Immersion Education for Orthopaedic Pathology: A Review of the Orthopaedic In-Training Examination and American Board of Orthopaedic Surgery Certification

Abstract

Residency programs have the task of training future orthopaedic surgeons and providing them with a solid knowledge base. This knowledge base, which ultimately guides the surgeon in decision-making and patient care, also figures prominently in how the resident performs on the Orthopaedic In-Training Examination and the American Board of Orthopaedic Surgery certification examination. The purposes of the Orthopaedic In-Training Examination, which was first administered in 1963, are to measure resident knowledge against a national standard, determine minimal standards for trainees, and measure the quality of teaching at the different residency programs1. Studies have correlated performance on the Orthopaedic In-Training Examination with performance on Part I of the American Board of Orthopaedic Surgery examination2,3. Residents with average scores in the 27th percentile or lower on the Orthopaedic In-Training Examination during postgraduate years two through five have a 57% chance of failing Part I of the American Board of Orthopaedic Surgery examination2. Investigators have analyzed the Orthopaedic In-Training Examination with regard to the various subspecialties and orthopaedic topics, including orthopaedic pathology4, hand5, sports medicine6, foot and ankle7, and osteonecrosis8. The purpose of these analyses was to determine the topics most likely to be included on the test and thereby facilitate the design of lesson plans and study aids for more focused preparation for the examination. The analysis by Frassica et al.4 of the content, question types, and types of images appearing on the orthopaedic pathology section of the test can be used to develop a curriculum for educating residents. As an example, the most common malignant bone tumors addressed by questions on the Orthopaedic In-Training Examination were metastatic bone lesions, osteosarcomas, and Ewing tumors. Other common benign bone lesions included osteomyelitis, giant cell …