First-time Test Takers Research Articles

Prevalence and factors associated with depression and anxiety among the Bangladeshi university entrance test-taking students using GIS technology

This study focuses on Bangladeshi university entrance test-taking students mental health problems and explores the geographical distribution of these problems using GIS technique. A cross-sectional survey was conducted among 1523 university entrance test-taking students. Data were collected on participants' socio-demographic characteristics, COVID-19-related factors, admission tests, depression, and anxiety. Chi-square tests and logistic regression were performed using SPSS software. GIS mapping was used to visualize the distribution of mental health problems across districts using ArcGIS. The study found that the prevalence rates of depression and anxiety among university entrance examinees were 53.8% and 33.2%, respectively. Males exhibited higher rates of depression and anxiety compared to females, while repeat test-taking students were more susceptible to these mental health issues compared to first-time test-takers. Factors such as urban residence, personal/familial COVID-19 infections, and COVID-19 deaths in close relationships were associated with increased mental health problems. District-based distribution showed no significant variation in depression, but anxiety varied significantly. Post-hoc GIS analysis revealed variations in the distribution of depression and anxiety among males, as well as variations in anxiety distribution based on student status across districts. This study emphasizes the high prevalence of depression and anxiety among university entrance examinees, emphasizing the importance of addressing mental health risks in this population. It also suggests the need for reforms in the university entrance test-taking system to reduce psychological problems and advocates for a more inclusive approach to student admissions to alleviate mental health burdens.

Re-evaluating GPT-4’s bar exam performance

AbstractPerhaps the most widely touted of GPT-4’s at-launch, zero-shot capabilities has been its reported 90th-percentile performance on the Uniform Bar Exam. This paper begins by investigating the methodological challenges in documenting and verifying the 90th-percentile claim, presenting four sets of findings that indicate that OpenAI’s estimates of GPT-4’s UBE percentile are overinflated. First, although GPT-4’s UBE score nears the 90th percentile when examining approximate conversions from February administrations of the Illinois Bar Exam, these estimates are heavily skewed towards repeat test-takers who failed the July administration and score significantly lower than the general test-taking population. Second, data from a recent July administration of the same exam suggests GPT-4’s overall UBE percentile was below the 69th percentile, and $$\sim$$ ∼ 48th percentile on essays. Third, examining official NCBE data and using several conservative statistical assumptions, GPT-4’s performance against first-time test takers is estimated to be $$\sim$$ ∼ 62nd percentile, including $$\sim$$ ∼ 42nd percentile on essays. Fourth, when examining only those who passed the exam (i.e. licensed or license-pending attorneys), GPT-4’s performance is estimated to drop to $$\sim$$ ∼ 48th percentile overall, and $$\sim$$ ∼ 15th percentile on essays. In addition to investigating the validity of the percentile claim, the paper also investigates the validity of GPT-4’s reported scaled UBE score of 298. The paper successfully replicates the MBE score, but highlights several methodological issues in the grading of the MPT + MEE components of the exam, which call into question the validity of the reported essay score. Finally, the paper investigates the effect of different hyperparameter combinations on GPT-4’s MBE performance, finding no significant effect of adjusting temperature settings, and a significant effect of few-shot chain-of-thought prompting over basic zero-shot prompting. Taken together, these findings carry timely insights for the desirability and feasibility of outsourcing legally relevant tasks to AI models, as well as for the importance for AI developers to implement rigorous and transparent capabilities evaluations to help secure safe and trustworthy AI.

ChatGPT Yields a Passing Score on a Pediatric Board Preparatory Exam but Raises Red Flags.

We aimed to evaluate the performance of a publicly-available online artificial intelligence program (OpenAI's ChatGPT-3.5 and -4.0, August 3 versions) on a pediatric board preparatory examination, 2021 and 2022 PREP® Self-Assessment, American Academy of Pediatrics (AAP). We entered 245 questions and answer choices from the Pediatrics 2021 PREP® Self-Assessment and 247 questions and answer choices from the Pediatrics 2022 PREP® Self-Assessment into OpenAI's ChatGPT-3.5 and ChatGPT-4.0, August 3 versions, in September 2023. The ChatGPT-3.5 and 4.0 scores were compared with the advertised passing scores (70%+) for the PREP® exams and the average scores (74.09%) and (75.71%) for all 10 715 and 6825 first-time human test takers. For the AAP 2021 and 2022 PREP® Self-Assessments, ChatGPT-3.5 answered 143 of 243 (58.85%) and 137 of 247 (55.46%) questions correctly on a single attempt. ChatGPT-4.0 answered 193 of 243 (79.84%) and 208 of 247 (84.21%) questions correctly. Using a publicly-available online chatbot to answer pediatric board preparatory examination questions yielded a passing score but demonstrated significant limitations in the chatbot's ability to assess some complex medical situations in children, posing a potential risk to this vulnerable population.

The Pass/Fail Effect: A Longitudinal Study of United States Medical Licensing Examination (USMLE) Step 1 Performance Over a Decade.

Objectives This study aimed to analyze the impact of theUnited States Medical Licensing Examination (USMLE) Step 1 transition to a pass/fail scoring system in 2022 on the performance of first-time test takers in three distinct groups: Doctor of Osteopathy (DO) and Doctor of Medicine (MD) examinees from US/Canadian schoolsand examinees from non-US/Canadian schools. The analysis spans a decade-long period from 2012 to 2022, offering insights into the implications of this pivotal change in medical education. Methods We analyzed the performance of first-time USMLE Step 1 examinees from US/Canadian MD and DO programsand non-US/Canadian schools from 2012 to 2022, including the transition year to a pass/fail scoring system. Data were obtained from USMLE performance data reports and organized into annual contingency tables. Descriptive statistics and comparative analysis were used to identify trends and differences in performance across the groups. Data visualization techniques were employed to illustrate these findings, and the results were contextualized within the broader changes in medical education. Results In 2021, first-time takers from US/Canadian MD and DO Degree programs had passrates of 96% and 94%, respectively, while non-US/Canadian schools had a pass rate of 82%. However, in 2022, these rates dropped to 93%, 89%, and 74%, respectively. The most significant relative decline was observed among non-US/Canadian Schools' first-time takers, with an 8% decrease. Repeaters consistently had lower pass rates across all groups. Conclusion The study reveals a notable decline in pass rates following the transition to pass/fail scoring, although this is based on just one year of data. This underscores the importance of students not rushing into the exam and dedicating sufficient time for preparation. The potential impact of this research could be transformative for medical education, but more years of data post-transition will be needed to confirm these initial findings. These findings serve as a reminder that the change in scoring does not diminish the rigor of the exam, prompting students to approach their studies with diligence and patienceand potentially paving the way for systemic improvements in medical education and healthcare delivery worldwide.

We Tabulated and Organized American Board of Neurological Surgeons Primary Exam Keywords (2015-2023) so You Don't Have to.

Background Passing the American Board of Neurological Surgeons (ABNS) Primary Exam is required for residents in training. Both the program directors and residents are given keywords of the exam afterward in the hope to help program directors determine their relative strengths and weakness.We have organized and tabulated these keywords for neurosurgery residents' benefit. Methodology We collected and analyzed ABNS Primary Exam keywords (2015-2023) in each of the exam's main categories for trends and recurrences. We examined the overall passing rates among first-time credit test takers. The frequency of each subcategory was calculated as a percentage within its corresponding category.Recurrent keywords were grouped together with their corresponding years and categorized as once, twice, or thrice and greater occurrences; the last category was considered to be high-yield keywords. Results The number of questions in Neurosciences and Neurology has decreased over the years while Neurosurgery and Critical Care questions have increased. Similarly, there are fewer keyword repeats in Neurosciences and Neurology. The most repeated keywords are in Neuroimaging. The most common keywords are presented and listed along with the years of occurrences.Overall, the passing rate among first-time credit test takers is over 90%. Conclusions Neurosurgery residents can consider the common keywords as a guide in preparation for the ABNS Primary Exam.

Fellowship Board Pass Rates Rising: Analysis of Pathology Subspecialty Board Examination Performance.

The American Board of Pathology (ABPath) publishes annual performance data for the anatomic pathology (AP) and clinical pathology (CP) board examinations, as well as for ABPath subspecialty examinations. Overall board pass rates for all AP and CP board examinees have increased during the past decade; however, no study has analyzed the board pass rates for pathology subspecialty examinations, and whether these follow the same trend. To evaluate ABPath subspecialty examination pass rates to assess the trend in certification. We analyzed the total number of first-time test takers and board pass rates for 11 pathology subspecialties recognized by the ABPath from 2007 to 2021, acquired from annual reports published by the ABPath. We compared the pass rates in 5-year intervals (2007-2011, 2012-2016, 2017-2021) for each individual specialty. We also analyzed the pass rate of CP subspecialties compared with AP subspecialties. The overall mean pass rate for ABPath subspecialty examinations during the previous 15 years was 89% (range, 78.9%-100%), with the overall pass rate being significantly higher in 2017-2021 (P = .02). The contemporary overall rate of passing was significantly higher for AP subspecialty examinations (P < .001) and was higher, though not significantly, for CP subspecialties (P = .13). There were significant differences between first-time test takers' mean pass rate (92.1%), repeat test takers' mean pass rate (54.5%), and the overall rate (P < .001). Contemporary pathology subspecialty board examination pass rates are significantly higher than historic rates, possibly reflecting continuously improving and readily available preparatory materials.

Preparing for the Fundamentals of Laparoscopic Surgery Exam: A Survey of Residents in Obstetrics & Gynecology

To describe the actual work-load and experience for first-time resident test takers preparing to meet the new high stakes cognitive and technical skills testing requirement for board certification in Obstetrics and Gynecology. A retrospective observational study. Participating residents completed a 2 page questionnaire about their preparation for the exam. Results are reported in aggregate. This study was conducted at the University of Texas Southwestern Medical Center, an academic medical school affiliated with both a private and public tertiary hospitals. Residents in obstetrics and gynecology who have completed their Fundamentals of Laparoscopic Surgery (FLS) certification exam between September 1, 2018 and September 31, 2019. Thirty-three PGY-2 and PGY-3 residents completed the survey. Participants spent an average of 6.7 ± 3.1 hours viewing online modules over an average of 3.6 ± 2.1 nonconsecutive days. Utilizing the campus simulation center, residents spent an average of 2.1 ± 2.1 hours on each of the 5 tasks to practice to the established proficiency score. Twenty-two out of 31 residents rated the ligating loop the easiest skill to master and 13/31 residents rated the precision cut the most difficult. The pass rate for the technical skills portion was 100% (33/33 residents) and for the cognitive portion was 93% (31/33 residents). Our data suggest that residents spent upward of 10 hours practicing to proficiency on the simulation tasks, in addition to time spent watching FLS-provided training videos. The 100% pass rate for the technical skills portion at our program may be impacted by a required technical skills curriculum that residents must complete prior to registering for the FLS exam. Obstetrics and gynecology residents and training programs will benefit from understanding the time and resources required for first-time resident test takers preparing to take the Fundamentals of Laparoscopic Surgery exam.

Burnout, does the university entrance test failing attribute? A Bangladeshi exploratory study.

Getting admission into a university is highly competitive globally and can be regarded as a mental stressor for some individuals. In Bangladesh, most of the universities allow students to repeat the test, whereas repeat test-taking students are supposed to suffer from psychological issues like burnout because of academic non-achievement in their first attempt. But there is no prior study assessing burnout to the population, which was investigated herein. A cross-sectional study was carried out among a total of 911 Bangladeshi university entrance test-taking students (i.e., 49.5% first-time test-takers). The survey measures included socio-demographics, admission-related issues, and mental health problems (depression, anxiety, and burnout). Of the mental health problems, depression, anxiety, and burnout were assessed by the Patient Health Questionnaire (PHQ-9), Generalized anxiety disorder (GAD-7), and Maslach Burnout Inventory—Student Survey (MBI–SS), respectively. In light of two-dimensional and three-dimensional cutoff schemes of the MBI—SS, about 43.7% and 17.3% of the test-taking students, respectively, were classified to be burnout in the total sample. Additionally, 48.1%, 71.4%, and 49.1% of the students in the total sample reported higher emotional exhaustion, higher cynicism, and lower academic efficacy, respectively. In respect to the student status, two-dimensional burnout (48.0% vs. 39.2%; χ2 = 7.164, p = 0.007), and emotional exhaustion (52.2% vs. 43.9%, χ2 = 6.789, p = 0.034) were significantly higher among the repeat test-taking students. Satisfaction with previous mock tests, depression, and anxiety were the associated factors of burnout in all three samples. Based on the present study, it can be concluded that the university entrance test appearing students are highly prevalent to burnout, and the rate increases with academic non-achievement. As the first study assessing burnout to the population, the findings are anticipated to be helpful for policymaking and further studies both inside and outside Bangladesh.

Do Orthopaedic In-Training Examination Scores Predict the Likelihood of Passing the American Board of Orthopaedic Surgery Part I Examination? An Update With 2014 to 2018 Data.

Previous research shows a correlation in performance between the Orthopaedic In-Training Examination (OITE) and the American Board of Orthopaedic Surgery (ABOS) Certifying Examination Part I; however, these studies are not current, with the most recent data from 2009. The purpose of this study was to update the relationship between the OITE and ABOS Part I scores with the five most recent nationwide cohorts of Part I scores and their corresponding OITE scores. The American Academy of Orthopaedic Surgeons provided the results for each resident taking the OITE from 2013 to 2017. The ABOS provided the results for each resident taking the Part I examination from 2014 to 2018. These two datasets were matched at the individual level and analyzed. Between 2014 and 2018, 3,502 first-time test-takers were present for the ABOS Part I Examination. A 96.6% pass rate was noted (3,383 of 3,502). A statistically significant correlation between the OITE score and ABOS Part I score was observed at all levels of training: postgraduate year (PGY) 1 r = 0.380, PGY2 r = 0.463, PGY3 r = 0.498, PGY4 r = 0.504, and PGY5 r = 0.504 (P < 0.001 for all correlations). The OITE scores continue to correlate with the ABOS scores and the pass rate for the ABOS with moderate strength correlation. However, although a correlation of the examinations exists when evaluated as a group, the predictive value of the OITE for passing the Part I examination for any specific individual is far from perfect. Individuals with PGY5 OITE percentile scores less than 10 pass the Part I examination, and individuals with PGY5 OITE percentile scores greater than 90 fail the Part I examination.

Suicidal behaviors and university entrance test-related factors: A Bangladeshi exploratory study.

The present study is the first investigating unexplored psychological issues of university entrance test-taking students in Bangladesh. This cross-sectional study investigates suicidal behaviors and their socio-demographic, admission test-related, and psychopathological risk factors among a total of 911-Bangladeshi university entrance test-takers. About 17.7% of the participants report suicidalthoughts, whereas it is 8.0% and 2.5% for suicide plans and suicide attempts, respectively. Significantly higher suicidal thought is observed in the repeat test-taking students compared to the first-time test-takers (20.7% vs. 14.6%, χ 2 = 5.669, p = 0.017), though the suicide plan and suicide attempt are not associated with student status. The suicidal thought risk factors include female gender, urban residence, satisfaction with the mock test, mental disorders etc. PRACTICAL IMPLICATIONS: The present findings warrant implementing initiatives for this suicide-prone cohort, especially for the test-failing students.

Factors Associated with Music Therapy Board Certification Examination Outcomes

Abstract The Music Therapy Board Certification (BC) Examination is a high-stakes test that affects test takers’ entry into the profession and reflects the quality of music therapy programs. Accumulating studies in the health sciences have identified the factors that contribute to first-time test takers’ success in passing credentialing examinations. However, these variables have not been investigated in music therapy. The purposes of this study are to investigate recent certificants’ perceptions and experiences of the BC examination and identify the predictors of success on the first attempt. It aims to delineate the factors associated with performance in the BC examination; identify effective strategies and resources for future test takers; and inform educators, internship directors, clinical supervisors, and test administrators regarding areas of concern and necessary support. A sample of 662 recent music therapy board certificants completed a 32-item online survey consisting of checklists, Likert scales, open-ended questions, and the Westside Test Anxiety Scale. Self-reported cumulative grade point average and general test anxiety scores were significant predictors of BC examination success on the first attempt. The results suggest the need for (a) a consistent standard for education programs that includes various theoretical orientations and clinical practice models to better prepare students with content knowledge and (b) program progression policies to identify students at risk of failing the examination and to provide remediation.

Correlation Between Radiology ACGME Case Logs Values and ABR Core Exam Pass Rate

There is discordance between the American Board of Radiology (ABR) and many radiology trainees with respect to the most appropriate means to prepare for the ABR Core Examination. Whereas the ABR suggests that participation in routine clinical examination interpretation best prepares a trainee for the practical material of the test, residents, and many program directors feel that time away from clinical service for study and review courses are necessary. This study examines the relationship between studies interpreted in the first three years of residency as reported in the Accreditation Council for Graduate Medical Education case logs and performance of first-time test takers on the ABR Core Examination. Accreditation Council for Graduate Medical Education case log data was anonymized for a single year cohort of residents in all accredited radiology residencies. This was then provided to the ABR and matched with performance on the Core Examination. A random effects logistic regression model was used to evaluate for a relationship between the number of examinations read and the pass/fail status of the Core Exam. Modeling using a linear and a quadratic term yields a significant relationship between case log values and Core Exam performance. There is a positive correlation until an inflection point of approximately 11,000 examinations, at which point a negative correlation develops. The data supports that active engagement in clinical duties is associated with better performance on the ABR Core Examination, with the caveat that there appears to be a point at which service outweighs educational value. Beyond this, performance on the examination declines.

Failure in Residency Education: Lessons Learned From Harry Potter, Oprah Winfrey, and the Marigold Hotel.

Failure in Residency Education: Lessons Learned From Harry Potter, Oprah Winfrey, and the Marigold Hotel.

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.

Integrating Edema Management Into Entry-Level Doctor of Physical Therapy Curriculum: A Case Report

Background and Purpose: The Commission on Accreditation in Physical Therapy Education includes criteria for the management of edema. The purpose of this case report is to outline content and instructional guidelines for edema and lymphedema management in 2 entry-level Doctor of Physical Therapy curricula. Case Description: Teaching edema management includes both general and specific knowledge of the anatomy and physiology of the lymphatic system, an understanding of the pathophysiology of edema, and competency in traditional and innovative skills of edema management in the context of a patient management model and evidence-based practice. Northwestern University Department of Physical Therapy and Human Movement Science has a required dedicated course that combines clinical management of patients with lymphatic and integumentary dysfunction. The University of Southern California integrates edema management throughout the 3-year curriculum. Both of these programs are presented in detail. Outcomes: The Northwestern program has been presented continuously since 2003; the University of Southern California began integrative edema management in 2002 and evolved into the current model in 2005. Mean scores on the Federation of State Boards of Physical Therapy examination consistently indicate that graduates from both schools rank higher than other first-time test takers from US accredited programs in the area of cardiovascular/pulmonary and lymphatic systems. Discussion and Conclusion: This report provides objectives, methods, and references to guide an instructional course in edema management in an entry-level Doctor of Physical Therapy curriculum. Two cases of integrating edema content within a current curriculum are presented. An essential element for a successful program is the availability of academic or clinical faculty trained in lymphedema management.

Effective Utilization of Computerized Curricular Assistive Tools in Improving NCLEX-RN Pass Rates for a Baccalaureate Nursing Program

Achieving satisfactory first-time pass rates on the national nursing licensure examination represents a challenge for nursing programs across the United States. The consequences of examination failure for first-time test takers can be devastating, both emotionally and financially. Nursing programs are evaluated by national higher-education credentialing bodies and state boards of nursing based on the first-time pass rate of their students. One Midwestern nursing program faced unsatisfactory first-time pass rates and developed strategies for improving first-time pass rates over a 3-year period. The nursing program utilized several strategies documented in the literature but found implementing computerized curricular assistive tools that complemented the nursing program's curriculum to be most effective. In addition, changing faculty and student culture on preparation for the national licensure examination was beneficial to all involved in the process.

Preparation Strategies of Osteopathic Medical Students for the COMLEX-USA Level 2-PE.

Since 2002, osteopathic medical schools have made curricular changes to further enhance the clinical skills of their students, to prepare them for residency training, and to pass the Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation (COMLEX-USA Level 2-PE). To report how students at osteopathic medical schools prepare for the COMLEX-USA Level 2-PE, and to investigate the effect of these techniques on examination performance. A standardized survey was given to students before the beginning of their examination to assess the preparation of osteopathic medical students for the COMLEX-USA Level 2-PE, such as coursework, orientation materials, and standardized patient (SP) encounters. Surveys that were completed by first-time test takers during the 2013-2014 and 2014-2015 test cycles were included in this study. Of 9120 surveys administered, 8733 were completed, achieving a response rate of 95.8%. Of those 8733 respondents, 8706 students (99.7%) reported having SP encounters during the first and second year of medical school, and 7379 (84%) reported having at least 1 SP encounter in years 3 and 4. Of 8733 students, 6079 (70%) reported receiving feedback from an osteopathic physician on their SP encounters, and 6049 (69%) and 6253 (72%) reported having viewed the COMLEX-USA Level 2-PE orientation video online and having read the examination's orientation guide, respectively. The largest difference in preparation between students who passed the COMLEX-USA Level 2-PE and students who did not was a prerequisite SP examination at their school, with 5574 students (68.9%) who passed reporting having participated compared with 364 students (56.5%) who failed. None of the differences in clinical skills training and test preparation was associated with statistically significant differences in pass or fail status. Osteopathic medical students use a variety of methods to enhance their clinical skills in preparation for the COMLEX-USA Level 2-PE, with universal use of SP programs since the COMLEX-USA Level 2-PE was implemented in 2004. Educators should continue to foster ways to develop students' clinical skills that reflect new advances in education and assessment to ensure that future osteopathic physicians can demonstrate competency in fundamental clinical skills before beginning postgraduate training.

Three-calendar-year Bachelor of Science in Nursing: an innovative curriculum program.

The 3-calendar-year Bachelor of Science in Nursing (BSN) curriculum program was developed to facilitate a quicker entry into professional nursing practice. This program offered many advantages, including financial and time-saving benefits for students, more efficient use of campus facilities, and flexibility in faculty scheduling. Evaluation of the program showed benefits in the success rate of course-work, in retention and graduation rates, and in subsequent NCLEX-RN pass rates. The NCLEX-RN pass rate for students in the 3-calendar-year BSN program was 98.33%, compared with the national average pass rate (88.01%) for the same 5-year period for first-time test takers. The 3-calendar-year BSN program met the needs of both traditional and nontraditional students. It produced quality nurse graduates who were successful NCLEX-RN first-time test takers. The program has potential to be adopted by other universities with a student base composed of individuals of modest resources and diverse backgrounds.

Confronting the Elephant in the Room: Can We Transcend Medical Graduate Stereotypes?

As a US medical graduate, I was not exposed to the travails of international medical graduates until 1993. That year, having just completed critical care training at the University of Chicago, I joined the faculty of a program where international medical graduates made up most of the trainees. I made this choice because I sensed an opportunity to have a positive impact on education and a community's health outcomes. At the time, some admonished me that I would be throwing away my career on “missionary work.” While this elitist comment sealed the deal, my choice was also prescient. My impact in a place that had not had formal critical care education and team coordination was instant and substantial.1 Eventually, I became program director of internal medicine and was charged with the task of building a top-tier residency. This journey has been simultaneously edifying, frustrating, and inspiring. Demographics of 21st Century Graduate Medical Education Data compiled by the National Resident Matching Program (NRMP)2 show that the percentage of international medical graduate (IMG) residents has remained relatively stable during the past decade at 17% to 20% overall and 28% to 36% for internal medicine programs (figure). While the NRMP publishes national specialty-specific match results, it excludes positions offered outside the match, which are often filled by IMGs. Thus, the number of IMGs in residency programs is unknown. Despite the sizeable proportion of IMGs who fill training programs, relatively little scholarly work has examined their demographics, distribution, and performance compared to US medical graduates (USMGs). A few studies and anecdotal data suggest that university programs train a greater percentage of USMGs, and community hospitals may have a higher percentage IMGs.3,4 A single large study of internal medicine residents examined aggregate examination scores over time finding that medical knowledge scores of IMGs compared favorably to those of USMGs.5 Between 1995 and 2000, IMGs “scored higher than graduates of US medical schools on every internal medicine in-training examination at every PGY level.”5 Although overall rates of internal medicine board certification are less in US-born international medical graduates (US-IMGs) than in non–US-IMGs and USMGs,6 no study has reported pass rates for first-time test takers in medicine or other disciplines. FIGURE NRMP Statistics Describing Percentage of IMGs Matching to All Residencies and Internal Medicine Residencies.

The Certified Asthma Educator (AE-C)

Introduction: The Centers for Disease Control and Prevention report that the number of individuals with asthma in the United States has increased by 4.3 million, or 12.3%, between 2001 and 2009, creating an increasing burden on our health care system. Effective patient education is a key component of asthma management. The National Asthma Educator Certification Board (NAECB) promotes “optimal asthma management and quality of life by advancing excellence in asthma education through the Certified Asthma Educator process.” Methods: Following completion of the asthma educator certification examination, applicants were invited to participate in a voluntary, anonymous Web-based survey. The survey was developed and approved by the Executive and Research Committees of the NAECB, with the objective of reviewing the experience of applicants seeking initial certification and of those seeking recertification. Results: Completed surveys were obtained from 988 applicants. Seventy-six percent of respondents were first-time test takers; the remaining respondents were repeat test takers. Eighty percent reported having passed the examination. Approximately 85% felt that the time allotted for the examination was “just right”; the level of difficulty was “ just right” for 65% of the respondents, and the clarity of the examination questions was rated as “good” or “excellent” by 72% of the respondents. Seventy-two percent responded that the examination reflected the role of the asthma educator and 88.1% would recommend the examination to others interested in asthma education. Open-ended responses highlighted benefits and barriers. Discussion: The asthma educator certification examination is reflective of the professional responsibilities of the asthma educator. Benefits and barriers are discussed in the context of published literature.