0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Academia and the Profession |

The In-Training Examination in Internal Medicine: An Analysis of Resident Performance over Time

Richard A. Garibaldi, MD; Raja Subhiyah, PhD; Mary E. Moore, PhD, MD; and Herbert Waxman, MD
[+] Article and Author Information

From the University of Connecticut School of Medicine, Farmington, Connecticut; the National Board of Medical Examiners, Philadelphia, Pennsylvania; and the American College of Physicians–American Society of Internal Medicine, Philadelphia, Pennsylvania.


Acknowledgments: The authors thank present and former members of the In-Training Examination in Internal Medicine Committee and members of the IM-ITE Steering Committee for their roles in developing the IM-ITE examination. They also thank Ms. Barbara Cusati for secretarial support.

Requests for Single Reprints: Richard A. Garibaldi, MD, Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030.

Current Author Addresses Dr. Garibaldi: Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030.

Dr. Subhiyah: National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA 19104.

Dr. Moore: 364 Youngsford Place, Gladwyne, PA 19035.

Dr. Waxman: American College of Physicians–American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106-1572.


Ann Intern Med. 2002;137(6):505-510. doi:10.7326/0003-4819-137-6-200209170-00011
Text Size: A A A

Background: The In-Training Examination in Internal Medicine (IM-ITE) has been offered annually to all trainees in U.S. medical residency programs since 1988. Its purpose is to provide residents and program directors with an objective assessment of each resident's personal performance on a written, multiple-choice examination and the performance of the residency program compared with that of its peers.

Objective: To analyze trends in the demographic characteristics and scores of examinees during the first 12 years of administration of this examination.

Design: Descriptive analysis over time.

Setting: U.S. residency programs in internal medicine, 1988–2000.

Participants: Residents at all levels of training in categorical, primary care, and medicine–pediatrics programs in the United States and Canada. The number of examinees increased from 7500 in 1988 to almost 18 000 in 2000.

Measurements: After calibration of the scores for each examination, test results were compared and analyzed for selected cohorts of residents over 12 years.

Results: More than 80% of residents in medicine training programs participate in the IM-ITE, most on an annual basis throughout their period of training. Test performance improves at a predictable rate with each year of training. Since 1995, international medical school graduates have persistently outperformed graduates of U.S. medical schools. Test results were affected by the timing of the examination, the time that was available to complete the examination, and the actual time that residents spent in internal medicine training before each examination.

Conclusions: The IM-ITE scores generally improve with year of training time spent in internal medicine training before the examination and time permitted to complete the examination. These observations provide evidence that the IM-ITE is a valid measure of knowledge acquired during internal medicine training.

Figures

Grahic Jump Location
Figure 1.
Number of examinees by country of medical school training, 1988–2000.circlestrianglesdiamondssquares

The total number of persons taking the examination ( ) is shown, as well as the number of examinees according to region of medical school training—United States ( ), Canada ( ), or international (non–U.S. or Canada) ( ).

Grahic Jump Location
Grahic Jump Location
Figure 2.
Mean scores per year, 1988–2000, of examinees by year of postgraduate year of training.

*Duration of examination increased from 6 to 7 hours. †Examination administered in October instead of January. PGY1 = postgraduate year 1; PGY2 = postgraduate year 2; PGY3 = postgraduate year 3.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Mean examination scores per year, 1988–2000, according to country of medical school training.trianglesdiamondssquares

Shown are the scores for graduates of U.S. medical schools ( ), Canadian medical schools ( ), and international (non–U.S. or Canadian) medical schools ( ).

Grahic Jump Location
Grahic Jump Location
Figure 4.
Mean examination scores, 1988–2000, for graduates of U.S. medical schools (circles) and for graduates of international (non–U.S.) medical schools (squares).Top.PGY3Middle.PGY2Bottom.PGY1

Examinees in postgraduate year 3 ( ) of U.S. residency training. Examinees in postgraduate year 2 ( ) of U.S. residency training. Examinees in postgraduate year 1 ( ) of U.S. residency training.

Grahic Jump Location
Grahic Jump Location
Figure 5.
Comparison of scores on consecutive annual examinations between international medical graduates and U.S. medical school graduates who began their training in 1996, 1997, or 1998.PGY1PGY2PGY3

In each cohort (based on year in which training began—1996, 1997, or 1998), resident performance on the examination is shown by training year (postgraduate year 1, 2, or 3 [ , , ]). *Examination was administered in October instead of January.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Journal Club
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)