The Journal of Bone & Joint Surgery

Introduction

Introduction | Evaluating the Resident-Selection Process: The Orthopaedic Residency Program Directors' Survey | What Selection Criteria Do Orthopaedic Program Directors Value Most? | The "Holy Grail" of the Resident-Selection Committee: Are There Effective Predictors of a Resident's Performance? | Objectifying the Subjective: Can the Affective Domain Be Measured? | Choosing the Right Residents: A Call for Help | Appendix | References

During the last several years, questions have been raised about the process and criteria that are used in the selection of applicants for orthopaedic residency programs, and it has been suggested that this process needs to be critically examined and revised ^1-5 . In an effort to improve the resident-selection process, the factors involved in the recruitment of residents have been extensively studied for over thirty years ^1,2,4,5-10 .

Most practical information about resident-selection criteria that is accessible to program directors, applicants, and medical school advisors is acquired from surveys of residency program directors ⁵ . However, there are limited data in the existing literature regarding the views of orthopaedic program directors on the criteria that are utilized to select residents. Wagoner and Suriano reported the most comprehensive data to date on resident-selection criteria, as assessed by program directors across fourteen different medical specialties; however, less than one-third of the orthopaedic directors who were sampled returned the questionnaire ⁵ . Clark et al. evaluated the characteristics of successful applicants to orthopaedic residency programs by reviewing the applications and letters of recommendations of orthopaedic residency candidates; however, in that study, there was no direct input from program directors ³ .

Criticism of deficiencies in the orthopaedic resident-selection process has continued to grow since 1984, when the Steering Committee on Resident Selection, sponsored by the American Orthopaedic Association, found that one in six resident selections made by orthopaedic program directors was thought to be inappropriate and that one in twelve was considered to be a serious mistake ^3,11,12 . Simon recently commented on the vexing nature of the orthopaedic resident-selection process by claiming: "I have not become better at it after twenty-five years." ¹² Calls for an overhaul of the resident-selection process continue to intensify ^2,5,8,12 . An assessment of the orthopaedic literature reveals a serious lack of objective data that evaluate the resident-selection process across multiple programs. To best evaluate potential problems in the resident-selection process, an objective basis for making possible changes should first be established.

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TABLE I: Ranking of the Twenty-six Resident-Selection Criteria According to the Results of the Questionnaire Completed by Orthopaedic Residency Program Directors

*The values are given as the mean and the standard deviation. N = number of respondents.

Rank	Score*	Resident-Selection Criteria
1	7.88 ± 1.71 (n = 109)	Rotation at director's institution
2	7.78 ± 1.48 (n = 109)	USMLE Part-I score
3	7.77 ± 1.34 (n = 108)	Rank in medical school
4	7.55 ± 1.57 (n = 109)	Formality/politeness at interview
5	7.35 ± 1.39 (n = 109)	Personal appearance of candidate
6	7.11 ± 2.12 (n = 102)	Performance on ethical questions at interview
7	7.01 ± 1.94 (n = 108)	Letter of recommendation by orthopaedic surgeon
8	6.92 ± 1.90 (n = 109)	Candidate is Alpha Omega Alpha member
9	6.47 ± 1.71 (n = 109)	Medical school reputation
10	6.25 ± 2.10 (n = 109)	Dean's letter
11	5.84 ± 2.26 (n = 108)	Personal statement
12	5.74 ± 2.56 (n = 107)	Failed first attempt at matching to an orthopaedic residency program
13	5.67 ± 2.46 (n = 106)	Telephone call placed on candidate's behalf
14	5.66 ± 1.97 (n = 109)	Candidate has published research
15	5.50 ± 2.14 (n = 108)	Candidate participated in a dedicated research experience
16	5.13 ± 1.89 (n = 108)	Letter of recommendation from nonorthopaedic surgeon
17	4.93 ± 2.20 (n = 109)	Candidate is MD/PhD
18	4.83 ± 2.13 (n = 109)	Reputation of undergraduate institution
19	4.61 ± 2.38 (n = 108)	Undergraduate grade-point average
20	4.44 ± 2.16 (n = 107)	Appearance of curriculum vitae
21	4.30 ± 2.15 (n = 109)	Letter of recommendation from a senior resident
22	3.94 ± 2.48 (n = 109)	Candidate has a relative affiliated with director's program
23	3.56 ± 2.12 (n = 108)	Candidate has an undergraduate engineering major
24	3.26 ± 2.41 (n = 108)	Thank-you letter from candidate
25	2.32 ± 2.22 (n = 66)	Performance on manual skills testing during interview
26	1.78 ± 1.76 (n = 64)	Evaluation by psychologist/psychiatrist during interview

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