Joseph Julie A, Terry Chris M, Waller Eva J, Bortsov Andrey V, Zvara David A, Mayer David C, Martinelli Susan M
Anesthesiology Resident, University of North Carolina School of Medicine.
Assistant Professor, Department of Anesthesiology, University of North Carolina School of Medicine.
J Educ Perioper Med. 2014 Jan 1;16(6):E072. eCollection 2014 Jan-Jun.
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.
美国各地的麻醉学住院医师每年都要参加一次在职培训考试（ITE）。ITE评估住院医师的知识水平，并提供个性化反馈，以指导低分部分的未来学习（1）。ITE的成绩与美国麻醉学委员会（ABA）笔试的结果相关（2）。在过去几年中，北卡罗来纳大学（UNC）观察到ITE成绩呈下降趋势。为应对这种下降，我们部门通过制定学术改进政策（AIP）对ITE进行了重新排序。AIP既对取得满意成绩给予奖励，也对表现不佳给予惩罚，以将ITE提升为一项“高风险”考试。我们的假设是，实施这项AIP将提高ITE成绩。
收集了UNC麻醉学系2004 - 2015年毕业班级的150名住院医师的ITE成绩。数据以与AIP实施前后全国分布相比得分低于第20百分位的住院医师人数呈现。此外，还比较了每个毕业班级的美国医师执照考试第一步（USMLE Step 1）的平均三位数成绩与相应毕业班级的ITE百分位平均成绩（USMLE不提供百分位成绩）。
2009年至2013年期间，ITE成绩低于第20百分位的住院医师人数稳步增加，在2011年达到峰值10人。2011年7月实施AIP后，得分低于第20百分位的人数减少了80%，从10人降至2人（p < 0.05）。
实施学术改进政策后，麻醉学住院医师的ITE成绩有所提高。
