• Tim Dwyer, Sara Wright, Kulamakan M Kulasegaram, John Theodoropoulos, Jaskarndip Chahal, David Wasserstein, Charlotte Ringsted, Brian Hodges, and Darrell Ogilvie-Harris.
• Women's College Hospital, Toronto, Canada Mt. Sinai Hospital, Toronto, Canada tim.dwyer@wchospital.ca.
• J Bone Joint Surg Am. 2015 Dec 2; 97 (23): 1985-91.

BackgroundCompetency-based medical education as a resident-training format will move postgraduate training away from time-based training, to a model based on observable outcomes. The purpose of this study was to determine whether junior residents and senior residents could demonstrate clinical skills to a similar level, after a sports medicine rotation.MethodsAll residents undertaking a three-month sports medicine rotation had to pass an Objective Structured Clinical Examination. The stations tested the fundamentals of history-taking, examination, image interpretation, differential diagnosis, informed consent, and clinical decision-making. Performance at each station was assessed with a binary station-specific checklist and an overall global rating scale, in which 1 indicated novice, 2 indicated advanced beginner, 3 indicated competent, 4 indicated proficient, and 5 indicated expert. A global rating scale was also given for each domain of knowledge.ResultsOver eighteen months, thirty-nine residents (twenty-one junior residents and eighteen senior residents) and six fellows (for a total of forty-five participants) completed the examination. With regard to junior residents and senior residents, analysis using a two-tailed t test demonstrated a significant difference (p < 0.01) in both total checklist score and overall global rating scale; the mean total checklist score (and standard deviation) was 56.15% ± 10.99% for junior residents and 71.87% ± 8.94% for senior residents, and the mean global rating scale was 2.44 ± 0.55 for junior residents and 3.79 ± 0.49 for senior residents. There was a significant difference between junior residents and senior residents for each knowledge domain, with a significance of p < 0.05 for history-taking and p < 0.01 for the remainder of the domains.ConclusionsDespite intensive teaching within a competency-based medical education model, junior residents were not able to demonstrate knowledge as well as senior residents, suggesting that overall clinical experience is critically important for achieving competency as measured by the Objective Structured Clinical Examination.Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

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