ortho attending AMA

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masaraksh said:
... well if a student is doing an away someplace - that place is probably pretty high on their list since they are spending money to go someplace, live there, and check out the program.

At least that was how it was for me. My aways were 1) super balanced program with strength in all subspecialties and trauma in an awesome place to live. 2) as before, but larger and more urban, 3) close to family, good program but weaker in a few subspecialties it seemed like.
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I’m guessing many people choose aways by programs they reasonably have a shot at and pick a few as safety nets too. Probably being overly neurotic but an attending at a safety net program could technically write you a halfway decent letter to increase the quality of their residents.
 
GonefromTX said:
My apologies in advance if my question seems somewhat dumb/offensive.

If a student is doing his/her away rotations and is the perfect student (excellent boards, hardworking, eager to learn, polite, well-liked by everyone etc), wouldn't the attendings be not inclined to write a nice LOR for that student? Writing a super good letter seems to run counter to the interest of the attending if a program highly desires a particular student to become their resident. I'm sure no one would sabotage us by writing a horrible letter, but writing an excellent letter for a highly desired student seems counter-productive as that student might get "snatched" by another program.
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Not in any situation I've seen. We write good letters to those who deserve it. There are so many great applicants that we have more than enough to go around.


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@OrthoTraumaMD M1 very interested in ortho here. Have my first ortho shadowing this weekend where I'll be shadowing a resident all day and taking night call with them. Any advice on how to get the most out of this experience?

Obviously as an M1 my contributions are probably minimal, but I plan to work hard and be as engaged as I can (without getting in the way). This will be my first time meeting people in the department so I would like to make a good impression and learn more about the department as a whole (good mentors, current research projects I could maybe join, etc)
 
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Frogger27 said:
@OrthoTraumaMD M1 very interested in ortho here. Have my first ortho shadowing this weekend where I'll be shadowing a resident all day and taking night call with them. Any advice on how to get the most out of this experience?

Obviously as an M1 my contributions are probably minimal, but I plan to work hard and be as engaged as I can (without getting in the way). This will be my first time meeting people in the department so I would like to make a good impression and learn more about the department as a whole (good mentors, current research projects I could maybe join, etc)
Click to expand...

You have a great plan going in. When you meet them for the first time (come ten minutes early), ask the resident how you can be most helpful. Some will want you to do paperwork, grab supplies, call people, etc. Save your questions for downtime when the resident isn't swamped. And learn to walk quickly! You'll do great.


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Someone on the med school subreddit said that only community programs truly offer "early operative experience". Is that true? And does early operative experience actually matter in terms of operative proficiency post-residency?
 
lagbydesign said:
Someone on the med school subreddit said that only community programs truly offer "early operative experience". Is that true? And does early operative experience actually matter in terms of operative proficiency post-residency?
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Community programs do tend to involve their residents at an earlier point, but a) it is very attending dependent, and b) the benefits of that are questionable. As a junior, your job is to learn the wards, consults, how to take care of patients etc. The most important thing to learn is when and why to operate, not how to operate. As long as you get some experience during residency, when it happens is less important. And any further lack of experience can be corrected in fellowship, which 95% of graduating residents do anyway.


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You may have answered this, but I couldn't find it from a quick search. Is there a certain score on Step 1 where you start to worry about students passing the orthopedic board exams? For example, have you found that a resident who got a 238 tended to not perform as well on his/her ortho boards as that resident who got a 248 on Step 1?

Not using this as an excuse to slack on Step since I haven't taken it yet but curious if you've noticed any correlations.

Thanks again for this!
 
pbrocks15 said:
You may have answered this, but I couldn't find it from a quick search. Is there a certain score on Step 1 where you start to worry about students passing the orthopedic board exams? For example, have you found that a resident who got a 238 tended to not perform as well on his/her ortho boards as that resident who got a 248 on Step 1?

Not using this as an excuse to slack on Step since I haven't taken it yet but curious if you've noticed any correlations.

Thanks again for this!
Click to expand...

Two part answer.
So, in terms of scores, here is an excerpt from a study by Dougherty in CORR 2010 about the correlation:
"We found a correlation between the USMLE Step 1 scores and the ABOS Part I percentile rank scores. In comparing USMLE Step 1 scores with ABOS Part I scores (Fig. 2), 33% of those who scored 209 or less on Step 1 failed the ABOS Part I. For a threshold of 223 or less, 16% failed the ABOS Part I. All candidates who scored above 227 on the Step 1 passed the ABOS Part I examination."
(Source: Do Scores of the USMLE Step 1 and OITE Correlate with the ABOS Part I Certifying Examination?: A Multicenter Study)
This, and other studies, seem to have 220-230 as the cutoff score for passing the ortho boards.
The second part to the answer is this: most Ortho residents don't even match with those scores anymore. The median is now in the 240s. So theoretically, they all should be passing the boards right? Nope. Some residents still fail. Those whom I've seen who failed had severe professionalism issues and had other problems, or they slacked and stopped reading/studying the moment they matched. The USMLE gets you in the door, but after you match, it's the OITE that matters more, so you still need to study once you're a resident.
Hope that makes sense.


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OrthoTraumaMD said:
Two part answer.
So, in terms of scores, here is an excerpt from a study by Dougherty in CORR 2010 about the correlation:
"We found a correlation between the USMLE Step 1 scores and the ABOS Part I percentile rank scores. In comparing USMLE Step 1 scores with ABOS Part I scores (Fig. 2), 33% of those who scored 209 or less on Step 1 failed the ABOS Part I. For a threshold of 223 or less, 16% failed the ABOS Part I. All candidates who scored above 227 on the Step 1 passed the ABOS Part I examination."
(Source: Do Scores of the USMLE Step 1 and OITE Correlate with the ABOS Part I Certifying Examination?: A Multicenter Study)
This, and other studies, seem to have 220-230 as the cutoff score for passing the ortho boards.
The second part to the answer is this: most Ortho residents don't even match with those scores anymore. The median is now in the 240s. So theoretically, they all should be passing the boards right? Nope. Some residents still fail. Those whom I've seen who failed had severe professionalism issues and had other problems, or they slacked and stopped reading/studying the moment they matched. The USMLE gets you in the door, but after you match, it's the OITE that matters more, so you still need to study once you're a resident.
Hope that makes sense.

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Click to expand...

Yes, that makes total sense! Thanks for the detailed, evidence-based response haha
I can see more now why showing professionalism and maturity goes a lot farther than some of us might think.

How do you prepare your residents for the ABOS Part 1 or OITE? Do they follow one of the "curriculums" on OrthoBullets? Is there anything you've seen that correlates with residents doing better on the boards than others (such as those who got more OR time tended to do better than those who didn't etc.).

Thanks again!!
 
pbrocks15 said:
Yes, that makes total sense! Thanks for the detailed, evidence-based response haha
I can see more now why showing professionalism and maturity goes a lot farther than some of us might think.

How do you prepare your residents for the ABOS Part 1 or OITE? Do they follow one of the "curriculums" on OrthoBullets? Is there anything you've seen that correlates with residents doing better on the boards than others (such as those who got more OR time tended to do better than those who didn't etc.).

Thanks again!!
Click to expand...

You're welcome. I place a lot of emphasis on evidence based medicine. So much so that my partners have taken to calling me Hermione because I'm always quoting trauma literature. Heh.

As for your other question, it is a bit of self directed learning from the available self assessment exams, review books, and our educational curriculum, which consists of lectures and workshops. Most of it, however, is self directed. I can tell you things all day long, but if you're not reading the books at home, it won't stick. Those who read consistently perform the best. But ultimately it's all about failing or passing. Abos part 1 scores don't matter, as long as you pass, you're fine and no one cares.


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Thank you for doing this! I am very interested in innovation/research and coupling it with patient care, and I'd like to become a leader in the field. As such, I would like to know what you think are some brand new or up-and-coming areas in ortho (stem cell therapy, cartilage restoration, etc.) that have relatively unexplored waters that will have plenty of opportunity for people such as myself
 
OrthoTraumaMD said:
You're welcome. I place a lot of emphasis on evidence based medicine. So much so that my partners have taken to calling me Hermione because I'm always quoting trauma literature. Heh.

As for your other question, it is a bit of self directed learning from the available self assessment exams, review books, and our educational curriculum, which consists of lectures and workshops. Most of it, however, is self directed. I can tell you things all day long, but if you're not reading the books at home, it won't stick. Those who read consistently perform the best. But ultimately it's all about failing or passing. Abos part 1 scores don't matter, as long as you pass, you're fine and no one cares.


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Click to expand...

Evidenced based medicine is surely the way to go, in any facet of life you can say. But sometimes, I like to trek on the road less traveled haha

Thank you again for your thorough responses - you really answer every question with great detail and care, its inspiring.
 
Adelsten said:
Thank you for doing this! I am very interested in innovation/research and coupling it with patient care, and I'd like to become a leader in the field. As such, I would like to know what you think are some brand new or up-and-coming areas in ortho (stem cell therapy, cartilage restoration, etc.) that have relatively unexplored waters that will have plenty of opportunity for people such as myself
Click to expand...

I answered this exact question earlier in the thread, one of the first few pages I think...


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OrthoTraumaMD said:
Two part answer.
So, in terms of scores, here is an excerpt from a study by Dougherty in CORR 2010 about the correlation:
"We found a correlation between the USMLE Step 1 scores and the ABOS Part I percentile rank scores. In comparing USMLE Step 1 scores with ABOS Part I scores (Fig. 2), 33% of those who scored 209 or less on Step 1 failed the ABOS Part I. For a threshold of 223 or less, 16% failed the ABOS Part I. All candidates who scored above 227 on the Step 1 passed the ABOS Part I examination."
(Source: Do Scores of the USMLE Step 1 and OITE Correlate with the ABOS Part I Certifying Examination?: A Multicenter Study)
This, and other studies, seem to have 220-230 as the cutoff score for passing the ortho boards.
The second part to the answer is this: most Ortho residents don't even match with those scores anymore. The median is now in the 240s. So theoretically, they all should be passing the boards right? Nope. Some residents still fail. Those whom I've seen who failed had severe professionalism issues and had other problems, or they slacked and stopped reading/studying the moment they matched. The USMLE gets you in the door, but after you match, it's the OITE that matters more, so you still need to study once you're a resident.
Hope that makes sense.


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Click to expand...

Soooo... I'm worried how will I have time to study for OITE with ortho hours!?!
 
masaraksh said:
I had to look up what this means. Why would anyone care.

I do wanna know if your car has more horsepower than the GDP of a small country though?
Click to expand...

lol.
As for your question about finding time to study... Well the 80h workweek is only at work..you read when you're home. It's all doable if you're consistent and don't "cram."


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This is so random, but it just popped into my head. If someone had gen surg as a backup and didn't match into ortho, could they match into an ortho residency after finishing their surgical residency? I know some ENTs and a few orthopods have matched into plastics in the past. I read about it on SDN if you're wondering what my source is, lol.
 
masaraksh said:
I had to look up what this means. Why would anyone care.

I do wanna know if your car has more horsepower than the GDP of a small country though?
Click to expand...

I'm pretty sure she knows I'm not serious. I care cause I like shoes.
Sorry to derail the threatd@OrthoTraumaMD
 
lagbydesign said:
This is so random, but it just popped into my head. If someone had gen surg as a backup and didn't match into ortho, could they match into an ortho residency after finishing their surgical residency? I know some ENTs and a few orthopods have matched into plastics in the past. I read about it on SDN if you're wondering what my source is, lol.
Click to expand...

No. You would have to go through the match process all over again and you would not have any advantage over other applicants. Some people do a preliminary year of general surgery and then go through the match again. But I've never seen anyone who went through an entire surgical residency only to apply to another. The only year you could potentially save is your first year, which is general surgery for both specialties.


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Thanks for an excellent thread.

Any suggestions, other than looking at another field, re the best course of action for a sub-230 applicant?

Thanks.
 
sunset57 said:
Thanks for an excellent thread.

Any suggestions, other than looking at another field, re the best course of action for a sub-230 applicant?

Thanks.
Click to expand...

Applying this cycle.

Personally, I'd say your best course of action would be to check in with the department at your school, rotate with them, see what your advisors/PD will say, whether they are willing to make calls for you, etc. Because without a bit of help with those in power, your app may simply be filtered out purely based on cutoffs (programs with 5 spots routinely get 700 apps). I'm sure @OrthoTraumaMD would agree?

Looking at the current applicant spreadsheet, there are even people with 250s with like <5 interviews...
 
masaraksh said:
Applying this cycle.

Personally, I'd say your best course of action would be to check in with the department at your school, rotate with them, see what your advisors/PD will say, whether they are willing to make calls for you, etc. Because without a bit of help with those in power, your app may simply be filtered out purely based on cutoffs (programs with 5 spots routinely get 700 apps). I'm sure @OrthoTraumaMD would agree?

Looking at the current applicant spreadsheet, there are even people with 250s with like <5 interviews...
Click to expand...

Yes I agree. You need someone to make a phone call for you. Otherwise you have very little chance of success with a low step score. It sucks, but many programs have interview cutoffs. It's a way to weed out applicants when you have 600+ similar applications. It's incredibly unfair because step scores don't make good residents. I tell people that I personally don't give a flying f*** how people did on step 1. I care only about two things: 1) are they trustworthy, will they lie to me about patients, things they did or didn't examine etc, and 2) are they reasonably normal people whom I can grab a beer with after work (not that I would, but you get the idea), will they get along with people and have camaraderie and not leave their co-residents to pick up the slack etc. But you have to rank people somehow, and unfortunately step 1 is one of those things that is universal and can be compared.


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Apologies if this has been asked already- I don't think I saw it.

Not a trauma specific question, but for ortho in general- Has your department made steps to integrate non-operative specialists into the department? And/or, are they planning to? I'm just curious if this will become more of a trend in the field. Out where I am, it seems to be in its infancy, where ortho departments have one or two non-op specialists (usually physiatrists who did fellowships in sports med) that work with 8-10 surgeons and are crazy overbooked.

As a follow-up question, do you find it helpful to work closely with non-op specialists? From the outside looking in, particularly for general ortho, it seems like it would be helpful; non-op doctors can work with patients who don't have surgical indications, help with post-surgical soft tissue problems, etc. Just wondering what your view is. Thanks for doing the thread!
 
ekmf27050 said:
Apologies if this has been asked already- I don't think I saw it.

Not a trauma specific question, but for ortho in general- Has your department made steps to integrate non-operative specialists into the department? And/or, are they planning to? I'm just curious if this will become more of a trend in the field. Out where I am, it seems to be in its infancy, where ortho departments have one or two non-op specialists (usually physiatrists who did fellowships in sports med) that work with 8-10 surgeons and are crazy overbooked.

As a follow-up question, do you find it helpful to work closely with non-op specialists? From the outside looking in, particularly for general ortho, it seems like it would be helpful; non-op doctors can work with patients who don't have surgical indications, help with post-surgical soft tissue problems, etc. Just wondering what your view is. Thanks for doing the thread!
Click to expand...

Yes! We are always looking for non-op sports medicine people to offload our clinics. We also have a physiatrist in our hospital that works closely with us and with the general surgery trauma teams. It's a thing in academic orthopaedic departments to have a strong relationship with their PM+R departments-- where I am, they are part of the musculoskeletal "family." When I go to conferences, I hear about more and more people incorporating non-op practitioners into their service lines, so yes, it is a trend as you said. I also think it's great, so we don't have to see every hip/ankle pain patient that comes through the door.
 
OrthoTraumaMD said:
Yes! We are always looking for non-op sports medicine people to offload our clinics. We also have a physiatrist in our hospital that works closely with us and with the general surgery trauma teams. It's a thing in academic orthopaedic departments to have a strong relationship with their PM+R departments-- where I am, they are part of the musculoskeletal "family." When I go to conferences, I hear about more and more people incorporating non-op practitioners into their service lines, so yes, it is a trend as you said. I also think it's great, so we don't have to see every hip/ankle pain patient that comes through the door.
Click to expand...

Do you feel that you have a good ratio/access to non-op specialists when you need them? I feel like (again, from an admittedly naive position) having a large amount of easily accessible non-op orthopedists is really smart for an ortho department to bring in a larger patient population and help with patient retention/satisfaction. I'm interested in ortho surgery but have recently been working with a non-op specialist, and seeing the additional techniques and treatments she can bring to the table has been super interesting.

Do you find yourself using non-op specialists to help with postop/post-healing rehab snags?
 
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Like why does ortho get consulted so much about osteomyelitis? Last time I checked this can be treated with antibiotics which is a medicine and medicine doctors give medicines. Are they also consulting CT Surgery for pneumonia?
 
ekmf27050 said:
Do you feel that you have a good ratio/access to non-op specialists when you need them? I feel like (again, from an admittedly naive position) having a large amount of easily accessible non-op orthopedists is really smart for an ortho department to bring in a larger patient population and help with patient retention/satisfaction. I'm interested in ortho surgery but have recently been working with a non-op specialist, and seeing the additional techniques and treatments she can bring to the table has been super interesting.

Do you find yourself using non-op specialists to help with postop/post-healing rehab snags?
Click to expand...

Yes I have pretty good access. But I don't use them that often because in trauma we generally know if we will operate or not, and we still have to see them ourselves. My elective partners use them more.


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masaraksh said:
Like why does ortho get consulted so much about osteomyelitis? Last time I checked this can be treated with antibiotics which is a medicine and medicine doctors give medicines. Are they also consulting CT Surgery for pneumonia?
Click to expand...

Haha. Well I don't mind those consults because I consult medicine for stupid things all the time. But generally yes, OM is a medical problem unless there is an abscess. I get into a lot of fights with ID over that.


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masaraksh said:
Like why does ortho get consulted so much about osteomyelitis? Last time I checked this can be treated with antibiotics which is a medicine and medicine doctors give medicines. Are they also consulting CT Surgery for pneumonia?
Click to expand...

This is a bad question and you should feel bad

Real comparison would be are they also consulting ct surgery for empyema and the answer is yes
 
OrthoTraumaMD said:
Empyema: abscess in the lung/pleural cavity. If an orthopod can recognize it on a chest CT scan, it's probably not good.


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Click to expand...

This is obviously the wrong thread to ask this, but since it tangentially came up...is it possible to distinguish the type of pleural effusion (eg empyema vs hemothorax) by imaging alone? My guess is no but I'm not sure.
 
Brahnold Bloodaxe said:
This is obviously the wrong thread to ask this, but since it tangentially came up...is it possible to distinguish the type of pleural effusion (eg empyema vs hemothorax) by imaging alone? My guess is no but I'm not sure.
Click to expand...

I'm no radiologist, but I'm pretty sure you can. Also you didn't specify what kind of imaging study you're talking about - CXR, CT, or MR and whether the cross-sectional studies are +/- contrast.

But yeah, I would think that with all of the modalities above you can likely distinguish the two without any clinical history.

Blood is dense and would have a characteristic amount of Houndsfield units on CT, it would also show layering. Empyema and para-pneumonic effusions would likely show a completely different pattern. And then this isnt taking into consideration, effect of contrast, other lung findings, loculations, etc. ... and I've never really read Chest MR but I'm pretty sure you can distinguish with that too.
 
masaraksh said:
I'm no radiologist, but I'm pretty sure you can. Also you didn't specify what kind of imaging study you're talking about - CXR, CT, or MR and whether the cross-sectional studies are +/- contrast.

But yeah, I would think that with all of the modalities above you can likely distinguish the two without any clinical history.

Blood is dense and would have a characteristic amount of Houndsfield units on CT, it would also show layering. Empyema and para-pneumonic effusions would likely show a completely different pattern. And then this isnt taking into consideration, effect of contrast, other lung findings, loculations, etc. ... and I've never really read Chest MR but I'm pretty sure you can distinguish with that too.
Click to expand...

Sigh...bones are so much easier...


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OrthoTraumaMD said:
Sigh...bones are so much easier...


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Click to expand...

I dunno, acetabular fractures seem pretty hard to classify, I've seen residents discuss whether something is ABC or not for what seemed to be hours.

Ultimately, yeah its easier - we just went to the OR, cut the butt or belly or both open, and put the pieces back in place.
 
masaraksh said:
I dunno, acetabular fractures seem pretty hard to classify, I've seen residents discuss whether something is ABC or not for what seemed to be hours.

Ultimately, yeah its easier - we just went to the OR, cut the butt or belly or both open, and put the pieces back in place.
Click to expand...

Hehe telling a BC fracture takes 10 seconds. Just follow the ilium on coronal CT and see if any part of it connects with the joint 🙂


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OrthoTraumaMD said:
Agree, it's my least favorite as well, along with pelvis. Too many potential things to go wrong, not enough return.
Click to expand...

That's refreshing to hear. Seriously. I'd been told that people go into trauma fellowship precisely because they like the acetabulum and pelvis cases. I'm interested in trauma but don't particularly enjoy those procedures and was worried that trauma wasn't for me. Good to hear that may not be the case.
 
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augeremt said:
That's refreshing to hear. Seriously. I'd been told that people go into trauma fellowship precisely because they like the acetabulum and pelvis cases. I'm interested in trauma but don't particularly enjoy those procedures and was worried that trauma wasn't for me. Good to hear that may not be the case.
Click to expand...

Well I think I'm in the minority there. I like those cases intellectually but they are dangerous and make me ill every time.


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Dear OrthoTraumaMD,
after shadowing some orthopedic surgeons and enjoying it immensely, ortho is still very much on my list. During my shadowing I had some exposure to pediatric ortho, my time there was probably the most fun and engaging. Now I am wondering how competitive pediatric fellowships are in general? Also I would be interested to know whether the treatment of neuromuscular stuff (cerebral palsy etc.) plays a big role in the daily life of a pediatric orthopod. Would appreciate any infos on the matter! Thank you!
 
hopeful123456789 said:
Dear OrthoTraumaMD,
after shadowing some orthopedic surgeons and enjoying it immensely, ortho is still very much on my list. During my shadowing I had some exposure to pediatric ortho, my time there was probably the most fun and engaging. Now I am wondering how competitive pediatric fellowships are in general? Also I would be interested to know whether the treatment of neuromuscular stuff (cerebral palsy etc.) plays a big role in the daily life of a pediatric orthopod. Would appreciate any infos on the matter! Thank you!
Click to expand...

I don't know a ton about ped ortho, but I do know that it's really not competitive.

The most competitive ones are probably sports and hand, but even those aren't crazy competitive.

Getting a residency is the tricky part.
 
hopeful123456789 said:
Dear OrthoTraumaMD,
after shadowing some orthopedic surgeons and enjoying it immensely, ortho is still very much on my list. During my shadowing I had some exposure to pediatric ortho, my time there was probably the most fun and engaging. Now I am wondering how competitive pediatric fellowships are in general? Also I would be interested to know whether the treatment of neuromuscular stuff (cerebral palsy etc.) plays a big role in the daily life of a pediatric orthopod. Would appreciate any infos on the matter! Thank you!
Click to expand...

Not competitive at all, more spots than applicants. Lots of neuromuscular CP type patients in peds ortho clinic.
 
hopeful123456789 said:
Dear OrthoTraumaMD,
after shadowing some orthopedic surgeons and enjoying it immensely, ortho is still very much on my list. During my shadowing I had some exposure to pediatric ortho, my time there was probably the most fun and engaging. Now I am wondering how competitive pediatric fellowships are in general? Also I would be interested to know whether the treatment of neuromuscular stuff (cerebral palsy etc.) plays a big role in the daily life of a pediatric orthopod. Would appreciate any infos on the matter! Thank you!
Click to expand...

Peds fellowships are easy to get, but there are some that are harder to get into. Most aren't bad, though. There are lots of CP kids, particularly if you work in a place that has a specialized center for that. Shriners hospitals come to mind.


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