Developing an Assessment Framework for Essential Internal Medicine Subspecialty Topics

Natasha Chida, Christopher Brown, Jyoti Mathad, Kelly Carpenter, George Nelson, Marcos C. Schechter, Paulina A. Rebolledo, Valeria Fabre, Diana Silva Cantillo, Sarah Longworth, Valerianna Amorosa, Christian Petrauskis, Catherine Boulanger, Natalie Cain, Amita Gupta, Jane McKenzie-White, Robert Bollinger, Michael Melia

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background : Assessing residents by direct observation is the preferred assessment method for infrequently encountered subspecialty topics, but this is logistically challenging.

Objective : We developed an assessment framework for internal medicine (IM) residents in subspecialty topics, using tuberculosis diagnosis for proof of concept.

Methods : We used a 4-step process at 8 academic medical centers that entailed (1) creating a 10-item knowledge assessment tool; (2) pilot testing on a sample of 129 IM residents and infectious disease fellow volunteers to evaluate validity evidence; (3) implementing the final tool among 886 resident volunteers; and (4) assessing outcomes via retrospective chart review. Outcomes included tool score, item performance, and rates of obtaining recommended diagnostics.

Results : Following tool development, 10 infectious disease experts provided content validity. Pilot testing showed higher mean scores for fellows compared with residents (7 [SD = 1.8] versus 3.8 [SD = 1.7], respectively, P < .001) and a satisfactory Kuder-Richardson Formula 20 (0.72). Implementation of the tool revealed a 14-minute (SD = 2.0) mean completion time, 61% (541 of 886) response rate, 4.4 (SD = 1.6) mean score, and ≤ 57% correct response rate for 9 of 10 items. On chart review (n = 343), the rate of obtaining each recommended test was ≤ 43% (113 of 261), except for chest x-rays (96%, 328 of 343).

Conclusions : Our assessment framework revealed knowledge and practice gaps in tuberculosis diagnosis in IM residents. Adopting this approach may help ensure assessment is not limited to frequently encountered topics.

Original languageEnglish (US)
Pages (from-to)331-335
Number of pages5
JournalJournal of graduate medical education
Issue number3
StatePublished - Jun 1 2018

ASJC Scopus subject areas

  • Medicine(all)


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