A Systematic Review of the Relationship Between In-Training Examination Scores and Specialty Board Examination Scores
Open accessAbstract
Background: In-training examinations (ITEs) are intended for low-stakes, formative assessment of residents' knowledge, but are increasingly used for high-stake purposes, such as to predict board examination failures. Objective: The aim of this review was to investigate the relationship between performance on ITEs and board examination performance across medical specialties. Methods: A search of the literature for studies assessing the strength of the relationship between ITE and board examination performance from January 2000 to March 2019 was completed. Results were categorized based on the type of statistical analysis used to determine the relationship between ITE performance and board examination performance. Results: Of 1407 articles initially identified, 89 articles underwent full-text review, and 32 articles were included in this review. There was a moderate-strong relationship between ITE and board examination performance, and ITE scores significantly predict board examination scores for the majority of studies. Performing well on an ITE predicts a passing outcome for the board examination, but there is less evidence that performing poorly on an ITE will result in failing the associated specialty board examination. Conclusions: There is a moderate to strong correlation between ITE performance and subsequent performance on board examinations. That the predictive value for passing the board examination is stronger than the predictive value for failing calls into question the “common wisdom” that ITE scores can be used to identify “at risk” residents. The graduate medical education community should continue to exercise caution and restraint in using ITE scores for moderate to high-stakes decisions.
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Average human performance on mARC-QA (66%) is comparable to typical accuracy on board examinations and in-training assessments.
“comparable to typical accuracy on board examinations and in-training assessments70”
From Limitations of large language models in clinical problem-solving arising from inflexible reasoning (2025) · cites this paper as [70]
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- Authors
- McCrary, H. C., Colbert-Getz, J. M., Poss, W. B., & Smith, B. K.
- Affiliations
- University of Utah (US)
- All authors are with the University of Utah School of Medicine.
- Corresponding author
- McCrary, Hilary C.
- Venue
- Journal of Graduate Medical Education
- Published
- 2020-12-29
- Volume
- 13
- Issue
- 1
- Pages
- 43-57
- ISSN
- 1949-8349 (ISSN-L)
- 1949-8357
- PMC
- PMC7901636
- OpenAlex
- W3130133331
- Cited by
- 31
- References
- 39
- Citations by year
- 2025: 9 · 2024: 10 · 2023: 6 · 2022: 5 · 2014: 1
- FWCI
- 0.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Graduate Medical Education (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Medical Education and Admissions
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- in-training examination, predictive validity, graduate medical education, high-stakes decision making
- MeSH terms
- Clinical Competence, Education, Medical, Graduate, Educational Measurement, Humans, Internship and Residency, Specialty Boards
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