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. 2007 Jul;22(7):962-8.
doi: 10.1007/s11606-007-0206-4. Epub 2007 Apr 28.

Factors associated with medical knowledge acquisition during internal medicine residency

Furman S McDonald  1 , Scott L Zeger, Joseph C Kolars
Affiliations

Factors associated with medical knowledge acquisition during internal medicine residency

Furman S McDonald et al. J Gen Intern Med. 2007 Jul.

Abstract

Background: Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge acquisition.

Objective: To examine associations of learning habits on medical knowledge acquisition.

Design, participants: Cohort study of all 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times over 4 years while enrolled in the Internal Medicine Residency, Mayo Clinic, Rochester, MN.

Measurements: Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects model.

Results: When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score increase of 5.1% per year (95%CI 4.1%, 6.2%; p < .001). In the year before examination, comparable increases in IM-ITE score were associated with attendance at two curricular conferences per week, score increase of 3.9% (95%CI 2.1%, 5.7%; p < .001), or self-directed reading of an electronic knowledge resource 20 minutes each day, score increase of 4.5% (95%CI 1.2%, 7.8%; p = .008). Other factors significantly associated with IM-ITE performance included: age at start of residency, score decrease per year of increasing age, -0.2% (95%CI -0.36%, -0.042%; p = .01), and graduation from a US medical school, score decrease compared to international medical school graduation, -3.4% (95%CI -6.5%, -0.36%; p = .03).

Conclusions: Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training.

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Figures

Figure 1
Figure 1
Baseline level of knowledge similar between classes. Shown here are the standard box plots for the first year IM-ITE scores for each class of residents which form the overall cohort for the study. The upper and lower portions of each box represents the 75th and 25th percentile for scores in each class. The horizontal line in the middle of each box represents the median score for each class. The vertical lines extending from each box reach to the next adjacent scores from the 75th and 25th percentile scores. If scores lie outside the adjacent values, they are represented by individual dots so that the full range of scores can be seen. The mean (SD) for the first year IM-ITE scores for the classes of 2003, 2004, 2005, and 2006 were 60 (8.1), 60 (7.7), 59 (7.6), and 61 (7.9), respectively. There was no statistical difference in these baseline score distributions assessed by ANOVA, p = .67
Figure 2
Figure 2
IM-ITE percentile vs score relationship. IM-ITE scores are reported as percent items correct (score) as well as a national percentile comparing an individual’s score with those of other residents of similar year in residency throughout the nation. Shown here is the 2003 IM-ITE percentile versus score relationship. A similar relationship exists for the 2002 IM-ITE. Below the 90th percentile, the percentile to score relationship is linear (slope 3.7, r2 = .98). Figure text and arrows demonstrate the association of UpToDate (UTD) use for 1 year on IM-ITE score (%) and percentile for average use of 20 minutes (min) per day. Year in residency: 1 (●) 2 (♦) 3 (■)
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Comment in

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