G. Paul DeRosa

Relationship between performance on part I of the American Board of Orthopaedic Surgery Certifying Examination and Scores on USMLE Steps 1 and 2.

Background This study investigated the strength of the relationship between performance on Part I of the American Board of Orthopaedic Surgery (ABOS) Certifying Examination and scores on United States Medical Licensing Examination (USMLE) Steps 1 and 2. Method USMLE Step 1 and Step 2 scores on first attempt were matched with ABOS Part I results for U.S./Canadian graduates taking Part I for the first time between 2002 and 2006. Linear and logistic regression analyses investigated the relationship between ABOS Part I performance and scores on USMLE Step 1 and 2. Results Step 1 and Step 2 individually each explained 29% of the variation in Part I scores; using both scores increased this percentage to 34%. Results of logistic regression analyses showed a similar, moderately strong relationship with Part I pass/fail outcomes: Examinees with low scores on Steps 1 and 2 were at substantially greater risk for failing Part I. Conclusions There is continuing empirical support for use of Step 1 and Step 2 scores in selection of residents to interview for orthopedics residency positions.

Utility of AAOS OITE scores in predicting ABOS Part I outcomes: AAOS exhibit selection.

BACKGROUND Residency programs commonly use performance on the Orthopaedic In-Training Examination (OITE) developed by the American Academy of Orthopaedic Surgeons (AAOS) to identify residents who are lagging behind their peers and at risk for failing Part I of the American Board of Orthopaedic Surgery (ABOS) Certifying Examination. This study was designed to investigate the utility of the OITE score as a predictor of ABOS Part I performance. METHOD Results for 3132 examinees who took Part I of the ABOS examination for the first time from 2002 to 2006 were matched with records from the 1997 to 2006 OITE tests; at least one OITE score was located for 2852 (91%) of the ABOS Part I examinees. After OITE performance was rescaled to place scores from different test years on comparable scales, descriptive statistics and correlations between ABOS and OITE scores were computed, and regression analyses were conducted to predict ABOS results from OITE performance. RESULTS Substantial increases in the mean OITE score were observed as residents progressed through training. Stronger correlations were observed between OITE and ABOS performance during later years in training, reaching a maximum of 0.53 in years 3 and 4. Logistic regression results indicated that residents with an OITE score below the 10th percentile were much more likely to fail Part I compared with those with an OITE score above the 50th percentile. CONCLUSIONS OITE performance was a good predictor of the ABOS score and pass-fail outcome; the OITE can be used effectively for early identification of residents at risk for failing the ABOS Part I examination.

Current state of fellowship hiring: Is a universal match necessary? Is it possible?

Currently, approximately 90% of the 620 graduating orthopaedic residents in the United States are planning on entering a postgraduate fellowship. Since January 2005, two of the largest fellowship match programs, sports medicine and spine surgery, were dissolved by the National Resident Matching Program (NRMP) because of a gradual decline in participation, leaving approximately 70% of applicants in a nonmatching, decentralized system. This leaves hand, shoulder and elbow surgery, and foot and ankle as the only three orthopaedic subspecialties that remain in some type of match program, creating an extremely complicated hiring environment for all residents. This paper focuses on the current state of fellowship employment and hiring in orthopaedic surgery in the United States, on the likely effects of reinstituting a match, and on how this might be accomplished. For this purpose, we present the results of surveys of fellowship directors and residents that we conducted and we describe how the present market for orthopaedic surgery fellows resembles the market for medical *This report is based on a symposium presented at the Annual Meeting of the American Orthopaedic Association on June 13, 2007, in Asheville, North Carolina.

AOA Symposium: Current State of Fellowship Hiring

Currently, approximately 90% of the 620 graduating orthopaedic residents in the United States are planning on entering a postgraduate fellowship. Since January 2005, two of the largest fellowship match programs, sports medicine and spine surgery, were dissolved by the National Resident Matching Program (NRMP) because of a gradual decline in participation, leaving approximately 70% of applicants in a nonmatching, decentralized system. This leaves hand, shoulder and elbow surgery, and foot and ankle as the only three orthopaedic subspecialties that remain in some type of match program, creating an extremely complicated hiring environment for all residents. This paper focuses on the current state of fellowship employment and hiring in orthopaedic surgery in the United States, on the likely effects of reinstituting a match, and on how this might be accomplished. For this purpose, we present the results of surveys of fellowship directors and residents that we conducted and we describe how the present market for orthopaedic surgery fellows resembles the market for medical *This report is based on a symposium presented at the Annual Meeting of the American Orthopaedic Association on June 13, 2007, in Asheville, North Carolina.

On volunteerism and orthopaedics: AOA critical issues.

Sometimes give of your services for nothing. And if the opportunity for serving a stranger in financial straits, give full assistance to all such. For wherever the art of medicine is loved, there is also a love of humanity—Hippocrates As the quotation above suggests, the selfless giving of one’s services and time has been recommended by generations of medical leaders since medicine’s earliest emergence as a paid profession. Whether such recommendations are prescriptive (i.e., what a physician should do if he or she is so inclined) or descriptive (i.e., what a physician is obligated to do, given his or her skills, as part of being a physician) has long been a subject of debate. The philosophical center of the debate is whether health care is a “right”—regardless of one’s ability to pay for it or deliver himself or herself to a physician. For if it is indeed a “right,” we are obligated to provide care to all. One man’s right is another man’s moral and ethical obligation. In this spirit, a recent American Orthopaedic Association (AOA) symposium and round table discussion (at the 2012 annual meeting) explored whether volunteerism should be considered a “core competency” and, if so, how we might implement it as we do the other competencies outlined by the Accreditation Council for Graduate Medical Education (ACGME). It is our opinion that a careful reading of the currently accepted ACGME competencies indicates that volunteerism clearly falls under the “professionalism” umbrella and should be considered part of what we must do (and must teach) to be (and to produce) complete, competent orthopaedic surgeons. In an on-site survey, the audience felt strongly that role modeling by faculty is an important predictor of resident behavior. Although most of the audience felt neutral about incorporating an international elective in a resident curriculum, …

Demystifying the Orthopaedic Certification Process

In the United States, a physician earns certification in a medical specialty by meeting the qualifications predetermined by the appropriate specialty board. The American Board of Medical Specialties and one of its twenty-four specialty boards—the American Board of Orthopaedic Surgery (ABOS)—offer certification as a voluntary process for individuals who have completed their training in a residency program accredited by the Residency Review Committee for Orthopaedic Surgery. The mission of the ABOS is to establish educational standards for orthopaedic residents and to evaluate the initial and continuing qualifications and competence of orthopaedic surgeons. The Board “defines minimum educational requirements in the specialty, stimulates graduate medical education and continuing medical education, and aids in the evaluation of educational facilities and programs.”1 The ABOS is one of three sponsoring organizations represented on the Residency Review Committee for Orthopaedic Surgery; the other two organizations are the Council on Medical Education of the American Medical Association and the American Academy of Orthopaedic Surgeons. An orthopaedic resident also serves on the committee. The Residency Review Committee functions autonomously under the direction of the Accreditation Council for Graduate Medical Education (ACGME). According to the ABOS, the goal of orthopaedic residency education is to prepare a resident to be a competent and ethical practitioner of orthopaedic surgery1. During their orthopaedic residency, applicants for certification by the ABOS must have received, and successfully completed, the following preparation1: A. Education in the entire field of orthopaedic surgery, including inpatient and outpatient diagnosis and care as well as operative and nonoperative management and rehabilitation. B. The opportunity to develop, through experience, the necessary cognitive, technical, interpersonal, teaching, and research skills. C. The opportunity to create new knowledge and to become skilled in the critical evaluation of information. D. Education in the recognition and management of basic …