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AAOS INSTRUCTIONAL COURSE LECTURE

NEW ORLEANS, LOUISIANA

ACGME REQUIREMENTS
ICL 311 RESIDENCY ACCREDITATION

MARCH 12, 2010 8:00 .


A M. 10:00 A.M.

TOPICS

(1) DIVERSITY, WOMEN AND UNDER-REPRESENTED MINORITIES

(2) DEVELOPING A COMPETENCY-BASED ORTHOPAEDIC


CURRICULUM

RICHARD E. GRANT, M.D.


PROFESSOR OF ORTHOPAEDIC SURGERY
UNIVERSITY HOSPITALS OF CLEVELAND/CASE MEDICAL CENTER
CLEVELAND, OHIO 44106
RACE ETHNICITY AND ORTHOPAEDICS

England and Pierce reported on the state of diversity in orthopaedics in 1999, after examining the selection patterns of
orthopaedic residents during twelve years prior to publication of their data. The percentage of diversity of orthopaedic
residents during those twelve years changed minimally as represented by the acceptance of African-Americans,
Hispanics, Native Americans, Puerto Ricans, and Mexican-Americans into orthopaedic residency education programs.
The percentage of Asian and Pacific Islanders quadrupled (2.2 percent in 1983, to 9.8 percent in 1995) during the
twelve years of the study. The percentage of White women residents remained unchanged. White male participation
in orthopaedic surgery declined in direct relation to the increase in Asian or Pacific Islander men.

A similar survey of 159 orthopaedic residency education programs garnered a fifty-six (56) percent response rate. The
distribution of orthopaedic residents and fellows was as follows: White non-Hispanics 84.2 percent; Asians 6.6
percent; African-Americans 3.6 percent; Native Americans 2.2 percent; Puerto Ricans (1.2 percent); Mexican-
Americans 0.8 percent; and, other Hispanics 1.0 percent. African-Americans and Hispanics were under-represented in
orthopaedic training programs compared with their numbers in the general American population.

Jimenez, R.L., noted that although one-third of the United States population, in 1999, was comprised of Latinos,
African-Americans, and Native Americans, only seven (7) percent of all orthopaedic surgeons were represented by
these minorities. Ostensibly, there is a need for minority orthopaedic surgeons who can communicate with and
comprehend a population of diverse patients to provide them with culturally-competent care. Intrinsic and extrinsic
barriers tend to impede women and under-represented minority medical students from choosing orthopaedics as a
career.

When the 2004 AAOS Orthopaedic Physician census results were published, among the certified practicing
orthopaedic surgeons, eighty-nine (89) percent reported they were Caucasian. Among AAOS candidate members,
eighty (80) percent identified as Caucasian. Asian-Americans constituted 3.8 percent of practicing orthopaedic
surgeons, and eight (8) percent of AAOS candidate members. African-American respondents constituted only 1.3
percent of practicing orthopaedic surgeons, and 2.9 percent of AAOS candidate members. In 2004, the overall density
of orthopaedic surgeons in the United States increased to 6.2 per 100,000 population base.

Over the past twenty years, the percentage of the American population consisting of non-White minorities continues to
expand at a steady rate. By 2050, the aggregate of non-White minorities are expected to become the majority.
Despite fifty years of effort and multiple programs to increase the representation of minorities in the health care
professions, minority representation remains grossly deficient. Under-representation of minority healthcare providers
has a negative effect on public health, inclusive of critical bench marks of racial and health disparities linked to
chronic illness, excessive comorbidities, and early demise. Such systemic deficits can be reduced or curtailed by
increased efforts for the recruitment and development of both under-represented minority medical students, medical
administrators, and full time academic faculty.

Nivet, Taylor, Butts, and Kondwani, et al, note that the recruitment of under-represented minority faculty is
compromised by barriers resulting from decades of systemic segregation, discrimination, tradition, culture, and elitism
in medicine and academic medical centers. The elimination of barriers to minority faculty would improve public
health, expand the focus of contemporary research agendas, and enhance the education and mentoring of under-
represented minority students.

Ayers, C.E., describes orthopaedic surgery as a specialty attracting an abundance of applicants for limited residency
slots. Performance measures reviewed by most orthopaedic residency programs include USMLE scores, election to
the Alpha Omega Alpha Honor Society, grade point averages, medical school class rank, personal statements, the
Dean's letter, and other letters of recommendation.

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The dynamics of barriers to minority candidates seeking entry into orthopaedic residencies include the sense that the
under-represented minority applicant pool is inadequate. Additional factors include certain methods related to
applicant screening criteria, the under-represented minority specialty preference, and the perception under-represented
minorities have of orthopaedic surgeons.

Gebhardt, M.C., notes that majority medical students exposed to classmates from diverse cultures and contrasting life
experiences different from theirs enable White male students in an orthopaedic residency to more effectively interact
with female and minority patients as a result of interacting with peers who are women or under-represented minorities.
The overall quality of care and the level of satisfaction for physicians and their patients are improved by such
interaction. Suggested remedies for expanding culturally-competent care include increasing the minority applicant
pool from kindergarten through the twelfth grade, and subsequent recruitment of talented students to enter the medical
field. Given the extent of current pipeline deficits, some form of short term affirmative action is necessary to increase
the level of diversity of orthopaedic residency programs and orthopaedic faculty.

Approximately three hundred million (300,000,000) people live in the United States. By 2000, 3.5 million American
residents were Hispanic, thirty-six (36) million were African-American, and fourteen (14) million were Asian-
American. By 2050, minority populations will outnumber the White population. Orthopaedic surgeons in the United
States will treat an increasingly diverse population from a variety of ethnic groups and cultural backgrounds. Jimenez,
R.L., explains the target audience for culturally-competent care education is not just the eighty (80) percent of
orthopaedic surgeons who are White males (N=16,000). All physicians must practice cultural competency. The
Accreditation Council of Graduate Medical Education (ACGME) has adopted program requirements addressing
cultural competency by adopting two of the six core competencies specifically directed toward the development of
cultural competency with a direct link to medical communication skills and professionalism.

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RESIDENT SELECTION CRITERIA:
CHALLENGES FOR WOMEN AND UNDER-REPRESENTED MINORITIES

Thordarson and Patzatkis found the selection of best applicants for orthopaedic residency programs remains elusive.
Only fair to poor correlations were noted between the resident's initial ranking, ranking on graduation from residency,
and their USMLE, ABOS, and OITE scores. The only relatively dependable correlation found was between the
Orthopaedic In Training Examination (OITE) and the American Board of Orthopaedic Surgery (ABOS) scores.
Faculty did not agree in their ranking of residents on graduation.

Selection criteria for acceptance into orthopaedic residency can vary when comparing applicant opinions to those of
faculty at academic medical centers. According to Bajaz and Carmichael's study, faculty favored performance on a
local rotation (externship), class rank, and interview performance as essential determinants. Residency applicants
thought externship performance, USMLE Step I scores, and letters of recommendation were the three most important
determinants of obtaining a residency.

Evarts, C.M., reflecting on the consensus of the American Orthopaedic Association (AOA) committee charged with
studying the processes involved in the selection of orthopaedic residents, offered the following suggestions to
orthopaedic program directors:
1) Use of standardized application forms;
2) full disclosure to applicants;
3) careful screening of candidates to be interviewed;
4) careful planning and implementation of the interview process and interview visit;
5) broad faculty representation and discussion of candidates at the time of selection; and,
6) due diligence, when necessary, to resolve incomplete information or conflicting candidate data.

Mallott, D., et al, emphasized the need to focus carefully on the applicant's behavior, character, and developing
professionalism observed over the course of a four year medical school curriculum. Such non-academic factors may
play a significant role in determining compatibility between a medical student applicant and an existent orthopaedic
residency program. Specific reference was made to non-academic factors, such as the candidate's Dean's letter,
interview, and other affective domain issues.

Luri, Lambert, and Grady-Weliky examine the relationship between the Dean's letter rankings and later evaluations by
residency program directors. Dean's letter rankings serve as a significant predictor of performance in internship.
Medical students identified by the Dean's letter as performing in the bottom half of their medical school class were
most likely to either under-perform or over-perform during their Post Graduate Year one (PGY-I).

Turner, Shaughnessy, Berg, Larson, and Hanssen developed a Quantitative Composite Scoring Tool (QCST) to be
applied in a standardized manner for orthopaedic residency screening and selection, in addition to predicting
orthopaedic residency performance. Four predictors were identified, including USMLE Part I scores, AOA status,
junior year clinical clerkship honors grades, and their QCST score. Outcome measurements consisted of OITE scores,
ABOS Cognitive Examination Part I scores, ABOS Oral Examination Part II scores, and internal assessments of
performance meriting attainment of satisfactory PGY-V (Post Graduate Year five) Chief Resident associate status.
Honors grades during the junior year clinical clerkships were associated strongly with Chief Resident performance.

Dirschl, Dahners, Adams, Crouch, and Wilson drew similar conclusions from their analysis of resident selection
criteria and subsequent residency performance. Academic performance and clinical clerkships in medical school were
identified as an important factor. The number of honors grades on medical school clinical rotations was their strongest
predictor of residency performance. AOA status was second.

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In an additional study examining the reliability of a scoring system for orthopaedic residency, Dirschl concluded that
no bench marks existed by which to define an acceptable intra-class correlation coefficient of a scoring model for
resident applicants. Great intra-observer variability existed when subjective elements were included in residency
screening scoring systems.

Orthopaedic residency programs must first determine what data elements are essential and highly valued in their
selection of residents. While systems based on calculating objective academic scores increase the objectivity of the
residency selection process, such scoring systems do not appear to correlate with outcomes of residency education
programs.

An additional study by Carmichael, Westmoreland, Thomas, and Patterson evaluating the relation of residency
selection factors to subsequent Orthopaedic In Training Examination performances, they concluded those residents
who previously scored 220 on the USMLE Step I had higher OITE scores than those scoring below 220.
Additionally, it was noted that residents who were married also had higher average OITE scores. A trend with regard
to AOA status was also detected. Residents who attained AOA status scored slightly higher on the OITE. Obviously,
few pre-residency variables correlate well with success during an orthopaedic residency. Even so, orthopaedic surgery
remains one of the most competitive specialties with more than a ninety-nine (99) percent match fill rate in the past
several years. An over-supply of qualified applicants leads to intense competition for these limited residency spots.

Thordarson's study found a poor correlation between USMLE Part I scores and an applicant's position on their
residency's initial rank list. Smilen, Funai, and Bianco question whether interviewers should be given applicants'
USMLE Part I scores. Knowledge by interviewers of USMLE Part I scores may negate the interview as an
independent means of evaluating potential residency candidates. Edmond, Deschenes, Eckler, and Wenzell found that
if USMLE scores are used to screen applicants for residency interviews, a greater percentage of African-American
applicants would be refused an interview.

Gilbert, et al, observed increased difficulty with comparing candidates if the interview process changes with each
candidate. Structured interviews were preferred. Structured interviews employ standardized questions for all
applicants, provide sample answers for comparison, and utilizes a panel for the interviews. The reliability and validity
of the interviewing process improves as structure is added. In general, residency programs agree in principle about the
important characteristics of a good resident. However, each program's perception of how they value certain resident
characteristics, and how those characteristics might manifest in their eventual practice profile, may differ considerably.
Ultimately, the identification of accurate selection criteria for residents is becoming increasingly important due to the
economic pressures of current and future healthcare funding and diverse societal forces.

Clark, R., et al, noted that deficiencies in the affective domain (character and personality traits) were the most
common reasons leading to discipline or dismissal of residents and may serve as the primary indicator of the resident's
ability to function professionally as an orthopaedic surgeon.

Dale, Schmitt, and Crosby focused on the misrepresentation of research criteria by orthopaedic residency applicants.
Berstein, Jazrawi, Della Valle, and Zuckerman's analysis of residency selection criteria highlighted the relationship
between the candidate's affective domain and their performance during residency and practice. The authors
anticipated the increasing importance of issues relevant to affective domain characteristics. They concluded that
affective domain characteristics would play a more important role in future residency selection committees'
deliberations.

White, A.A., questioned the selection process for orthopaedic residents, indicating that programs must put the horse,
namely the consideration of certain societal goals and responsibilities, before the cart. The cart was identified as the
selection criteria and processes for selecting residents into orthopaedic educational programs.

White concluded that one of the specific outcome goals that should be identified are efforts that can be directed to

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learning to recognize and evaluate characteristics of applicants that predict desired outcomes in competency.
Traditional screening and selection of applicants based largely on grades, test scores, and election to Alpha Omega
Alpha Honorary Society, have certain historically-based biases and limitations. The historic ethnocentric impacts on
western medical culture are profound, longstanding, and thoroughly interwoven into the fabric of our profession,
orthopaedics. White further concluded it is necessary to substantially change our residency selection process if we
hope to achieve some highly-significant humanitarian and pragmatic societal goals.

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ACCREDITATION COUNCIL OF GRADUATE MEDICAL EDUCATION (ACGME)
CORE COMPETENCIES AND THE DEVELOPMENT OF A COMPETENCY-BASED
ORTHOPAEDIC CORE CURRICULUM

Since the beginning of July of 2002, ACGME-accredited programs in the United States have been challenged to teach
and assess competency-based curriculums and better prepare physicians in residency programs to practice in the
rapidly-changing healthcare environment. Current accreditation requirements for residency education programs
mandate that residents are to participate in educational experiences that ensure attainment in six general competencies:
patient care; medical knowledge; practice-based learning and improvement; professionalism; interpersonal skills and
communication; and, systems-based practice. Competency in these six areas must be documented by dependable and
appropriate metrics or evaluation tools confirming an incremental growth in professional knowledge, patient-centered
care, and orthopaedic surgical skill acquisition.

Arnold, L., favors quantitative and qualitative approaches to the assessment of the desired level of professionalism
implicit in the framing of the six competencies. Techniques of assessment increasing the validity and reliability of
measuring a resident's progress include 360 assessments, performance-based assessments, learning portfolios, and
system designs inclusive of infrastructure support.

Resolution of a resident's unprofessional behavior would be addressed through due process documented by a warning,
and constructive confrontation to institute a structured program of remediation. There should be concordance between
the intervention and the etiology of the resident's lapse in professional behavior. The essentials of effective behavioral
contracts are inclusive of cognitive behavioral therapy, motivational interviewing, and continuous monitoring.

According to Cruess, one of the six competencies, professionalism, must be explicitly taught. Once the concept of
professionalism is defined and learned by residents and faculty alike, residents will require reinforcement through
example. Residents must understand what will be taught, expected, evaluated, and incorporated into the knowledge
base of residents and practicing faculty members. Cruess advocates specific learning experiences inclusive of self-
reflection on professionalism and adaptation of such practices into the continuum of medical education.

Cornwall concluded it is unlikely that professionalism is an innate or universal characteristic of college students
entering medical school or medical students entering a program of postgraduate residency education. Regardless, the
core competency, professionalism, becomes an essential value in effective medical practice.

Beach, Bar-On, Baldwin, Kittredge, Trimm, and Henry evaluated the use of an interactive, on-line resource for
competency-based curriculum development. Program directors were allowed to download competency-based
curriculum building tools using a specific web site. Most favored pre-designed formats over self-selected lists of goals
and objectives. Less frequently, web site subscribers downloaded resident evaluation forms and tutorials.
Respondents to the association's educational guidelines for residency confirmed that the on-line competency-based
curriculum building tools were easy to use, adaptable, and important to the understanding of mechanisms for
integrating the ACGME competencies into their residency programs.

Lurie, Mooney, and Lyness evaluated published evidence that the ACGME's six general competencies could each be
measured in a valid and reliable way. Fifty-six (56) of 127 articles identified met their inclusion criteria. Studies of
systems-based practice and practice-based learning and improvement viewed these competencies as inherent
properties of systems and not specific to individual resident behavior. Their review of the literature cited a lack of
evidence that current core competency measurement tools were able to asses the six competencies independently of
one another.

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Varkey, Karlapudi, Rose, Nelson, and Warner conducted a residency program director self-assessment survey
following a web-based institution-wide curriculum designed to facilitate the teaching and assessment of practice-based
learning and improvement (PBLI) and systems-based practice (SBP) in 115 ACGME-accredited residency and
fellowship programs. Additional initiatives included didactic sessions for residents and fellows, program director
workshops, and one-on-one consultations with program directors. While the authors documented a thirteen (13)
percent increase in a program directors' perceived ability to measure competency in one area, systems-based practice
(SBP), there was no change in the program directors' perceived confidence in the measurement of program-based
learning and improvement (PBLI).

Carraccio and Englander reviewed the current literature for all articles relevant to assessment of the six competencies
and resident performance. Their evaluation of current "best practices" endorsed the use of a web-based evaluation
portfolio, allowing faculty and program directors a variety of assessment tools to evaluate the diverse domains of
competence and reflective learning. Their web-based portfolio assessment program facilitated the evaluation of
resident competence and enhanced the faculty research infrastructure supporting their practice of evidence-based
education.

Yaszay, Kubiak, Agel, and Hanel conducted a national survey of orthopaedic program directors and selected
orthopaedic residents in an effort to define the experiences of orthopaedic residencies working toward the
incorporation of the ACGME's core competencies. Residents and program directors prioritized patient care and
medical knowledge. PBLI and SBP's were relegated to the lowest level of priority among the six competencies.
Orthopaedic program directors and residents suggested: a) greater clarification of the definition of each of the core
competencies and, b) greater commitment to the processes relevant to the development of competency in surgical
procedures.

Lee, et al, favored best practices for residency journal club activities and group discussion of existing medical
literature. The core competency of practice-based learning and improvement was enhanced by the use of a structured
review checklist, explicit written learning objectives, and a formalized meeting structure and process. While
Rosenfeld advocated the use of the residency program's morbidity and mortality (M&M) conference to teach and
assess the ACGME general competencies for instruction in PBLI, professionalism, interpersonal and communication
skills, and systems-based practice. During the redesign M&M conference, residents present the selected patient's
history and discusses the complication according to traditional morbidity and mortality conference models. However,
the resident is required to analyze the case presentation in terms of healthcare system issues contributing to the
patient's morbidity or mortality. In addition, the resident is tasked with identifying patient safety issues, and
communication problems with the patient, the patient's family, or with colleagues.

Issues relevant to ethnic dissonance, ethical issues, and challenges of cultural competency are also identified and
explored by the resident. Subsequently, as an example relative to this process, the case presented is reviewed by
faculty orthopaedic surgeons. Each ACGME competency is addressed as deemed relevant to the facts and outcomes
of the case presentation. Each resident presenter completes a practice-based improvement log, analyzing factors
precipitating the complication and/or the mortality. The resident is then tasked with providing suggestions for systems
improvement, increasing patient safety, improving communications and ethnic cultural-competency, or addressing
ethical issues. References from the literature supporting solutions for improved outcomes should be included in the
resident's practice-based learning and improvement log. Another method to teach the core competencies to
orthopaedic residents and faculty, and to determine whether both parties are satisfying the intended outcomes related
to the core competencies has been suggested by Stiles, et al. Their general surgery program initiated a daily morning
report as an effective "sign-out" and accounting of new admissions and consults from the previous day to their surgery
service.

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The morning general surgery report was restructured and presented in an evidence-based format addressing patient
care, medical knowledge, professionalism, interpersonal skills and communications, and practice-based learning and
improvement. Their guidelines included the participation of the on-call Attending, a review of all the pertinent
imaging studies, provisions for follow-up of selected cases, and a critical review of the peer-reviewed literature.
Surgical morning report and traditional orthopaedic fracture conferences appear to be very compatible with existent
resident didactic sessions, and the incorporation of ACGME competency requirements.

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RACE ETHNICITY AND ORTHOPAEDICS
REFERENCES

Ayers, C.E., "Minorities and the Orthopaedic Profession," Clinical Orthopaedics and Related Research. 1999 May;
(362)58-64.

Bollinger, L.C., "The Need for Diversity in Higher Education," Academic Medicine. 2003;78:431-436.

England, S.P., and Pierce, R.O.Jr., "Current Diversity in Orthopaedics: Issues of Race, Ethnicity, and Gender,"
Clinical Orthopaedics and Related Research. 1999 May;(362):40-3

Gebhardt, M.C., "Improving Diversity in Orthopaedic Residency Programs," Journal of American Academy of
Orthopaedic Surgery. Vol15,sup1,September 2007,S49-S50,2007,The American Academy of Orthopaedic Surgeons.

Grant, R.E., Banks, W.J.Jr., Alleyne, K.R., "A Survey of the Ethnic and Racial Distribution in Orthopaedic Residency
Programs in the United States," Journal of the National Medical Association. 1999 September;91(9): 509-12.

Harris, D.L, Mullan S., Simpson, C.E.Jr., Harmon R.G., "The Current and Future Need for Minority Medical Faculty,"
Journal Association of Academic Minority Physicians. 1991;2(1):14-7.

Ibrahim, S.A., "Racial and Ethnic Disparities in Hip and Knee Joint Replacement: A Review of Research in the
Veteran's Affairs Healthcare System," Journal of American Academy of Orthopaedic Surgery. 2007;15,sup1: S87-94.

Jimenez, R.L., "Barriers to Minorities in the Orthopaedic Profession," Clinical Orthopaedics and Related Research.
1999 May;(362):44-50.

Keppel, K., Garcia, T., Hallquist, S., Ryskulova A., Agress, L., "Comparing Racial and Ethnic Populations Based on
Healthy People 2010 Objectives," Healthy People STAT Notes. 2007 August;(26)1-16.

Nelson, C.L., "Disparities in Orthopaedic Surgical Intervention," Journal of the American Academy of Orthopaedic
Surgery. 2007;Vol15,sup1:S13-7.

Nivet, M.A., Taylor, V.S., Butts, G.C., Smith, Q.T., Rust, G., and Kondwani, K., "Diversity in Orthopaedic Medicine,
Number One Case for Minority Faculty Development Today," Mount Sinai Journal of Medicine. 2008, December 1;
75(6):491-8.

Petersdorf, R.G., Turner, K.S., Nickens, H.W., and Ready, T., "Minorities in Medicine, Past, Present, and Future,"
Academic Medicine. 1990 November;65(11):663-70.

Thomas, C.L., "African-Americans and Women in Orthopaedic Residency: The Johns Hopkins Experience," Clinical
Orthopaedics and Related Research. 1999;362:65-71.

Torucznik, M.A., "2004 Orthopaedic Physicians Census Results Released," American Academy of Orthopaedic
Surgery Bulletin. 2005 February;pp42-44.

White, A.A., "Resident Selection: Are We Putting the Cart Before the Horse?" Clinical Orthopaedics and Related
Research. 2002;399:255-259.

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RESIDENT SELECTION CRITERIA:
CHALLENGES FOR WOMEN AND UNDER-REPRESENTED MINORITIES
REFERENCES

Bajaj, G., Carmichael, K.D., "What Attributes are Necessary to be Selected for an Orthopaedic Surgery Residency
Position: Perceptions of Faculty and Residents," Southern Medical Journal. 2004 December;97(12): 1179-85

Berner, E.S., Brooks, C.M., Erdmann, J.B., "Use of the USMLE to Select Residents," Academic Medicine. 1993
October;68(10):753-9.

Berstein, A.D., Jazrawi, L.M., Della Valle, C.J., Zuckerman, J.D., "Orthopaedic Residents Selection Criteria,"
Journal of Bone and Joint Surgery. Am.2003 July;85-A(7):1400.

Carmichael, K.D., Westmoreland, J.B., Thomas, J.A., Patterson, R.M., "Relation of Residency Selection Factors to
Subsequent Orthopaedic In Training Examination Performance," Southern Medical Journal. 2003 May;98(5): 528-32

Case, S.M., Swanson, D.B., "Validity of NBME Part I and Part II Scores for Selection of Residents in Orthopaedic
Surgery, Dermatology, and Preventative Medicine," Academic Medicine. 1993 February;68(2sup): S51-6.

Clark, R., Evans, E.B., Ivey, F.M., "Characteristics of Successful and Unsuccessful Applicants to Orthopaedic
Residency Programs," Clinical Orthopaedics and Related Research. 1989;241:257-264.

Dailey, S.W., Brinker, M.R., Elliott, M.N., "Orthopaedic Resident's Perceptions of the Content and Adequacy of Their
Residency Training," American Journal of Orthopaedics. 1999 January;28(1):55.

Dale, J.A., Schmitt, C.M., Crosby, L., "Misrepresentation of Research Criteria by Orthopaedic Residency Applicants,"
Journal of Bone and Joint Surgery. 1999;81-A(12):1679-1681.

Dirschl, D.R., "Scoring of Orthopaedic Residency Applications: Is a Scoring System Reliable?" Clinical Orthopaedics
and Related Research. 339:260-264.

Dirschl, D.R., Campion, E.R., Gilliam, K., "Resident Selection and Predictors of Performance: Can We Be Evidence-
Based?" Clinical Orthopaedics and Related Research. 2006 August;449:44-9.

Dirschl, D.R., Dahners, L.E., Adams, G.L., Crouch, J.H., and Wilson, F.C., "Correlating Selection Criteria with
Subsequent Performance as Residents," Clinical Orthopaedics and Related Research. 2002 June;399:265-71.

Edmond, M.B, Deschenes, J.L., Eckler, M., Wenzell, R.P., "Racial Bias in Using USMLE Step I Scores to Grant
Internal Medicine Residency Interviews," Academic Medicine. 2001;76:1253-1256.

Evarts, C.M., "Resident Selection: A Key to the Future of Orthopaedics," Clinical Orthopaedics and Related Research.
2006 August;449:39-43.

Fine, P.L., Hayward, R.A., "Do The Criteria of Resident Selection Committees Predict Residents' Performances?"
Academic Medicine. 1995 September;70(9):834-8.

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Gilbart, M., Cusimano, M., Regehr, G., "Evaluating Surgical Resident Selection Procedures," American Journal of
Surgery. 181(2001)221-225.

Herndon, J.H., Allan, B.J., Dyer G., Gawa, A., Zurakowski, D., "Predictors of Success on the American Board of
Orthopaedic Surgery Examination," Clinical Orthopaedics and Related Research. 2009 September;467(9):2436-45-
EPUB 2009 June 26.

Luri, S.J., Lambert, D.R., Grady-Weliky, T.A., "Relationship Between Dean's Letter Rankings and Later Evaluations
by Residency Program Directors," Teach and Learn Medicine. 2007 Summer;19(3):251-6.

Mallott, D., "Interview, Dean's Letter, and Affective Domain Issues," Clinical Orthopaedics and Related Research.
2006 August;449:56-61.

Sherry, E., Mobbs, R., Henderson, A., "Becoming an Orthopaedic Surgeon: Background of Trainees and Their
Opinions of Selection Criteria for Orthopaedic Training," AUST-NZJ Surgery. 1996;Vol66,473-477.

Smilen, S.W., Funai, E.F., Bianco, A.T., "Residency Selection: Should Interviewers be Given Applicants' Board
Scores?" American Journal of Obstetrics and Gynecology. 2001;184:508-513.

Thordarson, D.B, Patzatkis, M.J., "Resident Selection: How Are We Doing, and Why?" Clinical Orthopaedics and
Related Research. 2007 June;459:255-9.

Turner, N.S., Shaughnessy, W.J., Berg, E.J., Larson, D.R., Hanssen, A.D., "A Quantitative Composite Scoring Tool
for Orthopaedic Residency Screening and Selection," Clinical Orthopaedics and Related Research. 2006
August;449:50-5.

White, A.A., "Resident Selection: Are We Putting the Cart Before the Horse?" Clinical Orthopaedics and Related
Research. 2002 June;(399):253-4.

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ACCREDITATION COUNCIL OF GRADUATE MEDICAL EDUCATION (ACGME)
CORE COMPETENCIES AND THE DEVELOPMENT OF A
COMPETENCY-BASED ORTHOPAEDIC CORE CURRICULUM
REFERENCES

Arnold, L., "Responding to the Professionalism of Learners and Faculty in Orthopaedic Surgery," Clinical
Orthopaedics and Related Research. 2002 August;449:205-13.

Batalden, P., Leach, D., Swing, S., Dreyfus, H., Dreyfus, S., "General Competencies and Accreditation in Graduate
Medical Education," Health Affairs. (Milwood) 2002 September-October;21(5):103-111.

Beach, P.S., Bar-On, M., Baldwin, C., Kittredge, D., Trimm, R.S., Henry, R., "Evaluation of the Use of an Interactive,
On-Line Resource for Competency-Based Curriculum Development," Academic Medicine. 2009
September;84(9):1269-75.

Brasel, K.J., Bragg, D., Simpson, D.E., Weigelt, J.A., "Competencies Using Established Residency Training Program
Assessment Tools," Surgery. 2002 February;131(2):214-5.

Carraccio, C., Englander, R., "Evaluating Competence Using a Portfolio: A Literature Review and Web-Based
Application to the ACGME Competencies," Teach Learn Med. 2004 Fall;16(4):381.7.

Cornwall, R., "Teaching Professionalism in Orthopaedic Residency," Journal of Bone and Joint Surgery. Am.2001
April;83-A(4):626.8.

Cruess, R.L., "Teaching Professionalism: Theory, Principles, and Practices," Clinical Orthopaedics and Related
Research. 2006 August;449:177-85.

Delzell, J.E., Ringdahl, E.N., Kruse, R.L., "The ACGME Core Competencies: A National Survey of Family Medicine
Program Directors," Family Medicine. 2005 September;37(8):576-80.

DiGiovanni, B.F., Gillespie, B.T., Flemister, A.S., Baumhauer, J.F., "Using Resident Input to Identify and Integrate
Essential Components of a Foot and Ankle Rotation," Foot and Ankle International. 2006 September; 27(9):728-33.

Gregory, J.K., Lachman, N., Camp, C.L., Chen, L.P., Pawlina, W., "Restructuring a Basic Science Course for Core
Competencies: An Example from Anatomy Teaching," Medical Teaching. 2009 September;31(9):855-61.

Heard, J.K., Allen, R.M., Clardy, J., "Assessing the Needs of Residency Program Directors to Meet the ACGME
General Competencies," Academic Medicine. 2002 July;77(7):750.

Hurwitz, S.R., "Guidelines for Teaching the Foot and Ankle in Orthopaedic Residency," Foot and Ankle International.
1999 April;20(4):272-5.

Hutol, O.A., Carpenter, R.O., Tarpley, J.L., Lomis, K.D., "Missed Opportunities: A Descriptive Assessment of
Teaching and Attitudes Regarding Communication Skills in a Surgical Residency," Current Surgery. 2006 November-
December;63(6):408-9.

Lee, A.G., Beaver, H.A., Greenlee, Oetting, T.A., Boldt, H.C., Olsen, R.J., Abramoff, "Teaching and Assessing
Systems-Based Competency in Ophthalmology Residency Training Programs," Survey of Ophthalmology. 2007
November-December;52(6):680-9.

12
Lee, A.G., Boldt, H.C., Golnik, K.C., Arnold, A.C., Oetting, T.A., Beaver, H.A., Olsen, R.J., Carter, K., "Using the
Journal Club to Teach and Assess Competence Practice-Based Learning and Improvement: A Literature Review and
Recommendation for Implementation," Survey of Ophthalmology. 2005 November-December; 50(6):542-8.

Long, D.M., "Competency-Based Residency Training: The Next Advance in Graduate Medical Education," Academic
Medicine. 2000 December;75(12):1178-83.

Moskowitz, E.J., Nash, D.B., "Accreditation Council for Graduate Medical Education Competencies: Practice-Based
Learning and Systems-Based Practice," American Journal of Medical Quality. 2007 September-October;22(5):351-82.

Lurie, S.J., Mooney, C.J., Lyness, J.M., "Measurements of the General Competencies of the Accreditation Council for
Graduate Medical Education: A Systematic Review," Academic Medicine. 2009 March;84(3):301-9.

Pellegrini, C.A., "Invited Commentary: The ACGME Outcome Project, American Council of Graduate Medical
Education," Surgery. 2002 February;131(2):205-9.

Risner, B., Nyland, J., Crawford, C.H., Roberts, Johnson, J.R., "Orthopaedic In Training Examination Performance: A
Nine Year Review of a Residency Program Data Base," Southern Medical Journal. 2008 August; 101(8):791-6.

Rosenfeld, J.C., "Using the Morbidity and Mortality Conference to Teach and Assess the ACGME General
Competencies," Current Surgery. 2005 November-December;62(6):664-9.

Stiles, B.M., Reece, T.B., Hedric, T.L., Sawyer, R.G., "General Surgery Morning Report: A Competency-Based
Conference that Enhances Patient Care and Resident Education," Current Surgery. 2006 November-December;
63(6):385-90.

Swing, S.R., "The ACGME Outcome Project: Retrospective and Prospective," Medical Teaching. 2007 September;
29(7):648-54.

Thomas, R.L., Allen, R.M., "Use of Computer-Assisted Learning Module to Achieve ACGME Competencies in
Orthopaedic Foot and Ankle Surgery," Foot and Ankle International. 2003 December;24(12):938-41.

Varkey, P., Karlapudi, S., Rose, S., Nelson, R., Warner, M., "A Systems Approach for Implementing Practice-Based
Learning and Improvement, and Systems-Based Practice in Graduate Medical Education," Academic Medicine. 2009
March;84(3):335-9.

Yaszay, B., Kubiak, E., Agel, J., Hanel, D.P., "ACGME Core Competencies: Where Are We?" Orthopaedics. 2009
March;32(3):171.

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