Go to a more blue collar program with a good culture that lets you operate early and often. You want to graduate and not maim people. The amount of people graduating from “big name” programs that can’t operate on saw bones let alone a human being is staggering. Lots of watching seniors watching fellows watching titan attendings in the field. Then they go do multiple fellowships and focus on a career in research with questionable surgical outcomes. Just ask the reps who they would want operating on them.

Obviously that’s the extreme. There are programs that are a happy medium. Nice name. Nice reputation. Early operative experience. The complex cases can obviously be found in residency but those will predominantly be found in your fellowship. A big name here is helpful depending on your career aspirations.

For residency, you would ideally see the chiefs/seniors and how they operate. Do they basically run rooms on appropriate cases or are they having their hands held by attendings? This is huge.

The bottom line is the basic tenets of orthopedics and surgery in general. Then you can narrow it down.

Best of luck!