title: An assessment of the Chilean National Examination of Orthopaedic Surgery.
abstract: BACKGROUND
  The Chilean National Examination of Orthopaedic Surgery (EMNOT) has been administered since 2009. It was developed to determine whether individual residents are meeting minimal knowledge standards at the end of their training programs.
  
  
  METHODS
  We performed a retrospective evaluation of the EMNOT for all years it has been administered (2009-2015). The test was analyzed for content, taxonomy of questions asked (1: direct recall; 2: diagnosis; 3: evaluation/decision-making), residents' performance, difficulty index and discrimination index.
  
  
  RESULTS
  During the years of EMNOT administration, the most frequently tested areas have been pediatric orthopaedics (22.9 %), spine (13.8 %), general orthopaedics (13.8 %) and musculoskeletal trauma (9.9 %). A significant increase in questions with images was observed, as well as a significant decrease in the percentage of Type 1 and an increase in Type 3 questions. The Difficulty Index showed a medium level of difficulty for all years the examination has been administered. The Discrimination Index showed good discrimination in 2009, fair discrimination from 2010 through 2012, and excellent discrimination from 2013 through 2015.
  
  
  CONCLUSIONS
  The EMNOT has evolved over several years to include better quality questions, better discrimination, and a more representative distribution of questions covering the different orthopaedic sub-specialties. This examination represents an effective instrument for quality assurance of orthopaedic residency programs in Chile.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile. jurrutia@med.puc.cl.
authors.forename: Julio
authors.initials: J
authors.lastname: Urrutia
authors.affiliation: Department of Orthopaedic Surgery, Universidad de Los Andes, Santiago, Chile.
authors.forename: Mario
authors.initials: M
authors.lastname: Orrego
authors.affiliation: Center of Medical Education, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Wright
authors.affiliation: Department of Orthopaedic Surgery, Universidad de Los Andes, Santiago, Chile.
authors.forename: Diego
authors.initials: D
authors.lastname: Amenabar
mesh_terms: D002677:Chile; D002983:Clinical Competence / Q000592:standards; D006801:Humans; D009985:Orthopedics / Q000592:standards*; D012189:Retrospective Studies; D013044:Specialty Boards / Q000592:standards*