Resident selection: are we putting the cart before the horse?

The selection of orthopaedic residents is a formidable task. We must put the horse, namely, the consideration of certain societal goals and responsibilities, before the cart, namely, the selection criteria and processes themselves. The recommendation is that the outcomes of our training programs produce, in addition to excellent clinical orthopaedists, some graduates with competence and talent in contribution to diversity, culturally competent care, assistance with elimination of healthcare disparities, skills in research, talent in leadership, skills in administration, and abilities in education. Once specific outcome goals are identified, efforts can be directed to learning to recognize and evaluate the potentials and success foreshadowing characteristics of applicants that predict, or are associated with, the desired outcome competencies. Traditional screening and selection of applicants based largely on grades, test scores, and election to Alpha Omega Alpha honorary society have certain historically based biases and limitations. The historic ethnocentric impacts on Western medical culture are profound, long-standing, and thoroughly interwoven into the fabric of our profession. It is necessary to substantially change our residency selection if we are to achieve some highly significant humanitarian and pragmatic societal goals.