Background Females and underrepresented in medicine (URiM) individuals currently comprise 50.5% and 23.8% of all medical student matriculates in the United States, respectively. However, orthopaedics remains the least diverse specialty with 18.3% female and 17.3% URiM residents. There has been an increasing amount of effort to increase diversity, equity, and inclusion (DEI) and remedy these representation gaps, however there remains a gap in the literature regarding the effectiveness of DEI initiatives at the medical student level and their impact on the future diversity of the orthopedic workforce. Thus, the purpose of this systematic review was to analyze the progress and current state of DEI efforts within orthopaedics at the medical student level. Methods A systematic review of the English literature was performed according to PRISMA guidelines using the following databases: PubMed, Web of Science, Embase, Scopus, Crochane from inception to October 20, 2023 using a combination of search terms. Eligible full text articles reported on various domains of DEI at the medical student level in the United States such as demographics, initiatives, and perspectives. Results A total of 3184 studies were screened and subsequently, 26 full-text articles met inclusion criteria. Eight articles discussed trends in diversity demographics within interest, application, and match with orthopaedics (30.8%), 10 articles discussed initiatives detailing methods and results of how to increase DEI in orthopaedics (38.4%), and 8 articles discussed perspectives on where to focus future outreach endeavors (30.8%). Conclusion Efforts to enhance female and URiM representation amongst orthopeadic residency programs at the medical student level have greatly improved over the past 15 years. Evidence shows a strong correlation between both the presence of underrepresented populations in faculty and resident positions as well as the implementation of outreach programs in influencing medical students' application into orthopeadic residency. A large majority of initiatives created for medical students stemmed from outside organizations as opposed to individual residency programs. Future studies should quantify the impact of local initiatives and national organizations on medical students and aim to better understand additional barriers into entrance of residency programs.