Mastering Research During Orthopedic Surgery Residency: Your Essential Guide

Why Research During Residency Matters in Orthopedic Surgery

Research during residency is no longer optional for many aspiring orthopedic surgeons—it is rapidly becoming an expectation. Whether your goal is to join an academic residency track, practice in a high-volume private group, or pursue a competitive fellowship, meaningful involvement in resident research projects can shape your skills, your CV, and your future opportunities.

In orthopedic surgery, evidence-based practice drives decisions about implants, surgical approaches, rehabilitation protocols, and patient selection. Orthopedic surgery residency programs increasingly emphasize scholarly activity as a core competency, and many use research productivity as a key metric of resident performance. Understanding how to integrate research into your training—without sacrificing clinical excellence—is critical for success in the ortho match and beyond.

This guide walks through what research looks like during orthopedic surgery residency, how to get involved effectively, what kinds of projects are realistic, and how to leverage this work for fellowships and future careers.

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The Role of Research in an Orthopedic Surgery Residency

Why Orthopedic Programs Care About Research

Several forces drive the importance of research during residency in orthopedic surgery:

1. Evidence-Based Practice
   Orthopedics is a rapidly evolving field. New implants, biologics, navigation systems, and minimally invasive techniques appear constantly. High-quality clinical trials, registry studies, and biomechanical investigations help determine what actually improves outcomes.

2. Program Accreditation and Reputation
   ACGME and other accrediting bodies expect residency programs to foster scholarly activity. Programs with strong research output tend to:

   • Attract competitive applicants
   • Place graduates into desired fellowships
   • Build national reputations in subspecialty areas (e.g., sports, joints, trauma, spine)

3. Fellowship and Career Advancement
   Competitive fellowships—sports, spine, trauma, pediatrics, oncology—often favor applicants with:

   • Peer-reviewed publications
   • National presentations
   • Ongoing research during residency
     Early research also lays the groundwork for an academic career, if you choose that path.

4. Skill Development Beyond the OR
   Research helps residents build skills that are valuable regardless of practice setting:

   • Critical appraisal of literature
   • Data interpretation and statistics
   • Scientific writing and communication
   • Project management and collaboration

How Programs Structure Research Expectations

The structure for research during orthopedic surgery residency varies widely:

• Research-Heavy Academic Programs

  • Dedicated research rotations (often 3–6 months across PGY2–PGY5)
  • Formal research curricula, mentorship committees, and required scholarly output
  • Onsite research coordinators, statisticians, and IRB support

• Balanced Academic/Community Programs

  • 1–2 protected half-days per month or short research blocks
  • Expectation of at least one completed project or presentation by graduation
  • Faculty-driven projects with resident involvement

• Primarily Community-Based Programs

  • Limited formal research infrastructure
  • Case reports, retrospective chart reviews, and QI projects more common
  • Research often self-directed by motivated residents with select mentors

Before ranking programs—or once you’ve matched—understand:

• How much protected time is realistically available
• Whether there are required research benchmarks (e.g., minimum publications)
• What support resources exist (biostatistics, IRB office, research staff)

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Types of Resident Research Projects in Orthopedics

Research during residency doesn’t have to mean running a randomized controlled trial. Matching your project type to your resources and timeline is essential.

1. Case Reports and Case Series

Best for: Early residents or limited resources
Examples:

• Rare tumor presentations or unusual fracture patterns
• Complications with novel implants
• Unique surgical techniques in complex deformity

Pros

• Fast to complete
• Excellent for learning basic literature search and scientific writing
• Good “first publication” for your CV

Cons

• Lower academic impact
• Many journals are saturated with case reports (acceptance rates can be low)

Actionable advice:
Start with at least one case report in PGY1–PGY2 to learn the mechanics of writing, submission, and responding to peer review.

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2. Retrospective Chart Reviews

Best for: Residents with access to institutional databases
Examples:

• Outcomes of distal radius fractures managed with volar plating vs casting
• Infection rates after total joint arthroplasty with different prophylaxis protocols
• Return-to-sport after ACL reconstruction by graft type

Pros

• Very feasible during a busy orthopedic surgery residency
• Leverages existing clinical data without needing prospective enrollment
• Can yield publishable results within 6–18 months

Cons

• Often limited by data quality and missing variables
• Risk of selection bias and confounding

Practical steps:

1. Identify a focused, clinically relevant question.
2. Confirm data availability in the EHR or registry.
3. Draft a clear inclusion/exclusion criteria and variable list.
4. Seek IRB approval (often as “minimal risk” or exempt).

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3. Prospective Cohort Studies and Clinical Trials

Best for: Residents in research-heavy or academic residency tracks
Examples:

• Comparing functional outcomes of different fixation methods for ankle fractures
• Prospective registry of patients undergoing shoulder arthroplasty
• Clinical trial of postoperative pain protocols in arthroscopy

Pros

• Higher methodology standards and academic impact
• Often suitable for national meetings and strong publications
• Excellent for those considering an academic career

Cons

• Complex logistics, longer timelines
• Often extend beyond residency years; may not see publication before graduation
• Requires strong mentorship and institutional resources

Resident tip:
If you start a large prospective project, pair it with smaller spin-off projects (baseline data, subanalyses) so you still achieve tangible output during training.

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4. Basic Science and Biomechanics

Best for: Residents with prior bench or engineering experience, or research-oriented programs
Examples:

• Biomechanical testing of new fixation constructs for proximal humerus fractures
• Cellular studies on cartilage regeneration or osteointegration of implants
• Animal models of tendon healing

Pros

• High potential academic impact
• Builds a strong platform for an academic residency track and future NIH-funded work
• Attractive to fellowships in sports, joints, and basic science-focused institutions

Cons

• Time-intensive; may require dedicated research year or block
• Steeper learning curve for those without prior bench experience

Practical advice:
If you’re seriously considering basic science, explore whether your program offers:

• A dedicated research year (between PGY2–PGY3, for example)
• Joint appointments with engineering or basic science labs

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5. Quality Improvement (QI) and Education Research

Best for: All residents, particularly at community programs
Examples:

• Improving adherence to DVT prophylaxis protocols after fracture surgery
• Standardizing perioperative antibiotic timing in spine cases
• Developing and evaluating a resident simulation curriculum for arthroscopy skills

Pros

• Often faster IRB pathways (or exempt as QI)
• Immediately improves patient care and resident experience
• Can be presented at quality/safety conferences and sometimes published

Cons

• Sometimes seen as lower-impact than large clinical trials
• Requires careful design to be suitable for publication

Resident strategy:
Consider at least one QI project—these often align naturally with ACGME requirements and can lead to quick, meaningful wins.

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Getting Started: From Idea to IRB

Step 1: Clarify Your Goals

Before you pick a project, define what you want from research during residency:

• Strengthen your ortho match application (for MS4s and incoming interns)
• Build a competitive CV for sports/spine/trauma fellowship
• Lay the foundation for an academic career
• Simply fulfill program requirements with high-quality work

Your goals shape:

• Project scope and complexity
• Whether you pursue an academic residency track
• How much protected time you should seek

Step 2: Find the Right Mentor

A strong mentor is the single most important factor in successful resident research projects.

What to look for:

• Track record of publishing regularly with residents
• Clear, responsive communication style
• Alignment with your subspecialty interests (if known)
• Willingness to help you navigate IRB, data collection, and authorship

How to find them:

• Ask senior residents: “Who gets things published with residents?”
• Review faculty publication lists on your department website
• Attend division conferences and see who leads active research groups

Action step for PGY1–PGY2: Schedule brief 15–20 minute meetings with 2–3 potential mentors to:

• Learn about their ongoing projects
• Share your interests and background
• Ask what they expect from resident collaborators

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Step 3: Narrow Your Research Question

A common rookie mistake is choosing a question that is too broad. Refine using the FINER criteria:

• Feasible – Realistic with your time and resources?
• Interesting – To you and to the field?
• Novel – Adds something new (or clarifies conflicting data)?
• Ethical – Safe and appropriate for patients?
• Relevant – Implications for clinical practice?

Example refinement:

Too broad:
“Do ankle fracture surgeries have good outcomes?”

Better:
“In adults with Weber B ankle fractures treated with lateral plating, what factors are associated with return to full weight-bearing by 12 weeks?”

Even better:
“In patients aged 18–65 with isolated Weber B ankle fractures treated with lateral locking plates at our institution from 2015–2022, are smoking status and BMI associated with delayed radiographic union (>12 weeks)?”

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Step 4: Understand IRB and Regulatory Basics

For most orthopedic resident research projects, you’ll need some level of IRB interaction:

Common project categories:

• Exempt: De-identified data, some QI, educational research
• Expedited: Minimal risk chart reviews, surveys
• Full board: Prospective interventional studies, higher-risk projects

Resident checklist:

• Complete CITI or similar human subjects training
• Draft a protocol with:
  • Background and rationale
  • Specific aims
  • Methods (population, variables, analysis plan)
  • Confidentiality and data security
• Work with your mentor and research office to submit IRB

Plan 4–12 weeks from submission to approval, depending on your institution.

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Step 5: Build a Realistic Timeline

Map your project against your clinical schedule.

Example realistic timeline for a PGY2–PGY3 chart review:

• Month 1: Finalize question, meet mentor, draft protocol
• Months 2–3: IRB submission and revisions
• Months 4–6: Data extraction and cleaning
• Months 7–8: Statistical analysis
• Months 9–10: Manuscript drafting with mentor feedback
• Months 11–12: Journal submission and respond to reviewer comments

Align intensive project periods with lighter rotations (e.g., elective, research block, night float if feasible).

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Integrating Research into a Busy Orthopedic Residency

Time Management Strategies

Orthopedic surgery residency is demanding. To succeed in research during residency, you must be deliberate about time.

Practical tactics:

• Micro-blocking research time

  • 30–60 minutes early morning or late evening, 3–4 times per week
  • Dedicated weekend blocks for writing or analysis

• Use your natural downtime

  • Between OR cases (if you’re waiting for turnover and have a laptop)
  • During call when census is low (and patient care is covered)

• Batch tasks

  • One session for literature search
  • One for creating data collection templates
  • One for drafting specific manuscript sections

• Collaborative division of labor

  • One resident handles chart abstraction
  • Another works on reference management and introduction
  • Another coordinates with statistician

Tools That Make Research Easier

• Reference management: Zotero, EndNote, Mendeley
• Writing: Microsoft Word or Google Docs with track changes
• Data: Excel, REDCap, SPSS, R (with biostats support)
• Task management: Trello, Notion, or simple shared spreadsheets

Ask your program which tools are institutionally supported (many provide REDCap and statistical software access).

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Choosing the Right Projects for Your Stage of Training

PGY1–Early PGY2: Learn the Basics

• Join at least one small, ongoing project
• Complete 1–2 case reports or small retrospective studies
• Learn how to structure abstracts and manuscripts

Late PGY2–PGY3: Build Depth

• Take on a more substantial project with first-author potential
• Consider a subspecialty focus (sports, joints, trauma, spine)
• Present at regional or national meetings

PGY4–PGY5: Transition to Leadership

• Mentor junior residents and medical students on projects
• Lead more complex projects or multi-center collaborations if feasible
• Use your research portfolio to support fellowship and job applications

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Leveraging Research for the Ortho Match, Fellowships, and Careers

For Medical Students Targeting Orthopedic Surgery Residency

If you’re still in medical school and planning for the ortho match:

• Get involved in orthopedic research early, ideally during MS2–MS3.
• Aim for:
  • At least 1–2 publications (any authorship)
  • Several abstracts/posters at regional or national meetings
• Use research mentors as letter writers; they can speak to your work ethic and reliability.

When interviewing, be prepared to:

• Explain your project’s question, methods, and key findings
• Articulate your specific role and contributions
• Reflect on what you learned and how it informs your future practice

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For Current Residents Eyeing Competitive Fellowships

Fellowship selection committees pay close attention to scholarly activity.

A strong research profile typically includes:

• First-author manuscripts in peer-reviewed orthopedic journals
• Oral or poster presentations at major meetings (AAOS, subspecialty societies)
• A coherent subspecialty theme (e.g., multiple projects in sports or trauma)

Actionable steps:

• By early PGY3, align your research with your intended fellowship area.
• Ask potential fellowship programs what they value: quantity vs depth, specific topics, types of studies.
• Prepare a concise research summary on your CV and be ready to discuss impact and future plans.

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Long-Term: Academic vs Private Practice

Academic track:

• Continued research is central to your career.
• Your resident research projects form the basis of your early academic identity.
• Consider:
  • Advanced degrees (e.g., MS in Clinical Research) if available
  • A dedicated research year or extended academic residency track

Private practice:

• Research experience remains valuable:
  • Helps you interpret literature critically
  • Enhances credibility with patients and colleagues
  • May lead to industry collaboration or involvement in multicenter trials

Either way, learning how to ask good questions, design feasible projects, and interpret data will serve you throughout your orthopedic career.

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Common Pitfalls and How to Avoid Them

1. Overcommitting to Too Many Projects

   • Start with 1–2 meaningful projects rather than 6 superficial ones.
   • Finish what you start; publications matter more than ideas.

2. Unclear Authorship Expectations

   • Discuss authorship order at the beginning of the project.
   • Revisit if roles change, but maintain transparent communication.

3. Poor Documentation and Data Management

   • Use standardized data collection forms.
   • Maintain secure, backed-up, de-identified datasets.
   • Document exactly how each variable is defined and collected.

4. Ignoring Statistical Consultation

   • Involve a statistician or biostatistics-savvy mentor early.
   • Avoid “p-hacking” or fishing for significant results without hypotheses.

5. Waiting Too Long to Start Writing

   • Begin writing background and methods sections while data are still being collected.
   • Use outlines and templates from prior successful papers.

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Frequently Asked Questions (FAQ)

1. How many publications do I need during residency to be competitive for fellowship?

There is no universal number, but for competitive orthopedic fellowships, many successful applicants typically have:

• Around 3–8 publications, with at least some as first author
• Several regional or national presentations

Quality and relevance to your chosen subspecialty often matter more than raw numbers. Focus on completing well-designed projects and seeing them through to publication.

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2. Do I need a dedicated research year in orthopedic surgery residency?

Not necessarily. A research year can be beneficial if:

• You are strongly interested in an academic career
• You want to pursue high-level basic science or complex prospective trials
• Your program and funding environment support it

However, many residents develop robust research portfolios without a formal research year by using protected time, efficient collaboration, and focused projects.

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3. Can I realistically do research in a community-based orthopedic residency program?

Yes. While resources may be more limited, you can:

• Focus on retrospective studies, case series, and QI projects
• Collaborate with nearby academic centers or former mentors
• Use your unique patient population or practice patterns as a rich data source

Even simple, well-executed studies from community programs can be impactful if they address practical questions.

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4. What if my project doesn’t produce “significant” results?

Negative or non-significant findings are still valuable if:

• The question is clinically important
• The study is well-designed
• Methods and limitations are clearly reported

Many journals publish well-executed negative studies, and these can contribute meaningfully to your CV and to clinical practice by preventing ineffective or unnecessary interventions.

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Research during residency in orthopedic surgery is both a challenge and an opportunity. With realistic planning, strong mentorship, and a clear sense of your goals, you can build a scholarly foundation that enhances your training, strengthens your fellowship and job applications, and improves the care you provide to patients throughout your career.