title: A multiple choice testing program coupled with a year-long elective experience is associated with improved performance on the internal medicine in-training examination.
abstract: BACKGROUND
  The Internal Medicine In-Training Exam (IM-ITE) assesses the content knowledge of internal medicine trainees. Many programs use the IM-ITE to counsel residents, to create individual remediation plans, and to make fundamental programmatic and curricular modifications.
  
  
  OBJECTIVE
  To assess the association between a multiple-choice testing program administered during 12 consecutive months of ambulatory and inpatient elective experience and IM-ITE percentile scores in third post-graduate year (PGY-3) categorical residents.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  One hundred and four categorical internal medicine residents. Forty-five residents in the 2008 and 2009 classes participated in the study group, and the 59 residents in the three classes that preceded the use of the testing program, 2005-2007, served as controls.
  
  
  METHODS
  A comprehensive, elective rotation specific, multiple-choice testing program and a separate board review program, both administered during a continuous long-block elective experience during the twelve months between the second post-graduate year (PGY-2) and PGY-3 in-training examinations.
  
  
  METHODS
  We analyzed the change in median individual percent correct and percentile scores between the PGY-1 and PGY-2 IM-ITE and between the PGY-2 and PGY-3 IM-ITE in both control and study cohorts. For our main outcome measure, we compared the change in median individual percentile rank between the control and study cohorts between the PGY-2 and the PGY-3 IM-ITE testing opportunities.
  
  
  RESULTS
  After experiencing the educational intervention, the study group demonstrated a significant increase in median individual IM-ITE percentile score between PGY-2 and PGY-3 examinations of 8.5 percentile points (p < 0.01). This is significantly better than the increase of 1.0 percentile point seen in the control group between its PGY-2 and PGY-3 examination (p < 0.01).
  
  
  CONCLUSIONS
  A comprehensive multiple-choice testing program aimed at PGY-2 residents during a 12-month continuous long-block elective experience is associated with improved PGY-3 IM-ITE performance.
authors.affiliation: Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0535, USA. mathisbr@ucmail.uc.edu
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Mathis
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Warm
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Schauer
authors.forename: Eric
authors.initials: E
authors.lastname: Holmboe
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Rouan
mesh_terms: D002983:Clinical Competence; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000706:statistics & numerical data; D008297:Male; D009820:Ohio; D012189:Retrospective Studies; D012647:Self-Assessment; D013223:Statistics as Topic; D013997:Time Factors; D014481:United States