The Orthopaedic Resident Selection Process: Proposed Reforms and Lessons From Other Specialties

Proposals for substantive reforms to the orthopaedic resident selection process are growing, given increasing applicant competitiveness, burgeoning inefficiencies and inequities of the current system, and impending transition of Step 1 to pass/fail. The COVID-19 pandemic has further catalyzed the need for reforms, offering unprecedented opportunities to pilot novel changes. However, a comprehensive collation of all proposed and implemented orthopaedic reforms is currently lacking. Thus, we aimed to characterize proposed orthopaedic-specific resident selection reforms in the context of reforms implemented by other specialties.

EMBASE, MEDLINE, Scopus, and Web of Science databases were searched for references proposing reforms to the orthopaedic resident selection process published from 2005 to 2020. An inductive approach to qualitative content analysis was used to categorize reforms.

Twenty-six articles proposing 13 unique reforms to the orthopaedic resident selection process were identified. The most commonly proposed reforms included noncognitive assessments (n = 8), application caps (n = 7), standardized letters of recommendation (n = 5), program-specific supplemental applications (n = 5), creation of a centralized database of standardized program information (n = 4), use of a standardized applicant composite score (n = 4), and a moratorium on postinterview communication (n = 4). Importantly, nearly all of these reforms have also been proposed or implemented by other specialties.

Numerous reforms to the orthopaedic resident selection process have been suggested over the past 15 years, several of which have been implemented on a program-specific basis, including noncognitive assessments, supplemental applications, and standardized letters of recommendation. Careful examination of applicant and program experiences and Match outcomes after these reforms is imperative to inform future directions.