In-Training Examination Research Articles

Improvement in American Board of Surgery In-Training Examination Performance With a Multidisciplinary Surgeon-Directed Integrated Learning Platform

The American Board of Surgery In-Training Examination (ABSITE) is a predictor of resident performance on the general surgery-qualifying examination and plays a role in obtaining competitive fellowships. A learning management system (LMS) permits the delivery of a structured curriculum that appeals to the modern resident owing to the ease of accessibility and all-in-one organization. This study hypothesizes that trainees using a structured surgeon-directed LMS will achieve improved ABSITE scores compared with those using an unstructured approach to the examination. A multidisciplinary print and digital review course with practice questions, review textbooks, weekly reading assignments, and slide and audio reviews integrated within an online LMS was made available to postgraduate year (PGY)-3 and PGY-4 residents in 2008 and 2009. Surveys were emailed requesting ABSITE scores to compare outcomes in those trainees that used the course with those who used an unstructured approach. Statistical analysis was conducted via descriptive statistics and Pearson chi-square with p < 0.05 deemed statistically significant. Surveys were mailed to 508 trainees. There was an 80% (408) response rate. Residents who used structured approaches in both the years achieved the highest scores, followed by those who adopted a structured approach in PGY-4. The residents using an unstructured approach in both the years showed no significant improvement. Residents who used a structured LMS performed significantly better than their counterparts who used an unstructured approach. A properly constructed online education curriculum has the potential to improve ABSITE scores.

The impact of an advanced certifying examination simulation program on the American Board of Surgery Certifying Examination passage rates.

The national pass rate for the American Board of Surgery Certifying Examination has decreased in the past 5 years. An individual's ability to pass might be as dependent on his or her handling of the psychology of the examination-the "examanship" -because it is about clinical knowledge and judgment. To assess this, we implemented the Advanced Certifying Examination Simulation (ACES) program. The ACES was created as a novel method to simulate the stress of the Certifying Examination and focuses on the examanship of the test. We compared the outcomes of the ACES program with its predecessor, a conventional mock oral program, as measured by residents' first-time pass rates on the Certifying Examination. First-time Certifying Examination pass rates of 26 residents who went through the ACES program were compared with 30 residents who completed the conventional mock oral program. There was a significant increase in passage rates for residents taking part in the ACES program (100%) compared with residents taking part in the conventional mock oral group (83.3%). The groups were equivalent based on previously determined predictive factors of Certifying Examination success, such as in-training and licensing examination scores. The ACES program provides feedback on the qualities of examanship: controlling anxiety, expressing a positive attitude, and maintaining a strong and confident voice. By providing a structured, simulated venue where residents can safely gain experience, we believe that ACES might lead to increased first-time passage rates on the American Board of Surgery Certifying Examination.

Organization of the Educational Milestones for Use in the Assessment of Educational Outcomes

Organization of the Educational Milestones for Use in the Assessment of Educational Outcomes

Development of the Family Medicine Milestones

In the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System (NAS), evaluation of performance on educational Milestones will be used for resident assessment and feedback and will also serve as an indicator of the educational effectiveness of family medicine residency programs. The Family Medicine Milestone Committee developed the Milestones for family medicine with the goal of characterizing the breadth, depth, and integrative functions of the specialty in an understandable and manageable context for both residents and faculty. In developing the Milestones, the committee attempted to minimize duplication across competencies and sought to highlight family physicians' relationships with their patients by integrating the biopsychosocial model, population, and community health and by working in health care teams. The committee also felt it was important to emphasize the fact that family physicians must have the skills to deal with the complexity of patients and the health care system, as well as demonstrate the thinking skills critical to managing both the complexity and often the uncertainty over the course of an illness and over a patient's lifespan, particularly for chronic disease.

Transitioning From a Noon Conference to an Academic Half-Day Curriculum Model: Effect on Medical Knowledge Acquisition and Learning Satisfaction

The academic half-day (AHD) curriculum is an alternative to the traditional noon conference in graduate medical education, yet little is known regarding its effect on knowledge acquisition and resident satisfaction. We investigated the association between the 2 approaches for delivering the curriculum and knowledge acquisition, as reflected by the Internal Medicine In-Training Examination (IM-ITE) scores and assessed resident learning satisfaction under both curricula. The Cleveland Clinic Internal Medicine Residency Program transitioned from the noon conference to the AHD curriculum in 2011. Covariates for residents enrolled from 2004 to 2011 were age; sex; type of medical degree; United States Medical Licensing Examination Step 1, 2 Clinical Knowledge; and IM-ITE-1 scores. We performed univariable and multivariable linear regressions to investigate the association between covariates and IM-ITE-2 and IM-ITE-3 scores. Residents also were surveyed about their learning satisfaction in both curricula. Of 364 residents, 112 (31%) and 252 (69%) were exposed to the AHD and the noon conference curriculum, respectively. In multivariable analyses, the AHD curriculum was associated with higher IM-ITE-3 (regression coefficient, 4.8; 95% confidence interval 2.9-6.6) scores, and residents in the AHD curriculum had greater learning satisfaction compared with the noon conference cohort (Likert, 3.4 versus 3.0; P = .003). The AHD curriculum was associated with improvement in resident medical knowledge acquisition and increased learner satisfaction.

Hospitalist Career Decisions Among Internal Medicine Residents

Hospital medicine is a rapidly growing field of internal medicine. However, little is known about internal medicine residents' decisions to pursue careers in hospital medicine (HM). To identify which internal medicine residents choose a career in HM, and describe changes in this career choice over the course of their residency education. Observational cohort using data collected from the annual Internal Medicine In-Training Examination (IM-ITE) survey. 16,781 postgraduate year 3 (PGY-3) North American internal medicine residents who completed the annual IM-ITE survey in 2009-2011, 9,501 of whom completed the survey in all 3 years of residency. Self-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2) and PGY-3. Of the 16,781 graduating PGY-3 residents, 1,552 (9.3 %) reported HM as their ultimate career choice. Of the 951 PGY-3 residents planning a HM career among the 9,501 residents responding in all 3 years, 128 (13.5 %) originally made this decision in PGY-1, 192 (20.2 %) in PGY-2, and 631 (66.4 %) in PGY-3. Only 87 (9.1 %) of these 951 residents maintained a career decision of HM during all three years of residency education. Hospital medicine is a reported career choice for an important proportion of graduating internal medicine residents. However, the majority of residents do not finalize this decision until their final year.

Enhancement of anesthesiology in-training exam performance with institution of an academic improvement policy

Anesthesiology resident physicians across the United States complete an annual in-training examination (ITE). The ITE evaluates resident knowledge and provides personalized feedback to guide future study in low scoring sections(1). Performance on the ITE correlates with outcomes on the American Board of Anesthesiology (ABA) written board examination(2). Over the last several years, declining ITE scores were observed at the University of North Carolina (UNC). In response to this decline, our department reprioritized the ITE by instituting an academic improvement policy (AIP). The AIP employed both reward for satisfactory achievement and consequence for under-performance to elevate the ITE as a "high stakes" examination. Our hypothesis was that implementation of this AIP would improve ITE scores. ITE scores were compiled from 150 residents in the Department of Anesthesiology at UNC for graduating classes from 2004-2015. Data is presented as the number of residents scoring below the 20th percentile when compared to the national distribution before and after the AIP. In addition, average USMLE Step 1 three-digit scores for each graduating class were compared to average ITE percentile scores of the corresponding graduating class (USMLE does not provide percentile scores). Between 2009 and 2013, the number of residents who scored below the 20th percentile on the ITE increased steadily to a peak of 10 in 2011. After implementation of the AIP in July 2011, there was an 80% decrease in those scoring below the 20th percentile, from 10 to 2 residents (p<0.05). Anesthesiology resident ITE scores improved after implementation of an academic improvement policy.

Trends in the History of Certification and Recertification of the American Board of Internal Medicine

This commentary reviews the trends of pass rates for certification and recertification in internal medicine. This is true for certification since the 1930s and recertification since 2000. Predictors of performance, such as program director ratings and the in-training examination, are discussed in addition to positive clinical outcomes in relation to recertification. Differences in examinations pass rates due to gender, geographic location and number of attempts are reviewed. Recent trends in internal medicine demonstrate a decline, which may be multifactorial in reasoning. This is not unique to internal medicine as declines in certification rates have been noted in general surgery as well. Methods of preparing for the examination are discussed to maximize performance on the examination.

Competency Champions in the Clinical Competency Committee: A Successful Strategy to Implement Milestone Evaluations and Competency Coaching

To create a clinical competency committee (CCC) that (1) centers on the competency-based milestones, (2) is simple to implement, (3) creates competency expertise, and (4) guides remediation and coaching of residents who are not progressing in milestone performance evaluations. We created a CCC that meets monthly and at each meeting reviews a resident class for milestone performance, a competency (by a faculty competency champion), a resident rotation service, and any other resident or issue of concern. University surgical residency program. The CCC members include the program director, associate program directors, director of surgical curriculum, competency champions, departmental chair, 2 at-large faculty members, and the administrative chief residents. Seven residents were placed on remediation (later renamed as coaching) during the academic year after falling behind on milestone progression in one or more competencies. An additional 4 residents voluntarily placed themselves on remediation for medical knowledge after receiving in-training examination scores that the residents (not the CCC membership) considered substandard. All but 2 of the remediated/coached residents successfully completed all area milestone performance but some chose to stay on the medical knowledge competency strategy. Monthly meetings of the CCC make milestone evaluation less burdensome. In addition, the expectations of the residents are clearer and more tangible. "Competency champions" who are familiar with the milestones allow effective coaching strategies and documentation of clear performance improvements in competencies for successful completion of residency training. Residents who do not reach appropriate milestone performance can then be placed in remediation for more formal performance evaluation. The function of our CCC has also allowed us opportunity to evaluate the required rotations to ensure that they offer experiences that help residents achieve competency performance necessary to be safe and effective surgeons upon completion of training.

Surgical resident accuracy in predicting their ABSITE score.

Background:The American Board of Surgery In-Training Examination (ABSITE) is given to all surgical residents as an assessment tool for residents and their programs in preparation for the American Board of Surgery qualifying and certifying examinations. Our objective was to ascertain how well surgical residents could predict their percentile score on the ABSITE using two predictor measures before and one immediately after the examination was completed.Methods:A survey was given to surgical residents in postgraduate year(s) (PGY) 2 through 5 as well as to research residents in November and December 2011, and immediately after the examination in January 2012, to ascertain their predicted ABSITE scores. Thirty-one general surgery residents were measured consisting of PGY-2 (22%), PGY-3 (19.4%), PGY-4 (19.4%), and PGY-5 (12.9%), and research residents 25.8%.Results:Mean prediction scores were consistently higher than actual examination scores for both junior and senior examination takers, with senior examination predictions exhibiting the highest proportion of variation on the actual examination score. Stratified linear regression analysis showed little predictive significance of all 3 examination predictions and actual score, except for the senior examination predictions in November 2011 (t test = 2.521, P = .027). We found no statistically significant difference in the proportion of residents overestimating or underestimating their predicted score. Secondary analysis using a linear regression model shows that 2011 scores were a statistically significant predictor of 2012 scores (overall F = 13.258, P = .001, R2 = 0.31) for both junior and senior examinations.Conclusion:General surgery residents were not able to accurately predict their ABSITE score; however, the previous year's actual scores were found to have the most predictive value of the next year's actual scores.

Is There an Association Between Study Materials and Scores on the American Board of Orthopaedic Surgeons Part 1 Examination?

BackgroundPrevious studies have shown that certain orthopaedic in-training examination scores can be used to identify which residents may be at risk for failing the American Board of Orthopaedic Surgeons (ABOS) Part 1 examination. However, no studies have examined how study resources may affect residents’ ABOS Part 1 scores. The goal of this study is to determine which review sources or review courses, if any, are associated with improved ABOS Part 1 scores. MethodsA survey was sent to 221 of the 865 examinees who took the ABOS Part 1 examination in 2012. The questions inquired the respondents how well they performed on previous orthopaedic in-training examinations and ABOS Part 1, along with the study sources they most commonly used, review courses they attended, and resources they would recommended if they were to retake ABOS Part 1 examination. ResultsOverall, 118 of the 221 (53%) survey recipients completed the survey. Six (5%) of the respondents failed ABOS Part 1 examination. Orthobullets and the American Academy of Orthopaedic Surgeons self-assessment examinations were recommended as the primary study source significantly more (p < 0.01) than most other resources, but there was no significant association between study source and passing ABOS Part 1 or scoring in a certain percentile on ABOS Part 1. Similarly, there were no associations between attending a review course and either passing or scoring in a certain percentile for ABOS Part 1. Half of the respondents who failed ABOS Part 1 attended multiple review courses. ConclusionsThere does not appear to be an association between improved ABOS Part 1 scores and orthopedic study materials or review courses. Further research into the value of certain educational modalities should be conducted to determine the best ways to educate orthopedic residents and determine the value of some of these commonly used orthopedic review modalities.

The Relationship Between Faculty Performance Assessment and Results on the In-Training Examination for Residents in an Emergency Medicine Training Program

Medical knowledge (MK) in residents is commonly assessed by the in-training examination (ITE) and faculty evaluations of resident performance. We assessed the reliability of clinical evaluations of residents by faculty and the relationship between faculty assessments of resident performance and ITE scores. We conducted a cross-sectional, observational study at an academic emergency department with a postgraduate year (PGY)-1 to PGY-3 emergency medicine residency program, comparing summative, quarterly, faculty evaluation data for MK and overall clinical competency (OC) with annual ITE scores, accounting for PGY level. We also assessed the reliability of faculty evaluations using a random effects, intraclass correlation analysis. We analyzed data for 59 emergency medicine residents during a 6-year period. Faculty evaluations of MK and OC were highly reliable (κ = 0.99) and remained reliable after stratification by year of training (mean κ = 0.68-0.84). Assessments of resident performance (MK and OC) and the ITE increased with PGY level. The MK and OC results had high correlations with PGY level, and ITE scores correlated moderately with PGY. The OC and MK results had a moderate correlation with ITE score. When residents were grouped by PGY level, there was no significant correlation between MK as assessed by the faculty and the ITE score. Resident clinical performance and ITE scores both increase with resident PGY level, but ITE scores do not predict resident clinical performance compared with peers at their PGY level.

Development of an Ambulatory Geriatrics Knowledge Examination for Internal Medicine Residents

The number of older adults needing primary care exceeds the capacity of trained geriatricians to accommodate them. All physicians should have basic knowledge of optimal outpatient care of older adults to enhance the capacity of the system to serve this patient group. To date, there is no knowledge-assessment tool that focuses specifically on geriatric ambulatory care. We developed an examination to assess internal medicine residents' knowledge of ambulatory geriatrics. A consensus panel developed a 30-question examination based on topics in the American Board of Internal Medicine (ABIM) Certification Examination Blueprint, the ABIM in-training examinations, and the American Geriatrics Society Goals and Objectives. Questions were reviewed, edited, and then administered to medical students, internal medicine residents, primary care providers, and geriatricians. Ninety-eight individuals (20 fourth-year medical students, 57 internal medicine residents, 11 primary care faculty members, and 10 geriatrics fellowship-trained physicians) took the examination. Based on psychometric analysis of the results, 5 questions were deleted because of poor discriminatory power. The Cronbach α coefficient of the remaining 25 questions was 0.48; however, assessment of interitem consistency may not be an appropriate measure, given the variety of clinical topics on which questions were based. Scores increased with higher levels of training in geriatrics (P < .001). Our preliminary study suggests that the examination we developed is a reasonably valid method to assess knowledge of ambulatory geriatric care and may be useful in assessing residents.

특수 목적견으로서의 품성 및 능력 관련 유전자들에 관한 생물정보학적 분석

특수 목적견(구조견, 군견, 안내견 및 탐지견)은 집중력, 소유욕, 대담성 등을 기반으로 한 훈련시험을 통해 선별된다. 최근 특수견으로서의 특수한 능력 및 품성에 대해 유전적인 정보가 중요한 인자로 다뤄지고 있다. 본 연구에서는 특수견으로서의 개의 특수한 능력 및 품성과 관련된 유전자들의 분자적인 특징을 고찰하고자 하였다. 이전 연구에서 보고된 24개의 유전자(AR, BDNF, DAT, DBH, DGCR2, DRD4, MAOA, MAOB, SLC6A4, TH, TPH2, IFT88, KCNA3, TBR2, TRKB, ACE, GNB1, MSTN, PLCL1, SLC25A22, WFIKKN2, APOE, GRIN2B, PIK3CG)를 선택하여 품성, 후각, 운동 및 학습능력 관련 유전자, 네 가지 카테고리로 분류하였다. 본 연구에서는 생물학적인 기법을 이용하여 이 유전자들의 염색체상의 위치, 유전자들 간의 네트워크를 통한 상호관계를 조사하였으며, 어떤 생물학적 기능과 관련이 있는지 Gene Ontology 분석과 데이터베이스를 기반으로 in silico 발현 양상을 살펴보았다. 또한 이전 연구를 통하여 품성 관련 유전자들의 다양한 유전적 다형성에 대한 보고를 조사하였다. 본 연구는 특수 견으로서 주요하게 고려되는 개의 고유한 능력 및 품성 관련된 유전자에 대해 분자적 특징을 제시하고 있다. 이 후보 유전자들은 개의 특수한 표현형과의 관계를 밝힐 수 있는 연구의 기초자료로서 이용될 수 있을 뿐만 아니라 핵심적인 유전인자로 응용되어 신속하고 정확한 특수견 선발에 기여할 수 있을 것으로 전망된다. Working dogs, such as rescue dogs, military watch dogs, guide dogs, and search dogs, are selected by in-training examination of desired traits, including concentration, possessiveness, and boldness. In recent years, genetic information has been considered to be an important factor for the outstanding abilities of working dogs. To characterize the molecular features of the canine genes related to phenotypes for working dogs, we investigated the 24 previously reported genes (AR, BDNF, DAT, DBH, DGCR2, DRD4, MAOA, MAOB, SLC6A4, TH, TPH2, IFT88, KCNA3, TBR2, TRKB, ACE, GNB1, MSTN, PLCL1, SLC25A22, WFIKKN2, APOE, GRIN2B, and PIK3CG) that were categorized to personality, olfactory sense, and athletic/learning ability. We analyzed the chromosomal location, gene-gene interactions, Gene Ontology, and expression patterns of these genes using bioinformatic tools. In addition, variable numbers of tandem repeat (VNTR) or microsatellite (MS) polymorphism in the AR, MAOA, MAOB, TH, DAT, DBH, and DRD4 genes were reviewed. Taken together, we suggest that the genetic background of the canine genes associated with various working dog behaviors and skill performance attributes could be used for proper selection of superior working dogs.

Genetic structure and variability of the working dog inferred from microsatellite marker analysis

Working dogs serve as military watch dogs, search dogs, rescue dogs, and guide dogs with un-come-at-able character. They are drafted by in-training examination including concentration, capacity for locomotion, boldness and earthly desires. In this study, genetic diversity and relationships among two groups of working dogs (pass and fail group in-training examination) were assessed based on 15 microsatellite markers in 25 individuals of working dogs (military watch dogs and Korean search dogs). For the 15 microsatellite markers, the values of allelic richness (A R ) ranged from 2.21 (pass group) to 1.60 (fail group) in military watch dogs, while A R ranged from 2.79 (pass group) to 2.72 (fail group) in Korean search dogs. Among 52 different alleles of military watch dogs, 22 alleles were detected in pass group only, while 8 alleles in fail group only. In case of Korean search dogs, 3 alleles were observed in pass group only, while 13 alleles in fail group only. These group-specific unique alleles reflect good biomarker for selecting working dogs (military watch dogs and Korean search dogs), indicating that those group specific microsatellite alleles could separate working dogs to be pass or fail group in out-training dog population. Taken together, this study demonstrates the feasibility of microsatellite analyses for the selection of superior working dogs objectively. Furthermore, this approach could be used for the proper selection of working dogs in combination with in-training examination.

Polymorphism analysis of tyrosine hydroxylase (TH) in military working dogs

Canine and human behavior are shaped by similar evolutionary processes, yet the identification of the behavioral phenotype is often difficult. A widely used method relies on breed stereotypes provided by experts such as dog trainers. To reveal a valid association between behavior and genetic factors, an association study of behavioral phenotyping and genotyping is essential. We screened for variable number of tandem repeat (VNTR) polymorphisms in intron 4 of the tyrosine hydroxylase gene in military working dogs (belonging to pass and fail groups based on the results of an in-training examination conducted by the drillmaster), which were scored based on possessiveness, audaciousness, concentration, and motor ability by qualification examination. We first characterized each genotype by sequencing, in which the 1/1 type consists of a single copy of a 36-bp sequence and the 2/2 type is a duplicated form of the 36-bp repeat unit. The 1/2 alleles showed a single nucleotide change as a heteroduplex, which generated a PCR product of similar size as that of the 1/1-182-bp. The military working dogs showed the 2/2 type of VNTR and heteroduplex. For the pass group, two dogs possessed 2/2 type (40 %), whereas three dogs were of the heteroduplex type (60 %). However, all members of fail group showed the 2/2 type (100 %). These data indicate that repeat polymorphisms with behavioral phenotyping can identify military working dogs that would pass or fail the in-training examination.

Faculty Prediction of In-training Examination Scores of Emergency Medicine Residents

BackgroundThe Emergency Medicine In-Training Examination (EMITE) is one of the only valid tools for medical knowledge assessment in current use by emergency medicine (EM) residencies. However, EMITE results return late in the academic year, providing little time to institute potential remediation. ObjectiveThe goal of this study was to determine the ability of EM faculty to accurately predict resident EMITE scores prior to results return. MethodsWe asked EM faculty at the study site to predict the 2012 EMITE scores of the 50 EM residents 2 weeks prior to results being available. The primary outcome was prediction accuracy, defined as the proportion of predictions within 6% of the actual score. The secondary outcome was prediction precision, defined as the mean deviation of predictions from the actual scores. We assessed several faculty background variables, including years of experience, educational leadership status, and clinical hours worked, for correlation with the two outcomes. ResultsThirty-two of the 38 faculty (84.2%, 95% confidence interval [CI] 69.6–92.6) participated in the study, rendering a total of 1600 predictions for 50 residents. Mean resident EMITE score was 81.1% (95% CI 79.5–82.8%). Mean prediction accuracy for all faculty participants was 69% (95% CI 65.9–72.1%). Mean prediction precision was 5.2% (95% CI 4.9–5.5%). Education leadership status was the only background variable correlated with the primary and secondary outcomes (Spearman's ρ = 0.51 and −0.53, respectively). ConclusionFaculty possess only moderate accuracy at predicting resident EMITE scores. We recommend a multicenter study to evaluate the generalizability of the present results.

So You Want to Become a Plastic Surgeon? What You Need to Do and Know to Get into a Plastic Surgery Residency

Sir: Plastic surgery is a highly sought-after surgical specialty that attracts some of the most accomplished candidates. The competitive landscape, endless medical school opportunities, and varied advice from colleagues and mentors make it difficult for students trying to focus their efforts on activities most likely to help them achieve a plastic and reconstructive surgery residency position. “So You Want to Become a Plastic Surgeon?” outlines key areas where medical students should focus their energies by demystifying some of the rumors surrounding the plastic surgery match process with objective data on the most relevant factors considered for residency.1 Every medical student knows the objectives: scoring well on Step 1, publishing articles, and achieving outstanding grades. Still, the article provides useful benchmarks for students as they study for Step 1 or rotate through the wards. However, as the article explains, matching in plastic and reconstructive surgery takes more than excellent test scores—letters of recommendation, subinternships, and interviews are just as important. With the statistics outlined in the article, medical students interested in plastic and reconstructive surgery can build better, more focused plans and goals for residency. Another interesting aspect of plastic surgery program placement involves international medical graduates. From an international medical graduate perspective, “So You Want to Become a Plastic Surgeon?” could be discouraging. There is no university ranking pool or Alpha Omega Alpha membership to help a program director scrutinize this type of applicant. Thus, the tendency of an international medical graduate to match into a plastic surgery program, especially an integrated one, is very rare (0.1 percent, to be precise).2 The medical field values multiculturalism and diversity along with the effort, hard work, and passion an international medical graduate brings from abroad. However, as a foreigner, “fitting the bill” of the ideal candidate seems nearly impossible. An international medical graduate applying does so as a knowingly imperfect applicant, even though he or she may possess all of the skills necessary to be an effective plastic surgery resident. Even after hard work, multiple publications, and strong letters, an interview often seems like a shot of luck—a miracle that brings you closer to that 0.1 percent matching rate. The standards required to achieve admittance into plastic surgery programs can be onerous; however, few studies have examined whether these criteria correlate with residency performance. Colleagues in orthopedic surgery searched for correlations between preresidency factors and residency performance later on.3,4 They found only a few. Grades during clinical rotations were the most consistent predictor of excellent faculty evaluations.3,4 In addition, United States Medical Licensing Examination scores and graduation from a highly ranked medical school as reported by the U.S. News & World Report were the best predictors of in-training and board examination scores during residency.3,4 This may not be surprising given that students who graduate from highly ranked medical schools are usually excellent test takers. Most of these studies were small and retrospective, and may be limited by range restriction. Thus, assessing only the top candidates matching into orthopedic surgery may have masked any correlations that might have existed between preresidency factors and residency performance. Although orthopedic surgery and plastic and reconstructive surgery are different fields, many similarities can be seen. Both are highly competitive surgical specialties that value the same applicant characteristics (e.g., United States Medical Licensing Examination Step 1 scores, letters of recommendation, and research publications) to select incoming residents. It is still unclear whether selection factors correlate with performance during residency, which is why selecting medical students for residency programs is just as much an art as it is a science. Articles such as this provide an evidence-based blueprint for students to structure their medical school experience and build their resume around to maximize their opportunities for residency. Just as important, though, as medical students, we must always remember why we chose plastic and reconstructive surgery in the first place and not get lost in the fray of publications, letters of recommendation, and Alpha Omega Alpha membership. Sadly, stiff competition has led to increasing percentages of plastic surgery applicants who claim so-called phantom publications on their application.5,6 As stressful as matching in plastic surgery might seem, a true passion for the field, hard work, and respect from your peers and superiors will undoubtedly go a long way toward achieving a position in a plastic and reconstructive surgery program. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Andre Alcon, B.A. Miles J. Pfaff, B.A. Yale University School of Medicine New Haven, Conn. Oriana Haran, M.D. Central University of Venezuela Caracas, Venezuela

Exploring the Relationship Between the American Board of Emergency Medicine In-Training Exam Scores and Mandatory Didactic Attendance for Emergency Medicine Residents

Exploring the Relationship Between the American Board of Emergency Medicine In-Training Exam Scores and Mandatory Didactic Attendance for Emergency Medicine Residents

Association between performance on neurology in-training and certification examinations

Association between performance on neurology in-training and certification examinations