Does an endocrinology subspecialty residency rotation enhance resident endocrine clinical knowledge?

Rupendra T Shrestha,J Bruce Redmon,Logan Butler,Andrew P.J Olson,Yeng M Miller-Chang,Jacqueline L Gauer

doi:10.1186/s12909-022-03110-6

Abstract

BackgroundInternal Medicine (IM) programs offer elective subspecialty rotations in which residents may enroll to supplement the experience and knowledge obtained during general inpatient and outpatient rotations. Objective evidence that these rotations provide enhanced subspecialty specific knowledge is lacking. The purpose of this study was to determine whether exposure to an endocrinology subspecialty rotation enhanced a resident’s endocrinology-specific knowledge beyond that otherwise acquired during IM residency.MethodsData were collected on internal medicine resident scores on the American College of Physicians Internal Medicine In-Training Examinations (IM-ITE) for calendar years 2012 through 2018 along with enrollment data as to whether residents had completed an endocrinology subspecialty rotation prior to sitting for a given IM-ITE. Three hundred and six internal medicine residents in the University of Minnesota Internal Medicine residency program with 664 scores total on the IM-ITE for calendar years 2012 through 2018. Percentage of correct answers on the overall and endocrine subspecialty content areas on the IM-ITE for each exam were determined and the association between prior exposure to an endocrinology subspecialty rotation and percentage of correct answers in the endocrinology content area was analyzed using generalized linear mixed-effects models.ResultsTwo hundred and thirty-three residents (76%) completed an endocrinology subspecialty rotation at some point during their residency; 121 (40%) residents had at least one IM-ITE both before and after exposure to an endocrine subspecialty rotation. Exposure to an endocrinology subspecialty rotation exhibited a positive association with the expected IM-ITE percent correct on the endocrinology content area (5.5% predicted absolute increase). Advancing year of residency was associated with a predicted increase in overall IM-ITE score but did not improve the predictive model for endocrine subspecialty score.ConclusionsCompletion of an endocrinology subspecialty elective was associated with an increase in resident endocrine specific knowledge as assessed by the IM-ITE. These findings support the value of subspecialty rotations in enhancing a resident’s subspecialty specific medical knowledge.

Highlights

Internal Medicine (IM) programs offer elective subspecialty rotations in which residents may enroll to supplement the experience and knowledge obtained during general inpatient and outpatient rotations
We considered the following fixed-effect covariates for each generalized linear mixed-effects models (GLMM): (1) a fixed effect denoting whether the student took the Internal Medicine In-Training Examinations (IM-In-training examination (ITE)) exam after an endocrinology rotation, (2) a fixed effect denoting the post-graduate year (PGY) level at the time of the IM-ITE, and (3) a fixed effect for the interaction of these two variables
With regard to overall IM-ITE scores, we found the GLMM using PGY level as the only fixed effect provided the best fit to the overall IM-ITE score

Summary

Introduction

Internal Medicine (IM) programs offer elective subspecialty rotations in which residents may enroll to supplement the experience and knowledge obtained during general inpatient and outpatient rotations. Objective evidence that these rotations provide enhanced subspecialty specific knowledge is lacking. In the US, these programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME) which sets standards for residency and fellowship programs and the institutions that sponsor them. As part of the ACGME standards, residency programs are charged with the task of preparing residents with the knowledge and skills to practice independently Such programs must provide regular objective assessment of resident competence [1]. Resident clinical experience and education in primarily outpatient subspecialties may be limited

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