Matching into Shoulder and Elbow Surgery Fellowships: Do USMLE Scores and AOA Status Still Matter?

Introduction: Despite the established importance of the United States Medical License Exam (USMLE) and Alpha Omega Alpha (AOA) status in orthopedic residency selection, their significance in the fellowship match remains unknown. This study evaluates the influence of USMLE scores and AOA status on interview invitation rates and match positions for shoulder and elbow surgery fellowship applicants.

Methods: This is a retrospective analysis of data from the San Francisco Match database from 2018 to 2023. The study included matched applicants for shoulder and elbow surgery fellowship, excluding unmatched applicants, osteopathic, and international medical graduates. USMLE scores were categorized into four tiers, and interview invitation rates were examined based on USMLE tier and AOA status. Additionally, the association between USMLE scores and AOA status were analyzed by applicant and fellowship rank positions. Statistical analysis included descriptive statistics, linear regression, and analysis of variance.

Results: Data from 218 matched applicants were included. On average, applicants submitted 23.3± 9.7 applications, with an average interview rate of 76%. The mean Step 1 and 2 score was 247 ± 11 (n = 141) and 253 ± 12 (n = 171), respectively. USMLE scores showed a positive correlation with interview rates (Step 1: p < 0.0001, B = 0.768; Step 2: p < 0.0001, B = 0.727), indicating that higher scores were associated with increased interview opportunities. AOA members accounted for 38% of applicants (of 183 with available data), and they demonstrated a higher average percentage of interviews compared to non-AOA applicants (79% vs 75%, p < 0.001). While no significant difference in the average Step 1 (p = 0.17) or Step 2 score (p = 0.79) was observed across applicant rank positions, AOA membership was more prevalent among applicants in higher rank tiers (p < 0.001). Additionally, AOA applicants (p < 0.001) and those with higher Step 2 scores (p=0.04) were more likely to be ranked higher by their matched fellowship program.

Conclusion: USMLE scores and AOA status correlate with interview invitation rates and applicant ranking for shoulder and elbow surgery fellowships. Future work should examine the influence of residency reputation and research productivity on shoulder and elbow surgery fellowship match outcomes.