Competency in Orthopaedic Surgery: Student Perceptions and Objective Knowledge Assessment

Identifying knowledge gaps and predictors of performance are proven ways to implement changes to a curriculum. This cross-sectional study investigates the subjective and objective competency of 52 medical students at McGill University in musculoskeletal (MSK) medicine, with a focus on orthopaedic surgery. We surveyed medical students to assess their confidence levels in orthopaedic surgery and their perceptions of its teaching. The students then completed a 25-question orthopaedics-focused exam as an objective assessment of their knowledge. Descriptive statistics were calculated, exam performance was compared across academic years, predictors of exam scores were analyzed, and student self-assessment accuracy was evaluated. Students reported lower confidence in orthopaedic surgery than in many other specialties, exam scores varied significantly across academic years (p = 0.007), and predicted exam performance was the only significant predictor of test score in multiple linear regression (R2 = 0.313, p = 0.025). Calibration analysis revealed a substantial miscalibration, where students with higher predicted scores tended to overestimate their performance, while those with lower predictions tended to underestimate themselves (intercept = 27.2, slope = 0.54). A Bland–Altman plot demonstrated wide limits of agreement between predicted and actual scores (mean bias −1.2%, 95% LoA −35.0% to +32.6%). These findings highlight meaningful orthopaedic knowledge gaps and miscalibrated self-assessment, emphasizing the need for targeted, structured educational interventions in the MSK curriculum.