Orthopaedic Surgery Interview

“Whatever course you decide upon, there is always someone to tell you that you are wrong. There are always difficulties arising which tempt you to believe that your critics are right. To map out a course of action and follow it to an end requires courage.”

~Ralph Waldo Emerson

Twice a year, we have mock oral boards. You may say oral boards sound like it's malignant, but it's not. It is just another assessment tool. Like the real orthopaedic mock boards, it always us to assess your understanding of orthopaedic knowledge in a dynamic setting. It does cause many residents a great amount of anxiety, but it is helpful. As the years progress, you can see a increase understanding of orthopaedic surgery. The residents feel that it is a mega pimp session. I guess, by definition, it is a question and answer session done without a #2 pencil and multiple choices. The purpose is not to make the resident uncomfortable and sweat; the purpose is the assess your application of what you learned.

Today, we had oral boards. It got me thinking. When we give the examination, the resident brings a known case and a is given an unknown case. Why don't we give the resident applicants a known question?

Our interview season is beginning this month. For those who are interviewing at out program (St. Louis University orthopaedic surgery), here is your question when you come into my room: "Tell me about yourself." Please keep your answers short and don't recite your resume. You can take a hint from a previous comment I make on the "tell me about yourself" question and answer.

Good luck all

“Thinking is easy, acting is difficult, and to put one's thoughts into action is the most difficult thing in the world.”
~Johann Wolfgang von Goethe

The rank list - a scientific process?

I sit here in my office thinking about the resident applicants that I am about to interview tomorrow, and I realize that this really is not a very scientific process. We have to go through and interview a number of applicants. Everyone sits down in a room and goes back and forth and tried to remember the people form weeks ago. We go back and forth who we like and who we didn't like. I actually think placing people at the bottom is the easiest part of the whole process. Those people that give you the willies are easy to spot, and it is usually a consensus thumbs down. The middle section is extremely difficult, and the top, sometimes, even more difficult.

At our institution, we review all of the applications to select those who we will interview. We split them into 2 piles, and 2 faculty members review half and the other 2 faculty members review the other half. Then we rank the applicants from 1 to whatever. Unlike some institutions, we actually read the applications first and offer interviews based on what we see. Now that is not very scientific. There is no exact formula; no cutoff by board scores. It comes from a gut feeling. Now understand that we don't have 500 applicants to review. We have a 6 year program, which deters some from applying. Most large programs and programs in more desirable cities have a larger number of applicants and therefore use some way of "screening". For most, the USMLE score is probably use in some way shape or form (e.g. cutoff). Smaller programs, like ours, are more likely to look at other factors like where you are from, the school you attend, your aspirations, where you rotated for AI's. These "other" factors come into play.

I sit here trying to think of what factors I am looking for once we have selected you for an interview. What makes me want to choose you? I guess it comes down to a number of things. We are all shaped by our own experiences. We tend to be drawn to things for different reasons. May be it is your alma mater; or may be we know the person who wrote your recommendation; or may be your personal statement brought to light something that is not evident in you application, something that is unique to you. The interview for most is a snapshot of who you are. I guess for me, I can't speak for anyone else, it is a gut feeling. As an attending, I have to trust you, I need to like you, I need to know that you will be a good representative of me to my patients, as well as, a good representative of our program. So we are shaped by our experiences. Bad previous residents or experiences may cloud our judgment of you (not something you can prepare for). If you come unprepared to the interview (don't know your CV or research, don't know about the program, and don’t have answers to the simple questions like why you are going into orthopaedics), I wonder is this how you will be when you enter the program. So, I guess what I would advise be yourself, know who you are, know your strengths and weaknesses, and some how bring that to the interviewers attention. You need to be able to be your own spin doctor.

So, needless to say the whole rank list comes basically out of some gut feelings. People that make us feel like you will be a good representative of our program. I personally feel that the people that I help train are somewhat a representative of me and our program. When they go onto fellowship, into practice, and present at meetings, I want to be like a proud parent and say that was one of ours.

Do I have a chance getting into an orthopaedic residency?

The first question I would like to put out there is:

Do I have a chance getting into an orthopaedic residency?

I personally think this is a very important question. It is a reality check. And this is something that you have to look at without kid gloves. You can ask you parents and friends (unless they are in the field and honest), because that's like asking you mother if she thinks you are pretty/hansom. You need to be brutally honest with yourself and get someone else to review you application who will be honest as well.

Lets look at what "relatively" objective measures you have in your application that will help you get into the door.

USMLE
This is definitely an area that gets a lot of press. Do programs have cutoffs and what are they? etc. Realize this is the only objective measurement that everyone has in common. So, most programs (I can not speak for all) use it in some way, shape or form, to get the numbers of applications down to a reasonable number to review for interview. Every program is different in this initial process. Some do have absolute cutoffs, some relative cutoffs, and others no cutoffs. It depends on the number of applications to the program. If you have 500 applicants, probably more like absolute cutoffs; if only 150, may be relative cutoffs. Regardless, the test will be used in someway, and you will need to do well on it.

This is were honesty and reality comes into play. If you score low (say 200-215 ave is now around 215), please be realistic. You are probably not going to one of the top 10 programs unless are able to pull some strings.

GRADES
This is something that differs from university to university. Some schools are very liberal with the honors, and others not. Regardless, 2 rotations you need concentrate on getting honors in are surgery and orthopaedics. Now, we can be lenient on the surgery honors, but if you don't honor orthopaedics, you are definitely a tougher sell.

AOA
This may be considered by some, but the elections for AOA are not always complete when the applications come out. So it is difficult to use as an evaluation tool for every applicant. It does in general correlate with the number of honors at most institutions.

RESEARCH
This is kind of hit or miss for me personally. Some applicants decide late, so should they take a year off and do research; find a project to tag on; do a month rotation. I think if you do research, you genuinely need to look as if you want to do research. Get a publication out of it, etc. I have review may applications were the research was kind of half ass, done so they can check that box off on the application. If you decide late to go into ortho, I feel it is better to concentrate on you strengths and make contacts who will be an advocate for you. If that means you end up doing research, fine. Make it look real though.

RECOMMENDATIONS
These need to be strong recommendations with key words. Words or statements like:
1. will be ranked high at our institution
2. we are actively recruiting for our program
3. one of the top students we have had this year; (or even better) on of the top students we have ever had.

Things that you don't want with you letter of recommendation.
1. you would not sign the waive to not be able to review you recommendation
2. a statement like " we tried to persuade him to go in to another less competitive area."

PERSONAL STATEMENT
At most institutions, this does not get read until interview time. In general for most it is a none factor. Most of the statements say similar things like
1. the applicant or a family member had some interaction with an orthopaedic surgeon and that is what made them interested in it
2. the applicant was an athlete
3. the applicant likes to work with his/her hands
4. on a rotation, the application had an experience which shaped his/her decision.

so, for me, I read the statement and if I start to see this theme, no bonus points.

Now this personal statement can be a plus or a minus. It is tricky if you decide to go outside of the norm. If it is too artsy and you sound crazy, minus; if you are creative and interesting, plus. But this is tricky and I would only recommend this for the literary inclined.

SUMMARY
In summary, most of these things are common sence. I don't think I am shedding a ton of light on the situation. The most important thing initially is to be realistic. If you don't have the numbers, you may need some other assistance, like an away rotation or people who can be advocates for you.

And is you are a good applicant (after being honest with yourself), you need to then ask yourself what makes you different. Something to set you apart, otherwise you all blend together.