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Orthopaedic Journal Publications and Their Role in the Preparation for the Orthopaedic In-Training Examination
David R. Marker, BS1; Dawn M. LaPorte, MD1; Thorsten M. Seyler, MD2; Slif D. Ulrich, MD2; Mike S. McGrath, MD2; Frank J. Frassica, MD1; Michael A. Mont, MD2
1 The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287
2 Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont: rhondamont@aol.com
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Stryker, Wright Medical, Vindico Medical Education).

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Nov 01;91(Supplement 6):59-66. doi: 10.2106/JBJS.I.00559
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In the last decade, there has been an effort to refocus on the efficacy of resident education practices. Much of this effort was summarized by a statement released in 1999 by the Accreditation Council for Graduate Medical Education, which defined medical knowledge as one of six clinical care domains in which residents must receive instruction and show competency. Since then, there have been a number of subsequent reformations to residency training, such as the limitation of resident work hours to no more than eighty hours per week. Within the orthopaedic community, these changes have resulted in a tremendous interest in optimizing resident education. This interest is reflected in the literature by a near doubling in the number of studies concerning orthopaedic resident education and/or training in the past five years from 2004 to 2008 (n = 75) as compared with the preceding five years from 1999 to 2003 (n = 46) (Fig. 1). This interest served as one of the justifications for the present study as we attempted to understand the role of using the recent medical literature for the education and training of orthopaedic residents.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Michael A. Mont, MD
    Posted on December 14, 2009
    Dr. Mont and colleagues respond to Dr. Springfield
    Sinai Hospital of Baltimore, Maryland

    From the outset, we do appreciate and respect the ideals that Dr. Springfield has advocated concerning the Orthopaedic In-Training Examination (OITE). However, it is our opinion that the nature of the OITE and how it is administered and utilized by most residency programs does not commonly support its use in this manner. The stated goals by the American Academy of Orthopaedic Surgeons, the administrating body for the OITE, are: 1) To measure resident knowledge against a national mean; 2) To determine minimal standards for residents; and 3) To measure the quality of training within various residency programs (1). We believe that it is up to the individual orthopaedic programs on how to best utilize the OITE. As per Dr. Springfield, there is no “passing score” on the OITE for an individual, but many programs use this test to evaluate their residents. Residents may be advised to score as well as possible and the results of these tests may comprise part of their yearly evaluations. In addition, Herndon et al. found that performance on the OITE predicts future performance on passing the American Board of Orthopaedic Surgery (ABOS) examination (2). The examination is set-up with an answer key and references to allow for intense future preparation. Although we did not analyze this, we believe that the majority of orthopaedic programs use the OITE in this evaluative manner and encourage ample preparation which includes self-study as well as weekly subject review sessions, question-and-answer sessions, and even encouragement to attend board review courses.

    We are sure that some programs treat the OITE in the manner suggested by Dr. Springfield; simply test your working knowledge since education is an ongoing process and one should not study specifically for the examination. This is one way to view the examination. However, the majority of orthopaedic programs encourage residents to focus on doing well on the OITE. This educational approach may be beneficial as it fosters organized study, especially in areas that the resident may not have been exposed to yet in their training, or for which the program may have certain practical knowledge-based deficiencies. Furthermore, because the OITE is designed to assess resident understanding regarding practical orthopaedic knowledge and skills, it is reasonable to consider that studying to perform well on the exam is also direct preparation for residents to excel in their future surgical practice. Based on this reasoning, the resources that were identified as being useful for performing well on the OITE can be recommended as educational tools for residents to expand their base of orthopaedic knowledge rather than as a means to cram for the examination. We are not in disagreement with Dr. Springfield’s ideals on how the test can be used, however, it is not the case for most programs, nor can non-study for the examination be enforced. It is also certainly up to each residency program to decide how it will use the OITE.

    In summary, we believe that orthopaedic residents should “be reading consistently and judiciously” as Dr. Springfield has suggested and that their reading should be “broad-based” and they should “learn the fundamentals” in addition to preparing for the OITE. We are not suggesting by this work that it is more important to “prepare” for the OITE than it is to be prepared to be an educated orthopaedic surgeon.


    1. Mankin HJ. The Orthopaedic In-Training Examination (OITE). Clin Orthop Relat Res. 1971:75:108-16.

    2. Herndon JH, Allan BJ, Dyer G, Jawa A, Zurakowski D. Predictors of success on the American Board of Orthopaedic Surgery examination. Clin Orthop Relat Res. 2009;467:2436-45.

    Dempsey S. Springfield, MD
    Posted on November 23, 2009
    Cramming Defeats the Purpose
    Partners Healthcare System, Boston, Massachusetts

    To the Editor:

    I check the oil level in my motorcycle periodically and if it is low I know I need to find out why. If I want to fool myself or a potential buyer I top it up with oil just before checking.

    Marker and associates are telling residents how to top up their knowledge oil just before the OITE (1). The OITE is not like other tests. It is not supposed to be specifically prepared for but rather it should be taken without special preparation so the resident and the program can check their education oil level. Specific preparation for the OITE surely improves scores but it is unlikely to improve knowledge in the long run and it defeats the main purpose of the examination.

    The OITE is a “tool that the orthopaedic community has established to evaluate resident training” as Marker and associates state, but its effectiveness is diminished when educational programs are built around preparing for the examination. It is a tool for individual residents to compare their knowledge against other residents and for Programs to compare themselves against other Programs. It is not an examination that a resident either passes or fails. Residents should not be “seeking the most effective resources for examination preparation.” They should be reading consistently and judiciously. Their reading should be broad-based to gain basic concepts and they should learn the fundamentals. As they progress in their education their reading can become more specific and directed depending upon their interest. The OITE is a guide to know if their learning is appropriate. Specific preparation for the OITE defeats its main purpose.

    Marker and associates give the wrong message to residents. They suggest it is more important to “prepare” for the OITE than it is to prepare to be an educated orthopaedic surgeon.

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.


    1. Marker DR, LaPorte DM, Seyler TM, Ulrich SD, McGrath MS, Frassica FJ, Mont MA. Orthopaedic journal publications and their role in the preparation for the Orthopaedic In-Training Examination. J Bone Joint Surg Am. 2009;91:59-66.

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