This study compared driving simulation performance after night call and after being off call in 22 medical residents and 1 medical student in a prospective within-subjects counterbalanced design. The results demonstrated an unexpected interaction between call and sex wherein men performed more poorly after night call than women as measured by lane variance and crash frequency. Secondary measures, including caffeine, actigraphy, and subjective total sleep time, did not differ between men and women. Collectively, results of this study and others suggest that medical residents are at risk when driving after a night on call and support the need for resident education to address sleep needs, consequences of sleep disruption, postcall recovery sleep, and countermeasures that may reduce residents' driving risks.

Our objective was to determine the ability of the internal medicine In-Training Examination (ITE) to predict pass or fail outcomes on the American Board of Internal Medicine (ABIM) certifying examination and to develop an externally validated predictive model and a simple equation that can be used by residency directors to provide probability feedback for their residency programs. We collected a study sample of 155 internal medicine residents from the three Virginia internal medicine programs and a validation sample of 64 internal medicine residents from a residency program outside Virginia. Scores from both samples were collected across three class cohorts. The Kolmogorov-Smirnov z test indicated no statistically significant difference between the distribution of scores for the two samples ( z ‫؍‬ R esidents in internal medicine must acquire competency in many content areas during their postgraduate training, including medical knowledge, clinical skills, clinical judgment, interpersonal skills, attitudes, ethics, and humanistic qualities as they apply across a vast range of content areas. 1 To assist both residents and program directors, the American College of Physicians, the Association of Professors of Medicine, and the Association of Program Directors in Internal Medicine developed the first national In-Training Examination (ITE) in internal medicine in 1988. This examination was developed to serve as an assessment tool, primarily for residents at the midpoint of training during the second postgraduate year (PGY2). The ITE enables residents and program directors to receive feedback and identify potential deficiencies before administration of the American Board of Internal Medicine (ABIM) certifying examination.The ABIM certifying examination has been the source of a variety of studies over the last decade. Most of these studies dealt with the ability of the ABIM certifying examination to measure the construct of medical knowledge needed by an internal medicine physician. 1-3 More recently, two studies have dealt specifically with the ability of the ITE to predict outcome on the ABIM certifying examination. 4,5 Both studies demonstrated a significant correlation between the ITE and the ABIM certifying examination scores. However, neither study externally validated its results. Therefore, the purpose of this study was threefold: replicate the previous studies through an alternative mode of analysis (logistic model), develop a predictive model that is validated by external data, and develop a simple equation that can be utilized by residency directors in a spreadsheet format to provide quick and easy ABIM pass/fail probability feedback. METHODSInternal medicine residency directors from the three Virginia medical schools were asked to provide ITE scores obtained during residents ' PGY2 year in 1992' PGY2 year in , 1993' PGY2 year in , and 1994, along with the ABIM pass/fail results for the corresponding classes in 1993, 1994, and 1995 who were taking the examination for the first time. The ITE scores reflect...

Residents on call experience decreased total sleep time (TST) and increased dysphoria. This study monitored changes in mood and sleepiness for 3 post-call days. Fifty-two internal medicine residents participated in the study. The residents wore actigraphs for the 4 to 9 days of the study. Each morning resident completed mood scales, a sleepiness scale, and estimated their prior night TST. The residents were on a 1-in-4 schedule. Call decreased subjective- and actigraphy-derived TST to less than 4 hr. During the 3 days post call, mood measures improved. Tension, depression, and anxiety stabilized on the first post-call day following the first night of off-call sleep during which the residents obtained about 7 hr of sleep. Vigor, fatigue, and confusion stabilized on the second post-call day. The Epworth Sleepiness Scale dropped to less than 11 after 1 post-call night and continued to decrease up to 3 post-call days. The effects of call linger past the first recovery night. For these residents, recovery sleep appeared inadequate, and the negative effects of call persisted across succeeding off-call days. Thus, for these residents on a 1-in-4 schedule, call affects their mood for much of the time when off call and potentially their personal and professional interactions during this period as well.

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This paper describes the first operational four-year combined family medicine/internal medicine residency designed to qualify residents for board examination in both disciplines, which began at Eastern Virginia Medical School in 1995. The authors describe key program features, including their block rotation schedule, interdisciplinary ambulatory precepting, and plans for achieving 50% ambulatory training experience, as well as their difficulties in implementing a collaborative core didactic experience. The authors present faculty survey data indicating that internal medicine faculty members are more likely to view the combined residency as a resource, while family medicine faculty members would like to concentrate on the categorical residency. A recent survey of combined residents indicates that they are satisfied with their choice of combined training and optimistic about the opportunity of garnering additional skills relative to their internal medicine and family medicine counterparts. The authors suggest that successfully implementing this interdisciplinary effort requires an atmosphere of mutual respect and an effort to find opportunities to positively affect the training experiences of both combined residents and their resident partners in family medicine and internal medicine.