CORR Insights^®: An Analysis of References Used for the Orthopaedic In-Training Examination: What are Their Levels of Evidence and Journal Impact Factors?

Excerpt

For 51 years, orthopaedic residents have been taking the Orthopaedic In-Training Examination (OITE), which is written by members of a committee of the American Academy of Orthopaedic Surgeons. As an objective evaluation of a resident’s knowledge about orthopaedics, the examination has had an important role in determining residency programs’ curricula. For some, it is the main focus of the teaching program. We know that the purpose of the OITE is an educational tool and that it should not be used for promoting or dismissing a resident. We also know that the examination covers the broad spectrum of orthopaedics, including its subspecialties and basic science. Since the majority of published orthopaedic articles have a level of evidence (LOE) of IV and V (case series, and expert opinion, respectively), it is not surprising to learn that Haughom and colleagues reported a mean level of 4.6. But is the use of a mean LOE a valid measure? Should more questions be based on a higher LOE? Also, is it valid to have one person (or in selected cases three) determine the LOE of an article when none was provided by the original article’s authors? Regarding impact factor, a measure of a journal’s quality, there are manipulative ways a journal can influence their impact factor. Is there a relationship between LOE and an impact factor? Since knowledge changes as time moves forward, the authors’ finding that 28% of reference articles used in the OITE were published more than 10 years before the test raises concerns about the importance and appropriateness of these questions that residents need to answer correctly. …