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Academia and the Profession |

The In-Training Examination in Internal Medicine

Richard A. Garibaldi, MD; Marie C. Trontell, MD; Herbert Waxman, MD; John H. Holbrook, MD; D. Theresa Kanya, MBA; Shahram Khoshbin, MD; John Thompson, MD; Maribeth Casey, MA; Raja G. Subhiyah, PhD; and Frank Davidoff, MD
[+] Article and Author Information

From the University of Connecticut Health Center, Farmington, Connecticut; the Robert Wood Johnson Medical Center, New Brunswick, New Jersey; the Albert Einstein Medical Center, the American College of Physicians, and the National Board of Medical Examiners, Philadelphia, Pennsylvania; the University of Utah, Salt Lake City, Utah; Brigham and Women's Hospital, Boston, Massachusetts; the University of Kentucky School of Medicine, Lexington, Kentucky. Requests for Reprints: Richard A. Garibaldi, MD, Department of Medicine, Room LG-004, University of Connecticut Health Center, Farmington, CT 06030-3950. Acknowledgments: The authors thank Jill Antunes, BA, and Kathleen L. Egan, PhD, for technical assistance and Ms. Mary Ann Argiro for secretarial support.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;121(2):117-123. doi:10.7326/0003-4819-121-2-199407150-00008
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Objective: The In-Training Examination in Internal Medicine (ITE-IM) has been offered to internal medicine trainees annually since 1988 as an instrument for self-assessment. This report outlines the manner in which the test is prepared, reviews the results of annual examinations, and analyzes trends during the past 6 years.

Design: Results of each examination were reviewed with regard to the demographic characteristics of persons taking the test, their previous medical training, and their present program affiliations.

Results: The number of residents participating in the ITE-IM has increased steadily over the past 6 years. In 1993, more than 12 000 residents from more than 90% of internal medicine training programs in the United States participated in the examination; the percentage of international medical school graduates taking the examination increased from 27% in 1988 to 47% in 1993. Statistical analyses of each examination have shown it to be reliable, internally consistent, and discriminating. Over the past 6 years, graduates of U.S. medical schools have scored consistently higher than those of international medical schools and schools of osteopathic medicine on all annual examinations. However, in 1993, for residents at all levels of training, the differences in scores between graduates of U.S. medical schools and graduates of international medical schools narrowed substantially. From 1988 to 1993, there has been a trend toward lower scores by every cohort on each subsequent examination. The decreases in scores are most pronounced for graduates of U.S. medical school and those of schools of osteopathic medicine. The lower scores may be caused by either an increased level of difficulty in the examination or decreased knowledge among examinees.

Conclusions: The ITE-IM is a useful instrument to assess the knowledge base of residents during internal medicine training. It provides residents and program directors with a reliable evaluation of themselves and their programs in comparison to their national peer groups. It also provides objective data to monitor trends over time in residents' scores and relates them to the changing demographic characteristics of trainees and to innovations in the clinical curricula of internal medicine training programs.

Figures

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Figure 1.
Average scores for residents in their second year of postgraduate training who graduated from U.

S. medical schools, international medical schools, and schools of osteopathic medicine. USMG = U.S. medical school graduate; IMG = international medical school graduate; USDO = U.S. graduate of school of osteopathic medicine. The asterisk indicates that the bar for 1988 includes graduates of both U.S. medical schools and schools of osteopathic medicine.

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Figure 2.
Average scores for graduates of U.S. medical schools, international medical schools, and U.S. schools of osteopathic medicine by stage of residency training.

USMG's = U.S. medical school graduates; IMG's = international medical school graduates; USDO's = U.S. graduates of school of osteopathic medicine; PGY = postgraduate year.

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