title: Levels of evidence have increased for musculoskeletal trauma questions on the orthopaedic in-training examination.
abstract: OBJECTIVE
  The purpose of this study was to determine if the levels of evidence for primary journal articles used as references for musculoskeletal trauma questions on the Orthopaedic In-Training Examination (OITE) have increased over a 15-year period.
  
  
  METHODS
  Basic science article.
  
  
  METHODS
  Geisinger Medical Center (Danville, PA), tertiary referral center.
  
  
  METHODS
  All 329 questions in the musculoskeletal trauma content domain on the OITE from 1995 to 1997 and 2010 to 2012 were reviewed. Baseline characteristics for each question and each reference were recorded. References were categorized as a textbook, a journal review article, an instructional course lecture, or a primary journal article. For each primary journal article, the level of evidence for the article was determined in accordance with the American Academy of Orthopaedic Surgeons Levels of Evidence Guidelines.
  
  
  RESULTS
  The level of evidence used for primary journal articles demonstrated a statistically significant increase from 1995 to 1997 to 2010 to 2012. Overall, 27% of primary journal articles cited on the 1995 to 1997 OITEs were level I, II, or III studies, increasing to 43% during the 2010 to 2012 period (p = 0.04). The Buckwalter classification for the OITE questions changed significantly between the 2 periods, with questions from 2010 to 2012 including more T1 questions (25% vs 39%) and fewer T3 questions (46% vs 39%, p = 0.016). The Journal of Bone and Joint Surgery and the Journal of Orthopaedic Trauma were the most frequently cited journals overall.
  
  
  CONCLUSIONS
  The levels of evidence for primary journal articles cited on the OITE for questions within the musculoskeletal trauma content domain have increased between 1995 and 2012. Our analysis can be used as a guide to help examinees prepare for musculoskeletal trauma questions on the OITE and as an aid in core curriculum development.
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania. Electronic address: clgrandizio@geisinger.edu.
authors.forename: Louis C
authors.initials: LC
authors.lastname: Grandizio
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: James C
authors.initials: JC
authors.lastname: Huston
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Shim
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: John M
authors.initials: JM
authors.lastname: Parenti
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Jove
authors.initials: J
authors.lastname: Graham
authors.affiliation: Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Joel C
authors.initials: JC
authors.lastname: Klena
mesh_terms: D000328:Adult; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods; D004521:Educational Measurement; D019317:Evidence-Based Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000379:methods; D007396:Internship and Residency / Q000379:methods; D008297:Male; D009141:Musculoskeletal System / Q000293:injuries / Q000601:surgery*; D009985:Orthopedics / Q000193:education*; D010414:Pennsylvania; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D058013:Test Taking Skills; D014947:Wounds and Injuries / Q000503:physiopathology / Q000601:surgery*
keywords: Medical Knowledge; OITE; Patient Care; Practice-Based Learning and Improvement; levels of evidence; orthopedics; research; resident education; trauma