Resident factors associated with American board of internal medicine certification exam failure

Figures & data

Table 1. ACGME Work Hour Requirements.

‘Pre-2003 Requirements’ included all of the following: Limit of 80 hours of work per week, when averaged over four weeks^[23] Minimum of one day in seven free from scheduled activities, averaged over four weeks^[23] Maximum frequency of in-house call of once every three nights, averaged over four weeks^[23] “2003–2011 Requirements” included all of the following: All three “pre-2003 requirements”^[23] Adequate rest period, ideally a minimum of 10 hours, between duty periods^[23] Limit of 24 hours of continuous duty, with up to 6 added hours for education and continuity of care^[23] Option to request an increase of up to 8 hours to the weekly duty hour limit, if certain criteria met^[24] “Post-2011 Requirements” included all of the following: All three “pre-2003 requirements”^[24] Minimum of 8 hours time off between scheduled duty periods, with very limited exceptions^[24] Limit of 24 hours of continuous duty (16 hours for first-year residents), with up to 4 added hours for continuity of care, with very limited exceptions^[24] 6 nights maximum of consecutive in-house night float duty^[24] Option to request an increase of up to 8 hours to the weekly duty hour limit, if certain criteria met^[24]

Table 2. Characteristics by result of first attempt at board exam^a.

	Board exam pass
Characteristic	No (n = 14)	Yes (n = 152)	P value
Age at start of residency, y	29.0 (28–31.8)	27.0 (26–29)(n = 151)	.01
Time between medical school graduation and residency graduation, y	3.0 (3–3)	3.0 (3–3)	.88
Distance of home address from program address, miles	13.7 (13.0–19.4)(n = 13)	13.8 (8.7–19.8)(n = 150)	.66
Gender = Woman	6 (42.9)	78 (51.3)	.59
MD (vs DO, MBBS, MB, BCh)	13 (92.9)	148 (97.4)	.36
Chief resident year	2 (14.3)	31 (20.4)	.74
Pursued subspecialty practice after graduation	11 (78.6)	88 (57.9)	.16
Alpha Omega Alpha Membership	0 (0.0)	29 (19.1)	.13
Marital status, single	6 (42.9)	67 (44.1)	>.99
Parented during residency	3 (21.4)	46 (30.3)	.76
Gave birth during residency	1 (7.1)	18 (11.8)	>.99
Institutional rotation during medical school	3 (21.4)	25 (16.4)	.71
Graduated from medical school outside USA	0 (0.0)	16 (10.5)	.37
Gap between medical school graduation and starting residency	2 (14.3)	22 (14.5)	>.99
Work hours			.46
2003–2011	9 (64.3)	76 (50.0)
Post-2011	3 (21.4)	30 (19.7)
Pre-2003	2 (14.3)	46 (30.3)
Additional graduate or professional degree	1 (25.0)(n = 4)	12 (27.3)(n = 44)	>.99
Primary language other than English	1 (7.1)	12 (7.9)	>.99

Abbreviations: DO, doctor of osteopathic medicine; MB, BCh, bachelor of medicine, bachelor of surgery; MBBS, bachelor of medicine, bachelor of surgery; MD, doctor of medicine.

^aValues are median (interquartile range) or No. of residents (%).

Table 3. In-Residency scholastic factors by result of first attempt at board exam.

	Board exam pass^a
Factor	No (n = 14)	Yes (n = 152)	P value
Area of program director concern present during residency	3 (21.4)	15 (9.9)	.18
Off-cycle residency graduation date	2 (14.3)	4 (2.6)	.08
Published article in residency	10 (71.4)	99 (65.1)	.77
Published abstract in residency	13 (92.9)	139 (96.5)(n = 144)	.43
Attended board review course	10 (90.9)(n = 11)	81 (85.3)(n = 95)	>.99
IM-ITE percentile rank
PGY1	36.0 (28.0–43.5)(n = 10)	63.0 (47.0–82.0)(n = 133)	<.001
PGY2	32.0 (11.0–39.0)(n = 13)	71.0 (52.2–85.0)(n = 142)	<.001
PGY3	24.5 (12.0–58.8)	69.0 (50.0–85.0)(n = 148)	<.001
USMLE score
Step 1	206.0 (204–218)(n = 13)	222.0 (208.5–232)(n = 151)	.02
Step 2 CK	210.0 (193.5–225)(n = 11)	230.0 (216.5–244)(n = 147)	.01
Step 3	200.0 (198–212)(n = 11)	221.0 (211–233)(n = 139)	<.001

Abbreviations: CK, Clinical Knowledge; IM-ITE, Internal Medicine In-Training Examination; PGY, postgraduate year; USMLE, USA Medical Licensing Examination.

^aValues are median (interquartile range) or No. of residents (%).

Table 4. Correlation Between Residents’ Test Scores and Age at the Start of Residency.

Variable	Estimate (95% CI)	Statistic	P value
IM-ITE percentile rank
PGY1	–0.07 (–0.23 to 0.09)	–0.85	.39
PGY2	–0.19 (–0.34 to – 0.04)	–2.42	.02
PGY3	–0.22 (–0.36 to – 0.07)	–2.87	.005
USMLE score
Step 1	–0.15 (–0.30 to 0.00)	–1.94	.06
Step 2 CK	–0.15 (–0.30 to 0.01)	–1.91	.06
Step 3	–0.18 (–0.33 to – 0.02)	–2.22	.03

Abbreviations: CK, Clinical Knowledge; IM-ITE, Internal Medicine In-Training Examination; PGY, postgraduate year; USMLE, USA Medical Licensing Examination.

Philibert I, Taradejna C. A brief history of duty hours and resident education. In: Philibert I, Amis S, editors. The ACGME 2011 duty hour standard: enhancing quality of care, supervision, and resident professional development. Chicago IL: Accreditation Council for Graduate Medical Education (ACGME); 2011. p. 5–9 https://www.acgme.org/globalassets/pdfs/jgme-monograph1.pdf. Retrieved 28 July 2022.

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Riebschleger M, Nasca TJ. New duty hour limits: discussion and justification. In: Philibert I, Amis S, editors. The ACGME 2011 duty hour standards: enhancing quality of care, supervision, and resident professional development. Chicago, IL: Accreditation Council for Graduate Medical Education; 2011. p. 29–35 https://www.acgme.org/globalassets/pdfs/jgme-monograph1.pdf. Retrieved 28 July 2022.

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