Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Impact of Subspecialty Elective Exposures on Outcomes on the American Board of Internal Medicine Certification Examination.

Tsagaris1,  Katina C., Schilling1,  Amber, Wang2,  Hong, Desale2,  Sameer, Adams1,  Michael, Shanmugam1,  Victoria K.

Georgetown University Hospital, Washington, DC
MedStar Research Institute, Washington, DC


Medical knowledge is an Accreditation Council for Graduate Medical Education (ACGME) core competency, which can be measured by scores on the American Board of Internal Medicine Certification Examination (ABIM-CE). While formalized elective curricula are known to improve subspecialty scores on the ABIM-CE, no studies have evaluated the impact of individual subspecialty elective exposures on resident medical knowledge as measured by the ABIM-CE.This study was designed to evaluate whether exposures to particular subspecialty electives impact ABIM-CE scores.


This was a retrospective study of ABIM-CE scores and elective exposures from residents enrolled in the Georgetown University Hospital internal medicine residency program between 2002 and 2010. Total and subspecialty scores (percentage of items correct) on the ABIM-CE were compared to subspecialty elective exposures.


For graduation years 2005 to 2013, 307 categorical residents were enrolled in the Georgetown Internal Medicine residency. Of these, 4 did not complete the residency, 29 were combined internal medicine-pediatrics residents, 144 did not have paired elective and ABIM-CE data and 18 withheld their ABIM-CE scores. Concurrent ABIM-CE scores and elective exposures were available for 111 residents. There were no significant differences in age, gender, or location of medical school between annual cohorts and none of these factors correlated with ABIM-CE scores. Rheumatology elective exposure was correlated with higher ABIM-CE score (77.79 +/- 0.76 compared to 79.96 +/- 0.78, p=0.048, table 1) whereas, none of the other subspecialty elective exposures had an association with ABIM-CE scores. There were no significant associations between elective exposures and total or subspecialty scores for any of the other subspecialties. ANOVA analysis comparing ABIM-CE scores in subjects with 0, 1 and more than 1 elective exposure in each subspecialty did not show a significant association between repeated elective exposures and improved performance on the ABIM-CE based either on the total percentage correct or the subspecialty percentage correct.

Table 1.: ABIM-CE total and subspecialty scores based on percent correct based on elective exposure. (p values are based on unpaired t-test)

No Elective ExposureElective Exposurep valueNo Elective ExposureElective Exposurep value 
RHEUMATOLOGY77.79+/-0.76 (n=57)79.96+/-0.78 (n=54)0.04878.82+/-1.4 (n=57)82.46+/-1.3 (n=54)0.06
INFECTIOUS DISEASES77.17+/-1.25 (n=23)79.28+/-0.6 (n=88)0.1278.87+/-2.59 (n=23)81.90+/-0.95 (n=88)0.19
NEPHROLOGY78.42+/-0.88 (n=45)79/.14+/-0.71 (n=66)0.5382.29+/-1.8 (n=45)85.53+/-1.5 (n=66)0.17
GASTROENTEROLOGY78,7+/-0.79 (n=46)78.95+/-0.76 (n=65)0.8277.41+/-1.59 (n=45)79.48+/-1.28 (n=65)0.31
PULMONARY78.19+/-1.20 (n=31)79.10+/-0.61 (n=80)0.4677.13+/-1.73 (n=31)79.00+/-1.22 (n=80)0.41
CARDIOLOGY78.67+/-0.97 (n=36)78.93+/-0.67 (n=75)0.8278.64+/-1.35 (n=36)81.35+/-1.17 (n=75)0.16
HEMATOLOGY78.73+/-0.77 (n=60)78.98+/-0.78 (n=51)0.8282.08+/-1.7 (n=60)80.16+/-1.81 (n=51)0.44
ENDOCRINOLOGY78.97+/-0.76 (n=39)78.78+/-0.75 (n=72)0.8677.62+/-1.8 (n=39)79.07+/-1.3 (n=72)0.51


This study identified a small but significant association between exposure to the rheumatology elective and score on the ABIM-CE. Repeated elective exposures in a single specialty were not associated with improved ABIM scores. Residents should consider these findings when they are making elective selections.

To cite this abstract, please use the following information:
Tsagaris, Katina C., Schilling, Amber, Wang, Hong, Desale, Sameer, Adams, Michael, Shanmugam, Victoria K.; Impact of Subspecialty Elective Exposures on Outcomes on the American Board of Internal Medicine Certification Examination. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :96

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