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Observational Study
. 2019 Jun 17;19(1):217.
doi: 10.1186/s12909-019-1617-8.

Measuring change in knowledge acquisition of Rwandan residents: using the American Board of Pediatrics International In-Training Examination (I-ITE) as an independent tool to monitor individual and departmental improvements during the Human Resources for Health program: an observational study

Natalie McCall  1 , Christian Umuhoza  2 , Cliff O'Callahan  3 , Tanya Rogo  4 , Diane Stafford  5 , Aimable Kanyamuhunga  2 , Peter T Cartledge  6
Affiliations
Observational Study

Measuring change in knowledge acquisition of Rwandan residents: using the American Board of Pediatrics International In-Training Examination (I-ITE) as an independent tool to monitor individual and departmental improvements during the Human Resources for Health program: an observational study

Natalie McCall et al. BMC Med Educ. .

Abstract

Background: Rwanda is the only African country to use the pediatric International In-Training Examination (I-ITE). The objectives of this study were to use the scores from the I-ITE to outline the baseline level of knowledge of Rwandan residents entering the pediatric residency and the trends in knowledge acquisition from 2012 to 2018, during the Human Resources for Health (HRH) Program, an education partnership between the Rwanda Ministry of Health and a consortium of US universities.

Methods: A retrospective descriptive analysis of the I-ITE exam scores, taken by all Rwandan pediatric residents for five of the six academic years of the study period. Individual resident scores were weighted using the non-Rwandan I-ITE sites to minimise confounding from annual variations in exam difficulty. Statistical analysis included descriptives with ANOVA to compare variation in annual mean scores.

Results: Eighty-four residents took 213 I-ITE exam sittings over the five exam cycles. The mean weighted I-ITE score of all residents increased from 34% in 2013 to 49% (p < 0.001) in 2018. The 32-point gap between the mean US-ITE and Rwandan I-ITE score in 2012-2013 was reduced to a 16-point gap in 2017-2018. First year resident (PG1) scores, which likely reflect the knowledge level of undergraduate medical students entering the residency program, increased from 34.8 to 44.3% (p = 0.002) between 2013 and 2018.

Conclusions: The I-ITE is an independent, robust tool, measuring both learners and the institutional factors supporting residents. This is the first study to demonstrate that the I-ITE can be used to monitor resident knowledge acquisition in resource-limited settings, where assessment of resident knowledge can be a major challenge facing the academic medicine community. The significant increase in I-ITE scores between 2012 and 18 reflects the substantial curricular reorganisation accomplished through collaboration between Rwandan and US embedded faculty and supports the theory that programs such as HRH are highly effective at improving the quality of residency programs and undergraduate medical education.

Keywords: Education, medical; Formative feedback; Global Health; In-training examination; Internship and residency; Rwanda.

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Conflict of interest statement

We declare no competing interest: One author (CO) is an unpaid member of the ABP Global Health taskforce. All authors are members of the HRH program and Rwandan academic staff of the University of Rwanda.

Figures

Fig. 1
Fig. 1
Annual variation in US-ITE, Non-Rwandan International-ITE and Rwandan Mean I-ITE scores. p-values represent ANOVA within category
Fig. 2
Fig. 2
Box-plot of weighted Rwandan scores by level of PG training. Box-plot represents: Medians, interquartile ranges, min and max scores. *There were no PG4 residents in the program in 2012-13 due to no recruitment of residents
See this image and copyright information in PMC

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References

    1. Cartledge P, Wachira J, Fagan C. Paediatric associations and postgraduate training programmes in Africa. Arch Dis Child. 2013;98:745–746. doi: 10.1136/archdischild-2013-304002. - DOI - PubMed
    1. Freed GL, Dunham KM, Switalski KE, Jones MD, McGuinness GA. Recently trained general pediatricians: perspectives on residency training and scope of practice. Pediatrics. 2009;123:S38–S43. doi: 10.1542/peds.2008-1578J. - DOI - PubMed
    1. Burg FD, Wright FH. Evaluation of pediatric residents and their training programs. J Pediatr. 1972;80:183–189. doi: 10.1016/S0022-3476(72)80576-6. - DOI - PubMed
    1. The American Board of Pediatrics . Am. Board. Pediatr. 2018. General pediatrics in-training examination.
    1. Du Y, Furter RT, Tan RJB, Althouse LA. In-training examinations: All about predictive validity and meaningful feedback. Paper presented at: American Educational Research Association Meeting 2016 Annual Conference; Washington, DC.

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