Introduction “Problem residents” are a common phenomenon in internal medicine residency programs. The most frequently identified cause is due to a deficiency in medical knowledge. One objective measure of medical knowledge is the American Board of Internal Medicine In-training Exam (ABIM ITE). Residents who score less than the 35th percentile on the ABIM ITE have a negative predictive value of 83% to fail the ABIM certifying examination. This study evaluates the effects of the implementation of a formal remediation program on study habits and achievement on the ABIM certification examination at a university-based internal medicine residency.
Methods Second- and third-year residents during the academic years 2004-2005 were divided into a remediation group and a control group. The remediation group consisted of residents that scored less than the 35th percentile on the ABIM ITE. The control group consisted of residents who scored greater than the 35th percentile on the ABIM ITE. The remediation program consisted of mandatory monthly examinations composed of questions from the Medical Knowledge Self Assessment Program. Prior to initiation of the remediation program, both groups were given a survey to determine their current study habits. On completion of the remediation program (typically at graduation), the residents repeated the same survey.
Results The remediation group consisted of seven residents. The control group consisted of 12 residents. Preintervention, both groups had similar length of hours allocated to studying on a daily basis: 1.4 hours for the remediation group and 1.6 for the control group. Postintervention study hours increased, 2.4 hours daily for the remediation group and 1.78 hours daily for the control group. Via the Wilcoxon signed-rank test with n = 4, there is no possible value that the sum of signed ranks would be significant at a baseline p ≤ .05. Of note, 75% of the residents in the remediation program who took the ABIM certifying examination passed and 100% of the residents in the control group who took the ABIM certifying examination passed.
Discussion Residency programs have been challenged in finding interventions to help their residents in gaining the medical knowledge necessary to pass the ABIM certification examinations as well as to be competent physicians. Previous studies have not shown any proven benefit of a remediation program. Even though the increase in study time was not statistically significant, the majority of residents in the remediation group who took their ABIM certifying examination passed on their first attempt. Limitations of the study included small sample size and some bias as the remediation group had a lower ITE score at baseline compared with the control group.
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