The Association Between Length of Training and Family Medicine Residents’ Clinical Knowledge: A Report From the Length of Training Pilot Study

Abstract

Background and Objective: The associations between training length and clinical knowledge are unknown. We compared family medicine in-training examination (ITE) scores among residents who trained in 3- versus 4-year programs and to national averages over time. Methods: In this prospective case-control study, we compared the ITE scores of 318 consenting residents in 3-year programs to 243 who completed 4 years of training between 2013 through 2019. We obtained scores from the American Board of Family Medicine. The primary analyses involved comparing scores within each academic year according to length of training. We used multivariable linear mixed effects regression models adjusted for covariates. We performed simulation models to predict ITE scores after 4 years of training among residents who underwent only 3 years of training. Results: At baseline postgraduate year-1 (PGY1), the estimated mean ITE scores were 408.5 for 4-year programs and 386.5 for 3-year programs, a 21.9 point difference (95% CI=10.1–33.8). At PGY2 and PGY3, 4-year programs scored 15.0 points higher and 15.6 points higher, respectively. When extrapolating an estimated mean ITE score for 3-year programs, 4-year programs would still score 29.4 points higher (95% CI=15.0–43.8). Our trend analysis revealed those in 4-year programs had a slightly lesser slope increase compared to 3-year programs in the first 2 years. Their drop-off in ITE scores is less steep in later years, though these differences were not statistically significant. Conclusions: While we found significantly higher absolute ITE scores in 4 versus 3-year programs, these increases in PGY2, PGY3 and PGY4 may be due to initial differences in PGY1 scores. Additional research is needed to support a decision to change the length of family medicine training.

Three years versus four years Saudi Board Family Medicine program: Graduates' academic performance, perceptions, burnout, and satisfaction with professional life

“…In contrast, another study comparing family medicine in-training examination scores among residents trained in 3- versus 4-year programs reported significantly higher scores in the 4-year program than in the 3-year program. [ 17 ]…”

Measuring Clinical Preparedness After Residency Training: Development of a New Instrument

“…15 A number of published papers related to this study can provide additional background. [16][17][18][19][20] Briefly, 17 residency programs in good standing with ACGME and who agreed to participate in required evaluation activities were selected to participate. All evaluation activities were overseen by researchers in the Department of Family Medicine at Oregon Health & Science University (OHSU).…”

Postresidency Practice Setting and Clinical Care Features According to 3 Versus 4 Years of Training in Family Medicine: A Length of Training Pilot Study

“…Thus, three groups of graduates were included in our analysis: (a) graduates of 3YR programs; (b) all graduates of 4YR programs (4YR-ALL); and (c) graduates of 4YR programs-only those completing 48 months of training (4YR-48). To stay consistent with both our study design and previously conducted core analyses, 12 we took all three groups into consideration as described next.…”

“…The Length of Training Pilot (LoTP) in family medicine is designed as a pilot study exploring multiple outcomes. Previous published findings from this pilot include the impact of training length on applicants and match results, 11 clinical knowledge, 12 and patient continuity visits, 13 as well as financial considerations associated with adding a fourth year of training. 14 Briefly, findings to date can be summarized as follows:…”