LETTER
In-Training Examination in Internal Medicine
Norman A. Desbiens, MD
1 January 1995 | Volume 122 Issue 1 | Pages 73-74
TO THE EDITOR:
I thank Garibaldi and colleagues [1] for their recent description of the results of the ITE-IM for the last 6 years. Our residents have participated in this program since its inception, and I have found it to be a valuable feedback and heuristic tool.
The authors point out a trend toward lower total scores for all cohorts. They postulate that this finding might reflect either an increased level of difficulty in the examination or a decreased level of knowledge among examinees, but selection bias[2] may also explain part or all of this finding. For example, because the test is voluntary, if the "best" programs or residents volunteered to take the examination sooner, the scores would be higher than those at a later period when more residents were taking the examination. The fact that the decrease in scores has been greatest for interns is consistent with selection bias, given that a rate of participation has increased more among interns than among second-year residents (only 36.9% of first-year residents who took the examination in 1993 took it in 1988, whereas 78.5% of second-year residents who took the examination in 1993 took it in 1988). If selection bias is present, the decrease in examination scores should disappear as the percentage of residents in all years who take the examination stabilizes at a high number.
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Author and Article Information
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Marshfield Clinic; Marshfield, WI 54449
1. Garibaldi RA, Trontell MC, Waxman H, Holbrook JH, Kanya DT, Khoshbin S, et al. The In-Training Examination in Internal Medicine. Ann Intern Med. 1994; 121:117-23.
2. Kleinbaum DG, Kupper LL, Morgenstern H. Selection bias. In: Beal C, ed. Epidemiologic Research. New York: Van Nostrand Reinhold; 1982:194-219.
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