Association of Gender and Race/Ethnicity with Internal Medicine In-Training Examination Performance in Graduate Medical Education

J Gen Intern Med. 2022 Jul;37(9):2194-2199. doi: 10.1007/s11606-022-07597-z. Epub 2022 Jun 16.


Background: Disparities in objective assessments in graduate medical education such as the In-Training Examination (ITE) that disadvantage women and those self-identifying with race/ethnicities underrepresented in medicine (URiM) are of concern.

Objective: Examine ITE trends longitudinally across post-graduate year (PGY) with gender and race/ethnicity.

Design: Longitudinal analysis of resident ITE metrics at 7 internal medicine residency programs, 2014-2019. ITE trends across PGY of women and URiM residents compared to non-URiM men assessed via ANOVA. Those with ITE scores associated with less than 90% probability of passing the American Board of Internal Medicine certification exam (ABIM-CE) were identified and odds of being identified as at-risk between groups were assessed with chi square.

Participants: A total of 689 IM residents, including 330 women and URiM residents (48%).

Main measures: ITE score KEY RESULTS: There was a significant difference in ITE score across PGY for women and URiM residents compared to non-URiM men (F(2, 1321) 4.46, p=0.011). Adjusting for program, calendar year, and baseline ITE, women and URiM residents had smaller ITE score gains (adjusted mean change in score between PGY1 and PGY3 (se), non-URiM men 13.1 (0.25) vs women and URiM residents 11.4 (0.28), p<0.001). Women and URiM residents had greater odds of being at potential risk for not passing the ABIM-CE (OR 1.75, 95% CI 1.10 to 2.78) with greatest odds in PGY3 (OR 3.13, 95% CI 1.54 to 6.37).

Conclusion: Differences in ITE over training were associated with resident gender and race/ethnicity. Women and URiM residents had smaller ITE score gains across PGY translating into greater odds of potentially being seen as at-risk for not passing the ABIM-CE. Differences in ITE over training may reflect differences in experiences of women and URiM residents during training and may lead to further disparities.

MeSH terms

  • Clinical Competence
  • Education, Medical, Graduate
  • Educational Measurement
  • Ethnicity
  • Female
  • Humans
  • Internal Medicine / education
  • Internship and Residency*
  • Male
  • United States / epidemiology