levels of evidence for foot and ankle questions on … disclosure statement . no conflict to...
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Levels of Evidence for Foot and Ankle Questions on the OITE: 15-Year Trends
Cory T. Walsh, Louis C. Grandizio DO, John Parenti MD, Gerard J. Cush MD
GEISINGER ORTHOPAEDIC INSTITUTE
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AOFAS Disclosure Statement
No conflict to disclose
Levels of Evidence for Foot and Ankle Questions on the OITE: 15-Year Trends
Cory T. Walsh MD
My Disclosure is in the Final AOFAS Mobile App
I have no conflicts with this presentation
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BACKGROUND
• There has been a trend towards evidence based medicine (EBM) in
the orthopaedic surgery literature.
• Levels of Evidence (LoE) for articles in peer reviewed journals have improved in the past decade.
• The OITE functions as a yearly indicator of orthopaedic resident knowledge and has been found to correlate with performance on ABOS Part I Examination
• There is a paucity of literature pertaining to LoE supporting OITE questions.
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PURPOSE & METHODS
PURPOSE • Determine if LoE for primary journal articles referenced within FA
content domain on OITE have increased over 15 year period
• Determine if both characteristics and taxonomy have changed during this same time period
METHODS
• All questions in FA content from 1995-1997 and from 2010-2012 were analyzed. Omitted questions excluded from official OITE
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METHODS
Data collection from OITE score reports included: • Year of publication, journal, source type (primary journal article,
review article, ICL, textbook) • For each primary journal we documented the LoE for each using
AAOS Levels of Evidence Guidelines
Taxonomy
• Using Buckwalter Classification questions were assigned T1, T2, or T3
• T1 – recall basic facts • T2 – interpret an imaging study or make a diagnosis • T3 – treatment and management provided clinical situation
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BASELINE CHARACTERISTICS
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Overall 1995-97 2010-12 P-value
Total number of included questions, N 132 78 54 --
Buckwalter Classification
T1, N (%)
T2, N (%)
T3, N (%)
39 (29.5%)
25 (19%)
68 (51.5%)
29 (37%)
15 (19%)
34 (44%)
10 (18.5%)
10 (18.5%)
34 (63%)
.0286
Number of references per question
1, N (%)
2, N (%)
3, N (%)
4, N (%)
Types of reference per question
At least 1 primary journal article, N (%)
At least 1 journal review article, N (%)
At least 1 textbook, N (%)
At least 1 ICL, N (%)
24 (18%)
88 (67%)
19 (14%)
1 (1%)
64 (48%)
55 (42%)
76 (58%)
3 (2%)
24 (31%)
46 (59%)
7 (9%)
1 (1%)
34 (44%)
28 (36%)
51 (65%)
2 (3%)
0 (0%)
42 (78%)
12 (22%)
0 (0%)
29 (54%)
27 (50%)
25 (46%)
1 (2%)
<.0001
.1762
.1061
.0291
.7871
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RESULTS
• 78 questions from 1995-1997, 54 questions from 2010-2012
• FAI was the most frequently cited source overall
TAXONOMY • Change in taxonomy distribution was statistically
significant – 34/54 were level T3
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RESULTS
Levels of Evidence • 6/54 (11%) of FA questions from 2010-2012 were Level I or II,
while 3/78 (4%) from 1995-1997 were Level I or II (p level = .1035)
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RESULTS
1995-97
OITE
(n=78)
2010-12
OITE
(n=54)
P-
value
Questions in each time period that cited level I-II evidence, N
(%)
Yes
No
Questions in each time period that cited level I-III evidence, N
(%)
Yes
No
3 (4%)
75 (96%)
5 (6%)
73 (94%)
6 (11%)
48 (89%)
8 (15%)
46 (85%)
.1035
.1111
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Comparison of the LoE for questions in each time period
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CONCLUSIONS
• There has been a trend towards creating OITE questions supported by higher LoE, which reflects the improved LoE in orthopaedic FA literature
• Increase in level 1 studies in comparing 1995-1997 to 2010-2012
• Change in question taxonomy with increased emphasis on clinical management questions compared to years past
• FAI was more frequently cited source
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CONCLUSION
Summary Our results can be used to help improve resident self-study and suggest that reviewing recent FAI articles may aid OITE preparation.
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References
Barr CR, Cheng I, Chou LB, et al. Foot and ankle questions on the orthopaedic in-training examination n: analysis of content, reference, and performance. Orthopedics.2012;35(6),472. doi: 10.3928/01477447-20120525-28.
Barske HL, Baumhauer J. Quality of research and level of evidence in foot and ankle publications. Foot Ankle Int, 2012;33(1):1-6. doi: 10.3113/FAI.2012.0001. Bernstein J, Kenniston JA, Nydick JA, et al. Levels of evidence are low for clinical management questions on the orthopaedic in-training examination. J Bone Joint Surg Am.
2010;92:508-511. doi: 10.2106/JBJS.I.00530. Buckwalter JA, Schumacher R, Albright JP, et al. Use of an educational taxonomy for evaluation of cognitive performance. J Med Educ. 1981;56:115-121. Dougherty PJ, Walter N, Schilling P, et al. Do scores of the USMLE Step 1 and OITE correlate with the ABOS Part I certifying examination?: a multicenter study. Clin Orthop and
Relat Res. 2010; 468(10):2797-2802. doi: 10.1007/s11999-010-1327-3. Hanzlik S, Mahabir RC, Baynosa RC, et al. Levels of evidence in research published in the journal of bone and joint surgery (american volume) over the last thirty years. J Bone
Joint Surg Am. 2009; 91:425-428. doi: 10.2106/JBJS.H.00108. Haughom BD, Goldstein Z, Hellman MD, et al. An Analysis of References Used for the Orthopaedic In-Training Examination: What are Their Levels of Evidence and Journal
Impact Factors? Clin Orthop and Relat Res. 2014; 472:4024-4032. doi: 10.1007/s11999-014-3895-0. Mankin HJ. The orthopaedic in-training examination (OITE). Clin Orthop Relat Res. 1971;75:108-116. Miyamoto RG, Klein GR, Walsh M, et al. Orthopedic surgery residents’ study habits and performance on the orthopedic in-training examination. Am J Orthop. 2007; 36(12):e185-
188. Razi Z, Abbassian A, Cro S, et al. Levels of evidence in foot and ankle surgery literature: progress from 2000 to 2010? J Bone Joint Surg Am. 2012;94:e112-1. doi:
10.2106/JBJS.K.01453. Sheibani-Rad S, Arnoczky SP, Walter NE. Analysis of the basic science section of the orthopaedic in-training examination. Orthopedics. 2012; 35(8), 1251-1255. doi:
10.3928/01477447-20120725-28. Srinivasan RC, Seybold JD, Kadakia AR, Analysis of the foot and ankle section of the Orthopaedic In-Training Examination. Foot Ankle Int. 2009;30(11):1060-1064. doi:
10.3113/FAI.2009.1060. Thordarson DB. Levels of evidence, evidence-based medicine, and Foot & Ankle International. Foot Ankle Int. 2008; 9(9):881-882. doi: 10.3113/FAI.2008.0881. | 12