Early Subspecialization in Orthopedic Surgery Training

Recent studies have shown that applicants to the American Board orthopaedic Surgery Part II examination are performing fewer procedures outside of their chosen subspecialty. In this study, the authors assessed whether trainees are beginning their subspecialization during residency. The authors reviewed the chosen fellowships and case logs of 231 residents graduating from 5 academic orthopedic residency training programs from 2002 to 2017. The number of cases logged by residents who chose a specialty was then compared with the number of cases logged by residents who chose other specialties. Residents who chose spine surgery (108.4 +/- 50.7 vs 74.4 +/- 60.2, P<.01), hand surgery (242.2 +/- 92.9 vs 194.3 +/- 78.2, P<.01), and sports medicine (278.5 +/- 105.8 vs 229.0 +/- 93.9, P<.01) performed significantly more procedures in their chosen fields than their colleagues. In contrast, for total joint arthroplasty (p=.18) and foot and ankle surgery (P=.46), there was no significant difference in the number of cases between residents who chose the subspecialty and those who did not. Residents pursuing careers in spine surgery, hand surgery, and sports medicine obtained additional operative exposure to their chosen field during residency. Formalizing this early experience with specialization tracks during the chief year may be considered.