Internal medicine resident perspectives on scoring USMLE as pass/fail.

BACKGROUND: The scoring rubric on the USMLE Step 1 examination will be changing to pass/fail in January 2022. This study elicits internal medicine resident perspectives on USMLE pass/fail scoring at the national level. OBJECTIVE: To assess internal medicine resident opinions regarding USMLE pass/fail scoring and examine how variables such as gender, scores on USMLE 1 and 2, PGY status and type of medical school are associated with these results. METHODS: In the fall of 2019, the authors surveyed current internal medicine residents via an on-line tool distributed through their program directors. Respondents indicated their Step 1 and Step 2 Clinical Knowledge scores from five categorical ranges. Questions on medical school type, year of training year, and gender were included. The results were analyzed utilizing Pearson Chi-square testing and multivariable logistic regression. RESULTS: 4012 residents responded, reflecting 13% of internal medicine residents currently training in the USA. Fifty-five percent of respondents disagreed/strongly disagreed with pass/fail scoring and 34% agreed/strongly agreed. Group-based differences were significant for gender, PGY level, Step 1 score, and medical school type; a higher percentage of males, those training at the PGY1 level, and graduates of international medical schools (IMGs) disagreed with pass/fail reporting. In addition, high scorers on Step 1 were more likely to disagree with pass/fail reporting than low scoring residents. CONCLUSION: Our results suggest that a majority of internal medicine residents, currently training in the USA prefer that USMLE numerical scoring is retained and not changed to pass/fail.

AAIM Recommendations for the 2020-2021 Internal Medicine Residency Application Cycle in Response to the COVID-19 Pandemic.

This statement was released in June 2020 by the Alliance for Academic Internal Medicine to provide guidance for the 2020-2021 residency application cycle in light of the COVID-19 pandemic. While many of the recommendations are specific to this cycle, others, such as the Department Summary Letter of Evaluation, are meant to be an enduring change to the internal medicine residency application process. AAIM realizes that some schools may not yet have the tools or resources to implement the template fully this cycle and look toward collaboration within the internal medicine education community to facilitate adoption in the cycles to come.

A Faculty Development Program to Reduce Rater Error on Milestone-Based Assessments.

BACKGROUND: Rater errors, such as halo/reverse halo, range restriction, and leniency errors, are frequently cited as threats to the validity of resident assessment by faculty. OBJECTIVE: We studied whether participation in faculty development on the use of a new Milestone-based assessment tool reduced rater error for participants compared to individuals who did not participate. METHODS: We reviewed evaluations of resident Milestones completed by faculty at the end of rotations between July 2012 and June 2013. The 2 Milestones in each competency with the greatest number of ratings were selected for analysis. RESULTS: A total of 412 evaluations were analyzed, including 217 completed by faculty who participated in the development activity, and 240 completed by nonparticipant faculty. All evaluations that contained identical scores for all Milestones (16%) were completed by nonparticipant faculty (χ(2)  =  37.498, P < .001). Faculty who had participated in development assigned a wider range of scores and lower minimum scores to residents, and provided the highest ratings for residents less frequently (P < .001) than nonparticipants. CONCLUSIONS: Faculty who participated in education about the Milestones demonstrated significantly less halo, range restriction, and leniency errors than faculty members who did not participate. These findings support a recommendation to develop a cadre of "core faculty" by training them in the use of Milestone assessment tools, and making them responsible for a significant portion of resident assessments.

Arthritis in the intensive care unit.

Acute arthritis in critically ill patients may be caused by local or systemic infection, by a flare of chronic joint disease such as rheumatoid or crystal-associated arthritis, or by less common entities such as hemarthrosis. Diagnosis requires analysis of synovial fluid, and appropriate treatment is based on its findings. Prompt diagnosis and treatment are usually necessary to prevent the significant morbidity associated with these conditions.