In-training examination and the general pediatric certification examination: Are there lessons?

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Althouse and McGuinness present and analyze performance of several cohorts of pediatric residents at various training levels (PL-1 through PL-3) on the in-training examination (ITE) and the subsequent general pediatric (GP) certifying examination. Not unexpectedly, performance on one predicts performance on other ITEs and the GP certifying examination, even though substantial variance in scores is not accounted for. Although program directors have seen performance data for years and use the ITE as a tool for counseling, it is useful for the general academic community to think about some educational issues as the American Board of Pediatrics engages stakeholders broadly in reassessing the design of residency education in pediatrics. One noteworthy finding of this study is that knowledge (as assessed by this single, imperfect tool) surged through the PL-1 year and again through the PL-3 year, with only middling gains through the PL-2 year. Wasted year? Wrong testing tool for actual skills gained? Additional gains as a result of supervising and teaching as a PL-3 resident? Circumstantial to PL-1s just having to improve beyond their medical student knowledge base, and PL-3s recognition that they just have to study for the certifying examination? Go figure—really.

We are challenged by 360° questions of how a pediatrician should operate to optimize the healthcare of children, what knowledge, skills, and tools a pediatrician needs to do so, and how board certification and maintenance of certification assure the public that doctors have such competencies. Any measurements, such as those provided by Althouse and McGuinness, cannot help but enlighten the circle.