Need advice: I bombed my ITE as a PGY-2 IM resident.

[Doctor_Strange]

I walked out of the exam thinking I did well on the ITE this year, but I did worse. Much worse. I barely touched MKSAP and that is on me, but I honestly felt like just by being a resident and through osmosis I was learning a lot, but clearly that has not been the case. My attendings say my fund of knowledge is decent.

I don't know. I feel like s**t. I had a really really bad divorce as an intern and afterwards every time I came home I did not study or do anything, I just went to bed or watched TV. That went on for months. I am finally out of that toxic and abusive short-lived marriage, but then I tell myself it is a cop-out to say my performance as a PGY-2 had anything to do with that...

Anyways, would appreciate any advice or thoughts. I think the answer is staring at me in the face: do more questions.

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[NotAProgDirector]

If you look at your two reports, you'll see that the absolute score is essentially the same -- 58% vs 57%. So basically there was no change. The problem is that everyone else is doing better, so you got left behind.

The good news is that they are only doing a bit better. I haven't seen the statistics of this exam, but usually you need to do 4-5% better on the absolute score to maintain the same percentile. So, it's not like you need to take your score from 57% to 92%. You just need to get it up a reasonable amount.

The bad news is that everyone else continues to improve, so now you're behind and you'll need to get caught up. Since you fell behind 4% this year, you'll need to improve your raw score by about 8% to get back to the 35th percentile next year. That's 1 in 10 questions -- so not insurmountable.

The best way to get the right answer to a question is to know the right answer. You need more right answers. You need to study more. Whether that's questions, flashcards, reading, videos, audios, or whatever totally depends upon what works best for you. You need a solid study plan. Start now.

 

[Doctor_Strange]

If you look at your two reports, you'll see that the absolute score is essentially the same -- 58% vs 57%. So basically there was no change. The problem is that everyone else is doing better, so you got left behind.

The good news is that they are only doing a bit better. I haven't seen the statistics of this exam, but usually you need to do 4-5% better on the absolute score to maintain the same percentile. So, it's not like you need to take your score from 57% to 92%. You just need to get it up a reasonable amount.

The bad news is that everyone else continues to improve, so now you're behind and you'll need to get caught up. Since you fell behind 4% this year, you'll need to improve your raw score by about 8% to get back to the 35th percentile next year. That's 1 in 10 questions -- so not insurmountable.

The best way to get the right answer to a question is to know the right answer. You need more right answers. You need to study more. Whether that's questions, flashcards, reading, videos, audios, or whatever totally depends upon what works best for you. You need a solid study plan. Start now.

Yes, I will be coming up with a study plan. It may eat somewhat into my research scholarship but I will just have to make time for both at this point. I still have my sights on fellowship and I want to be well-rounded and have a good fund of knowledge. Thank you for your advice and insight.

 

[DrMetal]

Do well as a resident, that's more important than your performance on those tests. Of course, study more, but I wouldn't sweat it if you’re otherwise performing well.

 

[shaggybill]

Do well as a resident, that's more important than your performance on those tests. Of course, study more, but I wouldn't sweat it if you’re otherwise performing well.

My program, albeit family medicine, would place residents on unofficial remediation if they didn't achieve a score above the 50th percentile. A retest was required and if you didn't improve significantly then you were in hot water. Can't remember all the specifics but they were fairly serious about it. Said it predicted pass/fail for FM boards and they didn't want residents progressing if board failure seemed likely based on that ITE.

 

[Doctor_Strange]

My program, albeit family medicine, would place residents on unofficial remediation if they didn't achieve a score above the 50th percentile. A retest was required and if you didn't improve significantly then you were in hot water. Can't remember all the specifics but they were fairly serious about it. Said it predicted pass/fail for FM boards and they didn't want residents progressing if board failure seemed likely based on that ITE.

That seems a bit extreme to aim for 50th %ile, but I also don’t know how the data around family board exams etc…

 

[mvenus929]

My program, albeit family medicine, would place residents on unofficial remediation if they didn't achieve a score above the 50th percentile. A retest was required and if you didn't improve significantly then you were in hot water. Can't remember all the specifics but they were fairly serious about it. Said it predicted pass/fail for FM boards and they didn't want residents progressing if board failure seemed likely based on that ITE.

I mean, my program would track ITE scores and help those who weren't predicted to pass... but that threshold was not the 50%ile, it was a prediction based on those who had previously taken the ITE and whether they passed on first attempt, as provided by ABP.

 

[DrMetal]

My program, albeit family medicine, would place residents on unofficial remediation if they didn't achieve a score above the 50th percentile. A retest was required and if you didn't improve significantly then you were in hot water. Can't remember all the specifics but they were fairly serious about it. Said it predicted pass/fail for FM boards and they didn't want residents progressing if board failure seemed likely based on that ITE.

If those are the requirements of your program, then abide by them, play ball, get 'er done. Don't try to fight the system as a resident, you wont win. I was fortunate to be in a less-deuchy program, but so be it.

In my book: if you have good rapport with your patients, if you can come up with a good differential diagnosis, good diagnostic and treatment plans, and execute said plans, you're winning.

In my residency class, the "top gun" scored 99th% on all tests but couldn't manage sick patients if they fell on her head. She's now a fellow somewhere. It's amazing who we promote.

We're seriously lacking in common sense when it comes to medical education/training . . .but that's not your fight as a resident. (I'm not even sure it's my fight as an attending. Nobody want's to change . . .we're too stupid).

 

[GoSpursGo]

Once upon a time, I also did worse as a PGY-2 compared to PGY-1. I absolutely did not take studying seriously as a PGY-1 or PGY-2, and honestly my PGY-3 ITE was not a great improvement either. I went from 90+% predicted to pass, to probably 50/50. Thankfully I eventually I got my **** together, studied my butt off for 3 months during fellowship, and barely cleared the passing bar for my peds boards.

I would take three things away from this story:
1) You aren't doomed. You can recover from this.
2) While there was a happy ending, the bottom line is that there is absolutely no substitute for studying. One way or another, I had to put my head down and answer a bunch of MCQs until I knew enough of the material to pass. I probably made it much harder on myself by waiting until the end to do it.
3) I am very, very lucky that I was at a program which did not care about ITE scores. Based on my experience, you could argue my program actually approaches things the wrong way and that maybe they should have leaned more aggressively on me after I slipped in PGY-2 to prepare for my PGY-3 ITE. In any event, talk to your PD, get their perspective on whether you should be worried or not, and if the answer is yes figure out how to prove that you are going to recover from this.

 

[Prehealth1011]

My program, albeit family medicine, would place residents on unofficial remediation if they didn't achieve a score above the 50th percentile. A retest was required and if you didn't improve significantly then you were in hot water. Can't remember all the specifics but they were fairly serious about it. Said it predicted pass/fail for FM boards and they didn't want residents progressing if board failure seemed likely based on that ITE.

I also have a classmate who ended up in an IM program where <40th percentile means endless tests, quizzes, meetings with advisor/PD etc

In my interview trail, I made a point to ask how the program approach ITE scores. Didn't end up ranking any program with a strict ITE policy. As an IM resident trying to apply for a competitive fellowship, I simply don't have the time to deal with this

 

[JibsGuy52]

Dude. I got smoked as well. I don’t really understand these grades. For example. You did 5% off the mean by endo. That means you are in the 26%. Come on. This is ridiculous.

 

[NotAProgDirector]

Not certain what you mean by you "don't understand these grades". The statistics on the subject scores can be wonky because the number of questions in each section is small. The whole exam has 300 or so questions, some of which don't count and are for future development. Each specialty has about 20 questions, with more in Gen Med and often cardiology, and less in some of the subs. You can tell how many questions there were -- look up your % correct score for a specialty, subtract from 100 to get % incorrect, and then count the number of incorrect questions which is in the latter part of the report. If you got X questions wrong and that's = Y% wrong on the test, then the number of questions is X/(y/100) (i.e. change the percentage to a decimal). If there are only 20 questions (and there are often less for endo), then each question is worth 5% -- which means that the percentiles have big steps in them with each question.

But the overall exam score / outcome is very solid, based on 250+ questions altogether. Almost every single IM resident takes the exam, and these are the same people who take the ABIM exam. The fail rate on the ABIM exam is usually around 10-12%, which is the same as the 12th percentile. So, this is something to take seriously and work on. There's still time left, but I recommend a solid study plan starting now. Remember that everyone else is studying also. Luckily IM ITE's don't count for anything -- they are not supposed to be used for promotion decisions, and not in fellowship letters, and not disclosed to anyone but the resident.

 

[Dral]

Agree with other sentiments. Not doomed, but now start to focus, especially the months leading up to boards. Take the exam seriously (like it's Step 1), figure out a study plan, and do it.

I went from 90th my first year on the ITE, to 45th my second year, to 24th my 3rd year (Derm, not IM though). My board exam was in July. I started my study plan in April. I ended up with 80 to 90th percentile in all the sections on the actual exam.

It might not hurt to start a plan now that involves something like doing a certain number of questions three days out of the week or whatever it takes. It'll surely make you a better clinician as well (at a formative time).

 

[FutureInternist]

My program, albeit family medicine, would place residents on unofficial remediation if they didn't achieve a score above the 50th percentile. A retest was required and if you didn't improve significantly then you were in hot water. Can't remember all the specifics but they were fairly serious about it. Said it predicted pass/fail for FM boards and they didn't want residents progressing if board failure seemed likely based on that ITE.

I had that at my Residency for IM…
We had all these meetings, even a separate Board Review with APD etc.

I told them that since there was no incentive to do well, I wasn’t going to waste time studying or even taking the full time to do the test.

Just blazed through the Qs, took my <30th percentile, knocked it out of the park on the actual boards, called my PD and said “Told you”..


Did the same in fellowship 😏

 

[AlbinoHawk DO]

I walked out of the exam thinking I did well on the ITE this year, but I did worse. Much worse. I barely touched MKSAP and that is on me, but I honestly felt like just by being a resident and through osmosis I was learning a lot, but clearly that has not been the case. My attendings say my fund of knowledge is decent.

I don't know. I feel like s**t. I had a really really bad divorce as an intern and afterwards every time I came home I did not study or do anything, I just went to bed or watched TV. That went on for months. I am finally out of that toxic and abusive short-lived marriage, but then I tell myself it is a cop-out to say my performance as a PGY-2 had anything to do with that...

Anyways, would appreciate any advice or thoughts. I think the answer is staring at me in the face: do more questions.

View attachment 360788

I wouldn't even be worrying about this. You went up on a few categories and slightly down on others. The average scores just changed a lot. Personally not a fan of these worthless tests. You can fail all of them in the 1 percentile then study your ass off and pass without a problem. I would suggest you wait until second semester PGY3 and then just memorize UWorld and MKSAP. You'll pass easily. I had a classmate with terrible PGY1 ITE that studied MKSAP all the time for the PG2 exam like a month prior and went up +35 percentile from last time

 

[Redpancreas]

A bit late, but your transparency is appreciated. I also went down in my second year after doing well my first year. The key is that during first year, a lot of us are still fresh off Step 2 CK or Step 3 and as we drift apart, we forget crap like management of thyroid nodules or Webber/Rinne that we don’t deal with in our daily practice. I mean, the ITE doesn’t test the 3 beta blockers that have mortality benefit in HF do they?

One thing to keep in mind is this won’t at all impact your fellowship chances. It doesn’t even seem to have affected your program’s impression of you. Most IM residents do what they can on these ITEs and start seriously board studying in the second half of third year and then move on…I recommend you focus on this after you have your fellowship match in hand.

Given that your score is below the range accepted at my shop, this would be something you’d be brought into talk briefly about, you would benefit from some minor review. Like APD said, it’s a matter of doing 10% better. I would recommend doing 5 MKSAP questions a day (150 a month!). Focus on a different section every month. Check your answers on the same way so you don’t leave things hanging. Alternatively you can buy UWorld which is a lot better than MKSAP for the real deal, but doesn’t have the built in text book.