PubMed · 5187649
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K Ono. 1968. [Qualifications for nursing].. https://pubmed.ncbi.nlm.nih.gov/5187649/
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Specific methods of mechanical ventilation management reduce mortality and lower health care costs. However, in the face of a predicted deficit of intensivists, it is unclear whether residency programs are training internists to provide effective care for patients who require mechanical ventilation. To evaluate these educational outcomes, we administered a validated 19-item case-based test and survey to resident physicians at 31 diverse U.S. internal medicine residency programs nationwide. Of 347 senior residents, 259 (75%) responded. The mean test score was 74% correct (SD, 14%; range, 37 to 100%). Important items representing evidence-based standards of critical care answered incorrectly were as follows: use of appropriate tidal volume in the acute respiratory distress syndrome (48% incorrect), identifying a patient ready for a weaning trial (38% incorrect), and recognizing indication for noninvasive ventilation (27% incorrect). Most accurately identified pneumothorax (86% correct) and increased intrathoracic positive end-expiratory pressure (93% correct). Better scores were associated with "closed" versus "open" intensive care unit organization (76 versus 71% correct, p = 0.001), resident perception of greater versus lesser ventilator knowledge (79 versus 71% correct, p = 0.001), and graduation from a U.S. versus international medical school (75 versus 69% correct, p = 0.033). Although overall training satisfaction correlated strongly with program use of learning objectives (r = 0.89, p < 0.0001), only 46% reported being satisfied with their mechanical ventilation training. We conclude that senior residents may not be gaining essential evidence-based knowledge needed to provide effective care for patients who require mechanical ventilation. Residency programs should emphasize evidence-based learning objectives to guide mechanical ventilation instruction.
BACKGROUND: The In-Training Examination in Internal Medicine (IM-ITE) has been offered annually to all trainees in U.S. medical residency programs since 1988. Its purpose is to provide residents and program directors with an objective assessment of each resident's personal performance on a written, multiple-choice examination and the performance of the residency program compared with that of its peers. OBJECTIVE: To analyze trends in the demographic characteristics and scores of examinees during the first 12 years of administration of this examination. DESIGN: Descriptive analysis over time. SETTING: U.S. residency programs in internal medicine, 1988-2000. PARTICIPANTS: Residents at all levels of training in categorical, primary care, and medicine-pediatrics programs in the United States and Canada. The number of examinees increased from 7500 in 1988 to almost 18 000 in 2000. MEASUREMENTS: After calibration of the scores for each examination, test results were compared and analyzed for selected cohorts of residents over 12 years. RESULTS: More than 80% of residents in medicine training programs participate in the IM-ITE, most on an annual basis throughout their period of training. Test performance improves at a predictable rate with each year of training. Since 1995, international medical school graduates have persistently outperformed graduates of U.S. medical schools. Test results were affected by the timing of the examination, the time that was available to complete the examination, and the actual time that residents spent in internal medicine training before each examination. CONCLUSIONS: The IM-ITE scores generally improve with year of training time spent in internal medicine training before the examination and time permitted to complete the examination. These observations provide evidence that the IM-ITE is a valid measure of knowledge acquired during internal medicine training.
BACKGROUND: Medical student performance evaluations have historically contained a significant subjective component. Multiple tools are used to assess fund of knowledge including subjective evaluation by faculty and residents as well as objective evaluations through standardized written and oral exams. We hypothesized that subjective evaluation of medical student knowledge would correlate with objective evaluation through written and oral exams. METHODS: Records of consecutive medical students assigned to the surgery clerkship from January 1999 and March 2001 were reviewed. The core surgical rotation consisted of two 4-week blocks on a private, county, or VA hospital service. Surgical knowledge was assessed subjectively by both faculty (FES) and senior residents (RES) using a 10-point scale with verbal anchors. Objective measures of student surgical knowledge included the National Board shelf exam (WE) and a semistructured oral exam (OE). Data are reported as mean +/- SEM. Spearman rank correlation coefficient (r) was used to assess relationships between groups (r > or = 0.5 --> positive correlation). RESULTS: A total of 354 students were evaluated. The mean FES was 7.8 +/- 0.05 (median = 7.75, range 4.75 to 9.75). The mean RES was 7.7 +/- 0.06 (median = 8.0, range 3.5 to 10.0). There was poor correlation between the subjective perception and objective measures of surgical knowledge (Table 1). Comparison of the FES and RES also showed poor correlation (r = 0.38). CONCLUSIONS: Subjective evaluation of surgical knowledge by faculty and residents correlates poorly with performance measured objectively. These results question whether subjective evaluation of surgical knowledge should be included as part of the evaluation process.