The most-cited sources on the orthopaedic in-training examination: question yield, reading efficiency, and time lag...

Each Orthopaedic In-Training Examination (OITE) question references one or more journal articles or textbook sections as the evidence-based origin of its "preferred response." Previous studies identified the number of references to the top sources but not the number of questions covered by these top sources. The current study analyzes the question yield, time lag from publication, and sequential benefit-in terms of OITE questions covered-of the most referenced sources in order to provide residents and educators strategies for developing an efficient reading program.

We analyzed all OITE references from 2002 to 2009 and identified 1. The most referenced journals, text- books, authors, and journal articles; 2. The question yield of the top journals; 3. The time lag from article publication to OITE reference; and 4. The additional question benefit of the top sources when added sequentially. We repeated the analysis considering only journal articles published within 5 years of each respective OITE.

The most referenced journals were the The Journal of Bone and Joint Surgery, American Edition (JBJS-Am), Clinical Orthopaedics and Related Research (CORR), and the The Journal of the American Academy of Orthopaedic Surgeons (JAAOS). JBJS-Am accounted for 14% of all references and was referenced on 24% of questions; CORR and JAAOS each contributed 6% of references and were referenced on 11% of questions. The average time from article publication to OITE reference was 8.1 years (median: 6 years, mode: 2 years). The top 29 authors were referenced on 15% of OITE questions. The two most-referenced articles were each referenced 7 times in 8 years. Regarding question yield, 18% of published JAAOS articles were referenced on an OITE, as opposed to 7% of JBJS-Am articles and 2% of CORR articles. Considering articles published within 5 years of an OITE, the number of questions referencing JBJS-Am decreased from 24% to 10%. The sequential benefit of adding JAAOS and CORR during the 5 years was an additional 8% of total questions.

When developing a reading curriculum, educators and residents should be aware of the question yield, reading efficiency, and time lag to publication of the most common OITE reference sources.