What Are Resident In-Training Exams?
Resident in-training exams (ITEs) have been designed to assess residents’ progress in training. They provide program directors with comparative knowledge assessment data to better understand program year (PGY) class progress and the knowledge gaps between residents in their respective PGY.
Two such tests are the American Board of Family Medicine In-Training Examination (ABFM-ITE) and the Internal Medicine In-Training Examination (IM-ITE).
The ABFM-ITE is given annually during the last week of October and can be taken by all residents in Accreditation Council for Graduate Medical Education (ACGME)-accredited Family Medicine programs.
The IM-ITE is offered each year in late August through mid-September and is designed by the American College of Physicians (ACP) in collaboration with the Alliance for Academic Internal Medicine.
Resident in-training exams (ITEs) can be taken on a yearly basis, and the cost is often paid for by residency programs. Program directors make the final decision about which tests residents should take and when they should take them.
The Questions on the ABFM-ITE exam (240 multiple-choice questions) are written by certified family physicians in private practice or academic medicine and reviewed by a committee comprised mostly of former residency program directors. After the test, you can download the answers and a critique with additional reading suggestions for all questions on the exam.
IM-ITE questions (300 items) are written by a committee of expert physician-authors and are meant to test the wide range of knowledge that a second-year resident would be expected to have. Areas tested include acute and chronic care, inpatient and ambulatory problems, and essential clinical skills.
Resident in-training exams will provide you with an assessment of your progress in acquiring medical knowledge.
Test results will indicate which areas you already know well and which ones will require more study before you take your certification exam. In-training exam results are also helpful to your program director, as they offer him or her the chance to evaluate the residency program in general as well as identify the areas where residents need reinforcement.
For the ABFM-ITE, there is no passing score; this is an assessment-only test. Scoring is similar to that used for the ABFM Certification Examination (in which raters are asked to imagine what a physician who is just barely qualified to be considered board certified would be able to do; each question is scored according to the probability that this abstracted physician will correctly answer it).
For the IM-ITE, the score is determined by the number of correct answers, and there is no penalty for guessing, so you should endeavor to answer all of the questions. The score is reported as a percentage of total questions answered, and there is no passing or failing level in this educational assessment test. After testing, you will be sent a report that shows your total percent correct score and percentile rank as well as the score and rank for each of the 11 major content areas tested, a list of educational objectives for each test question, and a norm table to use in comparing your score with those of various other groups of residents.
All resident in-training exams are self-assessment tools and are not meant to be used as qualifying or certifying tools. Your program director is prohibited from releasing any scores outside of the residency program. However, because the IM-ITE is part of the ACGME’s Internal Medicine Milestone Project, residency programs are allowed to use residents’ scores to participate in the Next Accreditation System, which uses the scores to determine the overall progress of residents.
According to Dr. Mark Deutchman, Senior Editor for Med-Challenger Family Medicine Board Review, residents take the ABFM-ITE every year at his institution, the University of Colorado, Denver.
“ITEs are now routinely given as online assessment activities,” says Dr. Deutchman. “Because the ABFM-ITE is a formative evaluation, it is a great way for residents to measure individual results at each resident’s review that will help the resident make a plan of study. If a resident’s exam score is lower than it should be, we might ask the resident put together a written, explicit study plan, but we have found ITE scores tend to go up automatically when re-assessment is done with an adaptive learning clinical education system.”
What Is the Best Way to Study for In-Training Exams?
Because in-training exams are designed to assess your progress in training, you will get a more accurate assessment if you do not cram for this test. Instead, make and stick with a long-term, overall study plan throughout the years of your residency, and regard every day of your residency and your time on the wards as study tools.
Dr. Deutchman also recommends accessing board review question banks with adaptive assessments for further clinical context and review while a topic is on your mind, as information learned within the context of a real patient scenario will be retained better than information learned during a cram session. Med-Challenger’s Family Medicine Board Review and Internal Medicine Board Review are excellent tools to prepare you for ITEs.
At Med-Challenger, our data suggests that frequent, short study sessions will give you better results than will infrequent, long sessions.
Additionally, you can log in to the ABFM website to download a trial In-Training Exam to see where your strengths and weaknesses lie, and then use the results to modify your long-term study plan. The ABFM also offers an online Bayesian Score Predictor that will give you an estimate of the probability of passing the ABFM certification examination on the basis of your scores on the ABFM In-Training Exams.
Lastly, don’t panic if the results of your resident in-training exams show inadequate progress. Instead, figure out exactly what went wrong, assess your strengths and weaknesses, and stick with an adjusted study plan that will address any weak areas.