Orthopaedic in-training examination performance: a nine-year review of a residency program database

Reverse total shoulder arthroplasty pain and function: new perspectives from a 10-year multicenter study at the 7-year follow-up

BACKGROUND

Reverse total shoulder arthroplasty (RTSA) can decrease shoulder pain and improve function. However, results reportedly deteriorate as patients approach mid-term follow-up and little is known about how this impacts physical health-related quality of life (PHRQOL) and mental health-related quality of life (MHRQOL). The study hypothesis was that shoulder function, pain, and medication use for pain would influence PHRQOL and MHRQOL.

METHODS

This prospective cohort study involving subjects from 6 orthopedic clinics and 12 fellowship-trained surgeons evaluated the influence of RTSA on PHRQOL, MHRQOL, shoulder function, pain, instability, and medication use over the initial 7 years of a 10-year study, and device survivorship and revision rates. Clinical examination, the American Shoulder and Elbow Surgeons (ASES) score, Short Form (SF)-12 PHRQOL and MHRQOL assessments, the single assessment numeric shoulder function evaluation (SANE), visual analog scale (VAS) shoulder pain and instability scores, shoulder pain, medication use for pain, surgery satisfaction, survivorship and revision rate data were collected pre-RTSA, and at 6-week, 6-month, 1-year, 2-year, 3-year, 5-year, and 7-year follow-ups.

RESULTS

Two hundred participants (108 female) of 69 ± 8.3 years of age, with gross rotator cuff deficiency (poor tissue quality or impaired dynamic stability) (n = 92), glenohumeral joint osteoarthritis (n = 88), failed primary total shoulder arthroplasty (n = 8), non-united humeral head fracture (n = 6) or 3-4 section comminuted humeral head fracture (n = 6) underwent pre-RTSA evaluation. Device survivorship was 94%. Friedman two-way ANOVA and Wilcoxon test pairwise comparisons revealed that compared to pre-RTSA, median active shoulder flexion (+ 25°) and external rotation (+ 10°) mobility improved by 6 months (p < 0.0001) and remained improved. Shoulder flexion (+ 1 grade), abduction, external rotation (+ 0.5 grade), and internal rotation strength (+ 1 grade) also improved by 6 months (p < 0.0001) and remained improved. ASES (+ 26.8), SANE (+ 17.5) and VAS pain (- 5.7) scores improved by 6 weeks (p < 0.0001) and remained improved, as medication use for shoulder pain decreased (- 24.6%) (p < 0.0001). SF-12 PHRQOL scores improved by 6 months (+ 11.5) and remained improved (p < 0.0001). Significant Spearman Rho correlations were observed between shoulder function (ASES or SANE) and SF-12 PHRQOL (r ≥ 0.52) and MHRQOL (r ≥ 0.20) scores (p < 0.0001) supporting the relationship between shoulder function and quality of life. Trend analysis revealed changing shoulder function, pain, and PHRQOL relationships between 2 and 3 years, and 5 and 7 years post-RTSA (Chi-Square, p < 0.05).

CONCLUSION

Excellent device survival and good-to-excellent perceived shoulder function, and PHRQOL improvements were observed. Secondary objectives of improved shoulder mobility, strength, pain and instability were also achieved. In contrast to previous reports, subjects did not display shoulder mobility or perceived function deterioration by the 7-year follow-up. Following chronic pain relief at 6 weeks post-RTSA, subjects appear to balance PHRQOL and shoulder pain relationships at the 6-month and 1-year post-RTSA follow-ups. Careful evaluation at this time may help patients with higher pain levels and lower function expectations reverse these trends, or patients with lower pain levels and higher function expectations to optimize RTSA use and longevity.

Outcomes Following Open Reduction Internal Fixation of Ankle Fractures (ORIF) By Podiatric Surgeons

Open reduction internal fixation of closed ankle fractures is a common procedure performed by podiatric surgeons. This is the first study to specifically evaluate complication rates of this procedure among podiatric surgeons using a large patient cohort. The rates of podiatric surgical complications were also compared to the complication rates reported in the orthopedic literature. There was no significant difference between podiatric surgeons and orthopedic surgeons with regards to surgical site infection. However, complication rates, including 1-year postsurgery deep vein thrombosis (DVT), malunion, and unplanned revision surgery within 90-day, were lower in our study, compared to the average rates reported in the orthopedic literature. The authors believe that the most important determinant for post ankle surgical complications is related to surgical volume and experience, rather than professional degree type.

The Educational Impact of a Fellowship-trained Orthopaedic Oncologist

INTRODUCTION

Musculoskeletal oncology is a subspecialty of orthopaedics with few fellowship-training locations. Although orthopaedic oncologists comprise a minority within the field of orthopaedic surgery, most work at academic centers and serve in leadership roles with notable impact on patients and the training of residents. This article investigates the objective impact orthopaedic oncologists have regarding resident operative case volume and performance on in-training examinations.

METHODS

The William Beaumont Army Medical Center and Texas Tech University Health Sciences Center of El Paso combined orthopaedic residency program's case logs and Orthopaedic In-Training Examination (OITE) scores between 2013 and 2018 were reviewed. This provided 3 academic years of data before and after an orthopaedic oncology faculty member arrived in 2016. The case volume and OITE examination performance before and after the addition of the orthopaedic oncology faculty member were compared.

RESULTS

After the addition of an orthopaedic oncology faculty member, a significant increase was observed in the program's OITE overall correctly answered questions (171.30 versus 181.03, P = 0.004) and oncology subsection percentile (56th to the 66th percentile, P = 0.038). An increase was also observed in resident oncology case volume from 29 oncology cases per year to 138 cases on average (P = 0.022).

DISCUSSION

The addition of a fellowship-trained orthopaedic oncologist results in increased exposure to orthopaedic oncology cases and improved resident performance on the OITE. This may correlate to improved American Board of Orthopaedic Surgeons Part I pass rates and improved overall resident satisfaction.

Impact of a weekly reading program on orthopedic surgery residents' in-training examination

In response to a decline in individual residents' performance and overall program performance on the Orthopaedic In-Training Examination (OITE), the authors' department initiated a daily literature reading program coupled with weekly tests on the assigned material. The goal of this study was to assess the effect of the reading program on individual residents' scores and the training program's OITE scores. The reading program consisted of daily review articles from the Journal of the American Academy of Orthopaedic Surgeons, followed by a weekly written examination consisting of multiple-choice or fill-in-the-blank questions. All articles were selected and all questions were written by the departmental chair. A questionnaire was given to assess residents' perceptions of the weekly tests. As a result of implementing the reading program for a 10-month period, residents' subsequent performance on the OITE significantly improved (mean score increase, 4, P<.0001; percentile score increase, 11, P=.0007). The difference in mean score was significant for residents in postgraduate years 3, 4, and 5. A statistically significant correlation was found between weekly test scores and performance on the OITE, with a significant correlation between weekly test scores and OITE percentile ranking. The study results also showed a positive correlation between reading test attendance and weekly test scores. Residents' anonymous questionnaire responses also demonstrated the reading program to be a valuable addition to the residency training curriculum. In conclusion, the study strongly supports the benefits of a weekly reading and examination program in enhancing the core knowledge of orthopedic surgery residents.

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).

Orthopaedic in-training examination: an analysis of the sports medicine section

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.

Do scores of the USMLE Step 1 and OITE correlate with the ABOS Part I certifying examination?: a multicenter study

BACKGROUND

The US Medical Licensing Examination (USMLE) and Orthopaedic In-Training Examination (OITE) are commonly used to select medical students or residents, respectively. Knowing how well these examinations predict performance on the American Board of Orthopaedic Surgery (ABOS) Part I certifying examination is important to provide evaluations for medical students and residents. Previous studies comparing the OITE scores with the ABOS Part 1 scores have been limited to one program.

QUESTIONS/PURPOSES

Therefore, we compared the scores on the USMLE Step 1 and OITE examinations with those on the ABOS Part I certifying examination using data from four ACGME approved residency programs.

METHODS

We reviewed 202 resident files from 1996 to 2008 from four programs in the same geographic region. Of those, 181 (90%) had complete records. De-identified data were used to compare USMLE Step 1 scores, OITE percentile rank scores, and ABOS Part I percentile rank scores. Pearson coefficients and receiver operator curves were calculated to assess the relationships between tests.

RESULTS

We found a correlation of 0.53 between the USMLE Step 1 and ABOS Part I, and an average correlation of 0.50 for postgraduate years (PGY) 2 through 5 OITE scores and ABOS Part I. There was a stepwise increase in correlation from PGY 2 through PGY 5 between the OITE scores and ABOS scores. Those who averaged in the 27th percentile or lower on the OITE had a 57% chance of failing the ABOS Part I examination.

CONCLUSION

USMLE Step 1 scores correlated with ABOS Part I certifying examination scores, and we therefore believe it may be used as one factor in resident selection. Use of the OITE scores in guiding education and feedback appears to be justified.

Relationship among United States Medical Licensing Step I, orthopedic in-training, subjective clinical performance evaluations, and american board of orthopedic surgery examination scores: a 12-year review of an orthopedic surgery residency program

OBJECTIVE

To improve the understanding of relationships among United States Medical Licensing Examination (USMLE Step I), Orthopedic In-Training Examination (OITE), Subjective Clinical Performance Evaluations, and American Board of Orthopedic Surgery Examination Part I (Abos-I) and Part II (Abos-II), which would help residency programs better achieve their educational mission.

DESIGN

A 12-year descriptive study of retrospectively collected data.

SETTING

One residency program with 47 resident participants.

RESULTS

Residents that failed Abos-I and Abos-II had lower program mean OITE year-in-training (YIT) percentile rank scores. The program mean OITE YIT percentile rank score had a moderate relationship with Abos-I (% correct) score (r = 0.68, p < 0.0001) and an insignificant relationship with USMLE Step I (3-digit) score (r = 0.22, p = 0.13). Residents with upper quartile (>or=220) USMLE Step I (3-digit) scores for our program had higher program mean OITE YIT percentile rank scores and Abos-I (% correct) scores than residents with lower quartile scores (<or=202). Residents who scored in the upper quartile (>or=55) for the program mean OITE YIT percentile rank score had higher Abos-I (% correct) scores than residents who did not. Residents who scored in the lower quartile for the third postgraduate year (PGY-3) program OITE YIT percentile rank score or for the program mean OITE YIT percentile rank score had a 5.2 and 5.8 time greater Abos-I failure risk, respectively. The program PGY-3 OITE YIT percentile rank score was the strongest Abos-I (% correct) score discriminator. Resident Abos-I (% correct), program mean OITE YIT, and program PGY-3 OITE YIT percentile rank scores were the strongest discriminators for Abos-II passage. Residents with a program mean OITE YIT percentile rank score >or=28, program PGY-3 OITE YIT percentile rank score >or=39, and USMLE Step I (3-digit) score >or=207 were more likely to pass Abos-I and II. Residents that had lower quartile USMLE Step I (3-digit) scores for our program had a 2.3 time greater Abos-I failure risk. Program residents with >or=2 below-average subjective clinical performance evaluations had lower Abos-I (% correct) scores but had similar Abos-I and II pass rates.

CONCLUSION

Our program uses the USMLE Step I (3-digit) score as a preacceptance estimate of likely supplemental guided mentoring needs. Program mean OITE YIT percentile rank and PGY-3 OITE YIT percentile rank scores help identify educational deficiencies and predict eventual Abos-I and II passage. Subjective clinical performance evaluations provide important supplemental information regarding professionalism, communication, and patient care skills.

Knowledge of levels of evidence criteria in orthopedic residents

The purpose of the levels of evidence system is to provide a framework for critical evaluation of orthopedic literature. This rating system is based on guidelines from the Oxford Centre for Evidence-Based Medicine and is currently in use in several orthopedic surgery journals. The purpose of this study was to investigate resident knowledge of the levels of evidence criteria used in classification of clinical articles. Thirty-eight residents from 5 orthopedic surgery training programs, from year-in-training 3 to 5, determined the levels of evidence rating of 10 blinded articles representing all levels of evidence types in the orthopedic literature. Residents were then provided with a levels of evidence information sheet and asked to re-rate each article. The mean percentage correct for the initial rating was 29.5% and for the post-education rating was 41.3%, with significant improvement after levels of evidence education (P<.001). The year-in-training-3 group had the highest mean percentage correct for the average of both tests (46.7%) compared to year-in-training-4 (34.2%) and year-in-training-5 (25.4%). Residents were significantly more accurate scoring therapeutic (41.1% correct pre-levels of evidence; 51.6% post-levels of evidence) than prognostic studies (6.6% correct pre-levels of evidence; 28.9% post-levels of evidence) (P<.001). Residents graded the level of evidence correctly in fewer than half the papers. These findings indicate that resident knowledge of levels of evidence criteria is limited and suggest a need for more education in this area.