Exploring the Pathways to Specialization: A Scoping Review of Factors Influencing Orthopedic Surgery Residents’ Choice of Fellowship
Authors: Woodrow Jackson , Aratikatla Adarsh , Ghandour Samir , Waryasz Gregory R. , Guss Daniel , Kwon John Y. , DiGiovanni Christopher W. , Bejarano-Pineda Lorena , Ashkani-Esfahani Soheil 
Published: December 2024

Category: Other Introduction/Purpose: Orthopedic surgery is witnessing a substantial increase in fellowship training, with a notable shift from almost 50% practicing as "generalists" to less than 15% over the least 35 years. The Orthopaedic Fellowship Match has expanded to include various subspecialties, contributing to a favorable job market for fellowship-trained surgeons. However, the surplus of fellowship positions compared to graduating residents raises considerations regarding individualized selection processes and addressing disparities in the orthopedic field. Methods: A scoping review of the literature on orthopedic surgery fellowship choices utilized a literature search following PRISMA-ScR guidelines, which were subsequently analyzed using Covidence systematic review software; inclusion criteria encompassed primary, survey-based studies from 2010-2023, involving orthopedic surgery residents, fellows, attending physicians, and plastic surgery residents pursuing hand surgery fellowships, who completed their residency training in the United States. Data extraction involved compiling an evidence table encompassing respondent training levels, target demographics, survey types, factors considered, survey distribution details, response rates, results, and study limitations. Results: Intellectual curiosity dominated all other reasons for choosing fellowship among orthopedic residents across various studies, even when considering gender discrepancies and differing response measurement forms. The choice of surgical procedures also significantly influences the fellowship preferences of medical residents; factors such as the complexity and case variety, exposure to bread-and-butter cases, and surgical experience consistently emerge as crucial considerations in determining fellowship preferences, reflecting a common trend among applicants. Mentorship plays a pivotal role in residents' choice of subspecialty, particularly for female residents facing challenges finding mentors of the same gender. Other less prevalent contributing factors influencing a resident's decision in pursuing a specific fellowship include family commitments, financial debt, lifestyle preferences, previous research, and timing of their decision. Conclusion: The surge in orthopedic surgery fellowship training is marked by a substantial increase in graduates opting for subspecialization, driven by factors like intellectual interest, the nature of procedures in a specific fellowship, and mentor influence or experience. Our study emphasizes these factors as pivotal in residents' choices. However, the need for extensive prospective studies arises to conclusively ascertain if these influences remain consistent across all residents and if additional unexplored factors might play a more significant role in determining specific fellowship paths.