Clinical News and Views
practitioner and resident scores
increased as the questions focused
on clinical thinking and problemsolving skills.
These results are consistent with
developing clinical thinking skills.
The practitioner treats more patients and is exposed to a greater
variety of clinical issues; residents,
particularly junior residents, are
just developing these skills.
Why practitioners
took the OITE
Practitioners reported the following two main reasons for taking
the OITE after being in practice for
many years: to prepare for recertification examinations and to assess
the currency of their orthopaedic
knowledge.
They found the examination
especially helpful in specialty areas
outside of their practice focus.
Practitioners replied that the questions were an impetus to look up
subjects that might not arise in
their day-to-day contacts. Some
practitioners thought taking the
test was a good way to know what
was being taught in orthopaedic
residency programs, and those who
interacted with residents thought
it would improve their ability to
Table 2: 2009 OITE quartile practitioner distribution compared to resident 2009 OITE scores
4. Appreciate the articular
geometry.
“Articular geometry is underappreciated,” he continued. Designs
shifted from the highly unconstrained implants of the 1970s to a highly constrained implant (see Fig. 2, page 18) to the current
single axis ankle, which uses two
planes of motion and multiple degrees of freedom.
Modern implants, he said, “try
to respect the radius to curvature
and should improve range of motion. The articular geometry enables inversion, eversion, and natural rotation.”
5. Better engineering means better
surgical equipment.
Improvements in the equipment
used in implant surgery have also
been significant and have helped
reduce variation in surgical technique, said Dr. Saltzman. The result
is more precise guidance that may
include provisional positioning of
the foot and ankle and fluoroscopic
guidance.
AAOS Now_October 2010.indd 21
Practitioner Results
Resident Results by PGY
Quartile
N
Overall Mean
SD
PGY
Overall Mean
First 93
133.90
24.15
1
145.95
Second
104
163.00
4.12
2
165.42
Third
100
177.00
4.50
3
174.59
99
205.07
20.88
4 & 5
183.50
Fourth
Table 3: 2009 OITE mean scores by cognitive structure (taxonomy)
Taxonomy
Practitioners Residents
(N = 396)
(N = 4,400)
I: Knowledge recall, comprehension, application
62.6
62.2
II: Analysis and/or synthesis requiring the integration of knowledge recall and interpretation
of clinical data
46.2
44.4
III: Problem solving and evaluation items requiring the ability to apply knowledge or interpret
information to solve a specific problem
59.8
53.9
instruct residents.
The change to an OITE on DVD
instead of paper allowed the inclusion of videos and multi-slice 3D
imaging with exam questions. This
gave the OITE the potential to bet-
total ankle
cuts that leave the talar bone microarchitecture poorly oriented to
the implant.
October 2010
ter represent what happens in actual practice. The comments from
practicing orthopaedic surgeons
are welcome because the goal
of the new format is to develop
questions that require the clinical
AAOS
21
Now
problem-solving skills necessary to
treat patients; therefore, the questions need to simulate the clinical
situations that trigger this kind of
thinking.
In summary, the 396 orthopaedic practitioners who took the
OITE and returned answer sheets
did very well; most matched or surpassed the performance of senior
orthopaedic residents. They had
diverse practice backgrounds and
provided valuable feedback on the
exam and on the new DVD-based
format. These results demonstrate
that general orthopaedic knowledge can be retained at a high level
well past residency training. Orthopaedic surgeons are life-long learners, indeed. NOW
More information, data tables,
and a link to the JAAOS article
can be found in the online version
of this article, available at www.aaosnow.org
Craig S. Roberts, MD, MBA,
is the current chair of the AAOS
Evaluation Committee; J. Lawrence Marsh, MD, chaired the
committee at the time of the 2009
OITE; Laura Hruska, MEd, is the
staff liaison to the Evaluations
Committee.
from page 18
A persistent problem in the
United States is the Food and Drug
Administration (FDA) requirement
that every implant must “be packaged as being fitted with cement,”
Dr. Saltzman said. He hopes the
FDA will soon recognize the shift
to porous metals and away from
cement.
Looking to the future, Dr. Saltzman said that many factors remain
unknown, including wear and
breakage rates of two- versus threepart prostheses, the minimum size
and optimal form of polyethylene,
how to stop talar subsidence, and
how to decrease the learning curve.
The larger question—“Who
should have fusion and who should
have a replacement?”—is also unanswered. NOW
Disclosure information: Dr. Hintermann—Integra; Dr. Saltzman—Elsevier, Tornier,
TotalChart, Twin Star Medical,
United Cerebral Palsy Research
and Education Fund, Zimmer.
2008 OSAE Final Scoring:
Dec. 31, 2010
• Earn up to 70 of the 120
CME credits required by
ABOS Maintenance of
Certification™ when you
take Scored and Recorded
OSAE, together with Orthopaedic Knowledge Update (OKU) 9 or OKU 1–9
on CD-ROM
• Meet the 20 credit SelfAssessment Examination
(SAE) requirement from
a Scored and Recorded
source
Answer files must be received by December 31, 2010, to be
included in the 2008 OSAE final scoring.
Terry Stanton is the senior science writer for AAOS Now. He can
be reached at [email protected]
9/27/2010 3:42:32 PM