Analysis of Tumor and Tumor-Like Entities Tested on the Orthopaedic In-Training Examination From 2012 to 2023.

Abstract

Background: The Orthopaedic In-Training Examination (OITE) is used by orthopaedic residency training programs to evaluate the knowledge base of orthopaedic surgery trainees and to predict future performance on the American Board of Orthopaedic Surgery (ABOS) certifying exams. The pathology section of the OITE has changed over the years, both in terms of the content assessed and the format of the questions. This study aims to describe such trends.

Methods: This study analyzed OITE questions from 2012 to 2023, focusing on tumors and tumor-like conditions of bone and soft tissue to guide resident preparation and core curriculum design. Questions were categorized by histologic photomicrographs, preferred responses, possible options, and implied entities. Additionally, questions were classified into four domains: diagnosis, treatment, next step, and multifactorial.

Results: Tumor-related questions constituted 10-16% of each OITE, with an equal number of questions concerning benign and malignant entities. Bone tumor questions averaged nine per year, while soft tissue tumor questions averaged four. The most frequently tested bone tumors were osteosarcoma and giant cell tumor, while pleomorphic sarcoma and liposarcoma were the most frequently tested malignant soft tissue tumors. Metabolic bone diseases such as osteoporosis, osteomalacia, and osteonecrosis were also frequently tested. Histologic photomicrographs were included in 120 questions over the study period, with osteosarcoma being the most depicted. A shift in question focus was observed, with diagnosis questions declining in favor of treatment and next-step management questions in recent years.

Conclusion: These findings provide a comprehensive overview of tumor-related content on the OITE, highlighting trends in question composition and format. This information can guide program directors in designing curricula that align with tested material, ensuring residents are well-prepared for both the OITE and ABOS exams. Emphasizing highyield topics and adapting to evolving question patterns can optimize educational outcomes and improve board pass rates.