Theiler Carly A, Vakkalanka J Priyanka, Obr Brooks J, Hansen Nicole, McCabe Daniel J
Department of Emergency Medicine University of Iowa Iowa City Iowa USA.
Division of Medical Toxicology, Department of Emergency Medicine University of Iowa Iowa City Iowa USA.
AEM Educ Train. 2023 Jan 24;7(1):e10840. doi: 10.1002/aet2.10840. eCollection 2023 Feb.
The American Board of Emergency Medicine (ABEM) In Training Exam (ITE) gauges residents' medical knowledge and has been shown to correlate with subsequent performance on the ABEM board qualifying examination. It is common for emergency medicine (EM) residencies to employ subspecialty-trained faculty members with the expectation of improved resident education and subspecialty knowledge. We hypothesized that the presence of subspecialty faculty in toxicology would increase residents' scores on the toxicology portion of the ITE.
We assessed ABEM ITE scores at our institution from 2013-2022 and compared these to national data. The exposure of interest was the absence or presence of fellowship-trained toxicology faculty. The primary outcome was performance on the toxicology portion of the ITE, and secondary outcome was overall performance on the exam.
Residents who had ≥1 toxicology faculty were 37% (95% CI: 1.01-1.87) more likely to surpass the national average for toxicology scores, and those who had ≥2 toxicology faculty were 77% (95% CI: 1.28-2.44) more likely to surpass the national average for toxicology scores on the ABEM ITE. With the presence of ≥2 toxicology faculty, there was also an increase in toxicology score by years in training, with residents being 63% (95% CI: 1.01-2.64), 68% (95% CI: 1.08-2.61), and 92% (95% CI: 1.01-3.63) more likely to surpass the national average for toxicology score in first, second, and third years of residency, respectively. There was no significant relationship between the presence of toxicology faculty and the overall ABEM ITE scores.
The presence of fellowship-trained toxicology faculty positively impacted residents' performance on the toxicology portion of the ABEM ITE but did not significantly impact the overall score. With the presence of ≥2 toxicology faculty we noted an improvement in toxicology scores throughout the 3 years of training, indicating that an individual rotation or educational block is probably less important than spaced repetition through a longitudinal curriculum.
美国急诊医学委员会（ABEM）的住院医师培训考试（ITE）用于评估住院医师的医学知识，并且已被证明与随后的ABEM资格考试成绩相关。急诊医学（EM）住院医师培训项目通常会聘请经过亚专业培训的教员，期望能改善住院医师的教育并提升其亚专业知识。我们推测毒理学亚专业教员的存在会提高住院医师在ITE中毒理学部分的分数。
我们评估了2013年至2022年我校的ABEM ITE成绩，并将其与全国数据进行比较。感兴趣的暴露因素是是否有经过专科培训的毒理学教员。主要结局是ITE中毒理学部分的成绩，次要结局是考试的总体成绩。
有≥1名毒理学教员的住院医师在毒理学成绩上超过全国平均分的可能性高37%（95%CI：1.01 - 1.87），有≥2名毒理学教员的住院医师在ABEM ITE中毒理学成绩超过全国平均分的可能性高77%（95%CI：1.28 - 2.44）。在有≥2名毒理学教员的情况下，随着培训年份的增加，毒理学成绩也有所提高，住院医师在住院第一年、第二年和第三年超过毒理学成绩全国平均分的可能性分别高63%（95%CI：1.01 - 2.64）、68%（95%CI：1.08 - 2.61）和92%（95%CI：1.01 - 3.63）。毒理学教员的存在与ABEM ITE的总体成绩之间没有显著关系。
经过专科培训的毒理学教员的存在对住院医师在ABEM ITE中毒理学部分的成绩有积极影响，但对总体成绩没有显著影响。在有≥2名毒理学教员的情况下，我们注意到在整个3年的培训过程中毒理学成绩有所提高，这表明单次轮转或教育模块可能不如通过纵向课程进行间隔重复重要。
