Abstract
Introduction:
The purpose of this study was to investigate the influence a personal experience with an orthopaedic injury or condition has on applicants' decisions to pursue orthopaedic surgery and to investigate current applicant motivations for pursuing orthopaedic surgery.
Methods:
This was a cross-sectional survey study of orthopaedic surgery applicants during the 2023 to 2024 application cycle who applied to the residency program at a single academic institution.
Results:
Of the 290 respondents (38.5% response rate), approximately two-fifths (37.6%) reported experiencing a musculoskeletal injury/condition that influenced their decision to pursue orthopaedic surgery, with 64.2% requiring surgical intervention. Injuries were most commonly sustained while playing soccer (21.0%), American football (19.0%), and basketball (10.0%). The most common injuries reported included anterior cruciate ligament rupture (14.1%), ankle fracture (9.4%), and meniscus tear (6.3%). Applicants with a history of an anterior cruciate ligament rupture represented 6.2% (18/290) of the entire applicant cohort. Approximately one-fifth (21.7%, 63/290) of applicants reported that a musculoskeletal injury or condition experienced by a family member or friend had influenced their decision to pursue orthopaedic surgery. The most commonly selected motivating factor for deciding to pursue orthopaedic surgery was intellectual curiosity (86.6%), followed by clinical rotation experience (84.8%), mentor/faculty interactions (75.9%), personal experience with a musculoskeletal injury/condition (60.0%), and academic opportunities (51.7%).
Conclusion:
A large portion of current orthopaedic surgery applicants were motivated to pursue orthopaedic surgery by a personal experience with an orthopaedic injury or condition. This study revealed many novel findings related to current orthopaedic applicant motivations for pursuing orthopaedic surgery as a career.
The underlying motivations for a medical student's chosen specialty are multifactorial and individualized. One's specialty selection may be influenced by a myriad of factors, ranging from personal interests to lifestyle considerations and academic factors. Among the many medical specialties, orthopaedic surgery remains one of the most competitive specialties to secure a residency position in Ref. 1. According to National Resident Matching Program data, in 2023, 1,492 applicants applied for a total of 916 positions, leaving an astounding 39% of applicants unmatched—many of whom are presumed to be considered competitive applicants.1 Orthopaedic surgery as a specialty is unique in its blend of intellectual challenge, procedural focus, and tangible patient outcomes. Understanding the motivations that draw students toward this competitive and demanding, yet highly rewarding, specialty is crucial for fostering a diverse and thriving future workforce within orthopaedic surgery.
Previous research has begun to shed light on the diverse factors influencing one's selection of orthopaedic surgery as a specialty choice.2,3 Reported motivating factors have included mentorship, clinical rotation experiences, salary, career prestige, academic interests, family or personal factors, and many others.2-6 One study indicated that 51% of medical students pursuing orthopaedic surgery had already decided to pursue orthopaedic surgery before their medical school clinical rotations, and 27% had decided before even starting medical school.2 These data suggest that a large proportion of students may choose to pursue orthopaedic surgery early in one's academic career and generally earlier than those pursuing many other medical specialties.2 However, studies focused specifically on orthopaedic surgery applicants lack in-depth analysis of the nuanced motivations driving student's career interests. In particular, these studies have failed to examine events or experiences taking place before medical school that may play an integral role in a student's choice to pursue orthopaedic surgery.
There is a commonly held perception in orthopaedic surgery that many medical students pursuing orthopaedic surgery may have had an influential personal experience with an orthopaedic injury or condition, thus sparking an early and lasting interest in the field. The purpose of this study was to identify the proportion of current orthopaedic applicants who had an influential personal experience with an orthopaedic injury or condition and investigate how this experience influenced their interest in pursuing orthopaedic surgery as a career. In addition, an analysis of motivating factors for current applicants pursuing orthopaedic surgery was done. We hypothesized that current orthopaedic surgery applicants possess a diverse range of motivating factors and that a sizeable portion of applicants were influenced to pursue orthopaedic surgery by a personal experience with an orthopaedic injury or condition.
Methods
Institutional review board approval was obtained before the initiation of this cross-sectional survey study. Survey recipients included orthopaedic surgery applicants during the 2023 to 2024 residency application cycle who applied to the Accreditation Council for Graduate Medical Education (ACGME) accredited orthopaedic surgery residency program at a single urban academic institution. Additional inclusion criteria included being older than 18 years and having access to e-mail.
We developed a 19-item branching survey (Supplemental Appendix, http://links.lww.com/JG9/A395), meaning that a different pathway of questions was presented based on the answer to the prior question. The motivating factors included in the survey were based on factors investigated and found to be influential in previously published applicant survey studies and factors believed to be influential by the authors. Strong face validity of the survey components was established following detailed review, discussion, and revision by a diverse group of attendings, residents, and applicants. The applicants who assisted with survey validation were not included as respondents in the final cohort. The survey was distributed electronically through e-mail to a total of 753 applicants, which included both medical students and current residents in preliminary or transitional year programs, all of whom were currently applying to orthopaedic surgery residency. The survey was administered within the period between the Electronic Residency Application Service application submission date and the Universal Interview Offer Day. This was to avoid potentially biased responses from applicants who may have had an unfavorable Universal Interview Offer Day or final match outcome. Survey responses were obtained and recorded through research electronic data capture (REDcap), a Health Insurance and Portability Accountability Act (HIPAA) compliant research tool and database. Responses were deidentified, and no protected health information (PHI) was collected as part of this survey. The survey collected responses for a total of 3 weeks, and zero follow-up reminder emails were sent. For appreciation of participation, each respondent was entered into a random drawing for a gift card, which was distributed electronically.
To achieve a 95% confidence level with a 5% margin of error for our cohort of 753 surveyed applicants, a minimum sample size of 255 responses was required. Categorical data are presented as counts and percentages and analyzed with chi-square testing. Statistical significance was set at P < 0.05. Statistical analysis was done with the Statistical Package for the Social Sciences (Version 26.0; SPSS).
Results
There were a total of 290 respondents, for a response rate of 38.5% (290/753). This consisted of 72.1% men and 26.9% women (Table 1). Most applicants classified themselves as White/Caucasian (63.1%), followed by Asian or Pacific Islander (16.9%), Black or African American (9.3%), or multiple/other (9.3%). Respondents attended medical schools in the Northeast (42.4%), Midwest (25.5%), Southeast (22.8%), Southwest (5.5%), and West (3.8%) regions of the United States. Almost half of respondents became interested in pursuing orthopaedic surgery while attending medical school (45.2%). The remainder of respondents became interested in pursuing orthopaedic surgery while in graduate school (5.5%), undergraduate school (27.6%), high school (15.9%), and middle school or younger (5.9%). No statistical differences were found in the timing to decide to pursue orthopaedic surgery based on sex or race. Almost three-fifths (59.3%, 172/290) of applicants reported having a personal experience with a musculoskeletal injury or condition to themselves, a family member, or a friend that influenced their decision to pursue orthopaedic surgery as a career.
Table 1.
Applicant Characteristics
| Factor or Variable | N (%) |
| Sex | |
| Female | 78 (26.9) |
| Male | 209 (72.1) |
| Prefer not to answer | 3 (1.0) |
| Race | |
| Asian/Pacific Islander | 49 (16.9) |
| Black or African American | 27 (9.3) |
| Multiple/other | 27 (9.3) |
| White/Caucasian | 183 (63.1) |
| Prefer not to answer | 4 (1.4) |
| Region of medical school | |
| Midwest | 74 (25.5) |
| Northeast | 123 (42.4) |
| Southeast | 66 (22.8) |
| Southwest | 16 (5.5) |
| West | 11 (3.8) |
| Level of schooling applicant decided to pursue orthopaedic surgery | |
| Middle school or younger | 17 (5.9) |
| High school | 46 (15.9) |
| Undergraduate school | 80 (27.6) |
| Graduate school | 16 (5.5) |
| Medical school | 131 (45.2) |
Personal Experience with a Musculoskeletal Injury or Condition
Approximately two-fifths (37.6%, 109/290) of current orthopaedic surgery applicants reported having a history of a musculoskeletal injury or condition to themselves that influenced their decision to pursue orthopaedic surgery as a career. Of these, 64.2% required a surgical intervention (Table 2). Their injury or condition was most commonly experienced while in high school (45.9%) or undergraduate school (26.6%). The applicants who required surgical intervention for their injury or condition were significantly more likely to have become interested in pursuing orthopaedic surgery at a younger age before medical or graduate school than those who did not require surgery (61.4% vs. 38.6%; P = 0.04). More than one-third (35.8%, 39/109) of applicants became interested in pursuing orthopaedic surgery during the same level of schooling that they experienced their injury or condition.
Table 2.
Characteristics of Personal Musculoskeletal Injuries/Conditions
| Factor or Variable | N (%) |
| Did your musculoskeletal injury/condition require surgical intervention? | |
| Yes | 70 (64.2) |
| No | 39 (35.8) |
| Level of schooling when personal musculoskeletal Injury/condition occurred | |
| Elementary school or younger | 6 (5.5) |
| Middle school | 8 (7.3) |
| High school | 50 (45.9) |
| Undergraduate school | 29 (26.6) |
| Graduate school | 9 (8.3) |
| Medical school | 7 (6.4) |
| Mechanism if it was an acute musculoskeletal injury | |
| Playing sports | 91 (83.5) |
| Recreational activity | 7 (6.4) |
| Traumatic injury | 5 (4.6) |
| Incidental event | 1 (0.9) |
| Prefer not to answer | 5 (4.6) |
| If your injury occurred while playing sports, which sport? | |
| Baseball | 6 (6.0) |
| Basketball | 10 (10.0) |
| Biking | 1 (1.0) |
| Boxing | 1 (1.0) |
| Cross country | 2 (2.0) |
| Fencing | 1 (1.0) |
| Figure skating | 1 (1.0) |
| Flag football | 1 (1.0) |
| American football | 19 (19.0) |
| Gymnastics | 3 (3.0) |
| Hockey | 4 (4.0) |
| Lacrosse | 4 (4.0) |
| Rowing | 1 (1.0) |
| Ski racing | 1 (1.0) |
| Snowboarding | 3 (3.0) |
| Soccer | 21 (21.0) |
| Swimming | 2 (2.0) |
| Tennis | 4 (4.0) |
| Track | 4 (4.0) |
| Ultimate frisbee | 1 (1.0) |
| Volleyball | 3 (3.0) |
| Weightlifting | 6 (6.0) |
| Wrestling | 1 (1.0) |
| If your injury occurred while playing sports, at what level of play? | |
| Elementary school or below | 4 (3.7) |
| Middle school | 6 (5.5) |
| High school | 45 (41.3) |
| Collegiate | 33 (30.3) |
| Professional | 3 (2.8) |
| If your injury occurred during recreational activity, which activity? | |
| Mountain biking | 1 (12.5) |
| Running | 1 (12.5) |
| Skiing | 1 (12.5) |
| Snowboarding | 1 (12.5) |
| Weightlifting | 3 (37.5) |
| Wiffleball | 1 (12.5) |
If an acute musculoskeletal injury was experienced, 83.5% occurred while playing sports, 6.4% during recreational activity, 4.6% during a traumatic event, and 0.9% during an incidental event (Table 2). The most common sports during which acute injuries were sustained included soccer (21.0%), American football (19.0%), basketball (10.0%), baseball (6.0%), and weightlifting (6.0%). Most sports injuries were sustained at the high school (41.3%) and collegiate (30.3%) levels of play. The remainder were sustained at the middle school (5.5%), elementary school (3.7%), and professional (2.8%) levels of play. The most common recreational activity during which an acute injury was sustained was weightlifting (37.5%).
Of those with a musculoskeletal injury or condition, the most commonly reported injuries or conditions included anterior cruciate ligament (ACL) rupture (14.1%), ankle fracture (9.4%), meniscus tear (6.3%), forearm fracture (3.9%), hand fracture (3.9%), Achilles tendon rupture (3.1%), clavicle fracture (3.1%), wrist fracture (3.1%), and shoulder labral tear (3.1%; Table 3).
Table 3.
Specific Musculoskeletal Injuries/Conditions
| Musculoskeletal Injury/Condition | N (%) |
| Achilles tendon rupture | 4 (3.1) |
| ACJ sprain | 2 (1.6) |
| ACL rupture | 18 (14.1) |
| Ankle dislocation | 1 (0.8) |
| Ankle sprain | 3 (2.3) |
| Bone bruise | 1 (0.8) |
| Chronic exertional compartment syndrome | 1 (0.8) |
| Chronic knee pain | 1 (0.8) |
| Chronic low back pain | 1 (0.8) |
| Compartment syndrome | 2 (1.6) |
| Connective tissue disorder | 1 (0.8) |
| Elbow UCL rupture | 3 (2.3) |
| Flexor tendon rupture | 1 (0.8) |
| Fracture—ankle | 12 (9.4) |
| Fracture—clavicle | 4 (3.1) |
| Fracture—distal humerus | 1 (0.8) |
| Fracture—femur | 1 (0.8) |
| Fracture—fibula | 1 (0.8) |
| Fracture—foot | 2 (1.6) |
| Fracture—forearm | 5 (3.9) |
| Fracture—hand | 5 (3.9) |
| Fracture—patella | 1 (0.8) |
| Fracture—wrist | 4 (3.1) |
| Hamstring strain | 1 (0.8) |
| Hamstring tear | 1 (0.8) |
| High ankle sprain | 1 (0.8) |
| Hip cam/pincer lesion | 1 (0.8) |
| Hip dysplasia | 1 (0.8) |
| Hip labral tear | 2 (1.6) |
| IT band syndrome | 1 (0.8) |
| Joint hypermobility | 1 (0.8) |
| Knee osteochondral defect | 1 (0.8) |
| Knee osteochondritis dissecans | 1 (0.8) |
| Lateral epicondylitis | 1 (0.8) |
| Legg-Calve-Perthes | 1 (0.8) |
| Lesser trochanter avulsion | 1 (0.8) |
| Lisfranc injury | 1 (0.8) |
| Mallet finger | 1 (0.8) |
| MCL sprain | 1 (0.8) |
| Meniscus tear | 8 (6.3) |
| Multiligamentous knee injury | 3 (2.3) |
| Osteochondroma | 1 (0.8) |
| Patellar instability | 1 (0.8) |
| Patellar tendon rupture | 1 (0.8) |
| Rotator cuff tear | 3 (2.3) |
| Shoulder instability | 2 (1.6) |
| Shoulder labral tear | 4 (3.1) |
| SLAP tear | 2 (1.6) |
| Spondylolysis | 2 (1.6) |
| Stress fracture—navicular | 1 (0.8) |
| Symptomatic bipartite patella | 1 (0.8) |
| Tendinitis | 1 (0.8) |
| TFCC injury | 1 (0.8) |
| Tibialis posterior tendon rupture | 1 (0.8) |
| Unspecified knee ligament injury | 2 (1.6) |
| Vertebral disk herniation | 2 (1.6) |
ACJ = acromioclavicular joint; ACL = anterior cruciate ligament; IT = iliotibial; MCL = medial collateral ligament; SLAP = superior labrum anterior to posterior; TFCC = triangular fibrocartilage complex; UCL = ulnar collateral ligament
Applicants with a history of an ACL rupture represented 6.2% (18/290) of the entire applicant cohort. Of those with ACL ruptures, all (100%) injuries occurred while playing sports, all (100%) required surgical intervention, and all (100%) injuries influenced the applicant's decision to pursue orthopaedic surgery. A significantly larger proportion of applicants with ACL ruptures became interested in pursuing orthopaedic surgery at a younger age before medical or graduate school compared with the rest of the cohort (50.0% vs. 19.9%; P = 0.003).
Family Member or Friend Experience With a Musculoskeletal Injury or Condition
Approximately one-fifth (21.7%, 63/290) of applicants reported that a musculoskeletal injury or condition experienced by a family member or friend had influenced their decision to pursue orthopaedic surgery as a career. In family members, this was most commonly a traumatic injury (39.4%) or degenerative condition (37.5%), with most (91.7%) requiring surgical intervention (Table 4). In friends, it was most commonly a sports injury (53.3%) or traumatic injury (33.3%), with most (80.0%) requiring surgical intervention.
Table 4.
Musculoskeletal Condition or Injury to a Family Member or Friend
| Family Member | N (%) | Friend | N (%) |
| What type of musculoskeletal condition or injury did they have? | |||
| Degenerative | 18 (37.5) | Degenerative | 1 (6.7) |
| Oncologic | 5 (10.4) | Oncologic | 1 (6.7) |
| Soft tissue | 3 (6.3) | Soft tissue | 0 (0) |
| Sports injury | 3 (6.3) | Sports injury | 8 (53.3) |
| Traumatic injury | 19 (39.4) | Traumatic injury | 5 (33.3) |
| Did their musculoskeletal condition or injury require surgical intervention? | |||
| Yes | 44 (91.7) | Yes | 12 (80.0) |
| No | 4 (8.3) | No | 3 (20.0) |
| Your level of schooling when their musculoskeletal injury/condition occurred | |||
| Elementary school or younger | 10 (20.8) | Elementary school or younger | 1 (6.7) |
| Middle school | 6 (12.5) | Middle school | 3 (20.0) |
| High school | 11 (22.9) | High school | 5 (33.3) |
| Undergraduate school | 6 (12.5) | Undergraduate school | 5 (33.3) |
| Graduate school | 4 (8.3) | Graduate school | 1 (6.7) |
| Medical school | 11 (22.9) | Medical school | 0 (0) |
Motivating Factors
The most commonly selected motivating factor for deciding to pursue orthopaedic surgery was intellectual curiosity (86.6%), followed by clinical rotation experience (84.8%), mentor/faculty interactions (75.9%), personal experience with a musculoskeletal injury/condition (60.0%), and academic opportunities (51.7%; Table 5). When asked to rank their top three motivating factors for pursuing orthopaedic surgery, intellectual curiosity (32.1%) and clinical rotation experience (27.6%) were the most commonly selected primary factors. “Other” motivating factors for pursuing orthopaedic surgery that respondents submitted are listed in Table 6.
Table 5.
Motivating Factors for Pursuing Orthopaedic Surgery as a Career
| Motivating Factor | Rate of Overall Selection, N (%) | Ranked 1, N (%) | Ranked 2, N (%) | Ranked 3, N (%) |
| Academic opportunities | 150 (51.7) | 7 (2.4) | 14 (4.8) | 28 (9.7) |
| Clinical rotation experience | 246 (84.8) | 80 (27.6) | 65 (22.4) | 52 (17.9) |
| Degree of financial debt | 18 (6.2) | 1 (0.3) | 2 (0.7) | 3 (1.0) |
| Family considerations | 30 (10.3) | 5 (1.7) | 3 (1.0) | 3 (1.0) |
| Intellectual curiosity | 251 (86.6) | 93 (32.1) | 63 (21.7) | 46 (15.9) |
| Lifestyle | 124 (42.8) | 8 (2.8) | 18 (6.2) | 16 (5.5) |
| Mentor/faculty interactions | 220 (75.9) | 40 (13.8) | 69 (23.8) | 50 (17.2) |
| Personal experience with a musculoskeletal injury/condition to yourself, a family member, or friend | 174 (60.0) | 40 (13.8) | 30 (10.3) | 57 (19.7) |
| Salary | 81 (27.9) | 4 (1.4) | 6 (2.1) | 15 (5.2) |
| Specialty prestige | 66 (22.8) | 2 (0.7) | 7 (2.4) | 5 (1.7) |
| Other | 40 (13.8) | 7 (2.4) | 7 (2.4) | 7 (2.4) |
Table 6.
“Other” Motivating Factors for Pursuing Orthopaedic Surgery as a Career
| Effect orthopaedics has on patients' quality of life and return to work, hobbies, family |
| Medical mission trip |
| Prior career developing pediatric and adult spinal instrumentation |
| Tangible effect on improving patients' quality of life |
| To restore others' functionality |
| I feel like the camaraderie of orthopaedics speaks to who I am as a person. I felt like I found my people |
| Interest in musculoskeletal system and surgery |
| Job as a personal trainer, working with the musculoskeletal system |
| Personal experience in construction |
| Sports injury |
| The art of surgery and enjoyment of orthopaedic medicine |
| Upholding certain values growing up and seeing those values reflected in orthopaedic surgery |
| Ability to have a clear and direct effect on patients' quality of life |
| Career before medical school |
| Experience with patient base |
| Lack of orthopaedic surgeon in my town |
| Previous nursing experience as an orthopaedic registered nurse before medical school |
| Rough period in my country when orthopaedic trauma skills were essential |
| Working as a medical scribe in an orthopaedic clinic |
Discussion
This study investigated how personal experiences with orthopaedic injuries or conditions influenced current applicants' decisions to pursue orthopaedic surgery as a career, as well as analyzed current applicant motivations for pursuing orthopaedic surgery. Almost three-fifths of applicants reported having a personal experience with a musculoskeletal injury or condition to themselves, a family member, or a friend that influenced their decision to pursue orthopaedic surgery as a career. Applicants selected a diverse range of motivating factors for pursuing orthopaedic surgery, with the most influential factors seemingly being related to intellectual curiosity and clinical experiences.
Astoundingly, almost two-fifths of applicants experienced a personal orthopaedic injury or condition that influenced their career choice. Most of these injuries were experienced at the high school level or below, and most occurred while playing sports. Sports injuries occurred primarily in soccer, American football, and basketball—all popular collision and contact sports in the United States. Interestingly, most injuries required surgical intervention, which predisposed applicants to deciding to pursue orthopaedic surgery at a markedly younger age. These findings suggest that early exposure to orthopaedic surgery at impressionable periods in one's academic career can have profound effects on long-term academic and career interests. Baldwin et al7 longitudinally surveyed medical students on their interests in orthopaedic surgery and contributing factors and found that both a personal experience as a patient and a vicarious experience knowing an orthopaedic patient were notable factors influencing early medical student interest in orthopaedic surgery. More advanced level of past athletic involvement was also identified as a notable influencing factor.
The most common orthopaedic injury or condition reported among applicants was an ACL rupture. Applicants with prior ACL ruptures represented about one in 16 of all orthopaedic surgery applicants in this cohort. These findings seem to support the common axiom within orthopaedic surgery academia of the stereotypical orthopaedic surgery applicant who had a prior ACL rupture that initially motivated them to pursue orthopaedic surgery as a career. ACL ruptures were reported in a diverse range of activities, such as soccer, American football, basketball, baseball, weightlifting, ultimate frisbee, and volleyball. All ACL ruptures required surgery, all influenced that applicant's decision to pursue orthopaedic surgery, and those with ACL ruptures became interested in pursuing orthopaedic surgery at a significantly younger age than the rest of the cohort. The profound effect that an ACL rupture seems to have on prospective orthopaedic surgery applicants is intriguing and could benefit from further investigation.
Orthopaedic injuries or conditions to family members or friends also seemed to affect applicants' decisions to pursue orthopaedic surgery. These exposures to orthopaedic surgery appeared to take place at a wider range of schooling level than personal injury experiences.
The most commonly selected motivating factors for pursuing orthopaedic surgery included intellectual curiosity, clinical rotation experience, mentor/faculty interaction, and personal experiences with an orthopaedic injury or condition. Interestingly, salary and degree of financial debt were some of the least commonly selected, indicating that the draw to orthopaedic surgery remains primarily academic in nature. These findings are consistent with findings in prior research. In a systematic review, Trinh et al4 identified mentorship, intellectual challenge, and specialty exposure as positive influencing factors for female medical students pursuing a surgical specialty. In a survey study of both orthopaedic residents and applicants and nonorthopaedic applicants, Johnson et al2 observed that no respondents selected income as the most important factor in specialty selection.
Rao et al3 surveyed 657 medical students from 10 institutions on motivating factors for selecting their specialty and found that subject matter was the most important reported factor, followed by the quality of life/lifestyle/stress level of the specialty. Similar to our findings, they identified experience as a patient as a notable influential factor for students interested in specifically orthopaedics. Interestingly, in their overall cohort of medical students pursing all medical specialties, not just those interested in orthopaedics, they found that previous experience as a patient of any medical specialty (e.g. cardiology, rheumatology, etc.) was an overall unimportant factor in specialty selection. These findings would suggest that personal experience as a patient is more influential for students who have been specifically orthopaedic patients. The underlying reason for this is unclear and could benefit from further research.
In their analysis, Johnson et al2 revealed that a larger proportion of orthopaedic residents and applicants decided to pursue orthopaedics before medical school compared with applicants pursuing other medical specialties. Our study found that about half of all applicants had decided to pursue orthopaedic surgery before graduate or medical school, which would have occurred before experiencing an orthopaedic clinical rotation. Many applicants in our cohort were exposed to sports participation and sports injuries at an early age, providing them with early impactful exposures to musculoskeletal medicine. These early experiences could conceivably place these applicants at an advantage in the orthopaedic surgery application process compared with applicants who may not have been exposed to orthopaedic surgery until medical school rotations by providing more time to build their curriculum vitae. Efforts to expose all students to orthopaedic surgery early in their academic career, and at the very latest early in medical school, are imperative to recruit the brightest minds in medicine to pursue orthopaedic surgery.
This study has several strengths. It represents a large sample size of current orthopaedic applicants from diverse demographic and geographic backgrounds, with a high response rate. Our cohort of 26.9% female respondents is similar to the proportion of female orthopaedic surgery applicants in the previous cycle (21.9%), representing a robust sampling of female applicants.8 By surveying orthopaedic applicants during the application period, their responses are likely more accurate than at any other time point and likely least influenced by evolving opinions or recall bias than if surveyed at other times during their careers. This study also has several limitations. The survey asked respondents to recall their specific influential musculoskeletal injury, which could introduce recall bias. However, investigating this research question in orthopaedic surgery applicants in an alternative way than recall would likely be exceedingly difficult. Although respondents included applicants from all regions of the United States, there was a larger proportion of applicants from the Northeast, and fewer from the West and Southwest. As such, the study results may not be representative of orthopaedic applicants to all residency programs across the United States. Finally, this study did not investigate how these motivating factors may correlate to match rates, as data were collected before Match Day to limit potential bias in responses due to interview invites and/or match outcomes for respondents. Future studies should investigate how applicant motivating factors relate to signaling patterns and match outcomes as the match continues to adapt over time.
Conclusion
This study revealed many novel and intriguing findings related to current orthopaedic applicant motivations for pursuing orthopaedic surgery as a career. This is the first study of our knowledge to investigate how personal experiences with orthopaedic injuries or conditions may influence an applicant's decision to pursue orthopaedic surgery, and the first to characterize those injuries and conditions. In addition, this study represents one of the largest sampling of current orthopaedic applicants available in the literature. This information is invaluable in characterizing the current orthopaedic applicant and can be used to help promote a diverse and competitive orthopaedic applicant pool to ensure the highest-quality treatment of orthopaedic patients.
Acknowledgments
Publication of this article was funded in part by the Temple University Libraries Open Access Publishing Fund.
Footnotes
None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Townsend, Dr. Soderquist, Dr. Hoy, Dr. Sewards, and Dr. Galos.
Contributor Information
Melissa Soderquist, Email: melissa.soderquist@tuhs.temple.edu.
J. Milo Sewards, Email: joseph.sewards@tuhs.temple.edu.
David Galos, Email: david.galos@tuhs.temple.edu.
References
- 1.National Resident Matching Program: Advance Data Tables, 2024 Main Residency Match, 2024. https://www.nrmp.org/match-data-analytics/residency-data-reports/. Accessed April 27, 2024 [Google Scholar]
- 2.Johnson AL, Sharma J, Chinchilli VM, et al. : Why do medical students choose orthopaedics as a career? J Bone Joint Surg Am 2012;94:e78. [DOI] [PubMed] [Google Scholar]
- 3.Rao RD, Khatib ON, Agarwal A: Factors motivating medical students in selecting a career specialty: Relevance for a robust orthopaedic pipeline. J Am Acad Orthop Surg 2017;25:527-535. [DOI] [PubMed] [Google Scholar]
- 4.Trinh LN, O'Rorke E, Mulcahey MK: Factors influencing female medical students' decision to pursue surgical specialties: A systematic review. J Surg Educ 2021;78:836-849. [DOI] [PubMed] [Google Scholar]
- 5.Solomon DJ, DiPette DJ: Specialty choice among students entering the fourth year of medical school. Am J Med Sci 1994;308:284-288. [DOI] [PubMed] [Google Scholar]
- 6.Ladha FA, Pettinato AM, Perrin AE: Medical student residency preferences and motivational factors: A longitudinal, single-institution perspective. BMC Med Educ 2022;22:187. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Baldwin K, Namdari S, Bowers A, Keenan MA, Levin LS, Ahn J: Factors affecting interest in orthopedics among female medical students: A prospective analysis. Orthopedics 2011;34:e919-e932. [DOI] [PubMed] [Google Scholar]
- 8.AAMC: ERAS Statistics: Historical Specialty Specific Data. https://www.aamc.org/data-reports/data/eras-statistics-data. Accessed April 27, 2024 [Google Scholar]