Abstract
BACKGROUND
Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge acquisition.
OBJECTIVE
To examine associations of learning habits on medical knowledge acquisition.
DESIGN, PARTICIPANTS
Cohort study of all 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times over 4 years while enrolled in the Internal Medicine Residency, Mayo Clinic, Rochester, MN.
MEASUREMENTS
Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects model.
RESULTS
When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score increase of 5.1% per year (95%CI 4.1%, 6.2%; p < .001). In the year before examination, comparable increases in IM-ITE score were associated with attendance at two curricular conferences per week, score increase of 3.9% (95%CI 2.1%, 5.7%; p < .001), or self-directed reading of an electronic knowledge resource 20 minutes each day, score increase of 4.5% (95%CI 1.2%, 7.8%; p = .008). Other factors significantly associated with IM-ITE performance included: age at start of residency, score decrease per year of increasing age, −0.2% (95%CI −0.36%, −0.042%; p = .01), and graduation from a US medical school, score decrease compared to international medical school graduation, −3.4% (95%CI −6.5%, −0.36%; p = .03).
CONCLUSIONS
Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training.
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References
ACGME Outcome Project. ACGME General Competencies Vers. 1.3 (9.28.99) Available at: http://www.acgme.org/outcome/comp/compFull.asp#2. Accessed May 1, 2006.
Internal Medicine In-Training Examination®. Last update February 7, 2006, available at: http://www.acponline.org/cme/itelg.htm?idxt. Accessed May 1, 2006.
Garibaldi RA, Subhiyah R, Moore ME, Waxman H. The in-training examination in internal medicine: an analysis of resident performance over time. Ann Intern Med. 2002;137(6):505–10.
Cantwell JD. The Mendoza line and in-training examination scores. Ann Intern Med. 1993;119(6):541.
Grossman RS, Fincher RM, Layne RD, Seelig CB, Berkowitz LR, Levine MA. Validity of the in-training examination for predicting American Board of Internal Medicine certifying examination scores. J Gen Intern Med. 1992;7(1):63–7.
Rollins LK, Martindale JR, Edmond M, Manser T, Scheld WM. Predicting pass rates on the American Board of Internal Medicine certifying examination. J Gen Intern Med. 1998;13(6):414–6.
Waxman H, Braunstein G, Dantzker D, et al. Performance on the internal medicine second-year residency in-training examination predicts the outcome of the ABIM certifying examination. J Gen Intern Med. 1994;9(12):692–4.
FitzGerald JD, Wenger NS. Didactic teaching conferences for IM residents: who attends, and is attendance related to medical certifying examination scores? Acad Med. 2003;78(1):84–9.
Cacamese SM, Eubank KJ, Hebert RS, Wright SM. Conference attendance and performance on the in-training examination in internal medicine. Med Teach. 2004;26(7):640–4.
Kolars J, McDonald F, Subhiyah R, Edson R. Knowledge base evaluation of medicine residents on the gastroenterology service: implications for competency assessments by faculty. Clin Gastroenterol Hepatol. 2003;1:64–8.
Hawkins RE, Sumption KF, Gaglione MM, Holmboe ES. The in-training examination in internal medicine: resident perceptions and lack of correlation between resident scores and faculty predictions of resident performance. Am J Med. 1999;106(2):206–10.
Dupras DM, Li JT. Use of an objective structured clinical examination to determine clinical competence. Acad Med. 1995;70(11):1029–34.
Shokar GS. The effects of an educational intervention for “at-risk” residents to improve their scores on the In-training Exam. Fam Med. 2003;35(6):414–7.
Ellis DD, Kiser WR, Blount W. Is interruption in residency training associated with a change in in-training examination scores? Fam Med. 1997;29(3):184–6.
Madlon-Kay DJ. When family practice residents are parents: effect on in-training examination scores. Fam Pract Res J. 1989;9(1):53–6.
Godellas CV, Hauge LS, Huang R. Factors affecting improvement on the American Board of Surgery in-training exam (ABSITE). J Surg Res. 2000;91(1):1–4.
Godellas CV, Huang R. Factors affecting performance on the American Board of Surgery in-training examination. Am J Surg. 2001;181(4):294–6.
Pollak R, Baker RJ. The acquisition of factual knowledge and the role of the didactic conference in a surgical residency program. Am Surg. 1988;54(9):531–4.
Shetler PL. Observations on the American Board of Surgery in-training examination, board results, and conference attendance. Am J Surg. 1982;144(3):292–4.
Bull DA, Stringham JC, Karwande SV, Neumayer LA. Effect of a resident self-study and presentation program on performance on the thoracic surgery in-training examination. Am J Surg. 2001;181(2):142–4.
Schilling LM, Steiner JF, Lundahl K, Anderson RJ. Residents’ patient-specific clinical questions: opportunities for evidence-based learning. Acad Med. 2005;80(1):51–6.
Peterson MW, Rowat J, Kreiter C, Mandel J. Medical students’ use of information resources: is the digital age dawning? Acad Med. 2004;79(1):89–95.
Fox GN, Moawad N. UpToDate: a comprehensive clinical database. J Fam Pract. 2003;52(9):706–10.
What is UpToDate? Available at: http://www.uptodate.com/service/faq.asp. Accessed May 1, 2006.
Diggle P, Heagerty P, Liang K, Zeger S. Analysis of Longitudinal Data, 2nd edn. Oxford, England: Oxford University Press; 2002.
Liang KY, Zeger SL. Regression analysis for correlated data. Annu Rev Public Health. 1993;14:43–68.
Green ML, Ruff TR. Why do residents fail to answer their clinical questions? A qualitative study of barriers to practicing evidence-based medicine. Acad Med. 2005;80(2):176–82.
Green ML, Ciampi MA, Ellis PJ. Residents’ medical information needs in clinic: are they being met? Am J Med. 2000;109(3):218–23.
Koonce TY, Giuse NB, Todd P. Evidence-based databases versus primary medical literature: an in-house investigation on their optimal use. J Med Lib Assoc. 2004;92(4):407–11.
Norcini JJ, Shea JA, Webster GD, Benson JA, Jr. Predictors of the performance of foreign medical graduates on the 1982 certifying examination in internal medicine. JAMA. 1986;256(24):3367–70.
Norcini JJ, Grosso LJ, Shea JA, Webster GD. The relationship between features of residency training and ABIM certifying examination performance. J Gen Intern Med. 1987;2(5):330–6.
Acknowledgments
The authors wish to acknowledge Peter A. Bonis, MD of UpToDate for his assistance in providing the UpToDate usage data. They further wish to thank Dr. Bonis for providing these data without any input into study design, analysis, or publication, which has allowed them to maintain scientific independence for this study. Study findings were presented in oral format at the Association of Medical Education in Europe Annual Meeting, Genoa, Italy, September 14–18, 2006. There were neither internal nor external funding sources for this study.
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McDonald, F.S., Zeger, S.L. & Kolars, J.C. Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency. J GEN INTERN MED 22, 962–968 (2007). https://doi.org/10.1007/s11606-007-0206-4
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DOI: https://doi.org/10.1007/s11606-007-0206-4