Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Renal, Electrolyte, and Hypertension Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Soc Nephrol. 2021 Nov;32(11):2714-2723. doi: 10.1681/ASN.2021020160.
The pass rate on the American Board of Internal Medicine (ABIM) nephrology certifying exam has declined and is among the lowest of all internal medicine (IM) subspecialties. In recent years, there have also been fewer applicants for the nephrology fellowship match.
This retrospective observational study assessed how changes between 2010 and 2019 in characteristics of 4094 graduates of US ACGME-accredited nephrology fellowship programs taking the ABIM nephrology certifying exam for the first time, and how characteristics of their fellowship programs were associated with exam performance. The primary outcome measure was performance on the nephrology certifying exam. Fellowship program pass rates over the decade were also studied.
Lower IM certifying exam score, older age, female sex, international medical graduate (IMG) status, and having trained at a smaller nephrology fellowship program were associated with poorer nephrology certifying exam performance. The mean IM certifying exam percentile score among those who subsequently took the nephrology certifying exam decreased from 56.7 (SD, 27.9) to 46.1 (SD, 28.7) from 2010 to 2019. When examining individuals with comparable IM certifying exam performance, IMGs performed less well than United States medical graduates (USMGs) on the nephrology certifying exam. In 2019, only 57% of nephrology fellowship programs had aggregate 3-year certifying exam pass rates ≥80% among their graduates.
Changes in IM certifying exam performance, certain trainee demographics, and poorer performance among those from smaller fellowship programs explain much of the decline in nephrology certifying exam performance. IM certifying exam performance was the dominant determinant.
美国内科医师学会（ABIM）肾脏病学认证考试的通过率下降，在所有内科亚专业中通过率最低。近年来，肾脏病学研究员匹配的申请者也越来越少。
本回顾性观察研究评估了 2010 年至 2019 年期间，首次参加 ABIM 肾脏病学认证考试的 4094 名美国 ACGME 认证肾脏病学研究员项目毕业生的特征变化，以及他们的研究员项目特征与考试成绩的关系。主要观察指标是肾脏病学认证考试的表现。还研究了过去十年中研究员项目的通过率。
内科认证考试成绩较低、年龄较大、女性、国际医学毕业生（IMG）身份以及在较小的肾脏病学研究员项目中接受培训与肾脏病学认证考试成绩较差相关。随后参加肾脏病学认证考试的人的内科认证考试百分位分数平均值从 2010 年的 56.7（SD，27.9）降至 2019 年的 46.1（SD，28.7）。当检查具有可比内科认证考试成绩的个体时，IMG 在肾脏病学认证考试中的表现逊于美国医学毕业生（USMG）。2019 年，只有 57%的肾脏病学研究员项目的毕业生 3 年综合认证考试通过率≥80%。
内科认证考试成绩的变化、某些学员的人口统计学特征以及来自较小研究员项目的较差表现解释了肾脏病学认证考试成绩下降的大部分原因。内科认证考试成绩是主要决定因素。
