Letter to the Editor: Does “Hoarding” Impact Interview Distribution Among Orthopaedic Surgery Residency Applicants? A Modeling Study Based on a Large Database

To the Editor,

We recently read the study by Hutchison et al. [2] with great intrigue. As medical students who aspire to become orthopaedic surgery residents, the intricate dynamics of the match process have always been front and center in our academic journey. From our first step into medical school, our goal to specialize in orthopaedic surgery has driven us to shape ourselves into competitive candidates. The article by Hutchison and colleagues rightly emphasizes the positive correlation between being a competitive applicant and securing interviews, which ultimately boosts match rates.

It is also worth noting that many of us consult external resources and online forums to strategize our application approaches and determine effective study techniques for pivotal STEP exams [1]. While mentors play a role in guidance, these platforms provide firsthand, current insights from peers navigating the same path. One specific concern that often arises in discussions amongst ourselves is interview “hoarding,” which is why the study in question resonated with us.

Orthopaedic surgery is one of the most competitive specialties in the match [3], so all strategies to improve the distribution of interviews and ultimately increase chances of matching are worth considering. Despite orthopaedics being fiercely competitive, the proposed redistribution models, to our surprise, did not demonstrate a substantial redistribution of interview invites to a large portion of the applicant pool. While these results may initially seem underwhelming, it’s essential to highlight how one of the proposed models was able to transition several candidates from receiving no interviews to securing at least one. For many, this seemingly small change could be life-changing. Some applicants dedicate years to the dream of becoming an orthopaedic surgeon, only to fail to secure even a single interview. In this light, even small shifts in interview distribution—from zero to one—can be momentous. If an applicant is granted even one opportunity to interview, it seems to us that this keeps a door open to that person’s lifelong dream.

We acknowledge the challenge that exists at the core of the orthopaedic match process: the soaring number of applicants and the limited residency positions. Despite this, we advocate for constant evolution and improvements. At our institution, we, the orthopaedic residency aspirants, have united in a unique peer-driven collaboration effort. Our approach involves weekly meetings to support one another’s research endeavors and to facilitate mentorship connections, leveraging the diverse experiences each of us brings. As upperclassmen, we have also begun collaborating on strategic application planning for orthopaedic electives and away rotations. We coordinate our program choices and away rotation timing to enhance our prospects at desired programs, sharing insights on program strengths and application tactics. Another key aspect of our informal initiative is engaging younger medical students earlier in their careers, sharing our accumulated knowledge and experiences. This approach not only helps in laying the groundwork for a student-driven mentorship model but also strengthens our collective residency prospects through shared research efforts and strategic planning.

We hope students at other institutions adopt comparable strategies and we encourage the broader medical education community to do their part in refining the landscape that is the orthopaedic match process.