Background: The Orthopaedic In-Training Examination (OITE) is an annual evaluation of orthopedic surgery residents that provides a national standardized assessment of resident knowledge. Analyses of the OITE have provided insight into high-yield content and trends in questioning that can better direct study strategies for individuals and help tailor curricula for orthopedic surgery residency programs to aid in preparation for the OITE and future board examination. Purpose: To provide a complete updated analysis of the shoulder and elbow domain of the OITE from 2012 to 2021 to contribute to the existing literature on the analysis of OITE questions and investigate evolving trends in questioning over the study period. Methods: All OITE questions related to shoulder and elbow topics from 2012 to 2021 were analyzed and comparisons were then made between the first 5 years (2012–2016) and the last 5 years of the study period (2017–2021). The total number of questions were determined as well as the percent weight of the exam for each year. Further characterization and analysis of questions was performed based on taxonomic classification, question topic, and imaging modalities utilized. Recommended references were also analyzed with regards to their source, level of evidence, and publication lag. Results: The shoulder and elbow domain of the OITE consisted of 274 questions, which accounted for an average of 10.5% of the OITE from 2012 to 2021. The most commonly tested topics accounted for 60.2% of all questions asked during the study period and were found to be basic anatomy (22.2%), rotator cuff arthropathy/reverse total shoulder arthroplasty (14.2%), glenohumeral arthropathy/total shoulder arthroplasty (7.7%), anterior instability/dislocation (6.9%), posterosuperior rotator cuff injuries (5.1%), and total elbow arthroplasty (4.0%). Questions pertaining to clinical management, treatment, and/or decision making (taxonomy 3) were the most prevalent (47.8%), although the ones on knowledge recall (taxonomy 1) have become more prevalent over the last 5 years of the study period. Imaging modalities continue to be heavily utilized and were present in 56.6% of OITE questions. The Journal of Shoulder and Elbow Surgery (22.4%), the Journal of Bone and Joint Surgery, American (15.8%), and the Journal of the American Academy of Orthopaedic Surgeons (15.5%) were the top three most frequently cited and accounted for 53.7% of all recommended references. During the study period, a significant increase in utilization of both the Journal of Shoulder and Elbow Surgery and the Journal of Hand Surgery was observed, while the publication lag from 2017 to 2021 (6.94 years) was found to be significantly lower than during the previous 5 years (8.23 years). The most prevalent level of evidence was Level IV (30.7%), followed by review articles (27.3%), while Level I was found to be the least common (5.1%). Only Level III studies were found to be significantly different between the study periods, becoming more prevalent in recent years. Conclusions: This study provides an updated account of the shoulder and elbow domain of the OITE over the past decade as well as an analysis of evolving trends in question content and recommended references, which may aid both residents and orthopedic surgery residency programs in preparation for the OITE and board examination.
Warnick et al. (Fri,) studied this question.