Relationship of residency program characteristics with pass rate of the American Board of Internal Medicine certifying exam

Figures & data

Table 1 Regional locations of internal medicine programs

		Number of programs with pass rate
Regional location	State	All	≥1 characteristics other than location
Mid Atlantic	New Jersey, New York, Pennsylvania	95	73
East North Central	Illinois, Indiana, Michigan, Ohio, Wisconsin	67	55
South Atlantic	Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia	53	42
Pacific	California, Hawaii, Oregon, Washington	38	25
New England	Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont	35	33
West South Central	Arkansas, Louisiana, Oklahoma, Texas	28	25
West North Central	Iowa, Kansas, Minnesota, Missouri Nebraska, North Dakota, South Dakota	19	19
East South Central	Alabama, Kentucky, Mississippi, Tennessee	15	13
Mountain	Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah	13	10
Territory	Puerto Rico	8	0
Total		405	371

Table 2 ABIM pass rate and regional location of residency program

Regional location	Number of programs	Mean±SD	p
Mid Atlantic	95	87.05±8.20	0.107
East North Central	67	84.61±10.73	0.325
South Atlantic	53	85.83±7.95	0.884
Pacific	38	85.81±9.04	0.914
New England	35	86.63±10.02	0.523
West South Central	28	85.44±8.03	0.905
West North Central	19	87.13±8.20	0.487
East South Central	15	83.16±9.81	0.302
Mountain	13	88.51±6.72	0.271
Territory	8	69.22±21.39	<0.001
All locations	371	85.65±9.51

ABIM=American Board of Internal Medicine.

Table 3 Baseline characteristics of residency programs

Program characteristics	Obs.	Mean±SD or number (%)
Pass rate of ABIM certifying exam	295	85.81±9.02
General information
Program size	295	21.03±12.44
Program type
University-based	295	106 (35.93)
Community based university affiliated hospital	295	156 (52.88)
Community-based	295	32 (10.85)
Military-based	295	1 (0.34)
Offers preliminary positions	295	202 (68.47)
Minimum score of USMLE Step 1 for interview consideration	243	206.3±11.27
Minimum score of USMLE Step 2 for interview consideration	181	209.01±10.97
Faculty and trainee information
Full-time paid female physician faculty (%)	292	32.98±13.87
Ratio of full-time equivalent paid faculty to positions	295	1.36±1.17
US medical graduate (%)	229	40.69±34.04
International medical graduate (%)	229	49.68±34.98
Doctor of osteopathic (%)	229	9.38±11.28
Female (%)	229	43.9±8.57
Work schedule information
Average hours/week on duty^a,b	295	61.97±6.35
Maximum consecutive hours on duty^a,b	295	16.37±3.33
Average number of 24-h off duty periods per week^b	295	1.28±0.27
Program allows moonlighting^c	295	213 (72.2)
Night float system (in or beyond first year)	295	279 (94.58)
Offers awareness and management of fatigue in residents	295	295 (100)
Educational environment
Average hours/week of regularly scheduled lectures/conferences^b	295	8.01±2.36
Training at hospital outpatient clinics^b	281	0.24±0.11
Training in ambulatory non-hospital community-based settings^b	220	0.11±0.09
Educational benefits
Physician impairment prevention curriculum	295	266 (90.17)
Integrative medicine curriculum	295	55 (18.64)
Debt management/financial counseling	295	226 (76.61)
Formal program to develop teaching skills	295	283 (95.93)
Formal mentoring program	295	277 (93.9)
Formal program to foster interdisciplinary teamwork	295	225 (76.27)
Continuous quality improvement training	295	294 (99.66)
International experience	295	152 (51.53)
Resident retreats	295	240 (81.36)
Off-campus electives	295	267 (90.51)
Hospice/home care experience	295	270 (91.53)
Cultural competence awareness	295	287 (97.29)
Instruction in medical Spanish or other non-English language	295	69 (23.39)
Alternative/complementary medicine curriculum	295	139 (47.12)
Economics of health-care systems curriculum	295	202 (68.47)
MPH/MBA or PhD training	295	50 (16.95)
Required research rotation	274	47 (17.15)
Educational features
Offers additional training beyond accredited length	295	26 (8.81)
Offers a primary care track	295	113 (38.31)
Offers a rural track	295	2 (0.68)
Offers a women's health track	295	13 (4.41)
Offers a hospitalist track	295	49 (16.61)
Offers a research track/non-accredited fellowship	295	49 (16.61)
Offers another track	295	55 (18.64)
Resident evaluation
Yearly specialty in-service examination required	295	295 (100)
Patient surveys	295	283 (95.93)
Portfolio system	295	246 (83.39)
360 degree evaluations	295	294 (99.66)
Objective structured clinical examinations (OSCE)	295	199 (67.46)
Program evaluation
Program graduation rates	295	284 (96.27)
Resident assessment of curriculum	295	255 (86.44)
In-training examination scores	295	294 (99.66)
Performance-based assessment scores	295	245 (83.05)
Employment policies and benefits
Part-time/shared positions	295	17 (5.76)
On-site child care	295	101 (34.24)
Subsidized child care	295	27 (9.15)
Allowance/stipend for professional expenses	295	285 (96.61)
Leave for educational meetings/conferences	295	246 (83.39)
Moving allowance	295	47 (15.93)
Housing stipend	295	22 (7.46)
On-call meal allowance	295	284 (96.27)
Free parking	295	220 (74.58)
PDAs	295	103 (34.92)
Placement assistance upon completion of program	295	176 (59.66)
Cross coverage in case of illness/disability	295	294 (99.66)
Policy prohibits hiring smokers/users of nicotine products	295	32 (10.85)
Compensation and leave
Salary compensation^b (USD)	285	51909.81±3914.27
Vacation days^b	295	18.13±3.99

^aExcluding beeper call; ^bduring first year; ^cbeyond first year; Obs.=observation.

Table 4 Results of the univariate linear regression analysis between the pass rate and program characteristics

Program characteristics	Coefficient (standard error)	p
General information
Program size	0.1348 (0.0416)	0.001*
Program type
University-based	2.2413 (1.0889)	0.040*
Community based university affiliated hospital	−1.7193 (1.0494)	0.102
Community-based	−0.3514 (1.6920)	0.836
Military-based	−15.8615 (9.0058)	0.079
Offers preliminary positions	−2.2305 (1.1250)	0.048*
Minimum score of USMLE Step 1 for interview consideration	0.0080 (0.0521)	0.879
Minimum score of USMLE Step 2 for interview consideration	0.0287 (0.0651)	0.660
Faculty and trainee information
Full-time paid female physician faculty (%)	−0.0069 (0.0380)	0.855
Ratio of full-time equivalent paid faculty to positions	0.8977 (0.4466)	0.045*
U.S. medical graduate (%)	0.0333 (0.0173)	0.056
International medical graduate (%)	−0.0166 (0.0170)	0.329
Doctor of osteopathic (%)	−0.1356 (0.0519)	0.010*
Female (%)	0.1045 (0.0691)	0.132
Work schedule information
Average hours/week on duty^a,b	0.1127 (0.0827)	0.174
Maximum consecutive hours on duty^a,b	0.0492 (0.1581)	0.756
Average number of 24-h off duty periods per week^b	−0.2992 (1.9767)	0.880
Program allows moonlighting^c	0.2288 (1.1745)	0.846
Night float system (in or beyond first year)	−3.9024 (2.3122)	0.093
Offers awareness and management of fatigue in residents	0 (N/A)	N/A
Educational environment
Average hours/week of regularly scheduled lectures/conferences^b	0.2111 (0.2229)	0.344
Training at hospital outpatient clinics^b	1.2489 (4.9136)	0.800
Training in ambulatory non-hospital community-based settings^b	−1.9703 (6.6846)	0.768
Educational benefits
Physician impairment prevention curriculum	−0.6246 (1.7670)	0.724
Integrative medicine curriculum	0.1754 (1.3511)	0.897
Debt management/financial counseling	−0.1174 (1.2431)	0.925
Formal program to develop teaching skills	2.6572 (2.6592)	0.318
Formal mentoring program	5.0446 (2.1785)	0.021*
Formal program to foster interdisciplinary teamwork	1.4558 (1.2340)	0.239
Continuous quality improvement training	−10.6570 (9.0319)	0.239
International experience	1.7695 (1.0478)	0.092
Resident retreats	−1.1893 (1.3493)	0.379
Off-campus electives	0.3391 (1.7952)	0.850
Hospice/home care experience	2.3139 (1.8846)	0.221
Cultural competence awareness	2.0633 (3.2374)	0.524
Instruction in medical Spanish or other non-English language	2.1183 (1.2369)	0.088
Alternative/complementary medicine curriculum	1.0675 (1.0523)	0.311
Economics of health-care system curriculum	1.6189 (1.1286)	0.153
MPH/MBA or PhD training	1.6615 (1.3992)	0.236
Required research rotation	1.7339 (1.4468)	0.232
Educational features
Offers additional training beyond accredited length	2.6965 (1.8495)	0.146
Offers a primary care track	1.0512 (1.0807)	0.331
Offers a rural track	−2.5422 (6.4108)	0.692
Offers a women's health track	0.0893 (2.5638)	0.972
Offers a hospitalist track	−2.6849 (1.4052)	0.057
Offers a research track/non-accredited fellowship	2.5240 (1.4062)	0.074
Offers another track	1.2318 (1.3492)	0.362
Resident evaluation
Yearly specialty in-service examination required	0 (N/A)	N/A
Patient surveys	0.8295 (2.6633)	0.756
Portfolio system	0.0578 (1.4139)	0.967
360 degree evaluations	−8.8168 (9.0386)	0.330
Objective structured clinical examinations (OSCE)	−1.4211 (1.1200)	0.206
Program evaluation
Program graduation rates	3.5523 (2.7696)	0.201
Resident assessment of curriculum	−1.4542 (1.5347)	0.344
In-training examination scores
Performance-based assessment scores	−1.2818 (1.4005)	0.361
Employment policies and benefits
Part-time/shared positions	4.0813 (2.2454)	0.070
On-site child care	3.2413 (1.0927)	0.003*
Subsidized child care	1.2915 (1.8233)	0.479
Allowance/stipend for professional expenses	−1.2586 (1.6905)	0.457
Leave for educational meetings/conferences	−0.7218 (1.4133)	0.610
Moving allowance	−2.0531 (1.4328)	0.153
Housing stipend	2.8371 (1.9962)	0.156
On-call meal allowance	4.3438 (2.7657)	0.117
Free parking	−0.8020 (1.2076)	0.507
PDAs	−1.7615 (1.0990)	0.110
Placement assistance upon completion of program	0.2196 (1.0726)	0.838
Cross coverage in case of illness/disability	−5.1188 (9.0484)	0.572
Policy prohibits hiring smokers/users of nicotine products	−1.2586 (1.6905)	0.457
Compensation and leave
Salary compensation^b (USD)	0.0002 (0.0001)	0.139
Vacation days^b	−0.1012 (0.1321)	0.444

^aExcluding beeper call; ^bduring first year; ^cbeyond first year; N/A, not applicable.

*p<0.05.

Table 5 Multivariate linear regression of the ABIM pass rate and significantly associated program characteristics

Program characteristics	Coefficient (standard error)	p
Ratio of full-time equivalent paid faculty to positions	1.2541 (0.5131)	0.015
Doctor of osteopathic (%)	−0.1468 (0.0501)	0.004
Formal mentoring program	5.6318 (2.3543)	0.018
On-site child care	2.8760 (1.2079)	0.018
Constant	78.9831 (2.3967)	<0.001

ABIM=American Board of Internal Medicine; adjusted R ² of the model is 0.0961.