1887
Volume 2020, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

The American College of Physicians’ (ACP) Internal Medicine In-Training Examination (IM-ITE) is designed to evaluate the cognitive knowledge of residents to aid them and program directors in evaluating the training experience. To determine the impact of the curriculum reform accompanied by the Accreditation Council for Graduate Medical Education (ACGME)-I alignment and accreditation on the internal medicine residency program (IMRP) using residents’ performance in the ACP's ITE from 2008 to 2016, and where the IMRP stands in comparison to all ACGME and ACGME-I accredited programs. This is a descriptive study conducted at a hospital-based IMRP in Doha, Qatar from 2008 to 2016. The study population is 1052 residents at all levels of training in IMRP. The ACP-generated ITE results of all the United States and ACGME-I accredited programs were compared with IM-ITE results in Qatar. These results were expressed in the total program average and the ranking percentile. There is a progressive improvement in resident performance in Qatar as shown by the rise in total average program score from 52% in 2008 to 72% in 2016 and the sharp rise in percentile rank from 3rd percentile in 2008 to 93rd percentile in 2016 with a dramatic increase during the period 2013 to 2014 (from 32nd percentile to 73rd percentile), which represents the period of ACGME-I accreditation. None of the factors (ethnicity, USMLE or year of residency) were statistically significant with a value >0.05 and standard coefficient ( − 0.017–0.495). There was negligible correlation between the USMLE test scores with the residents’ ITE scores with a value = 0.023 and a Pearson correlation r = 0.097. The initial ACGME-I alignment followed by the accreditation, together with whole curriculum redesign to a structured, competency-based program starting from 2008, has led to an improvement in the ITE scores in the IMRP. This was further evidenced by the lack of change in the residency entry selection criteria.

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2020-04-09
2020-11-25
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References

  1. Rollins LK, Martindale JR, Edmond M, Manser T, Scheld WM. Predicting pass rates on the American Board of Internal Medicine certifying examination. J Gen Intern Med. 1998; 13:6:414416.
    [Google Scholar]
  2. Garibaldi RA, Trontell MC, Waxman H, Holbrook JH, Kanya DT, Khoshbin S, et al.  The In-Training Examination in Internal Medicine. Ann Intern Med. 1994; 121:2:117123.
    [Google Scholar]
  3. Hawkins RE, Sumption KF, Gaglione MM, Holmboe ES. The in-training examination in internal medicine: resident perceptions and lack of correlation between resident scores and faculty predictions of resident performance. Am J Med. 1999; 106:2:206210.
    [Google Scholar]
  4. Holmboe ES, Hawkins RE. Methods for evaluating the clinical competence of residents in internal medicine: a review. Ann Intern Med. 1998; 129:1:4248.
    [Google Scholar]
  5. Kay C, Jackson JL, Frank M. The relationship between internal medicine residency graduate performance on the ABIM certifying examination, yearly in-service training examinations, and the USMLE Step 1 examination. Acad Med. 2015; 90:1:100104.
    [Google Scholar]
  6. McDonald FS, Zeger SL, Kolars JC. Associations of conference attendance with internal medicine in-training examination scores. Mayo Clin Proceed. 2008; 83:4:449453.
    [Google Scholar]
  7. Bode RS, Caputo GL. Reading program success on in-training and certifying exam scores. Acad Pediatrics. 2010; 10:7. Conference: 63rd Annual Session of the American Academy of Pediatric Dentistry, AAPD, Chicago, IL. Conference Start: 20100527 Conference End: 20100530. Conference Publication: (var.pagings).
  8. Harthun NL, Schirmer BD, Sanfey H. Remediation of low ABSITE scores. Curr Surg. 2005; 62:5:539542.
    [Google Scholar]
  9. Shokar GS. The effects of an educational intervention for ‘at-risk’ residents to improve their scores on the Intraining Exam. Fam Med. 2003; 35:6:414417.
    [Google Scholar]
  10. Accreditation Council for Graduate Medical Education. Manual of policies and procedures. Revised September 23, 2017. https://www.acgme.org/Portals/0/PDFs/ab_ACGMEPoliciesProedures.pdf. Accessed November 20, 2017.
  11. Meyers FJ, Weinberger SE, Fitzgibbons JP, Glassroth J, Duffy FD, Clayton CP. Alliance for Academic Internal Medicine Education Redesign Task Force. Redesigning residency training in internal medicine: the consensus report of the Alliance for Academic Internal Medicine Education Redesign Task Force. Acad Med. 2007; 82::12111219.
    [Google Scholar]
  12. Garibaldi RA, Subhiyah R, Moore ME, Waxman H. The in-training examination in internal medicine: an analysis of resident performance over time. Ann Intern Med. 2002; 137:6:505510.
    [Google Scholar]
  13. Grossman RS, Fincher RM, Layne RD, Seelig CB, Berkowitz LR, Levine MA. Validity of the in-training examination for predicting American Board of Internal Medicine certifying examination scores. J Gen Intern Med. 1992; 7:1:6367.
    [Google Scholar]
  14. Waxman H, Braunstein G, Dantzker D, Goldberg S, Lefrak S, Lichstein E, et al.  Performance on the internal medicine second-year residency in-training examination predicts the outcome of the ABIM certifying examination. J Gen Intern Med. 1994; 9:12:692694.
    [Google Scholar]
  15. Shetler PL. Observations on the American Board of Surgery in-training examination, board results, and conference attendance. Am J Surg. 1982; 144:3:292294.
    [Google Scholar]
  16. de Virgilio C, Chan T, Kaji A, Miller K. Weekly assigned reading and examinations during residency, ABSITE performance, and improved pass rates on the American Board of Surgery Examinations. J Surg Educ. 2008; 65:6:499503.
    [Google Scholar]
  17. Godellas CV, Huang R. Factors affecting performance on the American Board of Surgery in-training examination. Am J Surg. 2001; 181::294296.
    [Google Scholar]
  18. Bull DA, Stringham JC, Karwande SV, Neumayer LA. Effect of a resident self-study and presentation program on performance on the thoracic surgery in-training examination. Am J Surg. 2001; 181:2:142144.
    [Google Scholar]
  19. Dousa KM, Muneer M, Rahil A, Al-Mohammed A, AlMohanadi D, Elhiday A, et al.  Tailoring morning reports to an internal medicine residency in Qatar. J Grad Med Educ. 2014; 6:4:801804.
    [Google Scholar]
  20. Larson DB. Accreditation Council for Graduate Medical Education (ACGME). AJR Am J Roentgenol. 2007; 188:1:34.
    [Google Scholar]
  21. Dugdale DC. Ambulatory internal medicine training: challenges and opportunities. J Gen Intern Med. 2003; 18:4:313314.
    [Google Scholar]
  22. Wenderoth S, Pelzman F, Demopoulos B. Ambulatory morning report: can it prepare residents for the American Board of Internal Medicine examination? J Gen Intern Med. 2002; 17:3:207209.
    [Google Scholar]
  23. Carmichael KD, Westmoreland JB, Thomas JA, Patterson RM. Relation of residency selection factors to subsequent orthopaedic in-training examination performance. South Med J. 2005; 98:5:528532.
    [Google Scholar]
  24. Borman KR. Does academic intervention impact ABS qualifying examination results? Curr Surg. 2006; 63:6:367372.
    [Google Scholar]
  25. Sharma R, Sperling JD, Greenwald PW, Carter WA. A novel comprehensive in-training examination course can improve residency-wide scores. J Grad Med Educ. 2012; 4:3:378380.
    [Google Scholar]
  26. Edeiken BS. Remedial program for diagnostic radiology residents. Invest Radiol. 1993; 28:3:269274.
    [Google Scholar]
  27. Guerrasio J, Garrity MJ, Aagaard EM. Learner deficits and academic outcomes of medical students, residents, fellows and physicians referred to a remediation Program, 2006-2012. Acad Med. 2014; 89:2:352358.
    [Google Scholar]
  28. Hauer KE, Teherani A, Kerr KM, O'Sullivan PS, Irby DM. Impact of the United States Medical Licensing Examination Step 2 on medical school clinical skills assessment. Acad Med. 2006; 81:10:S13S16.
    [Google Scholar]
  29. Vucicevic D, Mookadam F, Webb BJ, et al.  The impact of 2011 ACGME duty hour restrictions on internal medicine resident workload and education. Adv Health Sci Educ Theory Pract. 2015; 20:1:193203.
    [Google Scholar]
  30. Rajaram R, Chung JW, Jones AT, Cohen ME, Dahlke AR, Ko CY, et al.  Association of the 2011 ACGME resident duty hour reform with general surgery patient outcomes and with resident examination performance. JAMA. 2014 Dec; 312:22:23742384.
    [Google Scholar]
  31. Fletcher KE, Davis SQ, Underwood W, Mangrulkar RS, McMahon LF Jr, Saint S. Systematic review: effects of resident work hours on patient safety. Ann Intern Med. 2004; 141:11:851857.
    [Google Scholar]
  32. Landrigan CP, Fahrenkopf AM, Lewin D, Sharek PJ, Barger LK, Eisner M, et al.  Effects of the Accreditation Council for Graduate Medical Education duty hour limits on sleep, work hours, and safety. Pediatrics. 2008; 122:2:250258.
    [Google Scholar]
  33. Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg. 2006; 243(6):864: discussion871875.
    [Google Scholar]
  34. Ulmer C, Wolman DM, Johns MME. Committee on optimizing graduate medical trainee (resident) hours and work schedule to improve patient safety. Resident duty hours: Enhancing sleep, supervision and safety, Washington, DC: The National Academy Press. Washington, DC: The National Academy Press 2008.
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