Orthopaedic in-training examination scores: A correlation with USMLE results

Background: Both the United States Medical Licensing Examination and the Orthopaedic In-Training Examination measure factual recall as well as interpretative and problem-solving skills. The former examination is used to a variable degree by postgraduate programs in resident selection. Orthopaedic In-Training Examination scores are one measure of the medical knowledge of residents and are used by all American orthopaedic residency programs on a yearly basis. This investigation was performed to retrospectively review Orthopaedic In-Training Examination scores of orthopaedic residents who took the examination in our program. In addition, we sought to determine whether a relationship existed between performance on the Orthopaedic In-Training Examination and the United States Medical Licensing Examinations taken while in medical school. Methods: The records of each orthopaedic resident who took the examination from November 1993 through November 2000 were reviewed. Correlation coefficients and 95% confidence intervals were calculated to assess the relationship, if any, between the Orthopaedic In-Training Examination percentiles and the three-digit scores on the Step-1 and Step-2 United States Medical Licensing Examination. In addition, examination scores were evaluated longitudinally from year-in-training 1 through 4. Results: A significant moderate-sized correlation was found between United States Medical Licensing Examination Step-2 scores and Orthopaedic In-Training Examination score percentiles (p < 0.05); however, with the numbers available, no correlation was seen between United States Medical Licensing Examination Step-1 scores and Orthopaedic In-Training Examination scores. The mean Orthopaedic In-Training Examination scores were in the 66th percentile for year-in-training 1, the 53rd percentile for year 2, the 57th percentile for year 3, and the 50th percentile for year 4. Residents in the laboratory for one year scored in the 88th percentile while in the laboratory (year 0), in the 86th percentile in year 1, and in the 48th percentile in year 4. Conclusion: Although Step-1 United States Medical Licensing Examination scores have been used by our department as a major factor in resident selection historically, our data failed to reveal a significant correlation with performance on the Orthopaedic In-Training Examination. The decrease in Orthopaedic In-Training Examination scores over time for our residents who worked in the laboratory is most likely attributable to multiple factors, including clinical workload hours.