Surgical skills month training leads to higher intern scores and performance, study shows

By Richard Samade, M.D., Ph.D.

A single-institution retrospective cohort study, published in the July/August issue of Current Orthopaedic Practice, compared orthopedic surgery interns who took the orthopedic in-training examination before and after the introduction of a surgical skills month.

For over 50 years, the orthopedic in-training examination (OITE) has served as the annual knowledge assessment of orthopedic surgery residents. The confirmed relationship between OITE and American Board of Orthopaedic Surgery (ABOS) Part I exam scores has motivated residency programs to develop strategies for improving OITE scores and resident education.

In 2013, nationwide changes were recommended to improve the education of orthopaedic residents in their first year of training (PGY-1s), including an option to provide a 30-day surgical skills month (SSM). Modules in the SSM include basics of arthroscopy, arthroplasty, internal fixation of fractures, and splinting.

The primary hypothesis of our team’s research was whether PGY-1 OITE scores differed between the three years before and after implementation of the SSM. We also evaluated the relationship between OITE scores for PGY-1s and PGY-2s (residents in their second year of training). Finally, we examined whether scores between PGY-1 to PGY-2 years differed between two cohorts. To accomplish these goals, we compared de-identified OITE scores of residents before (N₁=15) and after (N₂=16) SSM implementation.

Analyses revealed a significant increase in the percentage of correct answers when comparing the PGY-1 OITE scores of the pre-SSM group (44.8% +/- 4.13%) and the post-SSM group (49.9% +/- 8.44%). This indicated greater PGY-1 knowledge was acquired after the SSM implementation. 

Though regression analysis showed no relationship between PGY-1 and PGY-2 OITE scores prior to SSM, we identified a positive linear relationship after SSM implementation. There was no differential increase in OITE from PGY-1 to PGY-2 scores between the groups.

Our findings support the implementation of a one-month surgical skills training program in the resident curriculum to improve PGY-1 OITE performance. Furthermore, our analyses suggest that OITE performance may be improved in subsequent years following the initiation of this program.

One explanation for these findings may be that an early and formal introduction to subspecialty orthopedic topics during a skills month may help residents structure their knowledge base more effectively. In addition, this program may provide an opportunity to form long-term study habits for the OITE that are more effective for learning than self-directed review alone.