Orthopedic surgery residents may seek to transfer to another residency program for personal or professional reasons, including geographic considerations, conflicts with faculty, or perceived gaps in training curricula, according to a review published in the Journal of the American Academy of Orthopaedic Surgeons.

The investigators described common motivations for residency transfers, methods residents may use to identify transfer opportunities, regulatory requirements that affect training continuity, and transition planning strategies intended to support residents entering a new program.

Attrition and Reasons for Transfer

Orthopedic surgery is among the most competitive specialties in the US. Applicants often apply broadly and complete multiple away rotations before matching into residency programs, yet some ultimately train in programs they were previously unfamiliar with and encounter unexpected challenges during the 5-year training period.

The review noted that mismatches between resident learning styles and program teaching cultures may arise because of limited familiarity with programs during the application process, changes in program leadership, or differences between faculty teaching styles and resident learning preferences.

Published data indicates attrition rates of 3% to 5% in orthopedic surgery residency programs, compared with approximately 7% across surgical specialties overall.

Residents may consider transferring for several reasons, including distance from family members, professional conflicts with attending physicians, or perceived gaps in training curricula. Some residents also determine during training that orthopedic surgery does not align with their desired lifestyle. Burnout may contribute to these decisions, particularly during the early years of residency when residents must adapt to new clinical environments and workloads.

Exploring Resources Within the Existing Program

Before initiating a transfer, the researchers advised residents to explore potential solutions within their current programs. Program directors, faculty mentors, department chairs, and designated institutional officials may help address barriers to successful training and connect residents with institutional resources such as mentorship or wellness initiatives.

Teaching institutions increasingly recognize burnout risks during residency and may provide resources aimed at improving resident well-being and retention. Strategies may include structured mentorship, resident discussion forums with program leadership, and initiatives to address professional isolation or limited opportunities to raise concerns about training conditions.

Identifying Transfer Opportunities

Residents who pursue transfers may identify opportunities through several channels. Commercial platforms allow residents to search for available positions based on geography, specialty, or training year, while professional networks—including mentors and peer residents—may provide information about program vacancies.

Professional organizations and affinity groups may also facilitate networking with orthopedic faculty. In addition, residency program directors sometimes circulate vacancy announcements through professional listservs shared among orthopedic faculty and training programs.

In some circumstances, newly accredited programs or programs that receive approval from the Accreditation Council for Graduate Medical Education to increase their resident complement may recruit residents outside the National Resident Matching Program. Transfer opportunities may occur more frequently toward the end of the academic year, when programs address vacancies following Match Day.

Documentation and Evaluation

Residents pursuing a transfer typically prepare documentation that allows receiving programs to evaluate their training experience and academic performance.

Common materials include:

• Curriculum vitae summarizing education and academic achievements

• Personal statement describing reasons for transfer

• Case logs documenting surgical procedures performed during residency

• Standardized examination scores, including Orthopaedic In-Training Examination results

• Clinical rotation schedules and milestone evaluations

• Professional references and letters of recommendation.

Program leadership reviews these materials and may conduct interviews to understand the resident’s training experience and reasons for seeking a transfer.

Regulatory Requirements

Residency transfers involve regulatory considerations from both the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Orthopaedic Surgery (ABOS).

If a receiving program has an open position, the program director may complete required documentation through the Accreditation Data System. Programs may also request approval for temporary or permanent increases in resident complement when necessary.

Residents must also meet eligibility requirements for the ABOS Part I certification examination. These include 6 months of orthopaedic surgery rotations and 6 months of approved nonorthopaedic rotations during the intern year, as well as an average of at least 46 weeks of clinical education per year across the 5-year residency program. Training must include required subspecialty exposure, including 46 weeks each in adult orthopaedics and fractures/trauma, 23 weeks in pediatric orthopaedics, and 23 weeks in orthopaedic clinical subspecialties. The final 2 years of residency training must occur at a single program.

Transition Planning

Once a transfer is approved, the researchers recommended developing a structured transition plan tailored to the resident’s previous training experience.

Such plans may include customized rotation schedules that address gaps in prior clinical exposure, identification of faculty and peer mentors, and scheduled feedback meetings with program leadership. Early rotations may be assigned with faculty familiar with the resident’s background, while call responsibilities may increase gradually as the resident becomes familiar with institutional workflows.

Mentorship from both faculty and peers may help transfer residents learn institutional practices, develop professional relationships, and prepare for fellowship training opportunities.

Educational Monitoring

Regular feedback during the transition period may help residents address gaps in clinical experience or medical knowledge. Monthly meetings with program leadership early in the academic year may help identify challenges and assess readiness for advancement.

The Orthopaedic In-Training Examination remains a widely used measure of resident medical knowledge. Previous analyses have suggested that a 62.5% raw score on the examination predicts minimum passing performance on the ABOS Part I examination.

“Appropriate feedback and mentorship will enable the transferring orthopedic surgery resident to assimilate and thrive in their new residency program,” the lead author Jason Silvestre, MD, of the Medical University of South Carolina in Charleston, and colleagues wrote.

The researchers reported no conflicts of interest.

Source: Journal of the American Academy of Orthopaedic Surgeons