The In-Training Examination in Internal Medicine: An Analysis of Resident Performance over Time

17 September 2002 | Volume 137 Issue 6 | Pages 505-510

Background: The In-Training Examination in Internal Medicine (IM-ITE) has been offered annually to all trainees in U.S. medical residency programs since 1988. Its purpose is to provide residents and program directors with an objective assessment of each resident's personal performance on a written, multiple-choice examination and the performance of the residency program compared with that of its peers.

Objective: To analyze trends in the demographic characteristics and scores of examinees during the first 12 years of administration of this examination.

Design: Descriptive analysis over time.

Setting: U.S. residency programs in internal medicine, 1988–2000.

Participants: Residents at all levels of training in categorical, primary care, and medicine–pediatrics programs in the United States and Canada. The number of examinees increased from 7500 in 1988 to almost 18 000 in 2000.

Measurements: After calibration of the scores for each examination, test results were compared and analyzed for selected cohorts of residents over 12 years.

Results: More than 80% of residents in medicine training programs participate in the IM-ITE, most on an annual basis throughout their period of training. Test performance improves at a predictable rate with each year of training. Since 1995, international medical school graduates have persistently outperformed graduates of U.S. medical schools. Test results were affected by the timing of the examination, the time that was available to complete the examination, and the actual time that residents spent in internal medicine training before each examination.

Conclusions: The IM-ITE scores generally improve with year of training time spent in internal medicine training before the examination and time permitted to complete the examination. These observations provide evidence that the IM-ITE is a valid measure of knowledge acquired during internal medicine training.

Author and Article Information

From the University of Connecticut School of Medicine, Farmington, Connecticut; the National Board of Medical Examiners, Philadelphia, Pennsylvania; and the American College of Physicians–American Society of Internal Medicine, Philadelphia, Pennsylvania.

Acknowledgments: The authors thank present and former members of the In-Training Examination in Internal Medicine Committee and members of the IM-ITE Steering Committee for their roles in developing the IM-ITE examination. They also thank Ms. Barbara Cusati for secretarial support.

Requests for Single Reprints: Richard A. Garibaldi, MD, Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030.

Current Author Addresses Dr. Garibaldi: Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030.

Dr. Subhiyah: National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA 19104.

Dr. Moore: 364 Youngsford Place, Gladwyne, PA 19035.

Dr. Waxman: American College of Physicians–American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106-1572.