ABSTRACT

Background

In-training examinations (ITEs) are intended for low-stakes, formative assessment of residents' knowledge, but are increasingly used for high-stake purposes, such as to predict board examination failures.

Objective

The aim of this review was to investigate the relationship between performance on ITEs and board examination performance across medical specialties.

Methods

A search of the literature for studies assessing the strength of the relationship between ITE and board examination performance from January 2000 to March 2019 was completed. Results were categorized based on the type of statistical analysis used to determine the relationship between ITE performance and board examination performance.

Results

Of 1407 articles initially identified, 89 articles underwent full-text review, and 32 articles were included in this review. There was a moderate-strong relationship between ITE and board examination performance, and ITE scores significantly predict board examination scores for the majority of studies. Performing well on an ITE predicts a passing outcome for the board examination, but there is less evidence that performing poorly on an ITE will result in failing the associated specialty board examination.

Conclusions

There is a moderate to strong correlation between ITE performance and subsequent performance on board examinations. That the predictive value for passing the board examination is stronger than the predictive value for failing calls into question the “common wisdom” that ITE scores can be used to identify “at risk” residents. The graduate medical education community should continue to exercise caution and restraint in using ITE scores for moderate to high-stakes decisions.

ABSTRACT

Background

Wellness initiatives implemented by graduate medical education programs can help mitigate burnout in resident physicians.

Objective

This systematic review seeks to identify factors that impact the effectiveness of resident wellness interventions and to provide a conceptual framework to guide future interventions.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 6 electronic databases were searched in November 2019 using variations of the keywords “resident physicians,” “wellness,” and “intervention.” Peer-reviewed full-text English-language articles on controlled studies were considered for inclusion. The quality of the studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines.

Results

The initial search disclosed 1196 articles, of which 18 studies enrolling 666 resident physicians met inclusion criteria for qualitative review. Interventions using peer support and individual meditation enhanced well-being. Effective wellness interventions also used educational theory to guide program development, surveyed participants to guide intervention design, incorporated programming into existing didactic curricula, and recruited voluntary participants. The quality of most of the included studies was poor (13 of 18, 72%) and could be improved by using standardized wellness assessments supported by validity evidence.

Conclusions

This systematic review suggests that future resident wellness initiatives should focus on grounding interventions in educational theory, forging consensus on wellness instruments with validity evidence, and examining the impact of initiatives on patient outcomes. A logic model can provide a framework for designing and implementing effective wellness interventions.

ABSTRACT

Background

Since the Accreditation Council for Graduate Medical Education (ACGME) established the designated institutional official (DIO) role in 1998, there have been major changes in sponsoring institutions (SIs) and DIO responsibilities. Yet there remains a large gap in our knowledge regarding baseline SI and DIO characteristics as well as a need for institutions wanting to increase diversity in the DIO role and other leadership positions within the medical education community.

Objective

We sought to characterize demographics of DIOs and the SIs they oversee.

Methods

We identified SIs and DIOs on the ACGME website on February 15, 2020. Reviewed data included SI accreditation status, number of programs and resident/fellow positions, and DIO characteristics.

Results

We identified 831 SIs. SIs with continued accreditation sponsored more programs (median 4.0) than SIs with initial accreditation (median 1.0, P < .001). DIO age ranged from 29–81 years (median 57 years). Two-hundred eighty-three of 831 (34%) DIOs were women. Of 576 DIOs with known academic rank, 356 (62%) DIOs held senior academic rank. A higher proportion of male DIOs had senior academic rank (68% vs 52%; OR 1.90 [95% CI 1.34–2.70]; P < .001) and professor rank (39% vs 24%; OR 2.01 [95% CI 1.38–2.94]; P < .001) compared to female DIOs. Female gender was associated with a greater number of ACGME-accredited programs and filled resident/fellow positions per SI (P < .001 for both).

Conclusions

This study describes characteristics of DIOs and SIs and offers insights for those pursuing a DIO position.

The Journal of Graduate Medical Education is deeply grateful to the individuals who served as reviewers and provided critiques and helpful feedback to authors for articles in the 6 issues published in 2020. Reviewers shown in bold italics reviewed a significant number of articles, and JGME greatly appreciates the contribution of their time, energy, and expertise.

Eva Aagaard, MD

Cary Aarons, MD

Sawsan Abdel-Razig, MD

Mark Abrams, MD

Rolf Ahlzen, MD

Ralitsa Akins, MD

Monica Alba Sandoval, MD

Ibrahim Al-Busaidi, MB

Suzanne Allen, MD

Al'ai Alvarez, MD

Meshari Alwashmi, PhD

Richard Alweis, MD

Ashley Amick, MD