Examination In Internal Medicine Research Articles

Methods of preparing for the Certifying Examination in internal medicine and their efficacy.

Candidates for the 1991 Certifying Examination were asked how they prepared for the examination. There were 2,780 respondents (32% of the eligible candidates). The responding candidates used a mean of 5.2 study methods and gave higher educational value ratings to methods used most frequently. Regression analyses showed no independent contribution of study method or effort to explaining the variance in score for first-time takers, and a 2% contribution for repeat takers. Program director ratings were the most important predictors of score for first-time takers and previous examination score for repeat takers. Intensive study is likely to produce at most a small improvement in performance.

A core component of the certification examination in internal medicine.

To develop and test the psychometric characteristics of an examination of core content in internal medicine. A cross-sectional pilot test comparing the core examination with the 1988 certifying examination and two pretest examinations. The 1988 certifying examination of the American Board of Internal Medicine. A random sample of 2,975 candidates from 8,968 candidates who took the 1988 certifying examination were given the core examination; similarly drawn samples were each given one of two pretests of traditional questions. A framework for developing an examination of core internal medicine questions was designed and used to develop a 92-question core test with an absolute pass/fail standard. Candidates answered 74% of core internal medicine questions, compared with 64%, 52%, and 53% of traditional questions on the 1988 certifying examination and the two pretests. The discriminating ability of the core internal medicine examination was lower than that of the certifying examination (r-values were 0.28 and 0.34, respectively). The pass rate was 83% for the core internal medicine examination and 57% for the certifying examination; 27% passed the core examination and failed the certifying examination; 1% passed the certifying examination and failed the core examination. Core internal medicine questions were easier than but almost as discriminating as traditional questions of the certifying examination. A small percentage of candidates passed the certifying examination but failed the core examination.

Quality Standards Insurance in Internal Medicine

Recalling my residency training at the University of Massachusetts in the early 1970s, I was impressed with the attention to clinical diagnostic and management skills. It was assumed that we acquired the didactic database. Most impressive was the faculty's coverage of the emergency room, so that we residents could attend conferences. Nothing other than quality performance was acceptable. I do have a concern that priorities in some programs have changed to emphasize didactics, solely for the purpose of Board passage. The American Board of Internal Medicine (ABIM) examination has undergone significant modification over the ensuing years, responsive to the challenges of the times. One such challenge follows. Asked the eponym for the malady affecting a patient he had just examined, a Board candidate gave an impolitic response and received a failing grade for the examination. Perhaps, the politic approach would have been to look at the examiner's name and ascribed

The relevance to clinical practice of the certifying examination in internal medicine.

To determine the relevance of the initial certifying examination to the practice of internal medicine and the suitability of items used in initial certification for recertification. Using a matrix-sampling approach, items from the 1991 Certifying Examination were assigned to two sets of judges: directors of the American Board of Internal Medicine (ABIM) and practicing general internists. Each judge rated the relevance of items on a five-point scale. 54 current or former directors of the ABIM and 72 practicing general internists; practitioners were nominated by directors and their ratings were included if they spent > 80% of their time in direct patient care. The directors' mean rating of all 576 items was 3.98 (SD = 0.62); the practitioners' mean rating was 4.11 (SD = 0.82). The directors assigned to 27 items ratings of less than 3 and the practitioners assigned to 42 items ratings of less than 3; seven of these items received low ratings from both groups. There were differences in the two groups' ratings of the relevance of various medical content categories, but the mean rating of core items was higher than that of noncore items and the mean rating of items testing clinical judgment was higher than that of items testing knowledge or synthesis. These findings suggest that the initial certifying examination is relevant to clinical practice and that many of the examination items are suitable for use in recertification. Differences in perception appear to exist between practitioners and directors, and the use of practitioner ratings is likely to be a routine part of judging the suitability of items for Board examinations in the future.

NBME examination part I as a predictor of clinical and ABIM certifying examination performances

The authors studied the extent that National Board of Medical Examiners examination Part I (NBME Part I) performance was predictive of American Board of Internal Medicine examination (ABIME) scores and clinical skill ratings. Information was obtained for Jackson Memorial Hospital internal medicine residents who completed training from 1980 to 1988. There was a highly significant association (r = 0.57, p < 0.0001, n = 117) between ABIME and NBME Part I scores. Clinical evaluations and NBME Part I scores were less strongly related. The data indicate that NBME Part I scores are highly predictive of ABIME outcome. NBME Part I scores also appear to be predictive of clinical performance, but to a lesser extent.

A longitudinal description of patterns of certification in internal medicine and the subspecialties

To document the timings, frequencies, and outcomes of attempts at certification in internal medicine and the internal medicine subspecialties in the years following residency training for two cohorts of residents. Residents who had completed residency training and had been admitted to an American Board of Internal Medicine (ABIM) certifying examination in 1982 or 1983 were tracked through the ABIM database for five years. A total of 10,568 residents were studied. Of the cohort, 79% were men, 21% were women, 79% were graduates of U.S./Canadian medical schools (USMGs), and 21% were graduates of foreign medical schools (FMGs). Ultimately, 85% of the residents achieved certification in internal medicine. Cumulative pass rates were 87% for men, 81% for women, 92% for USMGs, and 60% for FMGs; rates increased minimally after the second attempt. Most (87%) residents first attempted the internal medicine examination in the year in which training had been completed. Delaying the first examination was associated with lower pass rates. Half of the candidates who had passed the internal medicine examination attempted subspecialty certification. Over all nine subspecialty examinations, the two-cycle cumulative pass rate was 87%. Higher percentages of FMGs than of any other subgroup attempted subspecialty certification. The detailed description extends the body of knowledge about certification in internal medicine and the nine internal medicine subspecialties. Questions are raised, such as why some candidates delay the first internal medicine examination and why some residents never seek certification. Future research could explore these issues as well as explanations for the observed differences in pass rates.

Evaluation of Students' Performance and Examination Procedures in Final Certifying Examinations in Internal Medicine (1982-1988)

We conducted a retrospective analysis to evaluate the performance of 459 students on their final certifying examination in internal medicine. These examinations were taken during 1982 through 1988, and the failure rate was 17.6%. Two hundred and five students (44.6%) received grade D (60-69% of the total marks) and 139 (30.1%) grade C (70-79% of total marks). Only 7.7% of the students scored higher (80% or more). A temporal trend has been observed in that a higher percentage of lower grades and lower percentage of higher grades has been observed in recent (1986-1988) compared with earlier (1982-1984) years. Female students generally performed on a par with males, though males students performed better on multiple choice questions (MCQs). The analysis also showed lower mean scores for the essay, oral, and clinical components in recent (1986-1988) than in earlier (1982-1984) years. In studying the interrelationships between different examination components, the MCQs were found to have the highest correlation with other procedures. A lower correlation was observed for clinical examination. Factor analysis also showed that MCQs had the highest and clinical examinations the lowest factor loading. Low correlation and factor loading were also noted for the essay portion. While in the newly implemented curriculum the essay paper has been wisely eliminated, our data suggest that the traditional clinical examination should be replaced by a more objective and structural method. Our analysis may serve as a guide for formulation of final certifying examinations in medical schools throughout the Kingdom.

Residents’ perception of evaluation procedures used by their training program

To determine the methods of evaluation used routinely by training programs and to obtain information concerning the frequencies with which various evaluation methods were used. Survey of residents who had recently completed internal medicine training. 5,693 respondents who completed residencies in 1987 and 1988 and were registered as first-time takers for the 1988 Certifying Examination in Internal Medicine. This constituted a 76% response rate. Virtually all residents were aware that routine evaluations were submitted on inpatient rotations, but were more uncertain about the evaluation process in the outpatient setting and the methods used to assess their humanistic qualities. Most residents had undergone a Clinical Evaluation Exercise (CEX); residents' clinical skills were less likely to be evaluated by direct observation of history or physical examination skills. Resident responses were aggregated within training programs to determine the pattern of evaluation across programs. The majority of programs used Advanced Cardiac Life Support (ACLS) certification, medical record audit, and the national In-Training Examination to assess most of their residents. Performance-based tests were used selectively by a third or more of the programs. Breast and pelvic examination skills and ability to perform sigmoidoscopy were thought not to be adequately assessed by the majority of residents in almost half of the programs. While most residents are receiving routine evaluation, including a CEX, increased efforts to educate residents about their evaluation system, to strengthen evaluation in the outpatient setting, and to evaluate certain procedural skills are recommended.

Trends in medical knowledge as assessed by the certifying examination in internal medicine

Trends in medical knowledge as assessed by the certifying examination in internal medicine

Trends in Medical Knowledge as Assessed by the Certifying Examination in Internal Medicine

The past decade has seen less competition for medical school positions accompanied by the declining interest of medical students in internal medicine. At the same time, the number of first postgraduate-year positions in internal medicine residencies has increased, as has the number of first-year residents who take those positions. The purpose of this study was to examine trends in the medical knowledge of internal medicine residents during the past 6 years. Comparison of performance on the items common to pairs of the certifying examinations of the American Board of Internal Medicine from 1983 to 1988 revealed that the scores of candidates in the reference group have declined, but not dramatically. This trend has occurred among candidates from the top residency programs as well as all other residency programs, and it is present in candidates of all levels of overall clinical competence. Continuing declines in this area could ultimately affect patient care.

Gender differences in the clinical competence of residents in internal medicine

To study the differences between cognitive and noncognitive skills of men and those of women entering internal medicine. Comparison of program directors' ratings of overall clinical competence and its specific components and pass rates for men and women taking the Certifying Examinations in Internal Medicine in 1984-1987. 14,340 U.S. and Canadian graduates taking the Certifying Examinations of the American Board of Internal Medicine for the first time in 1984-1987. Average program directors' ratings of overall competence were 6.70-6.78 for men and 6.60-6.71 for women. The greatest differences in ratings of specific components of competence were in the areas of medical knowledge and procedural skills, where men were rated higher than women, and humanistic qualities, where women were rated higher than men. Pass rates were stable over the four years of the study, and ranged from 85 to 86% for men and from 79 to 81% for women. Men consistently performed slightly better than women regardless of the type of residency or quality of medical school attended. Small but consistent differences were found in the performances of men and those of women completing training in Internal Medicine as measured by program directors' ratings and ABIM Certifying Examination performances.

An Application of Item Response Theory to Certifying Examinations in Internal Medicine

This study assessed the suitability of item response theory (IRT) for medical examination data. The specific purposes were (I) to see whether the American Board of Internal Medicine (ABIM) Certifying Examination data met IRT model assumptions and (2) to apply the one-parameter and three-parameter IRT models to the data and observe whether the expected benefits were obtained Analysis of examinees' responses to single-best-answer items supported the general assumptions of local independence, unidimensionality, and nonspeededness. The specific assumptions of the three-parameter model were met, in that items differed in discrimination and guessing. The estimated ability and item parameters were not initially as Tables as hoped, because of a few poorly estimated parameters and possibly the homogeneity of the examinee group and consequently the large number of items with poor discrimination. Future work needs to include content experts to help understand why some items do not fit and to ensure that the retained items result in a content-valid examination.

Predictors of the Performance of Foreign Medical Graduates on the 1982 Certifying Examination in Internal Medicine

This study describes a cohort of foreign medical school graduates (FMGs) who first sat for the American Board of Internal Medicine's (ABIM) 1982 certifying examination, compares their performance with that of US medical school graduates, describes differences between US citizen FMGs and alien FMGs, and examines which background factors predict success on the ABIM examination. Data for this study were derived by combining information retained by the Educational Commission for Foreign Medical Graduates with ABIM data. Most FMGs who took the 1982 ABIM certifying examination for the first time were educated in and citizens of Asia, but a sizable minority were US citizens educated in Europe. Scores and program directors' ratings were lower for FMGs than US medical school graduates, and they attended different types of training programs. United States citizen FMGs were very similar to alien FMGs. Foreign medical school graduates who did well on the ABIM examination had done well on the Educational Commission for Foreign Medical Graduates examination and were rated highly by their residency program director.

Predictors of the performance of foreign medical graduates on the 1982 certifying examination in internal medicine

Predictors of the performance of foreign medical graduates on the 1982 certifying examination in internal medicine

Integrated university training program in geriatric medicine accredited and evaluated by the Royal College of Physicians and Surgeons of Canada.

The Federated Council for Internal Medicine recommended in 1981 "increased emphasis on geriatric medicine in the medical school curriculum, the medical residency, and continuing medical education." In the same year the first examination for a Certificate of Special Competence in Geriatric Medicine was held in Canada. This was the culmination of a process begun in 1974 to establish the subject as a subspecialty within Internal Medicine. The Royal College of Physicians and Surgeons of Canada set up a Specialty Committee which developed criteria for the accreditation of training programs. Candidates have to be eligible to sit for the certification examination in Internal Medicine before they can sit for the Certificate of Special Competence in Geriatric Medicine which is awarded only after passing both examinations. Thirty-nine individuals sat for the examination in its first five years of whom 26 were successful. These now form a nucleus of well-qualified internist-geriatricians who are developing academic programs in geriatric medicine in Canadian Medical Schools.

An Intensive Review Course in Reproductive Endocrinology at The Massachusetts General Hospital, Boston, Massachusetts, October 1–-3, 1982

This course is designed to assist candidates in preparing for the Endocrinology and Metabolism Subspecialty Board Examination in Internal Medicine and Reproductive Endocrinology and Infertility Subspecialty Board in Obstetrics and Gynecology. Focus will be on recent advances in the understanding of the pathogenesis of hypothalamic, pituitary, adrenal and gonadal disorders. Diagnosis and management of intersexual problems will be covered. Didactic sessions will be balanced with case presentation seminars. Enrollment will be limited.

Performance of U.S. foreign medical graduates on certifying examinations in internal medicine: Benson JA, Meskauskas JA, Grosso LJ: Am J Med 1981; 270–273

Performance of U.S. foreign medical graduates on certifying examinations in internal medicine: Benson JA, Meskauskas JA, Grosso LJ: Am J Med 1981; 270–273

Performance of U.S. citizen-foreign medical graduates on certifying examinations in internal medicine

Increasing numbers of U.S. citizens are studying medicine abroad and returning for graduate medical education and practice. The numbers and performance of U.S. citizen and all other graduates of foreign medical schools on the certifying examination of the American Board of Internal Medicine were compared with those of graduates of U.S. medical schools for 1975–1980. Numbers of first-taker U.S. citizen foreign medical school graduates increased whereas numbers of all other foreign medical school graduates decreased during this period. In 1980, U.S. citizens represented 19 percent of all first-taker foreign medical school graduates. During the study period, annual examinations were passed by 79 to 82 percent of U.S. medical school graduates, 15 to 38 percent of U.S. citizen foreign medical school graduates, and 27 to 45 percent of all other foreign medical school graduates taking an examination for the first time. On each examination, U.S. citizen foreign medical school graduates did not do as well as all other foreign medical school graduates. Members of all groups met the same postdoctoral training requirements.

Psychologic and Psychosocial Aspects of Medical Practice

Excerpt In 1976Annals of Internal Medicinepublished a series of suggested readings for physicians reviewing medicine and its subspecialty fields, including neurology and dermatology, in preparation...

Development and evaluation of a specialty examination in internal medicine in Poland.

Development and evaluation of a specialty examination in internal medicine in Poland.