title: The orthopaedic in-training examination: perspectives of program directors and residents from the United States and Canada.
abstract: OBJECTIVE
  Objective assessment of resident performance continues to task program directors (PDs) with a formidable challenge. This study evaluated attitudes toward the Orthopaedic In-Training Examination (OITE), compared its value between countries, assessed its value against other metrics of resident performance, and examined program and resident factors predictive of high achievement.
  
  
  METHODS
  Survey.
  
  
  METHODS
  Orthopedic surgery residency programs across the United States and Canada.
  
  
  METHODS
  One hundred sixty-six PDs and 945 residents.
  
  
  RESULTS
  Eighty-eight PDs and 331 residents completed the surveys (response rates, 54% and 35%, respectively). PDs and residents in the United States assigned greater importance to the OITE than did those in Canada and reported OITE scores from the United States were significantly higher. PDs in the United States reported greater consequences for residents with poor scores than did PDs from Canada, including remediation and reprimand. Observed structured clinical examinations, internal examinations, and in-training evaluation reports were assigned greater importance by PDs and residents in Canada, but low or no importance by those in the United States. In preparation for the OITE, residents strongly favored prior OITE and American Academy of Orthopaedic Surgeons self-assessment questions, the 'AAOS Comprehensive Orthopaedic Review' textbook, the Journal of the American Academy of Orthopaedic Surgeons, and an OITE-based multiple-choice question website. Regression analysis identified resident and program emphasis on OITE studying and higher level of training as positive predictors for higher OITE scores.
  
  
  CONCLUSIONS
  The OITE is more important to PDs and residents in the United States than it is in Canada, and the reported OITE scores reflect these attitudes. PDs in Canada also employ a greater diversity of evaluative tools, a practice in keeping with recent advances toward competency-based medical education. The findings of this report may help PDs be aware of alternative methods of formative resident evaluation and ultimately improve the training of future independent surgeons.
authors.affiliation: Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Evaniew
authors.forename: Ginger
authors.initials: G
authors.lastname: Holt
authors.forename: Sharyn
authors.initials: S
authors.lastname: Kreuger
authors.forename: Forough
authors.initials: F
authors.lastname: Farrokhyar
authors.forename: Bradley
authors.initials: B
authors.lastname: Petrisor
authors.forename: Kelly
authors.initials: K
authors.lastname: Dore
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.forename: Michelle
authors.initials: M
authors.lastname: Ghert
mesh_terms: D000328:Adult; D002170:Canada; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000592:standards*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D009985:Orthopedics / Q000193:education* / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States