Residency Case Mix Impact on In-Service Training Exam Scores
Abstract
Learning Objectives: To examine the effect of increasing clinical exposure to common EM complaints had on in-service training exam scores, and provide some insight into how to further strengthen the relationship between these two pillars of training.
Background: The in-service training exam (ITE) for Emergency Medicine (EM) residents has been shown to predict subsequent pass rate on the American Board of Emergency Medicine (ABEM) qualifying exam. Multimodal learning theory suggests that clinical exposures to common EM presentations would be beneficial for acquiring and retaining medical knowledge. It is unknown whether greater clinical exposure is associated with higher scores on the annual ITE.
Objective: To determine whether a higher number of clinical patient encounters in a given domain correlates with higher ITE score across the corresponding ABEM domain.
Methods: This is a retrospective review examining ITE scores and chief complaints seen by EM residents from 2013-2021 at our main clinical site. Visits were attributed to the first assigned resident. Patient encounters were categorized by chief complaint into one of 20 domains of the ABEM Model of Clinical Practice using a previously published consensus process. ITE scores during the third year of training were broken down into percentages by domain. Linear regressions were performed comparing clinical exposure within a domain to the ITE score.
Results: Data were available for 70 residents. Correlation coefficients ranged between 0.01 and 0.29, indicating weak or no correlation (Table 1). Only 3 domains had significant correlations identified: Head, Ear, Eye, Nose, and Throat (multiple R=0.25, p<0.05), Musculoskeletal Disorders (multiple R=0.25, p<0.05), and Psychobehavioral Disorders (multiple R=0.29, p<0.05). Twelve of the categories demonstrated a negative correlation.
Conclusion: We found mostly weak, nonsignificant correlation between clinical exposure and ITE score within core EM domains. This may inform programmatic decisions for EM training, and further investigation is necessary to adequately describe the relationship between clinical training and exam performance.