Effective Strategies in Improving Internal Medicine In-Training Exam Performance - A Systematic Review

Background: IM-ITE is a self-evaluation instrument administered annually to provide residents and program leadership with a measure of the residents' knowledge compared with that of their peers nationwide. Many approaches have been used to improve the IM-ITE scores as a means of achieving a higher first-time board examination pass rate. While these interventions helped improve outcomes in target programs, it remains unclear whether one approach was superior to another and how different program demographics may have played a role in the outcome of the intervention. Objective: To identify the most effective methods used to improve IM-ITE scores in the literature. Methods: : We searched MEDLINE database on 12/4/2022, using the keywords: “internal medicine” AND “in-training exam” AND “performance”. Results: : A total of 35 articles were examined. Five articles met the inclusion criteria. Three of which were conducted in community-based residency programs. Two were conducted in university-based residency programs. None of these residency programs were new (established in the last 10 years) and all studies were carried out in a single institution. Interventions identified include creating a new curriculum, implementing a multiple choice-testing program, identifying learning styles associated with better IM-ITE performance, and transitioning to an academic half day (AHD) didactics structure. Conclusion: We identified a myriad of interventions that were successful at improving IM-ITE performance in their target cohorts to variable degrees. Interventions summarized in this review can be utilized by residency programs to improve IM-ITE performance among their residents and provide guidance to their faculty members in the process.