key: cord-291307-71s44kbs authors: Malhotra, Rajesh; Gautam, Deepak; George, Jaiben; Goyal, Devansh; Ansari, Mohammed Tahir title: Conducting orthopaedic practical examination during the Covid-19 pandemic date: 2020-07-10 journal: J Clin Orthop Trauma DOI: 10.1016/j.jcot.2020.07.002 sha: doc_id: 291307 cord_uid: 71s44kbs 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. 1 Introduction 24 The coronavirus disease (COVID-19) pandemic has affected the lives of millions of 25 individuals globally 1 . In India, a nationwide lockdown was implemented towards the end of 26 March leading to disruption of routine hospital services and residency training curriculum. 27 Despite continued efforts to stop the spread of COVID-19, the number of COVID-19 cases 28 continue to rise in the country, as a result of which there has been a paradigm shift from 29 "living after COVID" to "living with COVID-19" 2 . Since it is difficult to predict an end to 30 the pandemic, many services including educational activities have gradually resumed taking 31 into account the COVID-19 situation [3] [4] [5] [6] [7] [8] [9] . Like many other residency programs, our 32 department continued the majority of educational activities during the pandemic through 33 online portals 6, 9, 10 . We also successfully conducted the end-training evaluation of the 34 graduating residents. In this article, we would like to share our experience in conducting the 35 orthopaedic residency exit examination during this pandemic. 36 The conventional examination pattern involved clinical case presentations and viva voce. 37 Each candidate was traditionally allotted 4 clinical cases on the day of examination including 38 one long case and 3 short clinical cases. The candidate was expected to elicit history, perform 39 clinical examination and present the cases to the examiners following which there was a table 40 viva. However, the Covid-19 pandemic posed a few challenges that made conducting the practical 42 exams in a conventional manner unseemly, difficult and impractical. A total of seven 43 candidates completed the tenure of residency training and were appearing for the examination 44 in June 2020 and therefore 28 clinical cases were needed. So, the first challenge was to 45 arrange a relatively large number of patients with varied diagnoses who could be kept for 46 examination. With the out-patient department shut since last two and a half months and with 3 various travel restrictions in place, arranging cases was difficult. The second challenge was to 48 ensure the safety of both the examinees and the examiners who would be coming in close 49 contact with their patients. To overcome both these challenges, our department planned to 50 conduct a "zero-patient contact virtual practical exit examination" for orthopaedic residents. In order to replicate the conventional exam case-scenarios, clinical cases were prepared by were prepared, each consisting for one major case and 3 short cases. An attempt was made to 60 include at least one common type of short case in each group. The collection was mailed to 61 the external examiners in a password protected file. The External examiners selected 7 sets 62 out of the 14 available sets, to be kept for examination. Each set was given a numeric code 63 and random allocation of the sets to the candidate was ensured by chit-pull system on the day 64 of exam. A mock test was conducted two weeks before the date of the exam so that the candidates (Figure 4 A&B) . The case discussions carried 320 marks and were followed by table 97 viva for 80 marks on x-rays, osteology, orthopedic instruments, and, orthoses & protheses, 98 which were conducted in a conventional manner but with use of hand sanitizers, gloves and 99 adequate social distancing measures. After each candidate, the used instruments or materials 100 were sanitized before the other candidate entered the examination room to avoid fomite 101 transmission. If a candidate is from a hotspot or containment zone, the virtual examination 102 can also be conducted using web applications like Zoom™ or WebEx™ so that candidates 103 can take the exam from home (we have conducted the examination in similar fashion for the 104 fellows at our institution in arthroplasty, arthroscopy and musculoskeletal oncology). To evaluate the quality of examination pattern and level of satisfaction amongst the 107 examinees and the examiners, we designed a questionnaire aimed at assessing the feeling of The study has a few limitations (Table 3) . First, it is a pilot study and the number of 152 participants from examiner as well as examinee group is small. A study with larger number of 153 participants across the different states is needed to establish its reproducibility and value. We 154 believe that the proforma designed by us could help capture the relevant data to that end. Secondly, good quality photographs and/or videos may not be available at other places. In X-ray (E) along with the potential questions that can be asked by examiner (shown in the 255 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 257 draw Bryant's triangle (D) and describe X-ray findings (E). WHO. WHO Director-General's opening remarks at the media briefing on COVID-19 179 -11 Evaluation of the orthopedic residency 218 training program in Saudi Arabia and comparison with a selected Canadian residency 219 program Residency Programs and Diversity: Dilemmas and Challenges, an International 222 Perspective Use of Standardized Patients in Clinical Assessments: Recent 224 Developments and Measurement Findings External examiners were sent the collection as password protected file with instruction to select Each group (Long as well as Short) given number 1 to 7 as per the number of candidates appearing in the exam Random allocation of the Group numbers by chit-pull method for major and short cases separately to each candidate 2. Were you comfortable with the seating arrangement made for you in the exam room? 3. Do you think that the case details given in the digital presentation was sufficient enough to make differential diagnoses? 4. Do you think that the clinical photographs were good enough to elicit the clinical findings? 5. Do you think that the radiological pictures were good enough to reach up to a provisional diagnosis?6. Do you think that the interactive touch screen was helpful in compensating the absence of actual clinical examination?7. Do you think that the examination pattern was relevant to the type of academics that you had received/given in your institute?("Received" for the examinee; "Given" for the examiner) 8. Would you like to recommend such type of examination pattern in similar situations like pandemics?9. Do you think a mock test helps/helped in preparing for this pattern of examination? * ("helped" for examinee; "helps" for examiner) 10. Rate your overall satisfaction in (0 to 5) for the 'Zero-patient contact virtual practical examination' 1