Predicting pass rates on the american board of internal medicine certifying examination

Our objective was to determine the ability of the internal medicine In-Training Examination (ITE) to predict pass or fail outcomes on the American Board of Internal Medicine (ABIM) certifying examination and to develop an externally validated predictive model and a simple equation that can be used by residency directors to provide probability feedback for their residency programs. We collected a study sample of 155 internal medicine residents from the three Virginia internal medicine programs and a validation sample of 64 internal medicine residents from a residency program outside Virginia. Scores from both samples were collected across three class cohorts. The Kolmogorov-Smirnov z test indicated no statistically significant difference between the distribution of scores for the two samples ( z = 1.284, p = .074). Results of the logistic model yielded a statistically significant prediction of ABIM pass or fail performance from ITE scores (Wald = 35.49, SE = 0.036, df = 1, p < .005) and overall correct classifications for the study sample and validation sample at 79% and 75%, respectively. The ITE is a useful tool in assessing the likelihood of a resident's passing or failing the ABIM certifying examination but is less predictive for residents who received ITE scores between 49 and 66.     

Research training in six selected internal medicine fellowship programs

BACKGROUND: Effective July 1997, the American Board of Internal Medicine (ABIM) established a research pathway to certification to encourage research training of general internists and subspecialists. OBJECTIVE: To document the current status of research training in six selected subspecialty programs, to examine opportunities available for trainees to undertake formal course work, and to report the percentage of subspecialty programs that might accept research pathway fellows. DESIGN: National Study of Graduate Education in Internal Medicine questionnaires from 1996-1997 and 1997-1998. SETTING: Programs in internal medicine subspecialties accredited by the Accreditation Council for Graduate Medical Education. PARTICIPANTS: 1163 (84%) and 1094 (79%) directors of internal medicine subspecialty programs in 1996-1997 and 1997-1998, respectively. MEASUREMENTS: Survey questions on the amount of time fellows usually spend conducting research and available opportunities to pursue course work leading to an advanced degree. RESULTS: On average, during their last year of training, fellows enrolled in infectious disease, nephrology, endocrinology, and rheumatology programs spent 40% to 50% of their time conducting research, whereas fellows in gastroenterology and cardiology spent 25% to 30% of their time conducting research. Compared with programs sponsored by major teaching hospitals, a greater percentage of programs sponsored by academic medical center hospitals planned to accept persons interested in pursuing the new ABIM Research Pathway (28% vs. 8%) and to provide opportunities for fellows to obtain an advanced degree (60% vs. 14%). CONCLUSIONS: Few internal medicine subspecialty programs are currently designed to provide adequate research training as defined by the Institute of Medicine and the ABIM.     

Co‐creation by the ABIM Geriatric Medicine Board and the AGS – Helping Move Geriatrics Forward

The American board of internal medicine (ABIM) establishes standards for physicians. The American geriatrics society (AGS) is a not‐for‐profit membership organization of nearly 6,000 health professionals devoted to improving the health, independence, and quality of life of all older people. Beginning in 2013, ABIM redesigned its governance structure, including the role of the specialty boards. Specialty boards are charged with responsibilities for oversight in four main areas: (1) the assessments used in initial certification and maintenance of certification (MOC); (2) medical knowledge self‐assessment and practice assessment in the specialty; (3) building relationships with relevant professional societies and other organizational stakeholders; and (4) issues related to training requirements for initial certification eligibility within the specialty. The aim of this paper is to inform the geriatrics community regarding the function of geriatric medicine board (GMB) of the ABIM, and to invite the geriatrics community to fully engage with and leverage the GMB as a partner to: (1) develop better certification examinations and processes, identifying better knowledge and practice assessments, and in establishing appropriate training and MOC requirements for geriatric medicine; (2) leverage ABIM assets to conduct applied research to guide the field in the areas of training and certification and workforce development in geriatric medicine; (3) make MOC relevant for practicing geriatricians. Active engagement of the geriatrics community with ABIM and the GMB will ensure that certification in geriatric medicine provides the greatest possible value and meaning to physicians, patients, and the public.     

Do ratings on the american board of internal medicine resident evaluation form detect differences in clinical competence?

Objective: To determine whether raters using the American Board of Internal Medicine (ABIM) Resident Evaluation Form can detect differences among residents in clinical competence. Design: Cross-sectional study. Setting: Inpatient general medicine service in a university-affiliated public hospital. Participants: University-based internal medicine (UCIM) residents (ABIM certifying examination pass rate, 91%; mean score, 95th percentile), community hospital-based internal medicine (CHIM) residents (ABIM examination pass rate, 68%; mean score, 42nd percentile), and residents from three university-based non-internal medicine (UC non-IM) programs all assigned to the same inpatient general medicine service over a three-year period. Four hundred eighty-nine evaluations of 110 postgraduate-year-one residents were analyzed. Measurements and main results: Mean ratings for the UCIM residents were significantly higher than those for the CHIM or UC non-IM residents (analysis of variance [ANOVA], p<0.05). Variance was smallest for the UCIM residents (F test, p<0.01), and only the UCIM residents’ mean scores were in the “superior” range (7–9) in all evaluated categories. The mean ratings for the CHIM residents while at the university-affiliated hospital were not significantly different from the ratings of the same residents at their home hospital. The ratings for the CHIM residents at either site were significantly lower than those for the UCIM residents in all categories (ANOVA, p<0.05). Factor analysis revealed a single factor accounting for 76% of the variance among the ratings with all dimensions loading high on that factor (0.75–0.95), providing evidence for a “halo” effect. Mean interrater agreement over all variables was 0.87, indicating good consistency among raters. Conclusions: Ratings on the ABIM Resident Evaluation Form detect global differences among residents in clinical competence in the expected direction based on type of training program and performance on the ABIM certification examination, but fail to differentiate among the nine evaluated dimensions of clinical care. This rating method may be valid for assessing overall clinical performance, but is less useful for providing feedback in specific areas to individual residents. Presented in part at the annual meeting of the Society of General Internal Medicine, Seattle, Washington, May 1, 1991. Supported in part by grant PE 19179 for residency training in general internal medicine and general pediatrics from the Bureau of Health Professions, Health Resources and Services Administration of the Public Health Service.     

Perceptions of the certification standards of the American board of internal medicine

Perceptions of the certification standards of the American Board of Internal Medicine (ABIM) and the qualities of care provided by certified and non-certified practicing internists are reported from surveys of ABIM Board members, internal medicine program directors, and samples of third-year residents, practicing internists, nurses, and hospital administrators. ABIM pass rates were estimated accurately and viewed as appropriate. Physicians perceived the deficiencies of non-certifiable residents to be in clinical judgment and factual knowledge; non-physicians indicated deficiencies in humanistic qualities. The groups estimated that approximately 70% of all practicing internists and 37% of the non-certified internists they know provide excellent care while 15% of the certified internists give inappropriate care. Perceived deficiencies of internists giving low-quality care were nearly identical to those of non-certifiable residents. The results support ABIM's initial certification process and suggest that a written examination with well chosen standards would be useful for experienced internists.     

Procedural experience and comfort level in internal medicine trainees

BACKGROUND: The American Board of Internal Medicine (ABIM) has recommended a specific number of procedures be done as a minimum standard for ensuring competence in various medical procedures. These minimum standards were determined by consensus of an expert panel and may not reflect actual procedural comfort or competence. OBJECTIVE: To estimate the minimum number of selected procedures at which a majority of internal medicine trainees become comfortable performing that procedure. DESIGN: Cross-sectional, self-administered survey. SETTING: A military-based, a community-based, and 2 university-based programs. PARTICIPANTS: Two hundred thirty-two internal medicine residents. MEASUREMENTS: Survey questions included number of specific procedures performed, comfort level with performing specific procedures, and whether respondents desired further training in specific procedures. The comfort threshold for a given procedure was defined as the number of procedures at which two thirds or more of the respondents reported being comfortable or very comfortable performing that procedure. RESULTS: For three of seven procedures selected, residents were comfortable performing the procedure at or below the number recommended by the ABIM as a minimum requirement. However, residents needed more procedures than recommended by the ABIM to feel comfortable with central venous line placement, knee joint aspiration, lumbar puncture, and thoracentesis. Using multivariate logistic regression analysis, variables independently associated with greater comfort performing selected procedures included increased number performed, more years of training, male gender, career goals, and for skin biopsy, training in the community-based program. Except for skin biopsy, comfort level was independent of training site. A significant number of advanced-year house officers in some programs had little experience in performing selected common ambulatory procedures. CONCLUSION: Minimum standards for certifying internal medicine residents may need to be reexamined in light of house officer comfort level performing selected procedures.     

Expert ratings of primary care goals and objectives

OBJECTIVE: To develop consensus on proficiencies internal medicine residents should master in the area of primary and managed care. DESIGN: A draft compendium of primary care educational objectives including important clinical topics was developed at the Sepulveda Veterans Health Administration Medical Center Pilot Ambulatory Care and Education (PACE) Program as part of a local and regional primary care curricular review. Fifty-one experts, including leaders in the Society of General Internal Medicine, the Association of Program Directors in Internal Medicine, the American College of Physicians, general internal medicine division chiefs, and Veterans Affairs (VA) associate chiefs of staff for ambulatory care rated the compendium. MEASUREMENTS AND MAIN RESULTS: Eleven objectives and nine clinical topics were rated “critically important” (4.7 or above on a five-point scale). General internal medicine chiefs and associate chiefs of staff for ambulatory care judged them to be covered adequately in fewer than half of the 17 VA Western Region-affiliated internal medicine programs. Forty-five objectives and 77 clinical topics were considered at least somewhat important to the education of general internal medicine residents in primary care. The VA raters reported that in the prior academic year, their housestaffs had spent between 21% (postgraduate year I) and 33% (postgraduate year III) of their time in ambulatory care settings. CONCLUSION: With the emphasis on primary and managed care, there is a need for national consensus on educational objectives in primary care general internal medicine. This review provides educators with a benchmark to test the adequacy of their institutions’ curricula in primary care internal medicine. Presented in abstract Jorm at the annual meeting of the Society of General Internal Medicine, April 28, 1994, Washington, DC.     

Recent trends in internal medicine education: A brief update

This perspective attempts to bring graduate medical offices, residency programs and medical students interested in categorical internal medicine (CIM) a brief update on the American Board of Internal Medicine (ABIM), Accreditation Council for Graduate Medical Education (ACGME) and the National Registry for Medical Programs (NRMP) changes for the past 3–5 years in the United States (US). The US model for certification and recertification may serve as a homogenous example for other countries. This model will be described so that there is an understanding of the importance of such changes in the American system and its effect on resident education. This is critical knowledge for both teachers and learners in internal medicine in preparation for a lifetime career and requirements for certification/credentialing for both programs and their residents/fellows. Data from the review indicate a small increase in the number of applicants but a concordant decrease in ABIM initial certification exams. Programs should well be aware of the new focus on outcomes via the Next Accreditation System (NAS) being put forth by the ACGME.     

Internal Medicine chief residents suggest need to improve health care delivery and public policy education. Internal Medicine Center to Advance Research and Education

The primary objective in medical training remains skill development in the delivery of medical care through the understanding of bedside data collection, natural history of disease, use of diagnostic tools and the influence of therapy--all applied to a specific patient. More recently, also considered important is training on the broader issues of health care delivery and public policy, especially since the environment of medicine is changing rapidly. With limited curricular time these issues must compete with the traditional and important clinical training. To evaluate how these subjects have been included in internal medicine training, the Resident Physicians Section (RPS) of the American Society of Internal Medicine (ASIM) sponsored a survey of United States internal medicine chief residents which was conducted by the Internal Medicine Center to Advance Research and Education (IMCARE). The objectives of the study were to 1) study the extent of training on health care delivery and public policy issues offered to residents by internal medicine residency programs; 2) assess training opportunities now available; and 3) determine areas of study not fulfilling perceived needs. The questionnaire contained 12 questions. Chief residents rated the 1) quality of their program in preparing residents on health care delivery, public policy issues and practice management; 2) level of instruction provided on 12 topics; and 3) degree of priority these same topics should have. Respondents were asked to identify 1) any other relevant areas their residency program covered particularly well; 2) the amount of time which should be devoted to these socioeconomic topics in each year of training; and 3) the most appealing formats for learning about these topics. Despite the rapidly growing influence of socioeconomic issues on medical practice, many chief residents perceive that important topics are not being addressed adequately. This study provides information on areas addressed well and topics that should receive greater attention. Recommendations are made for further studies and strategies to increase the emphasis on socioeconomic topics during medical education.     

美国老年医学专科医生的培训和资格认证

美国老年医学专科医生必须经过一整套正规和系统的培训,包括4年大学本科和4年医学院的医学教育及3年内科(或家庭医学科)住院医生培训和1～3年老年医学专科培训.老年医学专科医生的资格认证和水平考核也很严格,除了全美统一的医师执照考试(3步)和各州政府医师执照的审批外,还有非政府性的老年医学专科医生的资格认证和水平考核.后者是一个很专业化的过程,包括自学、书面考试和患者调查等,其证书需要每10年更新1次.这一整套正规和系统的培训和专科资格认证考核确保了老年医学专科医生的高专业水平,同时,也避免各地老年医学专科医生专业水平参差不齐.希望通过我们的介绍能促进我国老年医学专科医生培训以及资格认证和水平考核正规化、系统化.     

Outpatient morning report

To clarify the use of outpatient morning report in internal medicine residency programs, we conducted a national survey of internal medicine residency directors and a local survey of a cohort of residents at a large teaching hospital. The program directors reported a 24% prevalence of outpatient morning report. The cohort of residents reported that the conference contributed much to their education by meeting specific learning needs and covering topics not covered elsewhere in their residency training. Presented at the Annual Meeting, Society of General Internal Medicine, San Francisco, Calif, April 30, 1999.     

内科学主要分支学科研究前沿的文献计量学分析

  目的 利用文献计量学方法分析内科学各主要分支学科的研究前沿。方法 根据期刊引证报告（JCR）中10个内科学分支学科（内分泌与代谢病学、心血管病学、血液病学、传染病学、肾脏病学、胃肠病学与肝病学、呼吸病学、风湿病学、重症医学、神经与精神病学）期刊的数目及各刊的影响因子,并咨询相应学科临床专家,选定50种期刊作为分析样本。从Web of Science下载2011年度上述期刊发表的论文及其引文,分别统计各学科引文频次并抽取其中的高被引论文,根据这些论文同时被引用的次数对高被引论文进行聚类分析,浏览各类别中高被引论文的标题和摘要,确定各类别的主要内容,以高被引论文聚类结果作为该学科的知识基础,分析引用这些高被引论文的当前（2011年）论文获得各分支学科的研究前沿。结果 从10个内科学专业分支学科中挑选了最具权威性的50种临床期刊;各学科总计挖掘出202条的高被引文献,38个高被引论文聚类（知识基础）,与各知识基础对应的2011年发表的152篇代表性论文,以及对这些代表性论文内容分析归纳的结果。结论 本研究确认并展示了10个内科分支学科的前沿进展,勾勒出当前各分支学科发展科研活动的静态结构。        

Morning report. A successful format

Morning report can function as an instructive teaching conference capable of providing a broad coverage of topics in internal medicine. A format at our institution that utilizes brief case presentations by on-call interns, followed by an in-depth discussion of key points among representative subspecialty staff, provided coverage of 85.6% of material present in three major medical references. An internal monitoring system used to guide case selection assures a broader coverage of topics. In addition, preconference preparation to delineate major teaching points, timely follow-up of previously discussed cases, and the generation of a pertinent bibliography are significant features of a format for morning report that provides a conference for exposing house staff to a wide variety of internal medicine problems.     

What do internal medicine residents know about rheumatology? A needs assessment for curriculum design

Clinical Rheumatology - We sought to determine if analyzing internal medicine (IM) resident performance on the in-training exam (ITE) might reveal curricular needs in rheumatology education beyond...     

The invention and development of American internal medicine

During the early twentieth century American physicians considered several different ways to identify medical specialists. The first autonomous specialty board was incorporated in 1924, and over the next few decades the board system became the accepted system for credentialing specialists. In 1936 the American Board of Internal Medicine (ABIM) became the twelfth specialty board. It was intended to recognize only a few outstanding internists, for the ABIM's founders believed that general practitioners should continue to deliver the vast majority of care. However, World War II greatly increased the importance of the ABIM and of the specialty boards system. The army medical services emphasized the importance of board certification, thus encouraging physicians to receive residency training and to sit for a specialty board. After the war, the expanding VA hospital system provided them a place to do so. Specialty training and board certification became the norm, not the exception. Also, the national exigencies of World War II forced Congress to devise a new system to distribute federal funds for biomedical research to universities. That system, continued as the National Institutes of Health, supported the subsequent growth of internal medicine in general, as well as its subspecialties. Both the ABIM and the other specialty boards were formed at a particular time and place in response to the specific interests of individuals and organizations, and their histories reflect both the ideals of their founders and the long-term structural effects of war.     

Resident expectations of morning report: a multi-institutional study.

BACKGROUND: Morning report, a cornerstone of inter nal medicine residency programs for many years, involves a diverse group of teachers and learners with heterogeneous learning goals. METHODS: We distributed a self-administered, cross sectional survey to internal medicine residents to clarify the objectives of the learners at morning report. We selected a convenience sample of internal medicine residents at community- and university-based programs Questions were answered in a Likert scale or multiple-choice format. RESULTS: Residents from 13 residency programs in 7 states participated. We received 356 completed surveys, which represented a 63% response rate. The house staff in our sample preferred that half of the guest attending physicians be generalists. They indicated that the primary function of morning report should be educational, and preferred to discuss the management of a few interesting cases rather than review all patients admitted the previous day. The majority of respondents (60.8%) favored a stepwise presentation of cases to simulate the chronology of receiving information. Disease process, diagnostic workup, and evaluation of tests and procedures were all considered important topics for discussion, while medical ethics and research methods were viewed as less important. Responses varied little when stratified by sex, postgraduate year, type of residency program, subspecialty fellowship plans, or location of medical school. CONCLUSIONS: Residents from a diverse group of programs expressed remarkably similar opinions about morning report. Consistent with the recently increased emphasis on ambulatory care and general internal medicine in residency training, they expressed a desire for about 50% of the guest attending physicians to be generalists. In addition, they preferred a style in which challenging cases were presented in a stepwise manner.     

Are Commonly Used Resident Measurements Associated with Procedural Skills in Internal Medicine Residency Training?

Background Acquisition of competence in performing a variety of procedures is essential during Internal Medicine (IM) residency training. Purposes Determine the rate of procedural complications by IM residents; determine whether there was a correlation between having 1 or more complications and institutional procedural certification status or attending ratings of resident procedural skill competence on the American Board of Internal Medicine (ABIM) monthly evaluation form (ABIM-MEF). Assess if an association exists between procedural complications and in-training examination and ABIM board certification scores. Methods We retrospectively reviewed all procedure log sheets, procedural certification status, ABIM-MEF procedural skills ratings, in-training exam and certifying examination (ABIM-CE) scores from the period 1990–1999 for IM residency program graduates from a training program. Results Among 69 graduates, 2,212 monthly procedure log sheets and 2,475 ABIM-MEFs were reviewed. The overall complication rate was 2.3/1,000 procedures (95% CI: 1.4–3.1/1,000 procedure). With the exception of procedural certification status as judged by institutional faculty, there was no association between our resident measurements and procedural complications. Conclusions Our findings support the need for a resident procedural competence certification system based on direct observation. Our data support the ABIM’s action to remove resident procedural competence from the monthly ABIM-MEF ratings.     

Internal medicine residency program director perceptions of USMLE Step 1 pass/fail scoring: A cross-sectional survey

The United States Medical Licensing Examination Step 1 will transition to a pass/fail exam starting no earlier than January 2022. Internal medicine residency programs will need to adapt to these changes. The purpose of this study was to investigate:1. internal medicine residency program directors’ perceptions on the change of Step 1 to a pass/fail exam, and2. the impact on other factors considered for internal medicine residency selection.A validated REDCap survey was sent to 548 program directors at active Accreditation Council for Graduate Medical Education internal medicine residency programs. Contact information from the American Medical Association''s Fellowship and Residency Electronic Interactive Database was used.The survey had 123 respondents (22.4%). Most internal medicine program directors do not support the pass/fail change. A greater importance will be placed on Step 2 Clinical Knowledge exam, personal knowledge of the applicant, clerkship grades, and audition electives. Allopathic students from less highly regarded medical schools, as well as osteopathic and international students, will be disadvantaged. About half believe that schools should adopt a graded pre-clinical curriculum (51.2%) and that there should be residency application caps (54.5%).Internal medicine program directors mostly disagree with the pass/fail Step 1 transition. Residency programs will need to reevaluate how applicants are evaluated. Other factors, such as Step 2 Clinical Knowledge score, personal knowledge of the applicant, grades in clerkships, and audition rotations will now be emphasized more heavily.