Orthopaedic In-Training Examination Research Articles

Analysis of the Basic Science Section of the Orthopaedic In-Training Examination

Since 1963, the Orthopaedic In-Training Examination (OITE) has been administered to orthopedic residents to assess residents' knowledge and measure the quality of teaching within individual programs. The OITE currently consists of 275 questions divided among 12 domains. This study analyzed all OITE basic science questions between 2006 and 2010. The following data were recorded: number of questions, question taxonomy, category of question, type of imaging modality, and recommended journal and book references. Between 2006 and 2010, the basic science section constituted 12.2% of the OITE. The assessment of taxonomy classification showed that recall-type questions were the most common, at 81.4%. Imaging modalities typically involved questions on radiographs and constituted 6.2% of the OITE basic science section. The majority of questions were basic science questions (eg, genetics, cell replication, and bone metabolism), with an average of 26.4 questions per year. The Journal of Bone & Joint Surgery (American Volume) and the American Academy of Orthopaedic Surgeons' Orthopaedic Basic Science were the most commonly and consistently cited journal and review book, respectively. This study provides the first review of the question content and recommended references of the OITE basic science section. This information will provide orthopedic trainees, orthopedic residency programs, and the American Academy of Orthopaedic Surgeons Evaluation Committee valuable information related to improving residents' knowledge and performance and optimizing basic science educational curricula.

Use of an Integrated, Anatomic-Based, Orthopaedic Resident Education Curriculum: A 5-Year Retrospective Review of Its Impact on Orthopaedic In-Training Examination Scores

Experts have called for a comprehensive didactic curriculum in orthopaedic residency training. This study examined the effects of an anatomic-based, integrated conference program on annual Orthopaedic In-Training Examination (OITE) scores at a single orthopaedic residency program. We implemented a new, integrated, anatomic-based curriculum in January 2005. Differences between scores were analyzed by postgraduate year (PGY) of training. OITE scores (percentile ranking and raw scores) of year 1 (PGY-2) through year 4 (PGY-5) residents exposed to the curriculum (2005-2009) were compared to prior PGY-2 through PGY-5 residents (2000-2004) who had experienced the previous unstructured curriculum. To evaluate for cohort effects, United States Medical Licensing Examination (USMLE) Step I scores for these 2 groups were also compared. Eight residents were exposed to the new conference program and 8 to the prior conference program. All residents' percentile rankings improved after exposure to the curriculum, although improvement was not statistically significant for all participants. The most dramatic improvements in OITE scores were seen for PGY-4 and PGY-5 residents, which improved from 65th to 91st percentile (P = .03) and from 66th to 91st percentile (P = .06), respectively. There were no differences between the cohorts in USMLE Step I scores. Initiation of an integrated, anatomic-based, resident conference program had a positive impact on resident performance on the OITE.

Foot and Ankle Questions on the Orthopaedic In-Training Examination: Analysis of Content, Reference, and Performance

The purpose of this study was to provide a comprehensive analysis of the Orthopaedic In-Training Examination's (OITE's) questions, question sources, and resident performance over the course of residency training.The authors analyzed all OITE questions pertaining to foot and ankle surgery between 2006 and 2010. Recorded data included the topic and area tested, imaging modality used, tested treatment method, taxonomic classification, cited references, and resident performance scores. Foot- and ankle-related questions made up 13.9% (186/1341) of the OITE questions. Thirteen general topic areas were identified, with the most common being foot and ankle trauma, the pediatric foot, and foot and ankle deformity. Imaging modalities were tested in approximately half of the questions. Knowledge of treatment modalities was required in 58.1% (108/186) of the questions. Recall-type questions were the most common. Trends existed in the recommended references, with 2 journals and 1 textbook being commonly and consistently cited: Foot and Ankle International, The Journal of Bone and Joint Surgery American Volume, and Surgery of the Foot and Ankle, respectively. Resident performance scores increased with each successive level of training.An understanding of the topics and resources used for OITE foot and ankle questions is an important aid in creating or improving residency programs' foot and ankle education curricula. With knowledge of question content, source, and resident performance, education can be optimized toward efficient learning and improved scores on this section of the examination.

Orthopedic Surgery Postgraduate Year 1 Intern Curriculum Improves Initial Orthopedic In-Training Examination Performance

To determine the efficacy of an educational curriculum designed for orthopedic surgery postgraduate year 1 (PGY-1) interns to improve initial Orthopedic In-Training Examination (OITE) performance. A retrospective cohort study was performed that evaluated the PGY-1 intern OITE performance of one residency training program (n = 55) during 7-year periods before (1996-2002) and after structured curriculum implementation (2003-2009). Linear regression analysis revealed insignificant changes in median PGY-1 intern OITE percentile rank during the precurriculum period (R = 0.08, P = 0.53). Postcurriculum period comparisons revealed significantly improving PGY-1 intern OITE percentile rank (R = 0.46, P = 0.048). Pre- and postcurriculum median US Medical Licensing Examination (USMLE) Step I scores did not display statistically significant differences (218.2 ± 6.6 vs 229.1 ± 13.8, Mann-Whitney U test, z = -1.5, P = 0.10). Spearman rho correlations revealed a moderate relation (r = 0.61) between postcurriculum PGY-1 intern OITE percentile rank and USMLE Step I score, but not during the precurriculum period. A moderate relation (r = 0.50) also was observed between postcurriculum USMLE Step I score and average OITE percentile rank during the 5-year residency program, but not during the precurriculum period. PGY-1 intern OITE percentile rank improved significantly with the addition of a specially designed educational curriculum. The stronger USMLE Step I score and PGY-1 intern OITE percentile rank relation observed during the postcurriculum period suggests that interns who participated in the educational curriculum were better prepared to translate general medical and patient care knowledge into orthopedic surgery knowledge.

Assessment of Musculoskeletal Physical Examination Skills and Attitudes of Orthopaedic Residents

Although the musculoskeletal physical examination is an essential part of patient encounters, we believe that it is underemphasized in residency education and that residents' physical examination skills may be lacking. We sought to assess attitudes regarding teaching of the physical examination in orthopaedic residencies, to assess physical examination knowledge and skills among residents, and to develop a method to track the skill level of residents in order to improve our physical examination curriculum. We created a thirty-question multiple-choice musculoskeletal physical examination test and administered it to our residents. We created a five-question survey assessing attitudes toward physical examination teaching in orthopaedic residencies and distributed it to U.S. orthopaedic department chairs We developed an Objective Structured Clinical Examination (OSCE), in which standardized patients enact four clinical scenarios, to observe and assess physical examination skills. The mean score on the multiple-choice physical examination test was 76% despite the fact that our residents consistently scored above 90% on the Orthopaedic In-Training Examination. Department chairs and residents agreed that, although learning to perform the physical examination is important, there is not enough time in the clinical setting to observe and critique a resident's patient examination. The overall score of our residents on the OSCE was 66%. We have exposed a deficiency in the physical examination knowledge and skills of our residents. Although the musculoskeletal physical examination is a vital practice component, our data indicate that it is likely underemphasized in training. Clinic time alone is likely insufficient for the teaching and learning of the musculoskeletal physical examination.

An Analysis of the Orthopaedic In-Training Examination Rehabilitation Section

One subject tested by the Orthopaedic In-Training Examination (OITE) is rehabilitation. Our purpose was to analyze the OITE's rehabilitation section to (1) identify the rehabilitation subjects that are tested, (2) evaluate trainee performance on this section, and (3) evaluate the literature cited for this section as an aide to the trainee preparation for future OITE examinations. This study included OITE examinations from 2004 through 2009. The rehabilitation sections of these examinations were analyzed for content, type of questions asked (taxonomy 1: direct recall; taxonomy 2: diagnosis; taxonomy 3: evaluation/decision making and development of a treatment plan), and literature cited. The mean score in the rehabilitation section of the OITE from 2004 to 2009 was also evaluated, and literature citations were tabulated. Orthopaedic surgery residency. In the 2004-2009 OITE examinations, a total of 1619 questions were administered, of which 53 (3.3%) related to rehabilitation. The most common rehabilitation questions assessed knowledge of prosthetic/orthotics (20.8%) and neuro-orthopedics (20.8%). Other questions addressed amputation (18.9%), physical therapy treatment and outcomes (18.9%), rehabilitation terminology (9.4%), and spinal cord injury (7.7%). Most frequently, the questions evaluated the trainee's direct recall of the subject (51%), evaluation/decision making and development of a treatment plan (30.1%), and diagnosis (18.9%). The mean score in the rehabilitation section of the OITE from 2004 through 2009 was 54.1% (range, 40% to 77.8%). A total of 53 references was used. The 3 most common references were the Journal of Bone and Joint Surgery-American Volume (10), Orthopaedic Knowledge Update (volumes 7 through 9) (8), and Clinical Orthopaedics and Related Research (7). To our knowledge, our study is the first to analyze the rehabilitation section of the OITE. Our results will help the trainee prepare for the examination by focusing on the appropriate content and literature.

An Analysis of the Hip and Knee Reconstruction Section of the Orthopaedic In-Training Examination

This article analyzes the hip and knee reconstruction section of the Orthopaedic In-Training Examination (OITE). All of the hip and knee reconstruction questions from 2005 to 2009 were analyzed, and the following data were recorded: number of questions per year in the hip and knee section, total number of questions on the OITE per year, national average score by year in training, references cited, taxonomy classification of each question, topics that were tested, imaging modalities used for a given question, and treatment modalities tested. Eight percent to 9% of the questions on the OITE each year were hip and knee reconstruction-related questions. Performance improved with each year in training, but not by a statistically significant amount. The most commonly tested topics over the past 5 years were anatomy and physiology, ligament and/or gap balancing during total knee arthroplasty (TKA), surgical approaches, properties of polyethylene, periprosthetic fractures about an arthroplasty, and questions dealing with the mechanical properties of implants. In 4 out of 5 years, the majority of questions were classified as Taxonomy 1 (knowledge and recall). The bulk of the questions each year did not require the examinee to interpret a radiograph or make a treatment decision. The most common references cited were from Journal of Bone and Joint Surgery (American), followed by the Journal of Arthroplasty. This detailed analysis of the hip and knee reconstruction section of the OITE should improve resident performance, and may serve as a study tool for the OITE.

Analysis of the Orthopedic In-Training Examination (OITE) Musculoskeletal Trauma Questions

Residency program directors are responsible for providing assessment and feedback about resident performance and for developing a comprehensive resident curriculum in orthopedic surgery. One measure of resident knowledge is the Orthopedic In-Training Examination (OITE). Scores of the OITE examination have been found to correlate with the American Board of Orthopedic Surgery Part 1 Certifying Examination. The purpose of this study was to identify commonly tested orthopedic trauma topics, the taxonomic distribution of questions, and literature references in the OITE to aid curriculum development and individual test preparation. The musculoskeletal trauma-related questions on the OITE during a 5-year period (2004-2008) were reviewed, and the number of questions, topics, taxonomic classification, and educational references associated with each question were analyzed. Nearly 30% of questions each year consist of musculoskeletal trauma-related topics. Femur, tibia, and hip fractures were the most commonly tested topics. The majority (65.6%) of musculoskeletal trauma questions tested recall of specific facts. Examiners referenced primary literature sources (74.9%) more than textbooks (25.1%). The Journal of Bone and Joint Surgery (American) and the Journal of Orthopaedic Trauma were cited most, accounting for 44.3% of all journal references. Forty-seven percent of the primary references were published within 5 years of the test administration. One method for assessing orthopedic knowledge is the OITE examination. Longitudinal analysis of trauma-related questions shows a consistent pattern of both topics and primary literature citation. This information may be used to help guide structured review for future OITE examinations and develop an orthopedic trauma curriculum for a residency program.

Analysis of the Trauma Section of the Orthopaedic In-Training Examination

The Orthopaedic In-Training Examination is a comprehensive test produced annually by the American Academy of Orthopaedic Surgeons, and was first administered in 1963. At the time of the examination's conception, its objectives were to: (1) measure the knowledge of orthopedic residents and provide objective comparisons; (2) help determine acceptable minimal standards for trainees; and (3) help provide an objective assessment of orthopedic education. We retrospectively reviewed all Orthopaedic In-Training Examinations from 2004 to 2008, with particular focus on the questions listed in the musculoskeletal trauma domain on each year's program director report. The musculoskeletal trauma domain, including topics, recommended answers, and references, was reviewed to provide an educational resource for residents and residency programs when studying or designing educational curricula. The information in this analysis may help in development of a core musculoskeletal trauma knowledge base or facilitate determination of appropriate journal club and didactic lecture content.

Evaluation of Shoulder and Elbow Questions on the Orthopaedic In-Training Examination as an Instrument for Enhancing Examination Preparation

The Orthopaedic In-Training Examination (OITE), produced by the American Academy of Orthopaedic Surgeons (AAOS), is administered yearly to orthopaedic residents across the United States. First administered in 1963, the OITE is the oldest existing examination of its kind created for specialty training. This examination serves multiple purposes. As initially set forth by the AAOS, the examination serves to (1) allow residents to assess their level of orthopaedic knowledge on the basis of a national average, (2) set minimal standards for orthopaedic residents, and (3) quantify the quality of education at various orthopaedic programs1. The OITE has served not only as an annual evaluation of orthopaedic resident training in the U.S., but also as a learning tool for residents, as they are subsequently given the preferred answers to questions and pertinent citations after examination scores are tallied. We analyzed the shoulder and elbow content of the OITE to assist trainees and residency training program directors in preparing for the OITE and, ultimately, the American Board of Orthopaedic Surgery (ABOS) examination. Research has shown OITE scores to be a predictor of success on the ABOS examination, and effective preparation for the OITE may serve trainees well in preparing for the examination at the culmination of their residency training2. Many residency training programs have formal OITE preparatory curricula, and the analysis and classification undertaken in this study can guide the creation and organization of a syllabus for this purpose. Preparing for the OITE can be an opportunity to focus on the highly tested topics in orthopaedics. Identification of commonly tested concepts may also help improve the efficiency of resident preparation by directing a methodical approach to a large volume of information. It is important to remember that the OITE has never been validated to measure the overall quality of …

An Analysis of the Musculoskeletal Trauma Section of the Orthopaedic In-Training Examination (OITE)

Since 1963, the Orthopaedic In-Training Examination (OITE) has been used to assess the knowledge of orthopaedic surgery residents1,2. Written and administered by the American Academy of Orthopaedic Surgeons (AAOS), the OITE is composed of approximately 275 questions that test residents’ knowledge in twelve categories: foot and ankle, hand, orthopaedic science, hip and knee reconstruction, orthopaedic diseases, spine, pediatric orthopaedics, medical-related issues, sports medicine, musculoskeletal trauma, rehabilitation, and shoulder and elbow. Although the OITE was initially intended to measure an individual resident's knowledge against a national standard1,2, recent studies have shown that scores on the OITE correlate with passing scores on the American Board of Orthopaedic Surgery (ABOS) Part-I written examination, which is taken at the completion of residency3,4. Prior to 2008, however, there were no analyses of the questions on the OITE. It seemed logical that an in-depth analysis of the test questions on the OITE would be a step toward improving OITE scores and, on the basis of the correlation between the OITE and the ABOS examination, might result in higher passing rates on the ABOS certifying examination as well. Analyses of the foot and ankle, pathology, sports, and hand sections of the OITE have previously been published, beginning in 20085-8. To our knowledge, however, there have been no publications related to the musculoskeletal trauma section. Using prior publications as an established model5-8, we focused on the musculoskeletal trauma questions on OITEs that were administered from the years 2005 to 2009 and attempted to provide a detailed analysis of these questions by analyzing the national performance data of residents at all levels of training, beginning with postgraduate year (PGY)-2 (completion of one year in training [YIT-1]), the references cited …

Review of the Current Literature as a Preparatory Tool for the Trauma Content of the Orthopaedic In-Training Examination

Currently, the only standardized evaluation of trauma knowledge throughout orthopedic training is found in the Orthopaedic In-Training Examination, which is administered annually to all residents by the American Academy of Orthopaedic Surgeons. Our goals were to assess the Orthopaedic In-Training Examination to (1) determine the content of the trauma questions, (2) identify the content of the 3 most frequently referenced journals on the answer keys, and (3) evaluate the correlation between those contents.We reviewed the trauma-related Orthopaedic In-Training Examination questions and answer keys for 2002 through 2007. Content for test questions and cited literature was assessed with the same criteria: (1) category type, (2) anatomic location, (3) orthopedic focus, and (4) treatment type. For each of the 3 most frequently referenced journals, we weighted content by dividing the number of times it was referenced by the number of its trauma-related articles. We then compared the journal data individually and collectively to the data from the Orthopaedic In-Training Examination trauma questions. A chi-square analysis with Yates correction was used to determine differences. Questions and literature were similar in the most frequently addressed items in each of the 4 areas: category type (taxonomy 3, treatment), 52.4% and 60.7%, respectively; anatomic location (femur), 23.3% and 27.7%, respectively; orthopedic focus (fracture), 51.0% and 56.5%, respectively; and treatment type (multiple/nonspecific), 39.0% and 35.4%, respectively.The content correlation found between the questions and literature supports the idea that reviewing current literature may help prepare for the trauma content on the Orthopaedic In-Training Examination.

Analysis of the Musculoskeletal Trauma Section of the Orthopaedic In-Training Examination (OITE)

To analyze the musculoskeletal trauma content domain of the Orthopaedic In-Training Examination (OITE) over a 5-year period (2005-2009) to better understand the question content and distribution of references cited. The questions, answers, and recommended readings from the musculoskeletal trauma portion (as defined by the American Academy of Orthopaedic Surgeons) of the OITE were reviewed from the five examinations. The total number of questions, presence/modality of images, topics covered, taxonomic classification, and references listed were compiled and analyzed. Two hundred fifty-four of 1351 questions (18.8%) were included in the musculoskeletal trauma domain. Imaging modalities were included with 28% of questions with plain radiographs alone being most common (83%). Fifty-six percent of the questions required the test taker to recall facts directly from the orthopaedic literature (taxonomy 1). The remaining 44% involved the interpretation of data, making a diagnosis, or formulating a treatment plan (taxonomies 2 and 3). No taxonomy 1 question was accompanied by a medical image. Upper extremity injuries were included in 25%, pelvis and acetabulum in 15%, and the lower extremity in 60% of the questions. The Journal of Orthopaedic Trauma was the most frequently cited reference source (24.1%) followed by the Journal of Bone and Joint Surgery, American Volume (20.8%). The musculoskeletal trauma section of the OITE remains the largest of the 12 content domains. Questions with associated images require a higher cognitive taxonomy. The Journal of Orthopaedic Trauma was the most cited reference. This analysis may help test question writers, future test takers, and faculty involved with resident education to better understand and prepare for this portion of the OITE.

Achieving Educational Excellence: A Strategic Initiative to Enhance Orthopedic Resident Academic Performance

Orthopedic resident training involves not only the hands-on learning of surgery but also should equally involve instructing the core knowledge of musculoskeletal medicine. Our program has developed a strategy that enhances resident educational performance; the educational curriculum entails conferences daily. Conferences include gross and surgical anatomy, orthopedic basic science, multidisciplinary trauma, radiology, pathology, journal club, and orthopedic subspecialty conferences. The primary purpose of the conference schedule is to provide the residents with a comprehensive education in orthopedic surgery. It is not geared toward taking the Orthopaedic In-Training Examination (OITE). The OITE is administered annually by the American Academy of Orthopaedic Surgeons (AAOS) and serves as an objective measure of knowledge acquisition. There has been a scientifically validated correlation between performance on the OITE and passage of the American Board for Orthopaedic Surgery Part I Examination. As a collective program, we have achieved at or above the 98th percentile nationally from 2004 to 2009. This academic success has not impacted the total surgical case volume negatively or interfered with Residency Review Committee (RRC) policies.

Success in Orthopaedic Training: Resident Selection and Predictors of Quality Performance

Multiple studies have attempted to determine which attributes are predictive of success during residency as well as the optimal method of selecting residents who possess these attributes. Factors that are consistently ranked as being important in the selection of candidates into orthopaedic residency programs include performance during orthopaedic rotation, United States Medical Licensing Examination (USMLE) Step 1 score, Alpha Omega Alpha Honor Medical Society membership, medical school class rank, interview performance, and letters of recommendation. No consensus exists regarding the best predictors of resident success, but trends do exist. High USMLE Step 1 scores have been shown to correlate with high Orthopaedic In-Training Examination scores and improved surgical skill ratings during residency, whereas higher numbers of medical school clinical honors grades have been correlated to higher overall resident performance, higher residency interpersonal skills grading, higher resident knowledge grading, and higher surgical skills evaluations. Successful resident performance can be measured by evaluating psychomotor abilities, cognitive skills, and affective domain.

Orthopaedic In-Training Examination: An Analysis of the Sports Medicine Section

Orthopaedic In-Training Examination: An Analysis of the Sports Medicine Section

Orthopaedic In-Training Examination

Background: Since 1963, the Orthopaedic In-Training Examination (OITE) has been administered to orthopaedic residents to assess resident knowledge and measure the quality of teaching within individual programs. The OITE has evolved dramatically over the years and now maintains a standardized format consisting of 275 questions divided among 12 sections. Purpose: To provide a detailed analysis of the OITE sports medicine section to identify patterns in question content, recommended references, and resident performance. Study Design: Cross-sectional study. Methods: All OITE sports medicine questions from 2005 to 2009 were analyzed, and the following data were recorded: resident performance scores, tested topics, type of imaging modalities, tested treatment modalities, taxonomy classification, and recommended references. Results: From 2005 to 2009, the sports medicine section composed 7.8% of the OITE. Mean resident performance on the entire OITE as well as on the sports medicine section improved during each year of training. Imaging modalities typically involved questions on radiographs and magnetic resonance imaging and constituted 27.4% of the OITE sports medicine section. Treatment modalities involved 36.8% of the OITE sports medicine section questions, including most treatment questions relating to ligament reconstruction or rehabilitation. The authors’ assessment of taxonomy classification showed that recall-type questions were most common; however, mean resident performance was minimally affected by type of taxonomy question. Finally, there were trends noted in recommended references; namely, the American Journal of Sports Medicine and Orthopaedic Knowledge Update Sports Medicine were the most commonly and consistently cited journal and review book, respectively. Conclusion: The current study provides some unique information relating to content, recommended references, and resident performance on the OITE sports medicine section. It is hoped this information will provide orthopaedic trainees, orthopaedic residency programs, and the American Academy of Orthopaedic Surgeons Evaluation Committee valuable information relating to improving resident knowledge and performance and optimizing sports medicine educational curricula.

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

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 …

Does a Trauma Course Improve Resident Performance on the Trauma Domain of the OITE?

Lecture-based courses are common in orthopaedic surgery; however, their effectiveness in improving medical knowledge has not been widely assessed. The Orthopaedic Trauma Association conducts a resident trauma course that occurs four to six weeks prior to the Orthopaedic In-Training Examination (OITE). The purposes of this study were to determine whether residents who had taken this course performed better on the trauma domain of the OITE and to compare the effect of the course with the effect of a focused rotation in orthopaedic trauma. The percentile scores on the trauma domain of the OITE for forty-seven residents in postgraduate year (PGY) 2 were reviewed. Twenty-nine residents who took a trauma course within six weeks before the OITE were compared with eighteen residents who took the course after the OITE. As a secondary analysis, the effect of a trauma rotation for the same PGY-2 residents before and after the OITE was also assessed. Baseline orthopaedic knowledge was assessed with use of the overall OITE percentage scores. The trauma domain scores were not significantly better among the residents who took the course (mean and standard deviation, 62.2 ± 9.9) compared with those who had not taken it (mean, 59.2 ± 6.2) (p = 0.2). A significant difference (p = 0.04) was found for a trauma rotation, with the residents who had a trauma rotation scoring better (mean, 64.5 ± 6.8) than the residents who had not (mean, 58.8 ± 8.9). The subgroup of residents who had both a course and a trauma rotation before the test scored significantly better (p = 0.01) than the subgroup that had neither of these experiences before the test (mean, 65.6 ± 8.0 and 56.9 ± 6.4, respectively). An orthopaedic trauma course alone does not enhance an orthopaedic resident's trauma medical knowledge as assessed on a standardized test. However, a trauma rotation before, and in particular the combination of both a course and a trauma rotation, can improve trauma test scores.

An Electronic Orthopaedic In-Training Examination

Following nearly 1 year of development, trials, surveys, and educational programs, in November 2009, the orthopaedic in-training examination (OITE) was successfully converted from the traditional print format and administered by DVD-ROM on local computers to more than 4,300 residents in 20 countries. A resident survey indicated a high level of satisfaction with the new examination. Questions with video and multislice image formats, presented as trial questions, performed well. Future versions of the OITE on DVD-ROM will eliminate some of the few difficulties experienced in 2009. The new electronic format offers excellent possibilities for improved imaging, the development of new and innovative questions, and an enhanced ability to approximate the practice environment-all of which can result in a better assessment of orthopaedic medical knowledge and an improved educational experience.