New Directions for the Orthopaedic InTraining Exam OITE J' Lawrence Marsh, MD Evaluation Committee C

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New Directions for the Orthopaedic
In-Training Exam (OITE)J. Lawrence Marsh,
MDEvaluation Committee ChairCarroll B Larson
Professor Residency Program Director Department
of Orthopaedics and RehabilitationThe University
of Iowa Hospitals and Clinics6th Annual ARCOS
ConferenceThe Wynn Hotel Las Vegas,
NevadaFebruary 27, 2009
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Some Background.

• The OITE was a 1st of its kind in specialty
  training
• November 1963
• 1,118 residents
• 150 questions
• This Year
• November 2008
• 4,243 Residents
• 871 Surgeons in Practice
• 275 questions

In Addition this Year 152 United State
Accredited Residency Programs 28 Osteopathic
Orthopaedic Surgery Training Programs 16 Canadian
Training Programs 11 International Saudi Arabia,
Italy, New Zealand, etc.
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ACGME Core Competencies
Patient Care Medical Knowledge Practice Based
Learning and Improvement Systems Based Practice
Professionalism Interpersonal Skills and
Communication
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Medical Knowledge

• The OITE is a comprehensive 275 item test
  comprised of twelve content domains
  characteristic of general orthopaedics
• Pediatric Orthopaedics
• Medically Related Issues
• Musculoskeletal Trauma
• Rehabilitation
• Hand
• Hip Knee Reconstruction
• Spine
• Foot Ankle
• Sports Medicine
• Shoulder Elbow
• Orthopaedic Science
• Orthopaedic Diseases

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The OITE in residency training
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What has Changed
We do more electronically
Utility Bills
Banking
We send E-Invites
Credit Card Bills
Most importantly the certifying exams will be
fully electronic!
Tickets airlines, trains, busses
Purchase post stamps
Movie Tickets
Send Gifts
Income Taxes
College Registrations
Reservations private business
Our Personal Purchases Sport Shoes, clothing,
etc.
On-line Registration Business leisure
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So After 45 Years It Is Time to make Changes

• Efficient Economical
• Technology Smart
• New educational possibilities

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Efficient and Economical

• This is a new time where many individuals
• Prefer to do their banking and personal business
  paper free,
• Prefer not to not purchase a newspaper but rather
  read it on-line,
• Prefer to have multiples books on DVD that are
  easily portable
• And .
• We all are more conscientious about how our
  actions impact our environment.

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Technology Smart

• Exam production process on a secure website
• No more scan sheets or filling in the bubbles
• No more sending the overnight fed-ex package
  with the answer sheets
• No more question books
• No more picture books

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New Educational Possibilities
Residents have different expectation from their
educational experience

• Include video clips, full MRIs, and more
  illustrations

• Embed illustrations into exam items

• Allow Participants to answer exam items
  directly, skip return later, review, change,
  and submit their final response.

• Portability of the copy after the exam for
  learning

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Examination Items that Assess Movement
Double click video to play
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Examination Items Regarding Patient Care and
Procedures
Double click video to play
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Number of Illustrations not Limited by Printing
Cost
29. A 65-year-old woman has had progressive left
hip swelling and pain for the past several
months. She denies any history of trauma.
Radiographs, a technetium Tc 99m scan, and an MRI
scan are shown in Figures 9a through 9d. A
biopsy would most likely reveal
1- malignant osteoid. 2- malignant cartilage
cells. 3- deposits of calcium phosphate. 4- acute
inflammation with gram-negative rods. 5- small
round blue cells.
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Examination Items using Surgical Procedures
Double click video to play
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2009 electronic OITE on DVD
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Exam details

• Exam Security
• Automatic shutdown password restart
• 7 hour timed exam
• Answers uploaded to flash drive
• Exam Features
• Multiple images and video
• Note feature on associated note pad
• Mark questions for later review

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Exam details

• Exam as an enduring educational product
• Residents will keep their DVD
• They will receive a code that will allow access
  in review mode
• Their response and preferred response
• Notes they made during test
• References
• Searchable by content domain
• Exam roll out??

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Summary

• We are committed to this change
• It offers tremendous advantages
• Cutting edge with risks prior to
• the rewards

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Questions??

• Comments positive and negative?
• Residents with simultaneous access to computers?
• Proctoring this exam?
• Flash drive answer uploads?
• Security concerns?
• How will this change your usual process?
• What obstacles do you see?

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Efficient Economical
The new format will be entirely on a single DVD
as opposed to the former set of books. The DVD
has many features that make this an enduring
educational product for the future. Examination
questions after the formal examinations can be
collegiately discussed utilizing the references
and preferred response and the ability to add
notes from further study on a item. Images,
MRIs, and videos are linked to the questions and
be manipulated to view the best comparisons while
discussing the question.
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Service Orientated

• During the examination residents will be able to
  
• Create notes using a notepad for every question
• Search by content domain
• Search on marked questions the exam
• After the examinations, residents will be take
  their DVD and once all the data has been compiled
  they will receive a code to access the
  examination in review mode
• Include their responses and the preferred
  response
• Include the references to examination items
• Contain their notes they made during the
  examination
• Searchable by content domain