American Board Of Internal Medicine Certification Examination Research Articles

USMLE Performance, Subsequent Standardized Testing, and ABIM Certification Exam Preparation for Internal Medicine Residency Programs: A Narrative Review.

Standardized examinations measure progress throughout medical education. Successful completion of the American Board of Internal Medicine Certification Examination (ABIM-CE) benchmarks completion of internal medicine (IM) residency training. Recent declines in initial ABIM-CE pass rates may prompt residency programs to examine strategies to improve learner performance. We synthesized published literature on associations between the United States Medical Licensing Examination (USMLE), in-training examination (ITE), and board preparation to support residents for ABIM-CE. We searched MEDLINE for test performance and preparation strategies for IM board certification during training. Relevant articles published until March 15, 2024, were screened using pre-defined criteria for narrative review, then codified into three domains (USMLE, ITE, curriculum/program strategies). Findings were grouped by theme into considerations for training programs seeking guidance on learning augmentation plans to improve resident performance on ABIM-CE. Themes drawn from articles focused on USMLE include validity in predicting CE performance, noting (1) failing USMLE Step 1 is associated with failing ABIM-CE, (2) any USMLE score < 220 increases failure probability, and (3) a mean USMLE ≥ 250 approximates ~ 100% pass rates on board examination. Inferences from ITE-focused articles support use as a predictive tool; specifically, a score < 35th percentile signals a resident at risk for failing the ABIM-CE while > 70th percentile is predictive of passing. Lastly, inferences from curriculum- and program-focused articles suggest standard contents (conferences) do not correlate with CE passage, while targeted clinical reasoning and remediation plans do. IM residency programs should consider adopting learning augmentation strategies targeted to at-risk residents to support CE passage.

An Exploratory Study of a Novel Adaptive e-Learning Board Review Product Helping Candidates Prepare for Certification Examinations

This article was migrated. The article was not marked as recommended. Objectives: Online board-review products are widely used to prepare for high-stakes examinations; however, it is unclear if these products are truly helpful and which features are most useful. This study examined the user ratings of an e-learning examination-preparation product and its impact on first-time American Board of Internal Medicine Certifying Examination (ABIM-CE) test takers. Methods: 4,400 users were anonymously surveyed between 2015 and 2017 to determine their level of satisfaction with the NEJM Knowledge+ Internal Medicine Board Review (NEJM Knowledge+) product and their board-exam passage rate. Results:The responding users' (n=836) average ratings of NEJM Knowledge+'s content, relevance, components, and features were high. Similarly, a subgroup of responding users from the United States who primarily used NEJM Knowledge+ to prepare for an initial ABIM-CE between 2014 and 2016 (n=153) rated the content, relevance, components, and features high, with practice exams, adaptive delivery of questions, and reports on progress, performance, and metacognition as the most valuable features. Importantly, this subgroup of users passed the ABIM-CE on their first attempt at a significantly higher rate than the national average (95% vs 89%, z=2.6397, p=0.0083). Conclusion:An e-learning examination-preparation product that features adaptive delivery of questions, offers detailed feedback, and analyzes overall metacognition may be an effective tool for first-time test takers preparing for initial certifying examinations.

Relationships Between the ACGME Resident and Faculty Surveys and Program Pass Rates on the ABIM Internal Medicine Certification Examination.

The Accreditation Council for Graduate Medical Education (ACGME) has surveyed residents since 2003, and faculty since 2012. Surveys are designed to assess program functioning and specify areas for improvement. The purpose of this study was to assess the association of the ACGME's resident and faculty surveys with residency-program-specific performance on the American Board of Internal Medicine (ABIM) certification exam. Data were available from residents and faculty in 375 U.S. ACGME-accredited internal medicine programs from the 2012-2013, 2013-2014, and 2014-2015 academic years. Analysis of variance and correlations were used to examine the relationship between noncompliance with ACGME program requirements as assessed by the resident and faculty surveys, and ABIM program pass rates. Noncompliance reported on the resident and faculty surveys was highest for programs not meeting the ACGME program requirement of an 80% pass rate on the ABIM certification examination. This relationship was significant for overall noncompliance, both within the resident (P < .001) and faculty (P < .05) surveys, for many areas within the two surveys (correlations ranged between -.07 and -.25, and P values ranged between .20 and < .001), and for the highest levels of noncompliance across areas of the resident (P < .001) and faculty (P < .04) surveys. ACGME resident and faculty surveys were significantly associated with ABIM program pass rates, supporting the importance of these surveys within the ACGME's Next Accreditation System.

Correlations Between Ratings on the Resident Annual Evaluation Summary and the Internal Medicine Milestones and Association With ABIM Certification Examination Scores Among US Internal Medicine Residents, 2013-2014

US internal medicine residency programs are now required to rate residents using milestones. Evidence of validity of milestone ratings is needed. To compare ratings of internal medicine residents using the pre-2015 resident annual evaluation summary (RAES), a nondevelopmental rating scale, with developmental milestone ratings. Cross-sectional study of US internal medicine residency programs in the 2013-2014 academic year, including 21 284 internal medicine residents (7048 postgraduate-year 1 [PGY-1], 7233 PGY-2, and 7003 PGY-3). Program director ratings on the RAES and milestone ratings. Correlations of RAES and milestone ratings by training year; correlations of medical knowledge ratings with American Board of Internal Medicine (ABIM) certification examination scores; rating of unprofessional behavior using the 2 systems. Corresponding RAES ratings and milestone ratings showed progressively higher correlations across training years, ranging among competencies from 0.31 (95% CI, 0.29 to 0.33) to 0.35 (95% CI, 0.33 to 0.37) for PGY-1 residents to 0.43 (95% CI, 0.41 to 0.45) to 0.52 (95% CI, 0.50 to 0.54) for PGY-3 residents (all P values <.05). Linear regression showed ratings differed more between PGY-1 and PGY-3 years using milestone ratings than the RAES (all P values <.001). Of the 6260 residents who attempted the certification examination, the 618 who failed had lower ratings using both systems for medical knowledge than did those who passed (RAES difference, -0.9; 95% CI, -1.0 to -0.8; P < .001; milestone medical knowledge 1 difference, -0.3; 95% CI, -0.3 to -0.3; P < .001; and medical knowledge 2 difference, -0.2; 95% CI, -0.3 to -0.2; P < .001). Of the 26 PGY-3 residents with milestone ratings indicating deficiencies on either of the 2 medical knowledge subcompetencies, 12 failed the certification examination. Correlation of RAES ratings for professionalism with residents' lowest professionalism milestone ratings was 0.44 (95% CI, 0.43 to 0.45; P < .001). Among US internal medicine residents in the 2013-2014 academic year, milestone-based ratings correlated with RAES ratings but with a greater difference across training years. Both rating systems for medical knowledge correlated with ABIM certification examination scores. Milestone ratings may better detect problems with professionalism. These preliminary findings may inform establishment of the validity of milestone-based assessment.

Concurrent Validity Between a Shared Curriculum, the Internal Medicine In-Training Examination, and the American Board of Internal Medicine Certifying Examination.

A core objective of residency education is to facilitate learning, and programs need more curricula and assessment tools with demonstrated validity evidence. We sought to demonstrate concurrent validity between performance on a widely shared, ambulatory curriculum (the Johns Hopkins Internal Medicine Curriculum), the Internal Medicine In-Training Examination (IM-ITE), and the American Board of Internal Medicine Certifying Examination (ABIM-CE). A cohort study of 443 postgraduate year (PGY)-3 residents at 22 academic and community hospital internal medicine residency programs using the curriculum through the Johns Hopkins Internet Learning Center (ILC). Total and percentile rank scores on ILC didactic modules were compared with total and percentile rank scores on the IM-ITE and total scores on the ABIM-CE. The average score on didactic modules was 80.1%; the percentile rank was 53.8. The average IM-ITE score was 64.1% with a percentile rank of 54.8. The average score on the ABIM-CE was 464. Scores on the didactic modules, IM-ITE, and ABIM-CE correlated with each other (P < .05). Residents completing greater numbers of didactic modules, regardless of scores, had higher IM-ITE total and percentile rank scores (P < .05). Resident performance on modules covering back pain, hypertension, preoperative evaluation, and upper respiratory tract infection was associated with IM-ITE percentile rank. Performance on a widely shared ambulatory curriculum is associated with performance on the IM-ITE and the ABIM-CE.

The relationship between internal medicine residency graduate performance on the ABIM certifying examination, yearly in-service training examinations, and the USMLE Step 1 examination.

To explore the relationship between United States Medical Licensing Examination (USMLE) Step 1 scores, yearly in-service training exam (ITE) scores, and passing the American Board of Internal Medicine certifying examination (ABIM-CE). The authors conducted a retrospective database review of internal medicine residents from the Medical College of Wisconsin from 2004 through 2012. Residents' USMLE Step 1, ITE, and ABIM-CE scores were extracted. Pearson rho, chi-square, and logistic regression were used to determine whether relationships existed between the scores and if Step 1 and ITE scores correlate with passing the ABIM-CE. There were 241 residents, who participated in 728 annual ITEs. There were Step 1 scores for 195 (81%) residents and ABIM-CE scores for 183 (76%). Step 1 and ABIM-CE scores had a modest correlation (rho: 0.59), as did ITE and ABIM-CE scores (rho: 0.48-0.67). Failing Step 1 or being in the bottom ITE quartile during any year of testing markedly increased likelihood of failing the boards (Step 1: relative risk [RR]: 2.4; 95% CI: 1.0-5.9; first-year residents' RR: 1.3; 95% CI: 1.0-1.6; second-year residents' RR: 1.3; 95% CI: 1.1-1.5; third-year residents' RR: 1.3; 95% CI: 1.1-1.5). USMLE Step 1 and ITE scores have a modest correlation with board scores. Failing Step 1 or scoring in the bottom quartile of the ITE increased the risk of failing the boards. What effective intervention, if any, program directors may use with at-risk residents is a question deserving further research.

Impact of subspecialty elective exposures on outcomes on the American board of internal medicine certification examination

BackgroundThe American Board of Internal Medicine Certification Examination (ABIM-CE) is one of several methods used to assess medical knowledge, an Accreditation Council for Graduate Medical Education (ACGME) core competency for graduating internal medicine residents. With recent changes in graduate medical education program directors and internal medicine residents are seeking evidence to guide decisions regarding residency elective choices. Prior studies have shown that formalized elective curricula improve subspecialty ABIM-CE scores. The primary aim of this study was to evaluate whether the number of subspecialty elective exposures or the specific subspecialties which residents complete electives in impact ABIM-CE scores.MethodsABIM-CE scores, elective exposures and demographic characteristics were collected for MedStar Georgetown University Hospital internal medicine residents who were first-time takers of the ABIM-CE in 2006–2010 (n=152). Elective exposures were defined as a two-week period assigned to the respective subspecialty. ABIM-CE score was analyzed using the difference between the ABIM-CE score and the standardized passing score (delta-SPS). Subspecialty scores were analyzed using percentage of correct responses. Data was analyzed using GraphPad Prism version 5.00 for Windows.ResultsPaired elective exposure and ABIM-CE scores were available in 131 residents. There was no linear correlation between ABIM-CE mean delta-SPS and the total number of electives or the number of unique elective exposures. Residents with ≤14 elective exposures had higher ABIM-CE mean delta-SPS than those with ≥15 elective exposures (143.4 compared to 129.7, p=0.051). Repeated electives in individual subspecialties were not associated with significant difference in mean ABIM-CE delta-SPS.ConclusionsThis study did not demonstrate significant positive associations between individual subspecialty elective exposures and ABIM-CE mean delta-SPS score. Residents with ≤14 elective exposures had higher ABIM-CE mean delta-SPS than those with ≥15 elective exposures suggesting there may be an “ideal” number of elective exposures that supports improved ABIM-CE performance. Repeated elective exposures in an individual specialty did not correlate with overall or subspecialty ABIM-CE performance.

A nomogram to predict the probability of passing the American Board of Internal Medicine examination

Background: Although the American Board of Internal Medicine (ABIM) certification is valued as a reflection of physicians’ experience, education, and expertise, limited methods exist to predict performance in the examination.Purpose: The objective of this study was to develop and validate a predictive tool based on variables common to all residency programs, regarding the probability of an internal medicine graduate passing the ABIM certification examination.Methods: The development cohort was obtained from the files of the Cleveland Clinic internal medicine residents who began training between 2004 and 2008. A multivariable logistic regression model was built to predict the ABIM passing rate. The model was represented as a nomogram, which was internally validated with bootstrap resamples. The external validation was done retrospectively on a cohort of residents who graduated from two other independent internal medicine residency programs between 2007 and 2011.Results: Of the 194 Cleveland Clinic graduates used for the nomogram development, 175 (90.2%) successfully passed the ABIM certification examination. The final nomogram included four predictors: In-Training Examination (ITE) scores in postgraduate year (PGY) 1, 2, and 3, and the number of months of overnight calls in the last 6 months of residency. The nomogram achieved a concordance index (CI) of 0.98 after correcting for over-fitting bias and allowed for the determination of an estimated probability of passing the ABIM exam. Of the 126 graduates from two other residency programs used for external validation, 116 (92.1%) passed the ABIM examination. The nomogram CI in the external validation cohort was 0.94, suggesting outstanding discrimination.Conclusions: A simple user-friendly predictive tool, based on readily available data, was developed to predict the probability of passing the ABIM exam for internal medicine residents. This may guide program directors’ decision-making related to program curriculum and advice given to individual residents regarding board preparation.

Associations between quality indicators of internal medicine residency training programs.

BackgroundSeveral residency program characteristics have been suggested as measures of program quality, but associations between these measures are unknown. We set out to determine associations between these potential measures of program quality.MethodsSurvey of internal medicine residency programs that shared an online ambulatory curriculum on hospital type, faculty size, number of trainees, proportion of international medical graduate (IMG) trainees, Internal Medicine In-Training Examination (IM-ITE) scores, three-year American Board of Internal Medicine Certifying Examination (ABIM-CE) first-try pass rates, Residency Review Committee-Internal Medicine (RRC-IM) certification length, program director clinical duties, and use of pharmaceutical funding to support education. Associations assessed using Chi-square, Spearman rank correlation, univariate and multivariable linear regression.ResultsFifty one of 67 programs responded (response rate 76.1%), including 29 (56.9%) community teaching and 17 (33.3%) university hospitals, with a mean of 68 trainees and 101 faculty. Forty four percent of trainees were IMGs. The average post-graduate year (PGY)-2 IM-ITE raw score was 63.1, which was 66.8 for PGY3s. Average 3-year ABIM-CE pass rate was 95.8%; average RRC-IM certification was 4.3 years. ABIM-CE results, IM-ITE results, and length of RRC-IM certification were strongly associated with each other (p < 0.05). PGY3 IM-ITE scores were higher in programs with more IMGs and in programs that accepted pharmaceutical support (p < 0.05). RRC-IM certification was shorter in programs with higher numbers of IMGs. In multivariable analysis, a higher proportion of IMGs was associated with 1.17 years shorter RRC accreditation.ConclusionsAssociations between quality indicators are complex, but suggest that the presence of IMGs is associated with better performance on standardized tests but decreased duration of RRC-IM certification.

Performance during Internal Medicine Residency Training and Subsequent Disciplinary Action by State Licensing Boards

Physicians who are disciplined by state licensing boards are more likely to have demonstrated unprofessional behavior in medical school. Information is limited on whether similar performance measures taken during residency can predict performance as practicing physicians. To determine whether performance measures during residency predict the likelihood of future disciplinary actions against practicing internists. Retrospective cohort study. State licensing board disciplinary actions against physicians from 1990 to 2006. 66,171 physicians who entered internal medicine residency training in the United States from 1990 to 2000 and became diplomates. Predictor variables included components of the Residents' Annual Evaluation Summary ratings and American Board of Internal Medicine (ABIM) certification examination scores. 2 performance measures independently predicted disciplinary action. A low professionalism rating on the Residents' Annual Evaluation Summary predicted increased risk for disciplinary action (hazard ratio, 1.7 [95% CI, 1.3 to 2.2]), and high performance on the ABIM certification examination predicted decreased risk for disciplinary action (hazard ratio, 0.7 [CI, 0.60 to 0.70] for American or Canadian medical school graduates and 0.9 [CI, 0.80 to 1.0] for international medical school graduates). Progressively better professionalism ratings and ABIM certification examination scores were associated with less risk for subsequent disciplinary actions; the risk ranged from 4.0% for the lowest professionalism rating to 0.5% for the highest and from 2.5% for the lowest examination scores to 0.0% for the highest. The study was retrospective. Some diplomates may have practiced outside of the United States. Nondiplomates were excluded. Poor performance on behavioral and cognitive measures during residency are associated with greater risk for state licensing board actions against practicing physicians at every point on a performance continuum. These findings support the Accreditation Council for Graduate Medical Education standards for professionalism and cognitive performance and the development of best practices to remediate these deficiencies.

Military Internal Medicine Resident Performance on the American Board of Internal Medicine Certifying Examination

The mission of military graduate medical education in internal medicine is to produce high-quality military internists prepared to practice in military environments. Board certification in internal medicine is an important outcome of internal medicine residency training. The American Board of Internal Medicine Certifying Examination (ABIMCE) first-taker pass rate of the graduates of an internal medicine residency program is a key measure of the quality of the program. We compared the ABIMCE first-taker pass rates for military and civilian internal medicine residency program graduates. Military internal medicine residency graduates had higher first-taker pass rates than their civilian counterparts. This is likely a reflection of the high-quality residents and the faculty at military programs. These results support the notion that military internal medicine residency programs continue to fulfill their mission of training high-quality internists.

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

To determine whether raters using the American Board of Internal Medicine (ABIM) Resident Evaluation Form can detect differences among residents in clinical competence. Cross-sectional study. Inpatient general medicine service in a university-affiliated public hospital. 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. 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. 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.

Predictive validity of certification by the American Board of Internal Medicine.

To determine the predictive validity of the American Board of Internal Medicine (ABIM) certification process. Prospective measurement of the knowledge, skills, and attitudes of 185 ABIM-certified and 74 noncertified internists by a written examination; evaluation by professional associates; a patient questionnaire assessing satisfaction with care, physician's counseling role, and preventive care; and review of records of patients with common illnesses. Practicing internists who completed training or received ABIM certification 5 to 10 years previously. Office-based practices in six western states. Physicians certified by the ABIM had significantly higher scores on the written examination than the noncertified physicians, and scores on our examination correlated highly with the ABIM certification examination (r = 0.73). Ratings of clinical skills by professional associates were significantly higher for certified internists and also correlated highly with ABIM examination scores (r = 0.53 to 0.59). Regression analysis showed that ABIM certification status was the major variable affecting performance on these measures of clinical competence. Results from other measures did not show many differences between certified and noncertified physicians in the care of patients with common illnesses, but modest differences in preventive care and a few differences in outcome favored the certified physicians. Comparison of findings from the written examination and the professional associate ratings with certification status and original ABIM certification examination scores shows predictive validity of ABIM certification. Further studies are needed to determine if certification status predicts important differences in the care of patients with complex illnesses.

The American Board of Internal Medicine recertification examination: process and results.

On 26 October 1974, 3356 diplomates of the American Board of Internal Medicine (ABIM) took a 1-day written examination for recertification consisting of multiple-choice, matching, and true-false questions derived from the American College of Physicians' Medical Knowledge Self-Assessment Program III and the ABIM Certifying Examination pool. The passing score was set by using a normative standard applied to a reference group of internists practicing general internal medicine who had had 2 or more years of residency training completed between the years 1949 and 1958. The passing score represented approximately 63% correct answers. The failure rate for the total number of examinees was 4.3%. Mean score of examinees showed an inverse relation with age but relatively slight differences when analyzed according to the degree of subspecialization, practice setting, hospital affiliation, or size of patient community.