Essential Pre-Interview Preparation for DO Graduates in Orthopedic Surgery

Understanding the Orthopedic Surgery Residency Landscape as a DO Graduate

Orthopedic surgery is one of the most competitive specialties in the residency match, and as a DO graduate you face a unique set of opportunities and challenges. Thoughtful pre-interview preparation can significantly improve your chances in the orthopedic surgery residency and ortho match process.

The DO Perspective in Orthopedic Surgery

With the single accreditation system, many former AOA orthopedic programs are now ACGME-accredited. This has expanded options for DO graduates, but competition has also intensified.

Key realities for DO applicants:

• Fewer DO-majority programs: Historically DO-friendly programs still exist, but you’ll be competing more directly with MD applicants.
• Board exams: Many programs now accept COMLEX alone, but some still strongly prefer or require USMLE Step scores. By interview season, your score profile is already set, but understanding how programs may view it will shape how you present your candidacy.
• Perception of osteopathic training: Many orthopedic attendings and program directors value the hands-on, musculoskeletal-heavy background of DO training—if you articulate it well.

Your goal in pre-interview preparation is two-fold:

1. Demonstrate you can excel in a high-demand surgical specialty (work ethic, resilience, technical interest).
2. Show how your osteopathic background is an asset to their residency program and patients.

Understanding this context will help you tailor every piece of your residency interview preparation.

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Laying the Foundation: Research and Strategy Before Interview Season

Serious preparation for the osteopathic residency match in orthopedics begins long before your first scheduled interview. The more strategic you are now, the more confident and authentic you’ll be when you sit in front of a program director.

Build a Program Intelligence System

Don’t approach interview season with scattered notes and vague impressions. Create a structured way to collect and compare information about each orthopedic surgery residency.

Use a spreadsheet or note system with columns for:

• Program basics
  • Location (city, region)
  • Size (number of residents per year)
  • Type (academic, community, hybrid, former AOA program)
  • Trauma level (I, II, etc.)
• Training features
  • Case volume (especially trauma, joints, sports, spine, hand, peds)
  • Early vs. late operative experience
  • Autonomy level (junior resident case logs, OITE performance expectations)
  • Call schedule and night float system
• DO-specific considerations
  • Number/percentage of current DO residents
  • Presence of DO faculty or leadership
  • Historical openness to COMLEX-only candidates
• Research and academics
  • Number of publications per resident on average
  • Research year options
  • Protected research time
• Culture and support
  • Resident camaraderie (how do they talk about each other?)
  • Wellness initiatives and mentorship programs
  • “Red flags” from blogs, Reddit, or residents (take anonymous sources with caution, but note consistent patterns)

Practical tip:
Before each interview, condense this into a one-page “Program Snapshot” you can review the night before and morning of the interview.

Leverage Away Rotations (If You’ve Done Them)

For orthopedic surgery, audition rotations are essentially month-long interviews. If you rotated at a program and received an interview, your pre-interview preparation should heavily incorporate that rotation experience.

Reflect in writing on:

• Memorable cases you scrubbed on or followed
• Residents or attendings you worked closely with
• Feedback you received and how you’ve acted on it
• Unique features of the program you observed (teaching style, autonomy, trauma volume)

You can then reference these in answers like:

• “Why our program?”
• “Tell me about a time you received critical feedback.”
• “Where else are you interviewing?” (to subtly indicate they remain a top choice because of your rotation experience)

If you did not rotate at a given program, compensate with deeper research and networking.

Networking Strategically as a DO Applicant

Use your osteopathic network to your advantage:

• Reach out to DO residents at programs you’re interviewing with:
  • Ask concise, respectful questions about culture, DO friendliness, and interview format.
  • Confirm how they recommend positioning your DO background.
• Leverage alumni connections from your COM:
  • Ask your school’s orthopedic faculty and alumni if they know or can introduce you to anyone in programs on your list.
• Professional societies:
  • AOA, AAOS, and specialty groups (e.g., AOSSM, AAHKS) often have student/trainee sections. If you’ve attended or presented at their meetings, mention this in interviews.

Networking isn’t about asking someone to “get you in”; it’s about understanding programs better so your interview performance is precise and informed.

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Mastering Common Residency Interview Questions (with an Orthopedic Focus)

You’ll encounter general interview questions residency programs use across specialties, plus orthopedic-specific questions. As a DO applicant, you’ll also frequently field questions that touch on your osteopathic training.

Below are key question categories along with tailored advice and examples.

1. “Tell Me About Yourself” and Personal Narrative

This is your first chance to set the frame: motivated, grounded, and a strong fit for orthopedic surgery.

A clear 60–90 second structure:

1. Where you’re from / background (10–15 seconds)
2. Medical school and how you discovered orthopedics (30–45 seconds)
3. What you’re doing now / recent focus (15–30 seconds)
4. Transition into why you’re excited to be there (10–15 seconds)

Example (DO-focused):

“I grew up in a small town in Ohio and was drawn early to medicine through sports injuries of my own. At [DO school name], I was initially open-minded about specialties, but early exposure to osteopathic manipulative medicine and my third-year ortho rotation really clicked—seeing how restoring function through biomechanics could change someone’s life. Since then, I’ve focused my electives and research on fracture management and outcomes after lower extremity trauma. Over the last year I’ve really confirmed that I thrive in the OR and on busy inpatient services. I’m excited to be here today because your program’s strong trauma exposure and the presence of several DO faculty strongly align with the type of training environment I’m seeking.”

2. “Why Orthopedic Surgery?” — Specifically for DO Graduates

Your answer should:

• Tie in hands-on, musculoskeletal-oriented osteopathic training
• Show you understand the demands and realities of ortho
• Demonstrate sustained commitment, not a last-minute decision

Avoid clichés like “I like fixing things” alone; expand on that.

Example:

“I’m drawn to orthopedics because it sits at the intersection of biomechanics, anatomy, and immediate, visible impact on function. During DO school, our musculoskeletal and OMM training gave me a strong appreciation for alignment, joint mechanics, and how subtle biomechanical issues can drive disability. On my orthopedic rotations I saw how that foundation translated directly into surgical decision-making—deciding when to operate, what construct to use, and how to plan rehab. I also enjoy the team-based, high-acuity environment of trauma and the longitudinal relationships in reconstructive and joint care. I’ve had enough exposure to understand the long hours and intensity of orthopedics, and that’s a challenge I’m excited about.”

3. “Why Our Program?” and the DO Graduate

This is one of the most important questions in orthopedics. Programs want to know:

• Have you done your homework?
• Do you fit their environment and priorities?
• Are you likely to rank them highly and stay for five years?

Tailor your answer with specifics:

• Unique case mix (e.g., high-level trauma, peds exposure, joints)
• DO-friendly environment (if applicable)
• Operative volume and early hands-on training
• Resident culture that aligns with your learning style

Example elements to include:

“Your program’s emphasis on early junior resident autonomy in the OR, the high trauma volume as a Level I center, and the track record of training DO residents who go on to competitive fellowships are especially compelling to me.”

4. Addressing “Why DO?” and Board Exam Questions

You may be explicitly or implicitly asked about:

• Why you chose osteopathic school
• Why you did or did not take USMLE
• How you think DO training has prepared you

Keep answers positive and future-focused; never defensive.

Example:

“I chose a DO program because I valued the emphasis on comprehensive, patient-centered care and the strong musculoskeletal focus. That perspective has been an asset in orthopedics, especially in clinic where assessing function, gait, and biomechanics is key. I took COMLEX [and optionally USMLE], and while exams are only one snapshot, they show I can handle a high-volume, complex knowledge base. More importantly, my performance on my orthopedic rotations and letters from faculty reflect that I can translate that into clinical and surgical decision-making.”

If you didn’t take USMLE and they ask:

“I focused on COMLEX, and I made sure my clinical performance, research, and away rotations demonstrated my readiness for orthopedic training. I’m confident that my experience managing high-acuity orthopedic patients and feedback from my attendings are more representative of what I can bring to your program.”

5. Behavioral and Ethics Questions

These aim to assess professionalism, resilience, and teamwork—critical in a demanding surgical residency.

Common prompts:

• “Tell me about a time you made a mistake.”
• “Describe a conflict with a resident or attending.”
• “Tell me about a challenging patient encounter.”
• “How do you handle stress or fatigue?”

Use the STAR method (Situation, Task, Action, Result) and, when possible, choose examples from orthopedic or surgical settings.

Example framework:

Situation: Brief setting/context
Task: What you were responsible for
Action: Specific steps you took
Result: Outcome + what you learned

For a mistake:

Emphasize early recognition, disclosure, learning, and systems awareness—not self-flagellation.

6. Technical, Clinical, and Orthopedic-Specific Questions

Some programs may ask knowledge-based or scenario questions:

• “Walk me through your evaluation of a trauma patient with an open tibial fracture.”
• “How would you counsel a 65-year-old with end-stage knee OA considering TKA?”
• “What are the potential complications of femoral nailing?”

Pre-interview preparation here means:

• Reviewing core ortho topics:
  • Fracture classification (AO, Garden, Schatzker broadly)
  • Basic trauma principles (ATLS, open fracture management)
  • Common elective procedures (TKA, THA, rotator cuff repair)
• Being humble and structured:
  • “First, I’d ensure the patient is stable…”
  • “From an orthopedic standpoint, I’d focus on…”

They aren’t expecting fellowship-level details; they’re assessing how you think.

7. “Where Do You See Yourself in 5–10 Years?”

For orthopedic surgery, this often includes:

• Fellowship interests (sports, joints, trauma, hand, spine, peds)
• Academic vs community practice
• Research and teaching interests

It’s okay not to be certain; show informed curiosity.

Example:

“Right now I’m most drawn to trauma and adult reconstruction, largely because of my experiences on those services, but I’m open to how residency will shape that. I do envision myself in a setting where I can be involved in resident or medical student teaching, and ideally in a program or practice that values quality improvement and outcomes research.”

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Practical Steps: How to Prepare for Interviews Day-to-Day

Effective residency interview preparation is systematic. Rather than “cramming,” build a routine that sharpens your content, delivery, and confidence.

1. Build a Personal “Interview Playbook”

Create a living document that includes:

• Key stories:
  • 3–4 patient care stories (including 1–2 ortho-related)
  • 2 teamwork/conflict/resilience stories
  • 1 research or QI story
• Bullet-point talking points for:
  • Why orthopedics
  • Why DO / osteopathic training
  • Why this program (customized bullets per program)
• Research summaries:
  • 1–2 sentences on each of your projects
  • Your role, methods, findings, and what you learned

Practice drawing from these stories for multiple questions. For instance, the same story can answer “a challenging patient encounter” and “a time you received tough feedback” if framed differently.

2. Mock Interviews: Content and Nonverbal Skills

Arrange at least 3–5 mock interviews:

• With an orthopedic faculty member (ideally)
• With your school’s career office
• With peers—especially those also applying in orthopedic surgery residency

Focus on:

• Clarity and pacing: Avoid rambling; keep answers focused.
• Tone: Confident but not arrogant; humble but not self-deprecating.
• Nonverbal communication:
  • Eye contact
  • Posture (especially critical in virtual interviews—avoid slouching)
  • Professional demeanor

Record at least one mock session (audio or video) and critique:

• Are you using too much filler (“um,” “like”)?
• Are your answers overly long?
• Do you smile or look engaged?

3. Preparing for Virtual vs In-Person Interviews

Many programs continue to use virtual formats, especially for initial interviews.

For virtual interviews:

• Technical setup:
  • Stable internet
  • High-quality webcam and microphone
  • Neutral, uncluttered background
  • Test Zoom/Teams/Thalamus or other systems ahead of time
• Camera framing:
  • Head and upper torso visible
  • Camera at eye level
• Lighting:
  • Light source facing you, not behind you

For in-person interviews:

• Plan travel carefully—arrive the day before when possible.
• Pack:
  • Printed CV and ERAS application
  • Notepad and pen
  • Comfortable but professional shoes (campus tours can be long)
• Research parking, hospital entry, and time to the department.

4. Polishing Your Application Materials Before Interviews

Program faculty often have your ERAS application, personal statement, and letters in front of them during interviews. Your pre-interview preparation should include:

• Rereading your:
  • Personal statement
  • Activity descriptions
  • Research/experiences sections
• Being prepared to discuss:
  • Any gap years or non-traditional paths
  • USMLE/COMLEX scores, especially if there were improvements or setbacks
  • Any red flags (leave of absence, professionalism comments), framed honestly but growth-focused

Example for a score dip:

“My Step/Level 1 score wasn’t where I wanted it to be, and that was a wake-up call to restructure how I studied and sought feedback. I made specific changes—more active learning, question-based practice, earlier review—and my performance on later exams and on clinical evaluations reflects that growth. I’m confident those same habits will serve me well here.”

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Showcasing Your Osteopathic Identity Confidently

As a DO graduate in the orthopedic surgery match, your osteopathic background is not a liability; it is a differentiator when framed properly.

Highlighting Osteopathic Principles in an Ortho-Relevant Way

Rather than generic OMM anecdotes, emphasize:

• Functional and biomechanical assessment skills:
  • Gait analysis
  • Posture and alignment
  • Kinetic chain implications for injuries
• Holistic view of recovery:
  • Understanding social determinants of health in post-op rehab
  • Integrating pain management strategies beyond opioids

Example to integrate during answers:

“My osteopathic training emphasized careful assessment of function and biomechanics. That’s been very valuable in orthopedic clinic when assessing, for example, knee pain that may originate from hip pathology or gait abnormalities.”

Handling Bias or Skeptical Questions Gracefully

If you sense subtle skepticism about DO training:

• Stay composed and professional.
• Lean on your clinical performance and orthopedic experiences.
• Avoid defensiveness; focus on evidence of your preparation.

Example:

“I’ve found that once I’m on the rotation or in the OR, what matters most is how I perform, how I work with the team, and how I care for patients. My rotations in orthopedics—both at my home institution and on away rotations—have consistently reinforced that my training has prepared me to contribute at a high level.”

Connecting with DO Faculty and Residents

Before each interview:

• Identify any DO faculty or residents from the program website.
• Consider mentioning during the interview:
  • “I noticed you have several DO graduates on faculty and in leadership; that’s encouraging as someone with a similar background.”
• Ask DO residents specifically:
  • “Were there any aspects of your transition into this program as a DO that you wish you had prepared for differently?”

This signals that you are intentional about your fit and growth.

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Final 1–2 Weeks: Consolidating Your Ortho Match Readiness

As interview season approaches or intensifies, your preparation should shift from information gathering to refinement and endurance.

1. Refine and Shorten Your Answers

Aim for:

• Most answers in the 60–90 second range
• Exceptions:
  • Complex behavioral questions: up to ~2 minutes
  • Very short prompts (“One or two words to describe yourself”): concise responses

Practice trimming:

• Remove tangents and repeated points.
• Lead with the most important idea.
• End answers with a forward-looking or reflective statement:
  • “…and that experience confirmed for me that I want to train in a high-volume trauma environment like yours.”

2. Prepare Thoughtful Questions for Interviewers

You will almost always be asked: “What questions do you have for us?”

Avoid questions easily answered by the website. Instead, ask:

For program directors:

• “How do you see the program evolving over the next 5–10 years?”
• “What traits do your most successful residents tend to share?”

For residents:

• “What do you think sets this orthopedic surgery residency apart from others?”
• “How does the program support residents pursuing fellowships in [your interest]?”
• “What’s one thing you’d change about the program if you could?”

For DO-specific insight (to DO residents):

• “What has been your experience as a DO graduate here in terms of support and mentorship?”

3. Plan Your Rank List Criteria Early

While not strictly “pre-interview,” having clear criteria in mind helps you listen more effectively during interviews and socials.

Criteria commonly used by DO graduates in orthopedic surgery:

• DO-friendliness and prior DO outcomes
• Trauma and operative volume
• Fellowship placement (particularly in your potential areas of interest)
• Culture and resident happiness
• Geographic preferences and support systems
• Research infrastructure (if academic career is a goal)

Keep a post-interview reflection document where you promptly jot down impressions the same day—before they blur together.

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FAQs: Pre-Interview Preparation for DO Graduates in Orthopedic Surgery

1. As a DO graduate, do I need to approach orthopedic surgery residency interviews differently than MD applicants?

The core principles of residency interview preparation are the same: know your story, understand each program, and communicate clearly and professionally. As a DO applicant, you should additionally:

• Be ready to articulate how your osteopathic training enhances your orthopedic approach, especially regarding biomechanics, function, and holistic care.
• Anticipate questions about board exams (COMLEX/USMLE) and respond factually and confidently.
• Highlight successful orthopedic rotations, research, and letters that demonstrate you can compete at the highest level.

Your goal is not to apologize for being a DO, but to show that your training has uniquely prepared you for orthopedic surgery residency.

2. How can I best explain not taking USMLE if programs ask about it?

Be honest, concise, and forward-looking. For example:

• Explain your reasoning (e.g., curriculum focus, financial constraints, advice you received).
• Emphasize your COMLEX performance, clinical evaluations, and orthopedic rotation feedback.
• Reassure them that your performance in demanding surgical settings is a better indicator of your ability to succeed than a single test.

Avoid sounding defensive; keep the focus on what you’ve done to demonstrate readiness for an orthopedic surgery residency.

3. How much orthopedic knowledge am I expected to have during interviews?

Programs know you are a medical student or recent graduate, not a fellow. You should:

• Be comfortable with basic orthopedic principles:
  • Evaluation and stabilization of common fractures
  • Management of open fractures (antibiotics, timing of debridement)
  • Initial workup for common issues (hip fractures, ACL injuries, rotator cuff tears)
• Know enough about your own research and clinical experiences to explain relevance to orthopedics.

If you don’t know an answer, it’s better to say, “I’m not entirely sure, but I would start by…” and outline your reasoning process, rather than guessing wildly.

4. What are some red flags in orthopedic surgery interviews, and how should I handle them?

Potential red flags include:

• Residents who seem consistently exhausted, unsupported, or unwilling to recommend their own program.
• Vague or evasive answers about case volume, operative autonomy, or fellowship placement.
• Comments that minimize wellness, mentorship, or diversity.

If you encounter these:

• Ask follow-up questions politely to clarify.
• Compare what you hear with objective data (case logs, fellowship lists, board pass rates).
• Reflect afterward on whether this environment aligns with your values and long-term goals.

Your pre-interview preparation should empower you not only to impress programs, but also to evaluate them critically and choose a residency that will help you thrive as a DO orthopedic surgeon.