This study explores the impact of perceived stress on the academic performance of orthopaedic surgery residents in the Philippines. Conducted as a cross-sectional investigation, it involved 126 residents who participated in the 2024 Philippine Board of Orthopaedics In-Service Training Examination (ITE). Stress levels were assessed using the Perceived Stress Scale-10 (PSS-10), while ITE scores served as the measure of academic performance. A significant negative correlation was identified between stress and academic performance (r = -0.3138, p = 0.00010). Residents experiencing high stress achieved lower scores (55.2%) compared to those with low to moderate stress (61.8%). Other demographic variables such as sex, age, marital status and type of training institution (public and private) were not significantly associated with stress level findings. On the other hand, key factors contributing to elevated stress included insufficient sleep (0–4 hours nightly; OR = 5.83, p = 0.0289) and limited awareness of mental health issues (OR = 13.34, p = 0.0014). These results highlight the pressing need for stress reduction initiatives, improved mental health education and strategies to address challenges posed by sleep deprivation and extensive work hours. This study provides a foundation for improving both academic outcomes and overall well-being in residency programs.