A Pilot Study of Orthopedic Applicants Regarding Sub-internship Number, Cost, and Preferences

Background and objective This pilot study surveyed orthopedic applicants regarding their experience with sub-internship (sub-I) rotations (number, cost, and selection criteria), seeking to identify potential barriers, and their implications for residency selection for future study. Methods Applicants to two orthopedic residencies in the Philadelphia area received surveys regarding the number/cost of sub-Is, factors affecting rotation site selection, and the influence of people/experiences on the rank list. Surveys were available between the rank list certification deadline and the match week. Results One hundred ninety out of 936 (20.3%) applicants completed the survey. One hundred thirty-three (70%) respondents completed ≥4 rotations (inclusive of home rotations). Osteopathic applicants completed more rotations than allopathic applicants (mean {M}=5.1 versus 3.8, p<0.001). Fifty-seven (30.0%) respondents stated that their rotation time was limited by cost, with 116 (61.1%) reporting a monthly cost of >$1600. Factors that were most important to applicants when selecting a rotation site were geographic location (4.8), program reputation (3.9), and word of mouth (3.8), while factors that were less important to applicants included social media presence (1.9), scholarship opportunities (2.1), and program website (2.5). Women valued program diversity more than men (3.6 versus 2.5, p<0.001). Residents (4.8) were the most influential people when determining rank order. Conclusions Current orthopedic applicants may be completing more sub-Is at a greater cost. Larger, nationally representative samples should seek to confirm these findings and determine whether sub-Is represent a barrier to entry in orthopedics. Our findings also highlight applicant preferences when selecting sub-Is and determining rank order. This should help programs better direct recruitment efforts and provide a more applicant-focused rotation experience.