Association of Gender and Race/Ethnicity with Internal Medicine In-Training Examination Performance in Graduate Medical Education.

Disparities in objective assessments in graduate medical education such as the In-Training Examination (ITE) that disadvantage women and those self-identifying with race/ethnicities underrepresented in medicine (URiM) are of concern. Examine ITE trends longitudinally across post-graduate year (PGY) with gender and race/ethnicity. Longitudinal analysis of resident ITE metrics at 7 internal medicine residency programs, 2014-2019. ITE trends across PGY of women and URiM residents compared to non-URiM men assessed via ANOVA. Those with ITE scores associated with less than 90% probability of passing the American Board of Internal Medicine certification exam (ABIM-CE) were identified and odds of being identified as at-risk between groups were assessed with chi square. A total of 689 IM residents, including 330 women and URiM residents (48%). ITE score KEY RESULTS: There was a significant difference in ITE score across PGY for women and URiM residents compared to non-URiM men (F(2, 1321) 4.46, p=0.011). Adjusting for program, calendar year, and baseline ITE, women and URiM residents had smaller ITE score gains (adjusted mean change in score between PGY1 and PGY3 (se), non-URiM men 13.1 (0.25) vs women and URiM residents 11.4 (0.28), p<0.001). Women and URiM residents had greater odds of being at potential risk for not passing the ABIM-CE (OR 1.75, 95% CI 1.10 to 2.78) with greatest odds in PGY3 (OR 3.13, 95% CI 1.54 to 6.37). Differences in ITE over training were associated with resident gender and race/ethnicity. Women and URiM residents had smaller ITE score gains across PGY translating into greater odds of potentially being seen as at-risk for not passing the ABIM-CE. Differences in ITE over training may reflect differences in experiences of women and URiM residents during training and may lead to further disparities.

Klein R ，Koch J ，Snyder ED ，Volerman A ，Simon W ，Jassal SK ，Cosco D ，Cioletti A ，Ufere NN ，Burnett-Bowie SM ，Palamara K ，Schaeffer S ，Julian KA ，Thompson V ... -  《-》

Do USMLE steps, and ITE score predict the American Board of Internal Medicine Certifying Exam results?

Rayamajhi S ，Dhakal P ，Wang L ，Rai MP ，Shrotriya S ... -  《BMC Medical Education》

Correlations Between the USMLE Step Examinations, American College of Physicians In-Training Examination, and ABIM Internal Medicine Certification Examination.

McDonald FS ，Jurich D ，Duhigg LM ，Paniagua M ，Chick D ，Wells M ，Williams A ，Alguire P ... -  《-》

Association Between Resident Race and Ethnicity and Clinical Performance Assessment Scores in Graduate Medical Education.

To assess the association between internal medicine (IM) residents' race/ethnicity and clinical performance assessments. The authors conducted a cross-sectional analysis of clinical performance assessment scores at 6 U.S. IM residency programs from 2016 to 2017. Residents underrepresented in medicine (URiM) were identified using self-reported race/ethnicity. Standardized scores were calculated for Accreditation Council for Graduate Medical Education core competencies. Cross-classified mixed-effects regression assessed the association between race/ethnicity and competency scores, adjusting for rotation time of year and setting; resident gender, postgraduate year, and IM In-Training Examination percentile rank; and faculty gender, rank, and specialty. Data included 3,600 evaluations by 605 faculty of 703 residents, including 94 (13.4%) URiM residents. Resident race/ethnicity was associated with competency scores, with lower scores for URiM residents (difference in adjusted standardized scores between URiM and non-URiM residents, mean [standard error]) in medical knowledge (-0.123 [0.05], P = .021), systems-based practice (-0.179 [0.05], P = .005), practice-based learning and improvement (-0.112 [0.05], P = .032), professionalism (-0.116 [0.06], P = .036), and interpersonal and communication skills (-0.113 [0.06], P = .044). Translating this to a 1 to 5 scale in 0.5 increments, URiM resident ratings were 0.07 to 0.12 points lower than non-URiM resident ratings in these 5 competencies. The interaction with faculty gender was notable in professionalism (difference between URiM and non-URiM for men faculty -0.199 [0.06] vs women faculty -0.014 [0.07], P = .01) with men more than women faculty rating URiM residents lower than non-URiM residents. Using the 1 to 5 scale, men faculty rated URiM residents 0.13 points lower than non-URiM residents in professionalism. Resident race/ethnicity was associated with assessment scores to the disadvantage of URiM residents. This may reflect bias in faculty assessment, effects of a noninclusive learning environment, or structural inequities in assessment.

Klein R ，Ufere NN ，Schaeffer S ，Julian KA ，Rao SR ，Koch J ，Volerman A ，Snyder ED ，Thompson V ，Ganguli I ，Burnett-Bowie SM ，Palamara K ... -  《-》

Racial and Ethnic Differences in Internal Medicine Residency Assessments.

Boatright D ，Anderson N ，Kim JG ，Holmboe ES ，McDade WA ，Fancher T ，Gross CP ，Chaudhry S ，Nguyen M ，Nguemeni Tiako MJ ，Colson E ，Xu Y ，Li F ，Dziura JD ，Saha S ... -  《JAMA Network Open》