Are We Choosing and Training the Best Surgeons?

The U.S. orthopaedic surgery residency match is among the most competitive in medicine; in 2024, 40% of applicants were unmatched. This drives applicants to differentiate themselves, while residency programs aim to evaluate candidates holistically. In order to understand the process that is used to select and educate the best surgeons, we examined medical student advising, the role of national organizations, and programmatic practices for resident selection. Effective career advising is essential for attracting and supporting highly qualified applicants. Exposure through preclinical courses, clerkships, and accessible mentorship enhances interest in orthopaedics among applicants with an array of experiences, skills, and backgrounds. National initiatives (e.g., the Orthopaedic Residency Information Network [ORIN]) provide centralized resources to address disparities in information access, although further standardization and consolidation are needed. Collaboration among national stakeholders is necessary to ensure fairness in the match process and to attract the best applicants. Initiatives like preference signaling have shown promise, increasing interview rates at preferred programs and better aligning applicants with residency opportunities. However, barriers such as limited access to research, costly away rotations, and expensive applications disproportionately affect underrepresented groups, highlighting the need for systemic changes. Resident selection practices must evolve to counter the inefficiencies and biases. Holistic review processes, structured interviews, and mission-driven scoring can improve alignment with program values. Programs must consider their setting and their population and also consider applicants who demonstrate an understanding of, and have an interest in caring for, that community. Improving orthopaedic residency selection requires collaborative efforts across organizations, advisors, and programs to refine processes and ensure the selection and training of those who will advance clinical orthopaedics and the science of orthopaedic surgery and also meet the needs of all patient populations.