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Panda N, Bahdila D, Abdullah A, Ghosh AJ, Lee SY, Feldman WB. Association Between USMLE Step 1 Scores and In-Training Examination Performance: A Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1742-1754. [PMID: 34323860 DOI: 10.1097/acm.0000000000004227] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE On February 12, 2020, the sponsors of the United States Medical Licensing Examination announced that Step 1 will transition to pass/fail scoring in 2022. Step 1 performance has historically carried substantial weight in the evaluation of residency applicants and as a predictor of subsequent subject-specific medical knowledge. Using a systematic review and meta-analysis, the authors sought to determine the association between Step 1 scores and in-training examination (ITE) performance, which is often used to assess knowledge acquisition during residency. METHOD The authors systematically searched Medline, EMBASE, and Web of Science for observational studies published from 1992 through May 10, 2020. Observational studies reporting associations between Step 1 and ITE scores, regardless of medical or surgical specialty, were eligible for inclusion. Pairs of researchers screened all studies, evaluated quality assessment using a modified Newcastle-Ottawa Scale, and extracted data in a standardized fashion. The primary endpoint was the correlation of Step 1 and ITE scores. RESULTS Of 1,432 observational studies identified, 49 were systematically reviewed and 37 were included in the meta-analysis. Overall study quality was low to moderate. The pooled estimate of the correlation coefficient was 0.42 (95% confidence interval [CI]: 0.36, 0.48; P < .001), suggesting a weak-to-moderate positive correlation between Step 1 and ITE scores. The random-effects meta-regression found the association between Step 1 and ITE scores was weaker for surgical (versus medical) specialties (beta -0.25 [95% CI: -0.41, -0.09; P = .003]) and fellowship (versus residency) training programs (beta -0.25 [95% CI: -0.47, -0.03; P = .030]). CONCLUSIONS The authors identified a weak-to-moderate positive correlation between Step 1 and ITE scores based on a meta-analysis of low-to-moderate quality observational data. With Step 1 scoring transitioning to pass/fail, the undergraduate and graduate medical education communities should continue to develop better tools for evaluating medical students.
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Affiliation(s)
- Nikhil Panda
- N. Panda is a clinical fellow of surgery, Massachusetts General Hospital and Harvard Medical School, and a postdoctoral researcher, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Dania Bahdila
- D. Bahdila is a doctoral candidate, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, and Department of Preventive Dental Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abeer Abdullah
- A. Abdullah is a doctoral candidate, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, and Department of Preventive Dental Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Auyon J Ghosh
- A.J. Ghosh is a clinical fellow of medicine and postdoctoral researcher, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sun Yeop Lee
- S.Y. Lee is research assistant, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - William B Feldman
- W.B. Feldman is associate physician and research fellow, Division of Pulmonary and Critical Care Medicine and the Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Xu AJ, Drain AE, Gonzalez AN, Kanofsky JA. The New PGY-1 Year: Lessons Learned. Curr Urol Rep 2020; 21:42. [PMID: 32813096 DOI: 10.1007/s11934-020-00996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Describe the ACGME's changes to the PGY-1 year in urology and discuss the benefits and challenges faced by training programs. RECENT FINDINGS There are no publications detailing the integration of the PGY-1 year in urology; however, response of other surgical subspecialties to their own integration has been studied. Benefits of integration include earlier exposure to techniques and knowledge specific to urology, potentially leading to increased preparedness for next steps in training and exams. Program directors have more flexibility to select rotations relevant to urology. Resident wellness may be improved as interns are incorporated into the department earlier and can help distribute the workload for senior residents. Challenges include decreased exposure to basic surgical knowledge and skills, decreased camaraderie with general surgery colleagues, and difficulties associated with evaluating interns who are spending limited time with urology departments. Overall, the change seems to have a positive impact on urological training.
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Affiliation(s)
- Alex J Xu
- Department of Urology, New York University Grossman School of Medicine, 222 East 41st, 12th floor, New York, NY, 10017, USA.
| | - Alice E Drain
- Department of Urology, New York University Grossman School of Medicine, 222 East 41st, 12th floor, New York, NY, 10017, USA
| | - Ashley N Gonzalez
- Department of Urology, New York University Grossman School of Medicine, 222 East 41st, 12th floor, New York, NY, 10017, USA
| | - Jamie A Kanofsky
- Department of Urology, New York University Grossman School of Medicine, 222 East 41st, 12th floor, New York, NY, 10017, USA
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Udawatta M, Preet K, Lagman C, French AM, Bruton C, Bergsneider M, Chung L, Romiyo P, Macyszyn L, Yang I. United States Medical Licensing Examination step 2 scores do not predict American Board of Neurological Surgery scores: A single-institution experience. J Neurol Sci 2020; 408:116556. [DOI: 10.1016/j.jns.2019.116556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/24/2019] [Accepted: 10/28/2019] [Indexed: 11/16/2022]
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Janney CF, Kunzler D, Safavi PS, Panchbhavi V. Orthopaedic In-Training Examination Resources and Residency Training for the Foot and Ankle Domain. Foot Ankle Spec 2019; 12:146-152. [PMID: 29707970 DOI: 10.1177/1938640018770808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Residency programs use the annual Orthopaedic In-Training Examination (OITE) prepared by the American Academy of Orthopaedic Surgeons (AAOS) to monitor resident progress and prepare them for the part 1 of the American Board of Orthopaedic Surgeons (ABOS) Certifying Examination. The purpose of this study was to determine resources residents currently use to prepare for the OITE and also to learn about their perception of training they receive in the foot and ankle subspecialty in their program and their interest in foot and ankle fellowship after residency. METHODS An anonymous survey was sent to both allopathic programs and osteopathic residents to learn what resources residents used to study for the OITE, preparatory question sets, on-call resources, their perception on training received in foot and ankle surgery, and their intent to pursue fellowship training. RESULTS A total of 130 residents participated in the survey. The majority of residents in allopathic and osteopathic residencies used Orthobullets (OB) to prepare for the OITE and use this resource while on-call. Most residents also used OB question sets to study along with the AAOS self-assessment examinations. In total, 43.2% of osteopathic residents felt they did not get enough exposure to foot and ankle subspecialty while in training, in contrast to 31.2% of allopathic residents. A total of 35% of all orthopaedic surgery residents felt they lacked enough exposure to foot and ankle orthopaedic surgery. Only 7 residents (6%, 6 allopathic, 1 osteopathic) intended to pursue a foot and ankle fellowship following graduation. CONCLUSION Online resources such as OB continue to be frequently used by residents for preparation for the OITE. Greater than one-third of orthopaedic residents feel they do not get enough exposure to foot and ankle orthopaedic surgery. Improvement in this area could be helped by continued endeavors from the American Orthopaedic Foot and Ankle Society such as the Visiting Professor Program and Resident Scholarship Program. LEVELS OF EVIDENCE Level V: Single Cross-Sectional Study.
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Affiliation(s)
- Cory F Janney
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (CFJ, DK, PSS, VP).,United States Navy, Washington, DC (CFJ)
| | - Daniel Kunzler
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (CFJ, DK, PSS, VP).,United States Navy, Washington, DC (CFJ)
| | - Pejma Shazadeh Safavi
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (CFJ, DK, PSS, VP).,United States Navy, Washington, DC (CFJ)
| | - Vinod Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (CFJ, DK, PSS, VP).,United States Navy, Washington, DC (CFJ)
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Camp CL, Degen RM, Hanssen AD, Dines JS, Karam MD, Turner NS. Residents and Program Director Perspectives Often Differ on Optimal Preparation Strategies and the Value of the Orthopedic In-Training Examination. JOURNAL OF SURGICAL EDUCATION 2018; 75:164-170. [PMID: 28673803 DOI: 10.1016/j.jsurg.2017.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 04/14/2017] [Accepted: 06/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this work was to compare resident and program director (PD) perspectives on the value of the Orthopaedic In-Training Examination (OITE), resident study habits, and best resources for optimal performance. DESIGN A national survey of orthopedic surgery residents and PDs. SETTING Mayo Clinic, Rochester, MN PARTICIPANTS: The survey was completed by 445 (41.5%) eligible orthopedic surgery residents and 37 (77.1%) PDs. RESULTS Although residents and PDs agreed on when (p = 0.896) and how much (p = 0.171) residents currently study, residents felt that the OITE was not as valuable of an assessment of their knowledge, and also felt their individual scores were less likely to remain confidential compared to PDs (p < 0.001). The mean OITE score below which residents were concerned about their ability to pass American Board of Orthopaedic Surgeons Part 1 was 9.7 percentile points higher than PDs threshold (42.3% vs. 32.6%, respectively, p = 0.003). Both groups agreed that it is important to dedicate focused study time to the OITE (p = 0.680) and to perform well (p = 0.099). Regarding the best resources and preparation strategies, both residents and PDs tended to agree on the value of most (6 of 10) study methods. Residents ranked practice question websites (mean ranking of 2.6 vs. 3.8 of 10, respectively; p < 0.001) and formal rotations in a subspecialty (6.0 vs. 7.7 respectively, p < 0.001) higher than PDs. In contrast, PDs tended to value their program's formal OITE prep program (4.1. vs. 5.3, respectively, p = 0.012) and reading primary literature (5.6 vs. 6.6, respectively, p = 0.012) more than residents. CONCLUSION Residents and PDs agreed on many critical components of this process; however, a number of key differences in perspectives exist.
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Affiliation(s)
| | - Ryan M Degen
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joshua S Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | | | - Norman S Turner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Nagasawa DT, Beckett JS, Lagman C, Chung LK, Schmidt B, Safaee M, Bergsneider M, Martin N, Gaonkar B, Macyszyn L, Yang I. United States Medical Licensing Examination Step 1 Scores Directly Correlate with American Board of Neurological Surgery Scores: A Single-Institution Experience. World Neurosurg 2017; 98:427-431. [DOI: 10.1016/j.wneu.2016.11.091] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
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Evaniew N, Holt G, Kreuger S, Farrokhyar F, Petrisor B, Dore K, Bhandari M, Ghert M. The orthopaedic in-training examination: perspectives of program directors and residents from the United States and Canada. JOURNAL OF SURGICAL EDUCATION 2013; 70:528-536. [PMID: 23725942 DOI: 10.1016/j.jsurg.2013.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/07/2013] [Accepted: 04/02/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Objective assessment of resident performance continues to task program directors (PDs) with a formidable challenge. This study evaluated attitudes toward the Orthopaedic In-Training Examination (OITE), compared its value between countries, assessed its value against other metrics of resident performance, and examined program and resident factors predictive of high achievement. DESIGN Survey. SETTING Orthopedic surgery residency programs across the United States and Canada. PARTICIPANTS One hundred sixty-six PDs and 945 residents. RESULTS Eighty-eight PDs and 331 residents completed the surveys (response rates, 54% and 35%, respectively). PDs and residents in the United States assigned greater importance to the OITE than did those in Canada and reported OITE scores from the United States were significantly higher. PDs in the United States reported greater consequences for residents with poor scores than did PDs from Canada, including remediation and reprimand. Observed structured clinical examinations, internal examinations, and in-training evaluation reports were assigned greater importance by PDs and residents in Canada, but low or no importance by those in the United States. In preparation for the OITE, residents strongly favored prior OITE and American Academy of Orthopaedic Surgeons self-assessment questions, the 'AAOS Comprehensive Orthopaedic Review' textbook, the Journal of the American Academy of Orthopaedic Surgeons, and an OITE-based multiple-choice question website. Regression analysis identified resident and program emphasis on OITE studying and higher level of training as positive predictors for higher OITE scores. CONCLUSIONS The OITE is more important to PDs and residents in the United States than it is in Canada, and the reported OITE scores reflect these attitudes. PDs in Canada also employ a greater diversity of evaluative tools, a practice in keeping with recent advances toward competency-based medical education. The findings of this report may help PDs be aware of alternative methods of formative resident evaluation and ultimately improve the training of future independent surgeons.
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Affiliation(s)
- Nathan Evaniew
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
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