The ACC's In-Training Examination (ITE) has become an important part of fellowship training, accurately assessing fellow knowledge and giving invaluable feedback to training programs, according to a paper published March 23 in the Journal of the American College of Cardiology.

Jeffrey T. Kuvin, MD, FACC, chair of the ACC In-Training Examination, and co-authors describe the development of the examination, administered annually to fellows in training (FITs), and report the outcomes since the exam's inception in 2011. The paper also outlines future directions for the ITE examination.

The ACC, in collaboration with the National Board of Medical Examiners, developed the first standardized ITE for cardiovascular FITs in 2011. In addition to testing knowledge, the examination utilizes the newly developed ACC Curricular Milestones to provide specific, competency-based feedback to program directors and FITs. The ACC ITE has been administered more than 5,000 times since 2011. The ITE was given to 1,319 FITs in 127 cardiology fellowship training programs in the first examination year (2011); to 1,732 FITs in 165 programs in the second year (2012); and to 1,969 FITs in 194 programs in the third year (2013). All training programs that participated in the initial two examinations participated in the third examination.

There was consistency in the examination scores between the three training years, Kuvin writes, with first-year fellows scoring similarly upon each examination administration. Results also revealed an incremental and statistically significant increase in FIT scores as the trainees move through their training years, on the basis of total test performance and performance within the major content areas. Each time they take the examination, fellows with more advanced training scored higher. For example, second-year fellows in 2012 scored higher, on average, than first-year fellows did the year prior.

"The examination is robust in its ability to discern beginner knowledge compared with that of the advanced trainee," explains Kuvin. "This type of knowledge assessment is key to allowing the trainee to focus on specific topics that are underdeveloped, and perhaps, under-recognized. Providing FITs with timely feedback on knowledge deficits allows the development of remediation plans during training, instead of discovering these knowledge deficits years later."

In an accompanying editorial comment, Douglas E. Drachman, MD, FACC, director of cardiology and interventional cardiology fellowship programs at Massachusetts General Hospital, commends those who developed the examination and adds that its scope could reasonably expand in the future. Drachmann notes that there is opportunity for cardiovascular subspecialty programs, such as interventional cardiology, electrophysiology, and heart failure/transplantation, to develop their own subject-specific in-training examinations. The format of the examination may evolve, too, he writes.

"Multiple choice questions are effective for the assessment of medical knowledge and patient care. Other core competencies, including systems-based practice or practice-based learning and improvement, are less easily assessed through this format," he writes. Moving forward, future assessment formats, such as simulation or direct observation, may complement the ITE in these specific competency areas, he adds.

"The potential of this examination to guide the educational objectives for fellows, program directors and the greater cardiovascular society has just begun to be realized," Drachman concludes.

Keywords: Electrophysiology, Fellowships and Scholarships, Heart Failure, Patient Care

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