Original Article

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

Authors: Craig S. Roberts, MD, John Nyland, EdD, Brandon Broome, MD

Abstract

Objective: 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.


Methods: 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).


Results: Linear regression analysis revealed insignificant changes in median PGY-1 intern OITE percentile rank during the precurriculum period (R2 = 0.08, P = 0.53). Postcurriculum period comparisons revealed significantly improving PGY-1 intern OITE percentile rank (R2 = 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.


Conclusions: 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.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Accreditation Council on Graduate Medical Education. Statement of justification/impact for the final approval of common standards related to resident duty hours.www.acgme.org/acWebsite/GME_info/gme_PPmanual902.pdf. Published September 2002. Accessed July 1, 2011.
 
2. Chapman DM, Hayden S, Sanders AB, et al. Integrating the Accreditation Council for Graduate Medical Education Core competencies into the model of the clinical practice of emergency medicine. Ann Emerg Med 2004; 43: 756–769.
 
3. Caldicott CV, Holsapple JW. Training for fitness: reconsidering the 80-hour work week. Perspective Biol Med 2008; 51: 134–143.
 
4. Singh R, Naughton B, Taylor JS, et al. A comprehensive collaborative patient safety residency curriculum to address ACGME core competencies. Med Educ 2005; 39: 1195–1204.
 
5. Krain LP, Lavelle E. Residents’ perspectives on professionalism. J Grad Med Ed 2009; 1: 221–224.
 
6. Cornwall R. Teaching professionalism in orthopaedic residency. J Bone Joint Surg Am 2001; 83: 626–628.
 
7. Miyamoto RG Jr, Klein RG, Walsh M, et al. Orthopaedic surgery residents’ study habits and performance on the orthopaedic in-training examination. Am J Orthop 2007; 36: E185–E188.
 
8. Joyner BD, Nicholson C, Seidel K. Medical knowledge: the importance of faculty involvement and curriculum in graduate medical education. J Urol 2006; 175: 1843–1846.
 
9. Pinney SJ, Mehta S, Pratt DD, et al. Orthopaedic surgeons as educators: applying the principles of adult education to teaching orthopaedic residents. J Bone Joint Surg Am 2007; 89: 1385–1392.
 
10. Flint JH, Jahangir AA, Browner BD, et al. The value of mentorship in orthopaedic surgery resident education: the resident’s perspective. J Bone Joint Surg Am 2009; 91: 1017–1022.
 
11. Carmichael KD, Westmoreland JB, Thomas JA, et al. Relation of residency selection factors to subsequent orthopaedic in-training examination performance. South Med J 2005; 98: 528–532.
 
12. Black KP, Abzug JM, Chinchilli VM. Orthopaedic in-training examination scores: a correlation with USMLE results. J Bone Joint Surg Am 2006; 88: 671–676.
 
13. Williams SC, Gulihar A, Dias JJ, et al. A new musculoskeletal curriculum. Has it made a difference? J Bone Joint Surg Br 2010; 92: 7–11.
 
14. Yaszay B, Kubiak E, Agel J, et al. ACGME core competencies: where are we? Orthopedics 2009; 32: 171.
 
15. Ranawat AS, Dirschl DR, Wallach CJ, et al. Potential strategies for improving orthopaedic education: strategic dialogue from the AOA resident leadership forum class of 2005. J Bone Joint Surg Am 2007; 89: 1633–1640.
 
16. Marsh JL, Hruska L, Mevis H. An electronic orthopaedic in-training examination. J Am Acad Orthop Surg 2010; 18: 589–596.
 
17. Buckwalter JA, Schumacher R, Albright JP, et al. The validity of orthopaedic in-training examination scores. J Bone Joint Surg Am 1981; 63: 1001–1006.
 
18. Risner B, Nyland J, Crawford CR, et al. Orthopaedic in-training examination performance: a nine year review of a residency program database. South Med J 2008; 101: 791–796.
 
19. Schneller ES, Wilson NA. Professionalism in 21st century professional practice: autonomy and accountability in orthopaedic surgery. Clin Orthop Relat Res 2009; 467: 2561–2569.
 
20. Baldwin DC Jr, Bunch WH. Moral reasoning, professionalism, and the teaching of ethics to orthopaedic surgeons. Clin Orthop Relat Res 2000; 378: 97–103.
 
21. Bebeau MJ. The defining issues test and the four component model: contributions to professional education. J Moral Educ 2002; 31: 271–295.
 
22. Caldicott CV, Danis M. Medical ethics contributes to clinical management: teaching medical students to engage patients as moral agents. Med Educ 2009; 43: 283–289.