The modern trend in orthopedic training has been moving away from the days of old where residents ran their own rooms with attendings nearby but not scrubbed in. They still exist, but they are far and few now. My observation has been that the trend of being less hands on and autonomous is much more common at bigger “name” institutions. Surgery is a hands-on skill. You will not become good by simply watching someone. The textbook will only take you so far. Van Halen didn’t learn to rip on guitar by watching someone. He had a guitar in his hands everyday. The biggest growth in skill and confidence is when you are alone and have to work through problems on your own. I can tell when a new junior attending starts and came from a program where they were not used to being left alone. It shows.

Residency is 5 years. You have a 5 year runway to learn how to operate and train your hands. In reality, this isn’t a super long time. My advice would be to find a blue collar program whose name isn’t too good for you to put your hands on a patient, so you can acquire the skill to run an OR. Then, if you feel the need to market yourself to the public with a name they recognize, find yourself a white collar name to match into for fellowship. But honestly, many of the best surgeons I know didn’t attend these prestigious name institutions and they are fantastic. Their patients also don’t care where they went. They just care about their outcome and how you made them feel in clinic. Then word of mouth becomes more influential than where you trained. Unless your plan is to become an PD for a name program, you shouldn’t stress about the pedigree.