Shaping Tomorrow’s Surgeons: Insights into PGY-1 Orthopaedic Training Across the United States




0009-0008-2349-5057 (Wong, Zachary)

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Orthopaedic surgery residency offers valuable opportunities for first-year residents to diversify their medical training beyond their specific field. The American Board of Orthopaedic Surgery (ABOS) mandates a five-year residency program for board certification, wherein the initial year, termed postgraduate year one (PGY-1), the curriculum is variable. ABOS permits up to six months in orthopaedic surgery rotations, with the remaining six months offering various educational experiences. Among the non-orthopaedic surgery months, at least three must be dedicated to either general surgery, trauma surgery, plastic/burn surgery, surgical or medical intensive care, or vascular surgery. The additional three months can encompass a range of hospital services. This study examined the rotations included in residency programs across the nation to analyze trends in PGY-1 orthopaedic resident experiences.


This study gathered data from the Electronic Residency Application Service (ERAS) list of participating orthopaedic programs across the United States for the 2023 application cycle. Program-specific information regarding PGY-1 rotations, both in orthopaedic and non-orthopaedic fields, as well as matriculated residents was gathered by utilizing each program’s publicly available internet resources. Programs with inadequate information regarding these variables were excluded from the study. Individual rotations were primarily divided into “month” intervals, which were defined on a program-to-program basis.


A total of 174 orthopaedic residency programs out of 201 participating programs with sufficient public data regarding PGY-1 curriculum were included in this study (86.6%). On average, these programs took 4.63 residents per application cycle.In assessing the ABOS requirement of 3 months of non-orthopaedic surgical rotations, the utilization rates among orthopaedic programs were as follows: intensive care (72.1%), plastics/burn care (67.4%), trauma (61%), general surgery (52.3%) and vascular (47.7%). The threshold of six months of orthopaedic surgery rotations was met by 90.11% of programs, with general orthopaedics, trauma, spine, and joints being the mostcommon subspecialties with an average of 4.1, 2.4, 1.2, and 1.6 months spent in these areas, respectively.


Among nationally accredited orthopaedic programs, notable differences exist in PGY-1 rotations. Our data revealed that within non-orthopaedic rotations, intensive care, plastics/burn care, and trauma were the most common, whereas general orthopaedics, trauma, and spine predominated within orthopaedic rotations. Understanding these curriculum differences in the first year of orthopaedic residency iscrucialto applicants as they navigate the intricacies of this highly technical field, marked by significant variability in training. Moreover, this information is valuable to current orthopaedic residents and program directors as they shape their program’s educational direction, ensuring that rotations are comprehensive and aligned with national trends. Future directions for our study include surveying program directors regarding the philosophy of their PGY-1 curriculum, aiming to better categorize the factors influencing educational design.