Background: A crowning step upon graduation from internal medicine (IM) residency training is the successful completion of the American Board of Internal Medicine (ABIM) licensing exam. ABIM Initial Certification Exam pass rates declined significantly during the COVID-19 pandemic from the preceding 4-year rolling test rate for first-time takers. Graduates of our IM residency training program suffered a similar albeit slight decrease in passing scores. We identified two potential causal factors for the increased failure rate: decreased focus on exam preparation and trainees requiring additional, customized support. In response, we implemented a monitoring and skills coaching program to identify and support at-risk residents preparing for the Internal Medicine boards.
Purpose: We designed the Learning Augmentation Plan (LAP) for IM residents at risk for failure on the ABIM Certification Exam in a large, urban, multihospital, single institution training program. Residents were identified as at-risk by the following LAP criteria: USMLE Step 1 score < 220, any In-Training Exam (ITE) score < 25th percentile, direct referral by residency program leadership or clinical competency committee (CCC), or self-referral. Residents enrolled in LAP received: 1) a faculty-led diagnostic session using a self-regulated learning microanalytic assessment, 2) an information session about best practices to utilize an existing question bank (NEJM Knowledge+, institutional subscription) with assignments based on ABIM learning objectives, 3) a prescription of an individualized learning plan, 4) review of NEJM Knowledge+ progress reports. LAP participants were coached and followed longitudinally throughout the duration of residency and following graduation until successfully passing the ABIM boards.
Description: The Learning Augmentation Plan (LAP) was launched in the fall of 2021 for active categorical, primary care, and research track residents (approximately 158/year) in our IM residency training program. Since program launch, thirty-nine IM residents (~12% per year) have met enrollment for LAP and 38 participated (97% enrollment rate). Most residents met LAP criteria by ITE performance (32/39; 86%), either alone (46%) or with concomitant Step 1 data (40%). Six residents (15%) met criteria by Step 1 only. To date, 23 individuals enrolled in LAP have completed the diagnostic session and received an individualized learning plan with longitudinal follow-up. Ongoing program participation or completion by LAP enrollees is 100%. Narrative comments by LAP residents were overwhelmingly positive. Comparative analysis data including program evaluation, self-assessment, and future performance on Certification Exam and ITE retesting is incomplete. Initial analysis demonstrates a 75% (8/12) pass rate on the ABIM Initial Certification Exam for LAP participants who have taken the exam.
Conclusions: LAP was implemented by our program for physician trainees who struggle with clinical reasoning and are at risk ABIM Certification Exam failure. On a yearly basis, LAP criteria identified a substantial cohort of residents eligible for intervention in a large training program for Internal Medicine. The LAP program had high enrollment and participation rates for IM residents immersed in training. Analysis of the effectiveness of LAP is ongoing, and final outcomes from comprehensive data is incomplete. Findings from the initial analysis of LAP as an intervention for residents at high-risk for failure on the ABIM boards are promising.