Evaluation of Spine Questions on the Orthopaedic In-Training Examination: An Update from 2013 to 2017

Spine is one subject evaluated by the Orthopaedic In-Training Examination. The purpose of our study was to analyze all spine-related questions on the OITE to determine the most commonly tested spine topics, as well as the level of evidence in cited references, to help guide resident preparation for future examinations. The OITE was analyzed from 2013 to 2017 for number of spine questions, subject matter, anatomy, and use of diagnostic imaging. The preferred responses were reviewed for journal article references and corresponding levels of evidence for each citation. The average number of spine questions on the OITE was approximately 25 (9.0% of the exam) with a focus on cervical spine (7.8; 31.5%) and lumbar spine (9.8; 39.5%). At least one type of diagnostic image accompanied 18.4 questions (74.2%), with magnetic resonance imaging being the most common modality (50.0%). Degenerative diseases (10.8; 43.5%) and trauma (7.0; 28.2%) made up the majority. The most commonly cited journals were Spine (21.5%), Journal of the American Academy of Orthopedic Surgeons (20.8%), Spine Journal (8.4%), and Journal of Bone and Joint Surgery (8.4%). Review articles made up an average of 27.4 citations annually (49.5%). Level I evidence investigations were cited 3.4 times per examination. Developing a study plan centered on review articles as well as on high-yield topics should lead to optimal preparation for residents on the OITE.