title: Enhancement of anesthesiology in-training exam performance with institution of an academic improvement policy.
abstract: BACKGROUND
  Anesthesiology resident physicians across the United States complete an annual in-training examination (ITE). The ITE evaluates resident knowledge and provides personalized feedback to guide future study in low scoring sections(1). Performance on the ITE correlates with outcomes on the American Board of Anesthesiology (ABA) written board examination(2). Over the last several years, declining ITE scores were observed at the University of North Carolina (UNC). In response to this decline, our department reprioritized the ITE by instituting an academic improvement policy (AIP). The AIP employed both reward for satisfactory achievement and consequence for under-performance to elevate the ITE as a "high stakes" examination. Our hypothesis was that implementation of this AIP would improve ITE scores.
  
  
  METHODS
  ITE scores were compiled from 150 residents in the Department of Anesthesiology at UNC for graduating classes from 2004-2015. Data is presented as the number of residents scoring below the 20th percentile when compared to the national distribution before and after the AIP. In addition, average USMLE Step 1 three-digit scores for each graduating class were compared to average ITE percentile scores of the corresponding graduating class (USMLE does not provide percentile scores).
  
  
  RESULTS
  Between 2009 and 2013, the number of residents who scored below the 20th percentile on the ITE increased steadily to a peak of 10 in 2011. After implementation of the AIP in July 2011, there was an 80% decrease in those scoring below the 20th percentile, from 10 to 2 residents (p<0.05).
  
  
  CONCLUSIONS
  Anesthesiology resident ITE scores improved after implementation of an academic improvement policy.
authors.affiliation: Anesthesiology Resident, University of North Carolina School of Medicine.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Joseph
authors.affiliation: Anesthesiology Resident, University of North Carolina School of Medicine.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Terry
authors.affiliation: Anesthesiology Resident, University of North Carolina School of Medicine.
authors.forename: Eva J
authors.initials: EJ
authors.lastname: Waller
authors.affiliation: Assistant Professor, Department of Anesthesiology, University of North Carolina School of Medicine.
authors.forename: Andrey V
authors.initials: AV
authors.lastname: Bortsov
authors.affiliation: Professor, Department of Anesthesiology, University of North Carolina School of Medicine.
authors.forename: David A
authors.initials: DA
authors.lastname: Zvara
authors.affiliation: Professor, Department of Anesthesiology, University of North Carolina School of Medicine.
authors.forename: David C
authors.initials: DC
authors.lastname: Mayer
authors.affiliation: Assistant Professor, Department of Anesthesiology, University of North Carolina School of Medicine.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Martinelli