Downsizing Internal Medicine Residencies

TO THE EDITOR:

Drs. Asch and Ende's excellent article [1] may yield the mistaken impression that the American Board of Internal Medicine (ABIM) favors downsizing internal medicine residency training programs by eliminating marginal residencies that fail to achieve a rolling, 3-year, 50% pass rate on the certifying examination. This strategy was one of several suggested by President-emeritus, Dr. John A. Benson, Jr., to raise awareness about the continuing poor performance of a small but significant number of programs and to take the steps necessary to improve their educational environment. Although the Board believes that program pass rates over time do provide valuable and important information, both ABIM and the Residency Review Committee for Internal Medicine have adopted a longstanding policy that pass rates should never be used as the only marker for quality. Other educational criteria, such as faculty/resident ratios, resident/bed ratios, institutional commitment to graduate medical education (sponsorship of other residency programs), resident composition, and accreditation status are essential to gain a more accurate picture of the strengths and weaknesses of individual training programs. The Board congratulates Drs. Asch and Ende on their thought-provoking article and appreciates the opportunity to clarify a potential misconception.