The Orthopaedic In-Training Examination (OITE) is a standardized examination administered annually by the AAOS. The OITE is the first and longest running yearly medical specialty examination in the United States. In 1960, J. Vernon Luck Sr, MD, who was, at that time, the first vice president of the AAOS, proposed a specialty examination to document and guide the process of learning during graduate training. First administered in 1963, the OITE continues to evolve to match the demands of orthopaedic surgeons in the contemporary healthcare environment.

The Central Evaluation Committee of the AAOS designs the examination. Their goal is to provide an examination that enables orthopaedic training programs to evaluate the quality, scope, and comprehensiveness of their educational programs. The OITE also provides residents detailed information about their performance in relation to their peer groups. This provides an opportunity for educational assessment by both orthopaedic educators and residents.

The OITE serves to demonstrate a resident’s learning progress during his or her orthopaedic residency training and helps prepare residents for the certification examination of the American Board of Orthopaedic Surgeons (ABOS). The published Study Guide and personal score reports provide the test takers with an opportunity to review their answers and learn from their mistakes. Reference articles from current orthopaedic literature are provided for each OITE question. Orthopaedic residency program directors also receive enhanced Study Guides explaining the subject and answers to each question. This is useful for small-group problem-based learning sessions for orthopaedic residents.

The current OITE contains 275 questions covering 12 categories. A small number of questions are eliminated from scoring each year by the AAOS after the results are examined. The OITE categories include the fellowship-trained disciplines as well as aspects of basic science and principles of orthopaedics (Table 1).

In 2017, the OITE will include a practice management category, with six questions. Beginning with the Nov. 11, 2017, examination, the following practice management-related topics will serve as source areas for the questions:

• Healthcare policy (such as the Affordable Care Act, the Medicare Access and Children’s Health Insurance Program Reauthorization Act, and the Health Insurance Portability and Accountability Act)
• Alternative payment models (such as bundled payments, accountable care organizations, and capitation)
• Current laws on self-referral and kickback (Stark Laws and Anti-Kickback Statute)
• Billing and coding (such as the International Classifications of Diseases-10th edition, and
  Common Procedural Terminology)
• Clinical integration and provider alignment
• Healthcare economics and financial performance

The need for orthopaedic surgeons to better understand practice management–related principles has never been greater, in particular as the U.S. healthcare system undergoes transformational change. It is hoped that the inclusion of practice management–related questions in the OITE will increase the emphasis on practice management–related content in orthopaedic residency programs’ curricula. A greater emphasis on practice management in residency training may be encouraged with future OITEs having 2 percent to 3 percent of the questions related to these important nonclinical topics.      

Jonathan Sprague, MS, is manager, assessments and examinations, in the AAOS Educational Programs Department; John Cherf, MD, MPH, MBA, is a member of the AAOS Health Care Systems Committee, the Council on Education, and the AAOS Now editorial board.