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Are We Choosing and Training the Best Surgeons?

Tessa Balach¹, Stuart Trent Guthrie², Nicole Schroeder³

¹Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois.

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|September 4, 2025

Summary

The competitive orthopaedic surgery residency match needs systemic changes to ensure fairness. Improving advising, national resources, and holistic review processes will help select and train diverse, qualified surgeons for all patient populations.

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Area of Science:

Orthopaedic Surgery
Medical Education
Residency Selection

Background:

The U.S. orthopaedic surgery residency match is highly competitive, with 40% of applicants unmatched in 2024.
Applicants seek differentiation, while programs aim for holistic candidate evaluation.

Purpose of the Study:

To examine medical student advising, national organizational roles, and programmatic practices in orthopaedic surgery resident selection.
To identify areas for improvement in the orthopaedic residency match process.

Main Methods:

Analysis of medical student advising strategies.
Evaluation of national initiatives like the Orthopaedic Residency Information Network (ORIN).
Review of programmatic resident selection practices, including holistic review and preference signaling.

Main Results:

Effective career advising and early exposure are crucial for attracting diverse applicants.
National initiatives improve information access but require further standardization.
Preference signaling shows promise, but barriers like research access and rotation costs disproportionately affect underrepresented groups.

Conclusions:

Collaborative efforts are needed to refine the match process, address systemic barriers, and ensure fair selection.
Holistic review, structured interviews, and mission-driven scoring can improve alignment with program values.
Systemic changes are essential to select and train surgeons who meet diverse patient needs and advance orthopaedic surgery.