title: Pulmonary and Critical Care In-Service Training Examination Score as a Predictor of Board Certification Examination Performance.
abstract: BACKGROUND
  Most trainees in combined pulmonary and critical care medicine fellowship programs complete in-service training examinations (ITEs) that test knowledge in both disciplines. Whether ITE scores predict performance on the American Board of Internal Medicine Pulmonary Disease Certification Examination and Critical Care Medicine Certification Examination is unknown.
  
  
  OBJECTIVE
  To determine whether pulmonary and critical care medicine ITE scores predict performance on subspecialty board certification examinations independently of trainee demographics, program director competency ratings, fellowship program characteristics, and prior medical knowledge assessments.
  
  
  METHODS
  First- and second-year fellows who were enrolled in the study between 2008 and 2012 completed a questionnaire encompassing demographics and fellowship training characteristics. These data and ITE scores were matched to fellows' subsequent scores on subspecialty certification examinations, program director ratings, and previous scores on their American Board of Internal Medicine Internal Medicine Certification Examination. Multiple linear regression and logistic regression were used to identify independent predictors of subspecialty certification examination scores and likelihood of passing the examinations, respectively.
  
  
  RESULTS
  Of eligible fellows, 82.4% enrolled in the study. The ITE score for second-year fellows was matched to their certification examination scores, which yielded 1,484 physicians for pulmonary disease and 1,331 for critical care medicine. Second-year fellows' ITE scores (β = 0.24, P < 0.001) and Internal Medicine Certification Examination scores (β = 0.49, P < 0.001) were the strongest predictors of Pulmonary Disease Certification Examination scores, and were the only significant predictors of passing the examination (ITE odds ratio, 1.12 [95% confidence interval, 1.07-1.16]; Internal Medicine Certification Examination odds ratio, 1.01 [95% confidence interval, 1.01-1.02]). Similar results were obtained for predicting Critical Care Medicine Certification Examination scores and for passing the examination. The predictive value of ITE scores among first-year fellows on the subspecialty certification examinations was comparable to second-year fellows' ITE scores.
  
  
  CONCLUSIONS
  The Pulmonary and Critical Care Medicine ITE score is an independent, and stronger, predictor of subspecialty certification examination performance than fellow demographics, program director competency ratings, and fellowship characteristics. These findings support the use of the ITE to identify the learning needs of fellows as they work toward subspecialty board certification.
authors: 1 Division of Pulmonary and Critical Care, Hennepin County Medical Center, University of Minnesota School of Medicine, Minneapolis, Minnesota.
authors: Robert R
authors: RR
authors: Kempainen
authors: 2 Hess Consulting, St. Nicolas, Quebec, Canada.
authors: Brian J
authors: BJ
authors: Hess
authors: 3 Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York.
authors: Doreen J
authors: DJ
authors: Addrizzo-Harris
authors: 4 Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington.
authors: Douglas C
authors: DC
authors: Schaad
authors: 4 Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington.
authors: Craig S
authors: CS
authors: Scott
authors: 5 Division of Pulmonary and Critical Care, Drexel University, Pittsburgh, Pennsylvania.
authors: Brian W
authors: BW
authors: Carlin
authors: 6 Applied Measurement Professionals, Inc., Olathe, Kansas; and.
authors: Robert C
authors: RC
authors: Shaw
authors: 7 American Board of Internal Medicine, Philadelphia, Pennsylvania.
authors: Lauren
authors: L
authors: Duhigg
authors: 7 American Board of Internal Medicine, Philadelphia, Pennsylvania.
authors: Rebecca S
authors: RS
authors: Lipner
mesh_terms: D000328:Adult; D002568:Certification / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000592:standards; D004521:Educational Measurement / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000193:education*; D005257:Fellowships and Scholarships / Q000592:standards*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015272:Pulmonary Medicine / Q000193:education*; D014481:United States
keywords: curriculum; education; specialty boards