The Decline in Family Medicine in-Training Examination Scores: What We Know and Why It Matters

Since the first Board examination in Ophthalmology in 1916, assessment of cognitive expertise has been foundational to Board Certification. Since then, there have been dramatic improvements in the methodology of high-stakes examinations, including psychometric techniques, the writing of questions, and differential item functioning analysis. In 1969, ABFM introduced the requirement of periodic recertification to the Board Certification Community, and subsequent research in the cognitive sciences has confirmed the importance of independent assessment of cognitive expertise across many fields. To support family medicine residencies, the ABFM conducts an in-training examination (ITE) every fall; as of 2008, the ITE uses the same psychometric scale as the certification examination, making the scores comparable to certification scores. With the aid of an easy to use, web-based app (https://rtm.theabfm.org/bayesian/predictor), residents and their residency directors can estimate their likelihood of passing the Board certification examination. In both of the past 2 years, this app has been accessed more than 200,000 times by more than 15,000 users.