Blog | Friday, October 14, 2011

QD: News Every Day--Intense testing, year-long clinical rotation led to better medical education


Multiple-choice testing coupled with a novel year-long clinical experience helped internal medicine residents improve their scores on the Internal Medicine In-Training Exam (IM-ITE), reported a study.

Study authors from The University of Cincinnati wrote in the advance online edition of the Journal of General Internal Medicine that the their medical school program had seen a decline in average individual percentiles on the IM-ITE year to year despite increasing absolute scores. Cumulative three-year American Board of Internal Medicine-Certifying Exam pass rates were consistently in the 25th to 50th percentile nationally.

They wrote, "We postulated that this decline in IM-ITE percentile and our suboptimal ABIM-CE pass rate was due in part to exposure to only a narrow variety of inpatient diagnoses seen in our traditional residency program thereby producing residents who lacked breadth in knowledge of internal medicine."

However, since July 2006, the program had been one of the 17 sites chosen to participate in the Residency Review Committee for Internal Medicine’s Educational Innovation Project, which let the school create new ways to train physicians without the need to adhere to many of the traditional guidelines of the Accreditation Council of Graduate Medical Education.

One solution was the "long-block," 12 consecutive months of residency from November of Year 2 to October of Year 3, consisting of ambulatory care, inpatient and outpatient electives, and research experiences with minimal overnight call.

Bradley Mathis, MD, FACP, an associate professor and lead investigator on the study, and colleagues designed a rotation-specific, multiple-choice testing program and a separate board review testing program administered during the long-block. The program involved administering pre- and post-rotation multiple-choice tests of 30 to 50 questions each, based on ACP's MKSAP. [ACP Internist is a publication of the College.] In addition, working collaboratively with ABIM, the faculty created six additional 60-question multiple-choice examinations based upon the self-assessment modules in the ABIM Maintenance of Certification program.

Results guided a personalized learning plan that included text reading and review, review of exams and test taking skill, peer-guided study groups and alternative learning methods such as video and audio taped reviews, Dr. Mathis said.

Participants included 104 residents. Forty-five participated in the study group during 2008-2009, and 59 residents in the three classes that preceded the use of the testing program from 2005 to 2007 served as controls.

After experiencing the educational intervention, the study group demonstrated a significant increase in median individual IM-ITE percentile score between postgraduate years two and three of 8.5% (P < 0.01). This was significantly better than the increase of 1% seen in the control group between its PGY-2 and PGY-3 examination (P < 0.01).

Dr. Mathis said in a press release that structured study programs similar to this one could lead to higher ABIM certification scores and better long-term clinical performance for these physicians as well as better patient experiences. The university provided funding for its study.