Analysis of the Foot and Ankle Questions on the Orthopaedic In-Training Examination Over a 10-Year Period (2012-2021)

Abstract

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: The Orthopaedic In-Training Examination (OITE) was first administered in 1963 by the American Academy of Orthopaedic Surgeons to evaluate and monitor the training and knowledge of orthopaedic surgery residents. After various iterations of the exam, the current OITE consists of 275 questions covering foot and ankle, hip and knee, shoulder, and elbow, spine, sports medicine, trauma, and basic science. The most recent investigation of the foot and ankle OITE questions evaluated content, references, and treatment methods included on the exams from 2006-2010. This study evaluates OITE test questions over a 10-year period from 2012-2021 for topic, taxonomy, treatment tested, imaging modality, and references cited. The goal of this analysis is to inform and optimize foot and ankle education among orthopaedic residency and fellowship programs. Methods: OITE questions between 2012 and 2021 were obtained through the AAOS 'ResStudy' online question bank. Each question was manually evaluated by each author for foot and ankle content. The total number of questions pertaining to foot and ankle were recorded for each year and the topic of each question was classified under broader topic areas: trauma, deformity, tendon disorder, diabetic foot, sports, great toe, lesser toe, pediatric foot, heel pain, arthritis, and tumor. Imaging techniques were classified as radiographs, magnetic resonance imaging (MRI), computerized tomography, and clinical photo or video. Question taxonomy was classified using criteria in a previous OITE question analysis with three groups2. Taxonomy 1 (T1): knowledge (requires recall of orthopaedic practice or literature); T2: comprehension (interpretation of information and/or diagnosis); T3: application (formulation of a treatment plan from provided information). References provided by AAOS were identified by journal title and publication date or textbook title and editors. Results: Overall, foot and ankle questions comprised of 11.5% (308/2679) of all the graded OITE questions. In recent years, the proportion of foot and ankle questions has decreased. From 2012-2017 the average proportion of foot and ankle questions was 12.6% per test, and from 2018-2021, the average proportion was 9.8%. The most common question taxonomy from 2012-2017 was T3 (application) comprising 60.9% of the question, however, from 2018-2021, T3 questions made up only 29.4% of foot and ankle questions. In total, 59.1% (182/308) of the questions required knowledge of treatment modalities, most commonly open reduction internal fixation and arthrodesis procedures. Imaging modalities were tested 67.9% (209/308) of the time, with radiographs appearing in 47.4% (146/308) of all questions. The most common journals cited were Foot and Ankle International, Journal of the American Academy of Orthopaedic Surgeons, and the Journal of Bone and Joint Surgery American Volume. Conclusion: The proportion of foot and ankle questions on the OITE has decreased over the past 10 years and there has been a reduced emphasis on application questions with a more balanced distribution among knowledge, comprehension and application questions recently. Residents and residency programs should ensure proficiency in interpreting radiographs, which are tested on almost half of all foot and ankle OITE questions.