Achieving educational excellence: a strategic initiative to enhance orthopedic resident academic performance

Education Improves Musculoskeletal Radiology Interpretation by Trainees in a Low-Resource Setting

OBJECTIVE

The aims of this study were to assess baseline musculoskeletal radiology knowledge among Haitian orthopedists and to determine the impact of an adult and pediatric musculoskeletal radiology lecture series.

DESIGN

Participants were given lectures reviewing normal and abnormal elbow radiographs and received assessments before and after the intervention. Bivariate and multivariate analyses were used to identify factors associated with baseline and postintervention scores.

SETTING

This study was carried out as part of the 2018 Haitian Annual Assembly of Orthopaedic Trauma. This is an annual continuing medical educational conference in the capital city of Port-au-Prince open to all Haitian orthopedic surgeons and associated care providers, with a strong focus on resident training.

PARTICIPANTS

Haitian orthopedic surgery residents and surgeons attending the 2018 Haitian Annual Assembly of Orthopaedic Trauma.

RESULTS

Thirty-seven residents and faculty consented to participate in this study and 32 (86.5%) were male with a median age of 33 (interquartile rage: 30-35). On multivariate analysis controlling for the title (resident versus attending), total years of orthopedics (beginning of residency and beyond), and formal radiology teaching in medical school or residency, conference attendance in the past was significantly associated with higher preintervention assessment scores (odds ratio = 1.24, 95% confidence interval = 1.06-1.44, p = 0.010]. The mean total preintervention accuracy for correctly identification of pathology, if present, was 70% compared to 83% at the postassessment (p < 0.001).

CONCLUSIONS

Overall, this study demonstrates that a brief lecture series at a continuing medical conference in Port-au-Prince, Haiti improved upper extremity radiographic interpretation based on pre and postassessments, and that prior conference attendance may be associated with higher baseline scores.

Design and implementation of the 2012 Canadian shoulder course for senior orthopedic residents

BACKGROUND

The objective of the present paper is to analyze the first edition of a comprehensive shoulder course for senior orthopedic surgery residents and the chosen evaluation tools.

HYPOTHESIS

A course focusing on shoulder surgery, requested by graduating residents in orthopedic surgery, will have a strong level of satisfaction and help improve skills, knowledge, and problem solving abilities in this domain as measured by a pre and post-test.

MATERIAL AND METHODS

A two-day course was created with practical sessions, lectures, and case studies. Participants were given a multiple choice pre and post course test and evaluation questionnaires after each session.

RESULTS

Sixty residents attended the course. Nine of the fifteen sessions scored above the 90% satisfaction cut-off; none of the sessions scored below 80%. However, only one question showed a statistically significant improvement after the course.

DISCUSSION

Response to this course was overwhelmingly positive and the sessions received positive evaluations. However, the method to evaluate residents was not adequate; residents reported learning on their freeform evaluations but this was not represented on the multiple choice evaluation method. Evaluation tools and course duration will be modified in future iterations to improve assessment and teaching.

LEVEL OF EVIDENCE

IV.

STUDY DESIGN

Observational.

Prevalence of answers to orthopaedic in-training examination questions in 3 commonly used orthopedic review sources

One of the greatest predictors for resident success on the Orthopaedic In-Training Examination (OITE) is reviewing previous OITE questions. However, no studies have examined which review sources contain the most answers to previously asked OITE questions. The goal of this study was to determine which review source contains the most answers to previously asked OITE questions. Each question from the 2006 to 2010 OITEs was examined. The questions were placed into 1 of 13 categories based on their topic. The publication date of the recommended readings associated with each question was recorded. The answer to each question was then searched for in 3 commonly used review sources: Miller's Review of Orthopaedics, 5th edition (MRO), American Academy of Orthopaedic Surgeons Comprehensive Orthopaedic Review (COR), and www.orthobullets.com (OB). Searchable electronic versions of each textbook were used, and each question had a 12-minute time limit. Of 1358 questions, 665 (49%) were found in all 3 sources. Significantly more answers were found on OB (99.4%) compared with MRO (60%) and COR (62%) (P<.0001). Significantly more answers to questions in each question category were found on OB compared with MRO or COR (P<.0001). More than 50% of all recommended readings for OITE questions were published within 5 years of the OITE. Residents using OB to review for the OITE will be exposed to significantly more answers of previously asked OITE questions than residents using MRO or COR (P<.0001).

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.