Tripler Army Medical Center Orthopaedic Surgery Residency Program
Tripler Army Medical Center Orthopaedic Surgery Residency Program
John M. Tokish, MD
Number of Residents:
15 - 3 per year
Number of Staff:
Length of Program:
Sherry D Pico
Tripler Army Medical Center
- 1-to-1 ratio of attending staff to house staff
- Use of advanced office technology, including electronic medical records and prescriptions, telemedicine capabilities, and computerized radiology imaging retrieval system
- Diverse patient population from Hawaii and Pacific Rim
- 2 OR days/2 clinic days/1 day of academics and research per week
- Daily morning report and pre-op conference
- Weekly teaching conference
- Monthly journal club
- Weekly evening academics
- PGY-1: Internship year
- PGY-2: General orthopaedics with 1-on-1 instruction
- PGY-3: Subspecialty training: pediatric orthopaedics, foot and ankle, trauma; attendance at nationally recognized courses in fracture treatment, prosthetics and orthotics, and orthopaedic oncology
- PGY-4: Spine, level-1 trauma, Texas Scottish Rite Hospital/Dallas Children’s Hospital in Dallas
- PGY-5: Chief resident year with rotations in adult reconstruction, sports medicine, complex hand surgery, optional medical readiness training exercises (MEDRETE) to prepare for orthopaedic care in developing countries
- Tripler Army Medical Center - Honolulu, HI
- Texas Scottish Rite Hospital for Children - Dallas, TX
- Queen's Medical Center - Honolulu, HI
- Children's Medical Center of Dallas - Dallas, TX
Click on thumbnail for full version
|There are no images attached to this page.|
The military match shares many characteristics with the civilian match, with some important differences depending on which branch of the military you are in. The military match is early, taking place in December instead of March. The timetable is therefore moved up a bit. (An example of a timetable is included below as a guide). The application process may vary as well. Air Force, Army, and Navy use a system called MODS for the application process. It is separate from ERAS, although you will need to complete ERAS as well. You will have access to a specific “PGY-1 applications” section on MODS sometime during the summer that fourth year starts. Like the civilian match, a CV, Personal Statement, MSPE and Letters of Recommendation are included in the application, and information on how to upload these will be sent to you. After the applications and rank lists are submitted, the Graduate Medical Education (GME) Board meets in mid-November and ranks the applicants using various criteria including grades, USMLE scores, research, performance on “audition” rotations, interviews, and prior military service. Candidates are either matched into the military residency of their choice, matched into a military second choice specialty, “deferred” into a civilian residency of their choice (see below) or matched into a military transitional year (see below). All Army info is available on the GME/HPSP website. Navy info is available on the HPSP website, and official instructions will be distributed in the spring of your 4th year.
The most important advice is to stay in contact with your branch of service regarding the application process. There are differences between the Army, Navy, and Air Force which may only be addressed within that specific branch. Use the following information as an introduction to the military match, confirming all information with your service specific instructions.
Active Duty Tours (ADT’s)
Your final rank list will be due in mid-October, so away electives at potential residency sites should be done before then (or at least started in early October). July to September is the best window, and some believe later is better since you will be fresher in the program’s mind when the Board meets. Setting up the ADT usually consists of calling or emailing the clerkship coordinator at the site and checking availability. Some sites have websites through which you can request rotations. This should be done as early as you can, and may need to be done before you know your Maryland 4th year schedule since some sites and rotations are very popular. It is much easier to schedule your Maryland rotations around your aways than vice versa. Program Directors also look well on in-person interviews (even if you do not do an ADT rotation) and may be open to a few day or week-long visit for interviews if you contact them directly and express interest. There are a limited number of programs, and the directors know each other well, so it is best not to ignore any programs or to act disrespectfully to ANYONE on a rotation.
For the Army, keep in mind that your ADTs for the Army are 45 days, while rotations are 30, and they cannot overlap, so planning an early (July-September) ADT at what you think your 2nd choice residency site will be then taking a break at home and going back for a 2nd ADT (October) at what you think your 1st choice residency is what many do.
Navy ADT’s cannot be taken in the same fiscal year (fiscal year begins October 1). To do 2 ADT rotations in the 4th year, one must be done before October 1 and one must be done after October 1 IF you are planning on using your annual ADT. You may do two rotations prior to October 1, however, one will be an ADT while the other is done as a civilian (i.e. you must pay for travel, meals, lodging, etc.).Like the Army, Navy ADTs are also 45 days, however you have the option of having the “extra” active duty time either before or after your active duty clerkship, allowing you to do back-to-back military rotations in Sept-Oct if the extra time is before your first rotation and after your second.
You don’t necessarily have to rotate in the specialty you want, you just need to be seen! The military is a very small world so word will get around if you are a good (or bad!) applicant no matter what specialty you may be rotating in. Certainly, if you are rotating in a different specialty then arrange for interviews with the specialty you want during your ADT. You could also arrange to spend some time with the department you are interested in, for example if you are interested in EM but are only able to get a medicine rotation, arrange to spend an afternoon in the ED. This is a good way to show interest while also getting a good look at your future residency program.
At the UMB end, you need to inform OSA of your intentions if you want your rotations to count for school credit (there is info on the OSA website on how to do this). You can do up to two away electives. If necessary, you can do the ADT’s during your vacation months. Away rotations cannot count as your required 4th year Sub-I’s, even if your workload is similar. There may be an exception if you address it personally and obtain permission in writing.
You should go to all ADT’s with an updated CV, Personal Statement, a photo and your appropriate Class A uniform uniform for Army/Air Force, and Summer/Dress Whites for Navy (this is what you will interview in).
Keep in mind that Walter Reed National Military Medical Center at Bethesda is very close to UMB, so if it is high in your rank order it might best to do a non-ADT away rotation. This way you don’t “waste” your ADT on a site that is so close (because you will not get per diem, hotel costs or rental car costs paid for). Make sure you update yourself on military practices and traditions.
In the Air Force, the applicant is required to interview with one military program in his/her specialty, and this interview may be by phone. However, it is in your best interest to interview with your top military choice at the latter end of an ADT at that site. The program director is only allowed to have your two-page application and your CV by JSGME Board rules. It may be worth interviewing with all of the program directors in your specialty by phone.
Similarly in the Army/Navy, you should interview with as many of the programs as possible, with at least interviewing in person with your top 2-3 choices. You can interview over the phone with your other choices. Interviews are expected to be done while on ADTs. Surprisingly, most programs are rather understanding when it comes to phone interviews; but still if you are not as competitive as you would like to be then it would be in your best interest to interview in person. Be aware that in the Army there is a deadline by which interviews should be completed. The MODS online forum is very helpful for this and they are very prompt with answering questions. For the Navy, the instructions sent out by the PGY-1 Program Manager are very clear, and they will respond to emails with any additional questions.
Interviews are like civilian interviews for the most part, only you will be wearing your uniform (MAKE SURE IT IS ON RIGHT OR YOU WILL REGRET IT!). Even if your interviewer says it’s not necessary, trust me, it goes a long ways to presenting yourself professionally and they will remember! Another obvious thing is to make sure you use appropriate salutations (“sir,” “ma’am,” etc), and prepare thank-you notes to keep yourself fresh in their minds.
Letters of Recommendation
In the Air Force LOR’s are limited to two; at least one letter from a military physician or program director is ideal. If not, anyone at school is fine, though heads of departments are better than others. The important thing is to have your letters stand out in some way. The more specific, the better you distinguish yourself.
The Army allows up to four LORs, again, with a preference for military doctors. Look for at least one from an Army physician that you worked with on an ADT (another reason to complete your ADTs early) and one from the chair of the Maryland department. They also allow you to use evaluations from away rotations to upload as “supporting documents”. This is likely similar in the other branches.
The Navy does not have limitations on LORs. Follow the guidance of your advisors in the specialty to which you are applying. As always, letters from department chairs and program directors in the specialty you are applying to will be viewed more favorably.
A civilian deferment is where you will complete your residency in a civilian program, this means that like medical school you will just be another resident in the program; meaning no uniform, no increased pay and not many “military demands” placed on you during residency. After completing residency training you will then pay back active duty time you owe as normal.
In the Army as of now you are NOT allowed to rank civilian deferment as one of your choices, in the Navy you are allowed to rank it wherever you would like.
To understand your chances of getting a civilian deferment (if this indeed is your first choice or near the top of your list), it is important to understand how residency spots are decided upon by the JSGME Board. Each branch of the military determines each year how many PGY1 openings it will allow in a given specialty. Each branch handles excess applicants for a given specialty differently, the Army is often the strictest with very few civilian deferments being given out and the Air Force is traditionally more liberal with the use of civilian deferments.
For each branch, they determine how many residents they need to train to satisfy their needs in the future, so if they determine they can train all of the residents that they need for a certain specialty then there will be NO civilian deferments in that specialty. On the other hand, if there is a large need for a specialty that exceeds their capabilities to train “in-house” so to speak, then there will be more deferment spots for that specialty.
How does your competiveness as an applicant play a role? Generally, the Board strikes a balance between 1) any branch wanting to keep the best students in an applicant pool for its PGY1 positions, and 2) honoring applicants’ top choices. If civilian deferment is your top choice, regardless of anything else, you should make your intentions known, both in your Personal Statement and in your interviews with program directors. The directors will offer you an assessment of where you stand in regard to a deferment. Be honest about what you want, both when speaking to directors and when ranking programs. The worst thing you can do is to try to “outsmart the system” by leaving program directors unimpressed or sabotaging your application in hopes that you will not be selected for a military residency. You may be very unpleasantly surprised in December.
For applicants that are not selected to train in a specific specialty, applicants will be assigned to a transitional year. This is like a general intern year where you spend your time in various departments (medicine, pediatrics, OBGYN, etc), similar to third year of med school. Some programs will allow you to re-apply for a residency as a PGY2 after a transitional year, while others will require you to do their specific PGY1 year (you would be an intern for a second year). Others then serve as a GMO. It is important to know what the expectation is of your particular specialty and service. In some of the more competitive specialties (competitive specialties are different depending on the service), applicants do a transitional year, serve as a GMO, then reapply in their desired specialty. The upside of doing this is that additional time-in service will give you more points when the board meets for residency selection.
For the Navy, GMO tours are much more common. Many people do GMO tours after intern year REGARDLESS OF WHAT YOU MATCH INTO. All Navy interns must reapply for PGY-2 spots. Depending on your specialty, available spots, and number of GMO’s returning from the fleet, you will either match into your residency or an operational tour (GMO, dive, or flight).
A Word about Competitive Residencies
All of the military branches vary by what is competitive and every year is very different with regards to what is a competitive specialty. This is because the pool of applicants is much smaller and thus is subject to more swings in popular sentiment.
Traditionally in the military the competitive specialties are: orthopedics, EM, general surgery and surgical specialties; but these even vary depending on the year.
- Register for Step II of the USMLE. Generally all of the services require Step II CK (the written portion) to be taken and scores available by September or October; make sure to check on this deadline!
- It is also advisable that you register and schedule Step II CS (the standardized patient portion) early because it fills very quickly, especially the Philadelphia site.
- Start arranging for your ADTs during this time, if not earlier! It is sometimes a tedious process so getting it done early is important. You don’t necessarily have to rotate in the specialty you want, you just need to be seen!
- Work on your CV and personal statement.
- Get your professional photos done -- one in uniform (if you don't have one from ODS/BOLC/COT) and one in civilian attire. OSA will give you more info about how to do this.
- This is also the time frame that the Air Force releases its available residency list, showing how many positions are available for each specialty in each location.
- Start requesting LORs, the earlier you get this done the better off you will be!
- Meet with a member of OSA to discuss your MSPE. Doing this early is important given that you will most likely be away for ADTs later in the summer. You should have at least a rough draft of your CV and personal statement for this meeting.
- It is also important that if you have an ADT scheduled for August, September and possibly October to give OSA a heads up that it is crucial to getting your evaluation into your MSPE quickly.
- Fine-tune your personal statement and CV, make plenty of copies and keep them at hand.
- Start collecting letters of recommendation if you haven’t already done so. Give faculty at least 3 to 4 weeks to complete your letter. These LOR’s need be uploaded by the letter writers. There is a sheet that you must print out from ERAS to give to faculty writing letters. Make sure you print this out and give it to them when you request the letter. Many suggest hand-delivering the LORs to ensure prompt uploading to ERAS.
- OSA will upload letters to MODS for you. Have your letter writers send letters on your behalf to Aline Dzaringa in OSA.
- Try to complete your ERAS application by the end of August/beginning of September.
- Complete your ERAS application if you haven’t done so already.
- Ensure that your letter writers have been uploading your letters into ERAS/MODS and if you have done an ADT make sure they get your evaluation and let them know that you would like it to appear in your MSPE.
- The AF written application is due at this time, along with the previously.
- Watch for dates on any forms you receive and make sure you get them in on time--- rank list, etc.
- Review your MSPE and transcripts to make sure all are correct.
- Final rank lists are due sometime in mid to end of October. Relax, have fun, and do your best on rotations.
Match results will be posted on MODS in mid-December. YAY! Enjoy a stress-free end of your 4th year!
For more information please contact:
Last Revision: March 8, 2018