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That's good to hear. I can't say this will end up the case (and technically there was a high pass in family med at the beginning ;)), but I've been unlucky this rotation by getting evals that have great comments, but with numerical scores that don't meet the honors cutoff, and then they decided to make the OSCE harder than everyone else because we're the last group, lol.

It's ok. I didn't honor medicine either. Bastards.

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Had a question about technical skills such as suturing! Is there a particular suturing method that is most commonly used on different surgical rotations like Gen surg vs OB vs ortho etc? In terms of ties, I've been told that a medical student should always stick to two-handed ties unless told otherwise. Is there truth to that? And are medical students expected to do things like vertical/horizontal mattresses or are we only allowed to do things like simple sutures?
 
Had a question about technical skills such as suturing! Is there a particular suturing method that is most commonly used on different surgical rotations like Gen surg vs OB vs ortho etc? In terms of ties, I've been told that a medical student should always stick to two-handed ties unless told otherwise. Is there truth to that? And are medical students expected to do things like vertical/horizontal mattresses or are we only allowed to do things like simple sutures?
Just gonna chime in based on my experiences. At my institution, gen surg and OB wanted you to only do two handed ties (granted I only got to do like 3 throws during surgery...). Ortho only ever uses instrument ties (I think I've seen maybe 2-3 instances of one handed ties that I can remember). Vertical vs horizontal mattress depends on the attending, but you should be allowed to do them because it's the same principle as simple interrupted.
 
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Had a question about technical skills such as suturing! Is there a particular suturing method that is most commonly used on different surgical rotations like Gen surg vs OB vs ortho etc? In terms of ties, I've been told that a medical student should always stick to two-handed ties unless told otherwise. Is there truth to that? And are medical students expected to do things like vertical/horizontal mattresses or are we only allowed to do things like simple sutures?

You should be able to do a good running subcuticular. I've used that on surgery, Ob, and ortho... skin always has to be closed no matter the specialty. I've always done one handed ties, but I suppose just do what the resident/attending tells you. Normally during third year they just said close/tie something and I did it the way I was most comfortable which was one handed.
 
Had a question about technical skills such as suturing! Is there a particular suturing method that is most commonly used on different surgical rotations like Gen surg vs OB vs ortho etc? In terms of ties, I've been told that a medical student should always stick to two-handed ties unless told otherwise. Is there truth to that? And are medical students expected to do things like vertical/horizontal mattresses or are we only allowed to do things like simple sutures?

Do whatever the attending says. You should know simple and mattress. Everything else we can teach you. About the instrument tying in ortho--not true. I hand tie almost exclusively because it gives you a better feel for the knot.
 
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Do whatever the attending says. You should know simple and mattress. Everything else we can teach you. About the instrument tying in ortho--not true. I hand tie almost exclusively because it gives you a better feel for the knot.
Even closing? Though I guess that's when you let the residents finish up and you can go get started for the next case. ;)
 
Do you work with podiatrists? How do you feel about them and their education? Do you think podiatrists and ortho's can work together in the same setting?
 
You're welcome! This is fun.

Most journals require subscriptions, but your medical school should have access. That said, here are my top journals, obviously slanted toward trauma.

-CORR (clinical orthopaedics and related research)
-JOT (Journal of orthopaedic trauma)
-JBJS (Journal of bone and joint surgery), American and British versions. The British version is now known as the bone and joint journal,
-JAAOS aka the Yellow Journal
-Injury
-Archives of orthopaedic and trauma surgery

As for institutions and individuals, that is a difficult question. For trauma, just look at past presidents of the OTA (Orthopaedic Trauma Association), on the website. They are all incredible people. There are so many that I cannot list them all, and if I did list those I was close to, I think it would give away my identity.

For institutions, many places are good for different things, but the places that come to mind are HSS, shock trauma, Harborview, UT Houston, Mayo, Rush.

Would you also consider Rothman Ortho as one of the top places for ortho?
 
@OrthoTraumaMD

Thank you for the response!

I would also like your opinion about authorship on publications. Does it look bad if an applicant if they have a number of papers but they were all 2nd, 3rd etc authors but not first author? Compared to an applicant who is a first author but only has one publication?

Something of that general trend is what I'm curious about - the impact of really being a first author and having only one or a few compared to a number of strong pubs where you're not first author though.

Thanks once again!
 
What kind of ortho-specific (and/or non-specific to ortho) volunteering or service that you or your colleagues have or are doing? What kinds of skills does an ortho bring to the table in these cases?
 
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@OrthoTraumaMD

Thank you for the response!

I would also like your opinion about authorship on publications. Does it look bad if an applicant if they have a number of papers but they were all 2nd, 3rd etc authors but not first author? Compared to an applicant who is a first author but only has one publication?

Something of that general trend is what I'm curious about - the impact of really being a first author and having only one or a few compared to a number of strong pubs where you're not first author though.

Thanks once again!

No one expects a med student to be first author. It's quite rare unless you took a dedicated research year.
Second or third is fine... the more important thing is that you can speak coherently about the research and why you enjoyed it, why you think it's important, etc.
 
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Do you think IR will be doing more and more MSK procedures in the future?

Just curious since fixing a femoral neck fx with cannulated screws under fluoro is basically "IR like"
 
Do you think IR will be doing more and more MSK procedures in the future?

Just curious since fixing a femoral neck fx with cannulated screws under fluoro is basically "IR like"

Nope. Percutaneous work still requires an intimate knowledge of biomechanics and anatomy, implants, etc. I don't ever see IR doing that.
 
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No one expects a med student to be first author. It's quite rare unless you took a dedicated research year.
Second or third is fine... the more important thing is that you can speak coherently about the research and why you enjoyed it, why you think it's important, etc.

Thanks!

Also, is community service really weighed heavily in applications?

I am genuinely interested in research and have spent a lot of time on research projects which has taken away from having "extensive" community service experiences. Is that red flag? My community service is not negligible but it is not in the 100 to 200 hours range of some students at my school.

I really enjoy research and spend a lot of time on my projects. I want to make sure this doesn't bite me in the butt in the future.
 
No one expects a med student to be first author. It's quite rare unless you took a dedicated research year.
Second or third is fine... the more important thing is that you can speak coherently about the research and why you enjoyed it, why you think it's important, etc.
On a similar topic, with regard to the "resume padding" thread, what is your opinion of putting relatively minor activities in (not like half a day, but not long-term either)? Also, would you be willing to look over a CV?
 
I am active in various orthopaedic organizations, particularly the OTA. I also do some mentorship type volunteer work... I can't go into specifics due to anonymity issues, but suffice it to say that lots of people are interested in what a surgeon has to say, particularly since I am a female in a very stereotypically male field (personally, I couldn't care less about the female part -- I'm a firm believer that mentorship of any kind is what matters, not the gender thing).

Can you just mentor us all :D
 
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Thanks!

Also, is community service really weighed heavily in applications?

I am genuinely interested in research and have spent a lot of time on research projects which has taken away from having "extensive" community service experiences. Is that red flag? My community service is not negligible but it is not in the 100 to 200 hours range of some students at my school.

I really enjoy research and spend a lot of time on my projects. I want to make sure this doesn't bite me in the butt in the future.

Research is vastly valued over community service when applying to ortho. I rarely hear the latter mentioned at all during interviews, unless the person has done something crazy like build a clinic in Africa (we have had a few of those actually!)...

So do your research and don't worry about it.
 
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On a similar topic, with regard to the "resume padding" thread, what is your opinion of putting relatively minor activities in (not like half a day, but not long-term either)? Also, would you be willing to look over a CV?

If it isn't a significant single event (like for example, volunteering during 9/11), I wouldn't bother with it. I understand the appeal of resume padding, but it is hard to separate the wheat from the chaff when the person lists every class presentation they ever gave. When I see an application like that, I tend to get bored reading it and downgrade it because I can't tell what's truly important. And if your app is all filler, we know it; we aren't as dumb as we look. So I would say just include those activities that you consider important--like if you were trying to present yourself to a blind date and only had a limited amount of time to say something about yourself and make yourself memorable, how would you impress them?

As for your other question, I have answered personal questions on PM in the past that people were too shy to ask on the thread, but I would prefer to stick to general questions that apply to all. If you have something specific about your CV that you want to ask me about, that's ok, but there are better people to do the "review" thing.
 
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If it isn't a significant single event (like for example, volunteering during 9/11), I wouldn't bother with it. I understand the appeal of resume padding, but it is hard to separate the wheat from the chaff when the person lists every class presentation they ever gave. When I see an application like that, I tend to get bored reading it and downgrade it because I can't tell what's truly important. And if your app is all filler, we know it; we aren't as dumb as we look. So I would say just include those activities that you consider important--like if you were trying to present yourself to a blind date and only had a limited amount of time to say something about yourself and make yourself memorable, how would you impress them?
But what if your life is boring and you don't have much to say about yourself?! :p
 
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The med student life: eat, sleep, study!
Really, though. I consider myself to be a relatively average guy who likes bones and works hard. Extracurriculars haven't been a huge focus for me. I have some, but I like relaxing and hanging with my wife. I'm always awed by the people that have their dedicated volunteer things and always work at the free clinic, yet still do well in school and have lives.
 
Really, though. I consider myself to be a relatively average guy who likes bones and works hard. Extracurriculars haven't been a huge focus for me. I have some, but I like relaxing and hanging with my wife. I'm always awed by the people that have their dedicated volunteer things and always work at the free clinic, yet still do well in school and have lives.

Honestly, the best orthopaedic resident is just like that: somebody who works hard and likes bones.
Extracurriculars don't matter as much. Just play to your strengths, and if you have research that's even better.
 
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Research is vastly valued over community service when applying to ortho. I rarely hear the latter mentioned at all during interviews, unless the person has done something crazy like build a clinic in Africa (we have had a few of those actually!)...

So do your research and don't worry about it.


Thank you for all of your diligent responses!

Sorry but I have one more followup question. Does it look bad if you're not intensely involved in research at your home institution? What if you've done a lot of work at a previous institution and are continuing with them or spent a summer somewhere and are focused on that work with that other institution?
 
I've read that trauma is the cornerstone of orthopedic education. What is your opinion on that? What does that mean for programs with "minimal" trauma (they do mostly elective cases) like Jefferson?
 
Thank you for all of your diligent responses!

Sorry but I have one more followup question. Does it look bad if you're not intensely involved in research at your home institution? What if you've done a lot of work at a previous institution and are continuing with them or spent a summer somewhere and are focused on that work with that other institution?

No, it doesn't look bad. If you have research with a previous institution, that is fine.
 
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I've read that trauma is the cornerstone of orthopedic education. What is your opinion on that? What does that mean for programs with "minimal" trauma (they do mostly elective cases) like Jefferson?

I agree with that statement. Trauma is the thing that residents have typically the earliest exposure to, due to covering ER and call. Also, trauma guys love to teach. From my work with the OTA and my general life, I can tell you that us trauma people are obsessed with education on all fronts. Understanding fractures requires knowledge of anatomy and biomechanics, two things that are the core of ortho. Fracture work is also usually how most residents get introduced to operative techniques that they then use in more complex cases. So generally yes, I agree.

As for your second question, I think trauma is important particularly if you plan on taking call as an attending, you should be able to deal with some basic fractures. But honestly, in this day and age and the advent of trauma rooms, you can pass off pretty much anything to your trauma partners, and they will be happy to take care of it. Even in an elective setting, there is some call (and I assume, some rotations dealing with trauma because it is a requirement for graduation)-- so even those residency programs will give you enough knowledge to deal with basic things. But you may need to supplement your trauma education with books etc, if you feel you are not getting enough. No program is perfect-- I didn't have a lot of peds, so I had to read quite a bit to feel like I was OK on the boards. It worked out. Of course, I would always suggest you go to a residency with a major trauma component, but I'm very biased in that direction, haha.
 
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I agree with that statement. Trauma is the thing that residents have typically the earliest exposure to, due to covering ER and call. Also, trauma guys love to teach. From my work with the OTA and my general life, I can tell you that us trauma people are obsessed with education on all fronts. Understanding fractures requires knowledge of anatomy and biomechanics, two things that are the core of ortho. Fracture work is also usually how most residents get introduced to operative techniques that they then use in more complex cases. So generally yes, I agree.

As for your second question, I think trauma is important particularly if you plan on taking call as an attending, you should be able to deal with some basic fractures. But honestly, in this day and age and the advent of trauma rooms, you can pass off pretty much anything to your trauma partners, and they will be happy to take care of it. Even in an elective setting, there is some call (and I assume, some rotations dealing with trauma because it is a requirement for graduation)-- so even those residency programs will give you enough knowledge to deal with basic things. But you may need to supplement your trauma education with books etc, if you feel you are not getting enough. No program is perfect-- I didn't have a lot of peds, so I had to read quite a bit to feel like I was OK on the boards. It worked out. Of course, I would always suggest you go to a residency with a major trauma component, but I'm very biased in that direction, haha.

Thank you. Your answers were enlightening.
 
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In terms of fellowships after, is there a significance placed on which academic institution you did your training at? I've heard that when comparing academic vs community hospitals it matters, but curious if fellowships go beyond even that and compare academic training centers when deciding.
 
In terms of fellowships after, is there a significance placed on which academic institution you did your training at? I've heard that when comparing academic vs community hospitals it matters, but curious if fellowships go beyond even that and compare academic training centers when deciding.

Sure there is. However, academic residency/fellowship doesn't mean you'd be the best surgeon. Plenty of academic places with not so great operative experience, both residencies and fellowship alike. Depends what you want to do afterwards.
 
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In terms of fellowships after, is there a significance placed on which academic institution you did your training at? I've heard that when comparing academic vs community hospitals it matters, but curious if fellowships go beyond even that and compare academic training centers when deciding.

Yes they do. In terms of academics, fellowships do look at where you went, specifically the quality of your faculty, and if they know or have relationships with any of them. That's really the important bit.
 
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Sure there is. However, academic residency/fellowship doesn't mean you'd be the best surgeon. Plenty of academic places with not so great operative experience, both residencies and fellowship alike. Depends what you want to do afterwards.

I definitely would agree with this - I've worked with some really talented doctors at community hospitals and in no way think academic centers make better doctors than community centers. But I am interested in doing academic work after, so for me it would likely be very important that I end up doing my residency at an academic center.

Yes they do. In terms of academics, fellowships do look at where you went, specifically the quality of your faculty, and if they know or have relationships with any of them. That's really the important bit.

On a similar note, I've been considering applying for a year long research position such as through the NIH or positions that randomly pop up. Assuming killer board scores after year 2, would it be better to do this year long research position between years 2 and 3 or between 3 and 4?
 
I definitely would agree with this - I've worked with some really talented doctors at community hospitals and in no way think academic centers make better doctors than community centers. But I am interested in doing academic work after, so for me it would likely be very important that I end up doing my residency at an academic center.



On a similar note, I've been considering applying for a year long research position such as through the NIH or positions that randomly pop up. Assuming killer board scores after year 2, would it be better to do this year long research position between years 2 and 3 or between 3 and 4?

Between 2 and 3 so you're done w step 1 and don't break up your clinical years. But may be a better question for PDs.
 
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Great to see this thread running, we are getting our questions answered =)

I am pgy1 ortho, almost finishing. I have few questions, hoping it will benefit others too.

1. Preparing for exams and building a good foundation seems very different to me. Reading heavy textbooks are time consuming but give you a good base but not a very efficient method of preparing for exams when you are drowning with oncalls, clinics, OT hours. So I am hoping you could give a detailed answer?

2. Many residents when asked about exam prep, they say one word 'do orthobullets'.. now how exactly do we DO orthobullets? Do you just do the question bank? or read the pages and answers the questions embedded in?

3. How do you chose the subspeciality?

4. How do you cover a rotation?
5. How to be the best resident and get the maximum out of your residency training?

6. How to control your anxiety, exam nerves, over all craziness of residency?

Thankyou!!
 
Great to see this thread running, we are getting our questions answered =)

I am pgy1 ortho, almost finishing. I have few questions, hoping it will benefit others too.

1. Preparing for exams and building a good foundation seems very different to me. Reading heavy textbooks are time consuming but give you a good base but not a very efficient method of preparing for exams when you are drowning with oncalls, clinics, OT hours. So I am hoping you could give a detailed answer?

2. Many residents when asked about exam prep, they say one word 'do orthobullets'.. now how exactly do we DO orthobullets? Do you just do the question bank? or read the pages and answers the questions embedded in?

3. How do you chose the subspeciality?

4. How do you cover a rotation?
5. How to be the best resident and get the maximum out of your residency training?

6. How to control your anxiety, exam nerves, over all craziness of residency?

Thankyou!!

Thanks for your qns.
1 and 2. (I combined these answers because they are related) Textbooks are great and there is no substitute for them. Things like orthobullets are good to review in a pinch, but they will not give you the solid base, as you said. In terms of preparing for exams, I would do Miller's, OKU, and the self assessment exams. You can also use OrthoBullets in terms of reading on specific topics and then doing the questions on the topic; another way to do them is to make practice tests for yourself using the questions--on the site they have that option if you sign up, to create a test for yourself from their question bank.

3. The subspecialty chooses you. You may not know until your third year. The important thing as a pgy1 is to remain open to all options. We arrive at our subspecialty in different ways… But most of us are pretty certain in terms of what we hate by the beginning of PGY4, and then choose among what is left and what will give us the lifestyle and money we think we want, while still remaining professionally interesting. It is very person dependent. I hated the repetitiveness of joints, but some people like knowing that they will be able to go home at a certain time every day because they can crank out a knee in an hour.

4. I'm not sure what the question means. Can you explain?

5. I answered this in various forms earlier on the thread, but the gist of it is: know everything about the patients on your list, come early and review stuff if you need to, be prepared for every case, read before and after cases, read at home, read read read!!! Oh, and don't be a jerk, pull your weight, and don't leave work for other people to do ("night shift's over so I will leave that 4am distal radius consult for the day person").

6. Reading. It is your lack of knowledge and experience that is making you anxious. The only solution for that is preparation. Read as much as you can, try to see as many cases as you can, and eventually it will go away, or will abate to a point where it is OK. It took me until third year to get there, and I still get nervous before I do a case as an attending. Fear is not bad, it keeps you honest.
Also, involve your family and friends in your life, do not cut them out. They can be a source of support for you during the hard times, and we all have them.
 
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Hi SDNers,

I have some free time and so am happy to answer any questions you may have about the myths and realities of orthopaedics, resident life, and general questions. Just avoid the "what are my chances with score X" questions-- so many better posts and options on this site for that. Orthogate is also a good site for their "ask the attending" section.

A bit about me: orthopaedic trauma attending, female, in my 30s, practicing in an academic setting in the US. Did my med school (allopathic/MD, if that matters), residency and fellowship training in the Northeast (though not all in the same place/state). My practice includes admin/research/education/mentorship responsibilities as well.

Ask away.

Why does insurance pay orthopedics so well/so much better than other surgical specialties?? Is there a specific reason?
 
Why does insurance pay orthopedics so well/so much better than other surgical specialties?? Is there a specific reason?

Not sure exactly, but if I had to speculate:
-we use a great deal of implants--every screw costs money
-our work is often intricate and dangerous
-we restore function and get people back to work, which is valuable.
 
Thanks for your qns.
1 and 2. (I combined these answers because they are related) Textbooks are great and there is no substitute for them. Things like orthobullets are good to review in a pinch, but they will not give you the solid base, as you said. In terms of preparing for exams, I would do Miller's, OKU, and the self assessment exams. You can also use OrthoBullets in terms of reading on specific topics and then doing the questions on the topic; another way to do them is to make practice tests for yourself using the questions--on the site they have that option if you sign up, to create a test for yourself from their question bank.

3. The subspecialty chooses you. You may not know until your third year. The important thing as a pgy1 is to remain open to all options. We arrive at our subspecialty in different ways… But most of us are pretty certain in terms of what we hate by the beginning of PGY4, and then choose among what is left and what will give us the lifestyle and money we think we want, while still remaining professionally interesting. It is very person dependent. I hated the repetitiveness of joints, but some people like knowing that they will be able to go home at a certain time every day because they can crank out a knee in an hour.

4. I'm not sure what the question means. Can you explain?

5. I answered this in various forms earlier on the thread, but the gist of it is: know everything about the patients on your list, come early and review stuff if you need to, be prepared for every case, read before and after cases, read at home, read read read!!! Oh, and don't be a jerk, pull your weight, and don't leave work for other people to do ("night shift's over so I will leave that 4am distal radius consult for the day person").

6. Reading. It is your lack of knowledge and experience that is making you anxious. The only solution for that is preparation. Read as much as you can, try to see as many cases as you can, and eventually it will go away, or will abate to a point where it is OK. It took me until third year to get there, and I still get nervous before I do a case as an attending. Fear is not bad, it keeps you honest.
Also, involve your family and friends in your life, do not cut them out. They can be a source of support for you during the hard times, and we all have them.

Thankyou VERY much. That was extremely valuable.
 
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Do you think private practice ortho will still be a thing in 10 years? On the one hand ortho is arguably the specialty with the greatest potential for making massive bank in a private practice model by virtue of ASCs, on the other hand hospital systems have been buying out private practices with a vigor that borders on the fanatical. I've also heard that the feds have been implementing regulations so onerous that almost the only reasonable explanation is that they are meant to make private practice untenable, almost certainly at the behest of the hospital lobby.

Do you have any insight as to how this is likely to shake out?
 
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Do you think private practice ortho will still be a thing in 10 years? On the one hand ortho is arguably the specialty with the greatest potential for making massive bank in a private practice model by virtue of ASCs, on the other hand hospital systems have been buying out private practices with a vigor that borders on the fanatical. I've also heard that the feds have been implementing regulations so onerous that almost the only reasonable explanation is that they are meant to make private practice untenable, almost certainly at the behest of the hospital lobby.

Do you have any insight as to how this is likely to shake out?

I think it's still possible, but will be more difficult. The likely reality is that private practice docs will merge together in massive groups like they have been doing to decrease costs. And yes, the government is trying very hard to choke private practice to death, so i didn't look at those options...but I also wanted academia.
 
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This thread is invaluable.. :clap:

More Questions:
1. When and why do orthopedic residents quit or swap? What is your opinion?
2. How do you get into academics? What is needed etc
3. If you had to break down of how much % should you know to be a safe orthopod, what would it be? For example my seniors often say, you can never know everything, you should know 100% of trauma, basic science and anatomy. 50% of spine, recon, path, peds and 25% of hand and foot ! or is this complete BS?!
4. Generally speaking - Which one of the fields are more relaxed with better life style and hours out side? Hand, foot/ankle? Onco?
 
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This thread is invaluable.. :clap:

More Questions:
1. When and why do orthopedic residents quit or swap? What is your opinion?
2. How do you get into academics? What is needed etc
3. If you had to break down of how much % should you know to be a safe orthopod, what would it be? For example my seniors often say, you can never know everything, you should know 100% of trauma, basic science and anatomy. 50% of spine, recon, path, peds and 25% of hand and foot ! or is this complete BS?!
4. Generally speaking - Which one of the fields are more relaxed with better life style and hours out side? Hand, foot/ankle? Onco?

1) Most orthopedic residents are pushed out from what I have seen, very few quit or swap out of their own choice. It's either resign or get fired, or a non renewal of contract. Usually is due to some personality/professionalism issue, and rarely due to incompetence.

2) the formula to get into academics is to attend a high powered academic residency and get a bunch of research under your belt. Then continue on with an academic fellowship or two. Along this road, you should find a mentor or two that are big whigs that'll help you with an academic career.

3) No one knows hundred percent of everything, even practicing Orthopods their subspecialties. There's simply too much to know. Just work hard and formulate a good study routine and you'll do well for yourself.

4)easiest lifestyle is probably all sports practice, although foot and ankle and hand can be easy as well.
 
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This thread is invaluable.. :clap:

More Questions:
1. When and why do orthopedic residents quit or swap? What is your opinion?
2. How do you get into academics? What is needed etc
3. If you had to break down of how much % should you know to be a safe orthopod, what would it be? For example my seniors often say, you can never know everything, you should know 100% of trauma, basic science and anatomy. 50% of spine, recon, path, peds and 25% of hand and foot ! or is this complete BS?!
4. Generally speaking - Which one of the fields are more relaxed with better life style and hours out side? Hand, foot/ankle? Onco?

1. I have seen both people who quit and those who were fired. This happens for a variety of reasons, most dealing with professionalism or competence issues. Unfortunately it is very difficult to fire a bad resident; the real process involves probation, meetings, and second chances, all of which keep bad people in for far longer than necessary.

2. There are many ways but the key is getting a fellowship at an academic place with people who will vouch for you. It doesn't matter if your residency is academic or not.

3. You should know as much of everything as you possibly can. A lot of it depends on where you work and what partners you have. I don't need to know crazy hand specifics because I send it to my partners. But if you're out in the sticks doing everything then you should aim for more general knowledge.

4. Hand.
 
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