is a great score, and you've improved on step 2. Sure, you may not be invited to interview at those places with cutoffs, but honestly, I think cutoffs are not the way to go anyway. The general rule is if you rank 10 places, you will very likely match.

For your last question, I said this in another post, but it is almost impossible to do strictly trauma when you are in private practice. Unless you are constantly being fed by your partners, you need to be prepared to do other things to supplement your income, like total joints. If you are dead set on doing only trauma (as I was), you need to be in a hospital setting. Overall I think the two situations are comparable in terms of family life, but I would posit that the private guys actually work a little harder because they are not salaried and they "eat what they kill" in terms of RVUs.

 

[Chillbo Baggins]

I know a couple pages back you answered a question on what books interns should read, but what do you think about for med students going to do ortho rotations?

I've heard Hoppenfeld's Surgical Exposures, Handbook of Fractures, and Netter's Concise Orthopedics. Are all of these still good in the smart phone age? Fine with going with older editions?

 

[joker2400]

I know a couple pages back you answered a question on what books interns should read, but what do you think about for med students going to do ortho rotations?

I've heard Hoppenfeld's Surgical Exposures, Handbook of Fractures, and Netter's Concise Orthopedics. Are all of these still good in the smart phone age? Fine with going with older editions?

I managed just fine with Netters, orthobullets, and Wheeless'. More info in those sources than you will need.

 

[OrthoTraumaMD]

I know a couple pages back you answered a question on what books interns should read, but what do you think about for med students going to do ortho rotations?

I've heard Hoppenfeld's Surgical Exposures, Handbook of Fractures, and Netter's Concise Orthopedics. Are all of these still good in the smart phone age? Fine with going with older editions?

I think all those are great books and should suffice.

 

[OrthoTraumaMD]

I know a couple pages back you answered a question on what books interns should read, but what do you think about for med students going to do ortho rotations?

I've heard Hoppenfeld's Surgical Exposures, Handbook of Fractures, and Netter's Concise Orthopedics. Are all of these still good in the smart phone age? Fine with going with older editions?

I forgot one other thing--- OrthoBullets website. Great in a pinch, and works on a smartphone. Wheeless is there too, but it's not as easy or intuitive to use.

 

[tennislover1989]

Thank you for doing this!

What would you think of an applicant who decided on ortho rather late in medical school? I thought I would like gen surg but it bored me to tears, and I was considering OBGYN but I've been having a lot of reservations about the specialty itself and the lifestyle. I'm now 1 rotation away from finishing my M3 year and just completed an ortho elective, which I absolutely loved. As cliched as it sounds, I feel like this could be the specialty for me, especially trauma. However, I'm worried because I feel like it's relatively late in the game to be jumping on the ortho train. So many of my classmates who are interested in ortho have been doing relevant research from day 1 and already have their letters lined up. My step 1 is in the mid 240s and I have several publications but none that are ortho-specific. My question is not technically related to my chances of matching/stats, but more of what you would think of an applicant who's medical school career was not tailored towards getting into/preparing for an ortho residency. I'm not sure if this is just the perception of my school or if this is really what PDs are looking for, so I'd appreciate your insight!

 

[SunsFun]

Anyone who takes time off from residency due to ANYTHING is a risk, including childbirth--because guess what, someone has to pick up the job you left behind. What I said was, if a program wanted to find out what someone's plans were, they could do it without asking the question directly. What they do with that info is up to them; and indeed, most programs don't care. Women are MORE, not less, likely to match into ortho because the specialty is currently geared toward diversity and attracting women. So yes, they will be more successful in the match than a male with the same credentials. What you call "buying into male machismo" is actually adopting a very simple rule: if you can't take the heat, get out of the kitchen. Women, like men, must be prepared for the rigors and sacrifices of a surgical residency. Giving them special concessions or accommodations is a disservice to those who have actually made those sacrifices, and a strain on those who have to do extra work as a result. you seem to be peddling an ideological argument that doesn't belong here.

Do you actually have anything to back up your claim that women will be more successful in match due to this supposed "diversity focus"? I've been hearing this a lot lately but my personal experience begs to differ.

I also haven't seen any good evidence to show that "kitchen heat" is necessary or even helpful in ensuring that residents are prepared. I do agree, however, that this has been ongoing conversation that is far outside of the scope of this thread. Carry on.


Sent from my iPhone using SDN mobile app

 

[OrthoTraumaMD]

Do you actually have anything to back up your claim that women will be more successful in match due to this supposed "diversity focus"? I've been hearing this a lot lately but my personal experience begs to differ.

I also haven't seen any good evidence to show that "kitchen heat" is necessary or even helpful in ensuring that residents are prepared. I do agree, however, that this has been ongoing conversation that is far outside of the scope of this thread. Carry on.


Sent from my iPhone using SDN mobile app

Evidence as in hard evidence? No, because hiring based on gender is sexist. Although CORR does devote an article per issue to women in ortho (either about women or written by a woman), which tells you a lot about what's on people's minds. My evidence is extensive personal experience over the last few years, based on everything I have seen myself, and heard from fellow surgeons in different programs. Female applicants are scrutinized much more carefully because they are rare. As for advantages, time and again in residency interviews, I have heard things like "OK, so which girl will we take?" It is just a numbers game. Out of 100 ortho applicants, about 5-10 are female. If the program is looking to hire a woman, and you are one, your chances are 1/10 rather than 1/90. Therefore you have an advantage in the match.

We will have to disagree on the kitchen heat thing. Maybe not for all residents, but for surgical specialties it is a rite of passage and it ensures that we can take on the stresses of attending life. (I kind of want resident hours again.)

 

[caffeinemia]

Is Godinez still applicable or is that just outdated? Can we safely debride and temporize trauma with vacs and antibiotics for moar than 72 hours these days?