Exploring the Orthopaedic Surgery Match

Introduction: Orthopaedic Surgery remains one of the most competitive medical specialties to successfully match into. Historically, the United States Medical Licensing Examination Step 1 score was a major determinant of match success. Since its conversion to pass/fail status in January 2022, uncertainty has emerged regarding how programs mentor and advise applicants. The purpose of this study was to examine the changes in Orthopaedic Surgery applicant characteristics before the transition from a scored examination (2017-2022) to a pass/fail examination (2023-2025). Methods: The authors accessed the Texas Seeking Transparency in Application to Residency survey database, which contains survey information from graduating medical students nationwide regarding residency application characteristics. Characteristics of matched versus unmatched applicants between 2017 to 2022 and 2023 to 2025 were compared. Results: A total of 1,652 Orthopaedic Surgery applicants responded to the survey from 2017 to 2025 (data collected in May 2025). Since the incorporation of a pass/fail Step 1, Step 2 scores and research productivity has increased, volunteerism has decreased, and other academic metrics have remained unchanged. Conclusions: Applicants demonstrated shifts in characteristics without a corresponding change in match rates. From 2023 to 2025, applicants bolstered Step 2 performance and research output as primary differentiators in the absence of a numerical Step 1 score. Traditional academic markers such as class rank, clerkship performance, and Alpha Omega Alpha membership remained stable, while volunteer and leadership involvement declined moderately over the same period. These findings provide evidence-based guidance for navigating the Orthopaedic Surgery selection process in the postnumerical Step 1 era.