Levels of Evidence Have Increased for Musculoskeletal Trauma Questions on the Orthopaedic In-Training Examination

• Published in: Journal of surgical education Vol. 72; no. 2; pp. 258 - 263
• Main Authors: Grandizio, Louis C., DO, Huston, James C., MD, Shim, Stephanie S., MD, Parenti, John M., MD, Graham, Jove, PhD, Klena, Joel C., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2015
• Subjects: Adult; Curriculum; Education, Medical, Graduate - methods; Educational Measurement; Evidence-Based Medicine - education; Female; Humans; Inservice Training - methods; Internship and Residency - methods; levels of evidence; Male; Musculoskeletal System - injuries; Musculoskeletal System - surgery; OITE; orthopedics; Orthopedics - education; Pennsylvania; Quality Improvement; resident education; Surgery; Surveys and Questionnaires; Test Taking Skills; trauma; Wounds and Injuries - physiopathology; Wounds and Injuries - surgery; Pennsylvania; trauma; Patient Care; levels of evidence; Medical Knowledge; orthopedics; Practice-Based Learning and Improvement; resident education; OITE; research
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2014.10.005

Objective The purpose of this study was to determine if the levels of evidence for primary journal articles used as references for musculoskeletal trauma questions on the Orthopaedic In-Training Examination (OITE) have increased over a 15-year period. Design Basic science article. Setting Geisinger Medical Center (Danville, PA), tertiary referral center. Participants All 329 questions in the musculoskeletal trauma content domain on the OITE from 1995 to 1997 and 2010 to 2012 were reviewed. Baseline characteristics for each question and each reference were recorded. References were categorized as a textbook, a journal review article, an instructional course lecture, or a primary journal article. For each primary journal article, the level of evidence for the article was determined in accordance with the American Academy of Orthopaedic Surgeons Levels of Evidence Guidelines. Results The level of evidence used for primary journal articles demonstrated a statistically significant increase from 1995 to 1997 to 2010 to 2012. Overall, 27% of primary journal articles cited on the 1995 to 1997 OITEs were level I, II, or III studies, increasing to 43% during the 2010 to 2012 period (p = 0.04). The Buckwalter classification for the OITE questions changed significantly between the 2 periods, with questions from 2010 to 2012 including more T1 questions (25% vs 39%) and fewer T3 questions (46% vs 39%, p = 0.016). The Journal of Bone and Joint Surgery and the Journal of Orthopaedic Trauma were the most frequently cited journals overall. Conclusions The levels of evidence for primary journal articles cited on the OITE for questions within the musculoskeletal trauma content domain have increased between 1995 and 2012. Our analysis can be used as a guide to help examinees prepare for musculoskeletal trauma questions on the OITE and as an aid in core curriculum development.