Conducting orthopaedic practical examination during the Covid-19 pandemic

Abstract

Background: As the coronavirus disease (COVID-19) pandemic is expected to stay for a longer time, educational activities including residency training have gradually resumed with the aid of virtual tools. In addition to continuing the residency education during COVID-19, it is also important to conduct their examination so that the graduations of final year residents are not delayed. The conventional exam pattern involved clinical case presentations and required resident interaction with a number of patients. However, in view of the COVID-19 pandemic we conducted a "zero-patient contact virtual practical exit examination" for orthopaedic residents.

Methods: In order to replicate the conventional exam case-scenarios, clinical cases were prepared in a digital presentation format. The candidate used N-95 facemasks and gloves, and adequate social distancing was maintained in the examination area. We also designed a 10- item questionnaire aimed at assessing the quality and satisfaction with the exam pattern.

Results: The mean score for overall satisfaction with the virtual pattern was 4.5 (out of 5) in examiner group while it was 4.1 in examinee group. Higher scores were also reported for questions related to safety of the exam, relevance and quality of the virtual cases, etc. The mean total feedback score for the examiner and examinee group was 48 and 43.4 respectively (out of 50).

Conclusion: Orthopaedic residency end-of-training examinations can be successfully conducted during the COVID pandemic, and we hope our experience will be helpful to other residency programs.

Keywords: Covid-19 pandemic; Orthopedic practical examination; Orthopedic residency.

Fig. 1

Representative diagram of the examination hall showing the seating arrangement for the examiners and the examinee.

Fig. 2

Photograph showing use of touch screen by the examinee to draw and demonstrate some important surface markings, lines, and triangles.

Fig. 3

A long case used in the examination showing history (A), examination (B–D), and X-ray (E) along with the potential questions that can be asked by examiner (shown in the notes section which will only be visible to the examiner when the slide is in presenter mode). A video file was used to demonstrate telescopy test (C) and interactive tools were used to draw Bryant’s triangle (D) and describe X-ray findings (E).

Fig. 4a

Photograph of the power point slide mentioning the brief history and clinical presentation of the patient to be read by the examinee in a typical short case scenario.

Fig. 4b

Photograph of the power point slide containing suggested line of questions by the examiners and the relevant clinical signs and radiographs. The examinees are allowed to mark and draw lines over the photographs in the screen.

Fig. 5a

Histogram showing mean score of satisfaction for individual questions by the examiners and examinees.

Fig. 5b

Histogram showing total mean score of satisfaction by the examiners and examinees.