ICL explores how orthopaedic surgeons can support medical students through the match process

For medical students seeking orthopaedic residency, matching is getting tougher. Although the data shift from year to year, it is helpful for faculty to be aware of general trends. That was one of the messages in Instructional Course Lecture 409, “Be a lighthouse for your medical students: how to help them navigate during changing times to a successful match,” held during the AAOS 2025 Annual Meeting.

By keeping track of trends in the orthopaedic surgery match process, “We can see where we’re going, what things are increasing and decreasing, and that’s what we have to use to advise our students,” explained presenter Alfonso Mejia, MD, MPH, FAAOS, residency program director and vice head of the Department of Orthopaedic Surgery at University of Illinois College of Medicine. “A lot of times, people base how they advise their students on their own personal experience from decades ago, and it’s essentially meaningless. This is changing fast, and you need to know what’s going on.”

The importance of research
One emerging trend is the relationship between research and matching. In 2021, the mean number of abstracts, presentations, and publications for those who matched was 14.3. It was 14.2 for those who did not match. In 2024, the numbers were 23.8 for matched and 18 for unmatched.

“This is sort of an arms race, which is why many are taking a research year between M3 [third year of medical school] and M4 [fourth year of medical school],” Dr. Mejia said. “It’s much better to take a research year in that structure than it is to take one after you don’t match.”

Among the main reasons research has become so important are the facts that many rotations are evaluated on a pass/fail basis and that glowing recommendation letters have become the norm. “I can’t tell you how many times I read a letter that says: ‘This is the best person I’ve met in the last 25 years,’” Dr. Mejia said.

As the value of research goes up, the value of volunteering may be going down. With research being scored so aggressively, Dr. Mejia suggests that it could be better to encourage students to save their volunteerism for residency, or even later when they are practicing.

Dr. Mejia cautioned that research has its limitations — it is no substitute for good grades and test scores. Medical students should never sacrifice academic performance to conduct more research. He also noted that students should begin conducting research early: during their first year or the summer between their first and second years. In addition, the type of research matters — students hoping to match into orthopaedics should focus their research in this area.

In addition to learning more about the field itself, conducting research in orthopaedics gives students a leg up: “You’re going to be able to get a letter of recommendation from someone who’s known in this community,” Dr. Mejia explained. “If it’s from a urologist, I don’t know who that person is. Also, when it comes to the interview, we can discuss your research. If your research is photosynthesis, for example, you can say anything. I can’t assess whether you’re telling me something reasonable, and we can’t really have a conversation.”

Mentoring medical students
Melvyn Harrington, MD, FAAOS, residency program director in the Department of Orthopaedic Surgery at Baylor College of Medicine, encouraged faculty to engage early with medical students who are interested in pursuing orthopaedic residency.

“It’s critical for students to really know what it takes and how to play the game,” Dr. Harrington said. “It’s also a great way to start hooking them up with various faculty mentors and help them learn about your department and the process in general.”

Faculty should help their medical students have a realistic vision by providing current information on residency programs, linking students with orthopaedic faculty and residents, and helping students conduct orthopaedic research. Dr. Harrington suggests encouraging interested students to join the medical school’s orthopaedic surgery interest group. If one does not already exist, faculty should create one. “It’s a great way to give general information to first-years and get them interested,” he said. “Those who remain interested can develop contacts with residents, researchers, and attendings.”

A variety of boot camps and other activities can help prepare students to pursue orthopaedic residency, such as casting and basic suturing workshops. Interview coaching is also important, as many students have only experienced their medical school interviews and their skillsets vary. Actual interview practice gives students opportunities to hone their skills, receive actionable feedback, and master the many nuances associated with successful interviewing, such as smiling and making eye contact.

What if a student does not match?
Not matching is a major disappointment for any student, but it is not the end of the world — there are still paths forward. From a faculty standpoint, it is important to identify these students as soon as possible to help them consider their options.

Paul J. Dougherty, MD, FAAOS, FACS, professor and chair of the University of Florida–Jacksonville Department of Orthopaedic Surgery and Rehabilitation, noted that students can pursue the Supplemental Offer and Acceptance Program or research. There are also opportunities to pivot into general surgery or other specialties.

“That’s why it is very important to meet with these students the Monday after match day,” Dr. Dougherty said. “Have faculty available to discuss the different potential options and make it a win for them so, coming out of it, they could potentially have a good match the next cycle.”

Josh Baxt is a freelance writer for AAOS Now.