Design and implementation of an academic enrichment program to improve performance on the internal medicine in-training exam

The internal medicine In-Training Exam (ITE) is administered at residency training programs to assess medical knowledge. Our internal medicine residency program witnessed a performance decline on the ITE between 2011 and 2014. The goal of this quality improvement project was to improve medical knowledge among residents as measured by an improvement in performance on the ITE, through the design and implementation of an Academic Enrichment Program (AEP). The AEP was designed in 2014–2015, and entailed a multipronged approach, including strengthening and tailoring of the didactic curriculum, establishment of a minimum conference attendance rate, and adoption of the New England Journal of Medicine Knowledge-Plus Internal Medicine Board Review platform. Residents performing below a pre-specified percentile rank cutoff on the previous year’s ITE in any of the 12 content areas were required to complete a pre-specified percentage of the question bank in that specific topic. We examined a total of 164 residents enrolled in our program under the categorical training track. The mean (± SEM) ITE percentile for the 12 content areas increased significantly from calendar years 2011–2014 to 2015–2018, reflecting implementation of the AEP (p < 0.001). In brief, compared to the AEP-unexposed graduating classes of residents, the AEP-exposed graduating classes of residents displayed a significant improvement in the mean ITE percentile rank. This quality improvement project was carried out at a single institution. The implementation of a structured academic enrichment program significantly improves performance on the ITE.