Background/Purpose:

Elective choice during residency is influenced by future career goals and perceived knowledge gaps. There is limited literature directly comparing elective exposures to outcomes on the American Board of Internal Medicine Certification Exam (ABIM-CE). Developing structured curricula within an elective experience has been shown to enhance ABIM-CE performance (Shanmugam et al, BMC Med Edu, 2012). Studies have shown outcomes on the in-training exam, a surrogate marker for the ABIM-CE, can be improved with conference attendance and self-directed reading. Comfort with managing specialty specific conditions after elective completion has not been well studied. The major aim of this study was to determine if completion of a 2 week rheumatology rotation improved residents’ board preparedness and comfort with diagnosing and treating common rheumatologic diseases.

Methods:

Informed consent was obtained from all participating residents. The curriculum was based equally on inpatient and outpatient experiences, with formal didactics. A 10 question pre-test using knowledge based multiple choice questions on a variety of rheumatologic principles was given at the start of the rotation. At rotation completion, a different 10 question post-test was administered. Residents completed a pre and post rotation survey assessing to what degree the rotation enhanced their board preparedness and comfort with diagnosing and treating rheumatologic conditions. Comfort was measured on a 5-point Likert scale (1: not comfortable and 5: very comfortable). Paired samples t-tests were used for pre and post comparisons and bivariate correlations were evaluated using Spearman’s rho.

Results:

Twenty residents participated in the study. There was no significant difference between individual pre and post rotation question test scores (pre-test mean = 8.1±1.2, post-test mean = 7.7±1.2, p = 0.290). Interestingly, comfort with board preparedness significantly improved (pre-level mean = 2.3±1.2, post-level mean = 3.5±1.0, p<0.001), as did comfort with diagnosing (pre-level mean = 2.3±1.2, post-level mean = 3.5±1.0, p<0.001) and treating (pre-level mean = 2.0±0.9, post-level mean = 3.7±0.8, p<0.001) rheumatologic conditions (moving overall from “somewhat uncomfortable” to “comfortable” ranges). There was no correlation between composite test scores and comfort with board preparedness (p=0.280). There was also no correlation between composite test scores and amount of independent reading time on rheumatology specific topics (p=0.718).

Conclusion:

This study shows that completion of a rheumatology elective greatly increases resident comfort with diagnosing and treating common rheumatologic conditions. Interestingly, while there was no improvement in ABIM style test scores, residents felt much more comfortable with the ABIM-CE after the rotation. The differences between subjective and objective findings warrant further investigation into the relationship between comfort and knowledge acquisition. Additionally, whether ABIM style questions truly capture clinically relevant knowledge or whether residents are not appropriately gauging board preparedness should be explored.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-of-elective-completion-in-enhancing-board-preparedness-and-comfort-with-diagnosing-and-treating-rheumatologic-conditions-in-a-cohort-of-internal-medicine-residents-at-an-academic-medical/