William N. Levine, MD, FAAOS | D. Joanna Kim, MD
March 22, 2024
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On Monday of Match Week, all medical students who applied for a residency position find out whether they matched to a residency program. If you got the email that you did not match – first off, I am so sorry. After watching close friends go through the process of not matching, SOAPing and re-applying, it is one of the most challenging, devastating, and emotionally draining situations. I want to acknowledge that those emotions are valid, and facing these disappointments probably is tougher than I can only imagine. However, it is important to know that there are options to navigate through this set back. We can still get you across that finish line and still pursue your career goals!
Reach out to your dean/advisor/mentor:
First, call your medical school advisor, dean, and/or your close mentor. Seeking support and guidance is critical to navigate the next steps. Do not be embarrassed or ashamed, they are used to dealing with these setbacks and will use their experience to help you during this challenging time. Reach out to mentors and advisors who can provide feedback on your residency application and review if there were red flags in your application. Was it your letters of recommendation? Lack of experiences or publications? Understanding areas for improvement can help you figure out next steps.
The most important question that needs to be answered is can I match in orthopedic surgery? Are there fatal flaws that mentors were too risk-averse to share? You need to know if it is worth pursuing your passion for orthopedic surgery. If there are any fatal flaws then it is best to know what those are and likely pivot to another specialty.
Consider your options and next steps:
Just remember, there are 3 options to consider:
- Research year: if lack of experiences, connections, or research was the major reason why the match was unsuccessful, consider a research year. Confirm with your school if you will be able to defer graduation. Through a research year, you will not only gain valuable research experience to set yourself apart, but you will also gain insight into the department and the program. It also allows you to gain one-on-one mentorship with attendings, which can ultimately lead to a strong portfolio for the next cycle. However, a research year can negatively impact you if you don’t get involved in projects, so make sure to be proactive and productive during your year. If possible, consider gaining additional clinical experience during the upcoming year. Also, the best-case scenario is that you begin research immediately and do not have to wait until June. If you cannot start immediately, it makes it very difficult to have any meaningful work completed before you must reapply for the next cycle.
- Participate in the Supplemental Offer and Acceptance Program (SOAP): SOAP is a process through which unmatched applicants can apply for and potentially obtain positions that remain unfilled after the main Match process. It is very rare for there to be ANY unfilled orthopedic residency positions (in the current 2024 cycle, there was only one), but if any exist, you can apply and interview for these programs.
- Preliminary Intern Year and Re-Application: You can also SOAP into a preliminary general surgery internship position and re-apply as an intern into another orthopedic residency program. It is important to recognize that your time will be split between clinical duties as a resident. This means that there likely will not be opportunities for sub-internship rotations. This also means that you will be balancing 80-hour work weeks while trying to strengthen and build your application. You will also be applying as a MD graduate, rather than MD student, which may or may not be a consideration to some programs.
A recent study1 from 2020 showed that applicants who pursued a research year or surgical internship after initially not matching had a subsequent match rate of 52.1% and 64.0%, respectively (p = 0.46). Female applicants and AOA status were both positive predictors of success.
Prepare for the next Match cycle:
Use the time before the next Match cycle to prepare the strongest residency application. Ask your dean or mentors to see what your biggest deficiency was in your application. Be proactive, personally reach out to the programs where you rotated and ask to speak with the program director. Ask for any concrete feedback that may be a blind spot. Write these down and try to target these during the next year. This is your time to prove to programs that you are an excellent candidate!
- Research: During your research year, be as productive as you can. Join projects and showcase that you work hard and can be a “closer” – push the project past the finish line. Demonstrate your academic work through research and attend all conferences that you can. Conferences can not only help with your application, but also gives you the opportunity to network and find mentors from all over the country.
- Clinical work: If you have free time, offer to follow along residents during their consult days and sharpen up your orthopedic knowledge. Find out how you can be helpful, whether that is grabbing supplies, holding while casting, and/or writing thorough notes. Try to shadow in the OR and/or clinic to get to know faculty and residents outside the context of research.
- Sub-internship/rotations: Plan out your sub-internship and rotations earlier. If you have the opportunity to do additional away rotations, do not choose the same programs to which you rotated the first time. Select programs that are amenable to matching reapplicants (check with your mentors, alumni from your school and review the program information on AOA’s ORIN). Prepare for these sub-internships throughout the year by jotting down notes from clinic, OR, and consult days.
Re-application:
Prepare for your ERAS application in advance and seek advice from mentors early and often. This may involve making sure you are obtaining stronger letters of recommendation, planning your list of programs early, refining your personal statement, and improving your interview skills.
- Interview: Be prepared to answer the question “why do you think you did not match?” and “what did you do to prepare yourself as an excellent candidate for an orthopedic residency program?”. You should be able to self-reflect and define where the deficiencies were and how you worked hard to improve those specifically. This not only shows deep level of introspection that is an essential skill as a resident, but also shows how resilient and passionate you are about making yourself a great orthopedic resident for their program. Avoid defensive posturing – simply answer the question and move on.
- Rotations: For your rotations, prepare to work hard. Be the first one there, and the last one out. Offer to write notes, take consults with residents, help whenever and wherever needed. You are there to prove yourself as a team player and a resident who they want to be part of their family – make sure you showcase your work ethic and personality during the month!
- Program list: The list of programs that you are applying to should be broad; you should not limit yourself to a geographic region. Go through your program list with your mentors and reach out for any advice regarding where and how many you should apply to.
Remember that not matching in residency does not define your capabilities as a resident or who you are. Keep pursuing your passion for orthopedic surgery and remain proactive in seeking opportunities to achieve your goals. You can do it!
References
- Kheir MM, Tan TL, Rondon AL, Chen AF: The fate of unmatched orthopaedic applicants: risk factors and outcomes. JBJS Open Access 2020 Apr-Jun; 5(2): e20.00043. Published online 202 Jun 24. Doi: 10.2106/JBJS.OA.20.00043 PMID: 32832827
DISCLOSURES: Dr. Levine is on the Columbia faculty, serves as Board or committee member for the American Shoulder and Elbow Surgeons, and is on the editorial or governing board for the Journal of the American Academy of Orthopaedic Surgeons. Dr. Levine serves as an unpaid consultant to Zimmer Biomet. Dr. Kim This individual reported nothing to disclose.
Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.
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