Orthopaedic In-training Exam Preparation among Orthopaedic Surgery Residency Programs

The Orthopaedic In-Training Examination (OITE) is given annually to residents to assess their knowledge of clinical orthopaedics and orthopaedic basic science. This study sought to determine what resources orthopaedic residency programs recommend and/or require for residents as preparative tools for the OITE and to understand which resources are most beneficial.

An anonymous electronic survey was distributed to program directors of orthopaedic surgery residency programs. It included questions about resources that program directors recommended or required residents to use when preparing for the OITE.

The survey was prepared and the results analyzed at two academic medical institutions in Louisiana. The survey was available to respondents in December 2019 and January 2020.

The survey was delivered to program directors of 148 ACGME accredited orthopaedic surgery residency programs in the United States.

148 orthopaedic surgery residency program directors received the survey and 44 responded (response rate: 29.7%). Twenty-nine programs (73.2%) reported that practice tests/review of old OITE exams positively correlated with better scores. The most recommended resources for OITE preparation were Orthobullets (35 programs; 85%) and Res Study (AAOS) (27 programs; 67.5%). Programs having formal/required preparation programs had lower mean overall scores on the OITE than programs that did not. Those without a formal/required program scored in the 60th percentile, while those with a formal/required program scored in the 53.3^rd percentile, a difference of 6.7 percentile points (p = 0.049). The mean overall percentiles were significantly higher for programs that reported having a threshold/goal OITE score for residents compared to those that didn't. Programs with a threshold/goal score scored in the 60.6^th percentile on average, while those without a threshold/goal score scored in the 51.7^th percentile on average, a difference of 8.9 percentile points (p = 0.0095).

There is substantial variability in the resources that are utilized in preparation for the OITE, with the most commonly recommended resource being Orthobullets. The study method most cited as having a positive impact on scores was practice tests/review of old OITE exams. Having a formal/required program resulted in programs having lower OITE scores. Setting a goal/threshold score correlates positively with an increase in OITE score. Encouraging residents to use practice questions/old OITE tests, setting a goal/threshold score and avoiding formal/required preparation programs may improve resident performance on the OITE.