Pulmonary Section Development Influences General Medical House Officer Interests and ABIM Certifying Examination Performance

¹ From the Department of Internal Medicine, Bowman Gray School of Medicine, Winston-Salem, NC.

To determine whether sectional development in pulmonary and critical care medicine influences medical house officers' (HO) interests and knowledge about respiratory medicine, we reviewed HO performance on the American Board of Internal Medicine (ABIM) certifying examination during 4 years before and 5 years after reorganization of our section. After major changes in the program and introduction of new educational opportunities, HOs more often selected pulmonary consultation electives (68.6% vs 47.8%; p=0.009) and entered pulmonary fellowships after completion of residency training (12% vs 3%; p=0.047). Total ABIM examination score did not change, but performance on its respiratory disease component improved from a median national percentile score of 48.5% (1986 to 1989) to 80.0% (1990 to 1994) (p=0.0365). In relation to other specialty component scores, the rank of the respiratory disease percentile improved from the lowest specialty score to the highest. ABIM examination scores correlated with the cumulative faculty effort directed toward HO teaching (r=0.70; p=0.04) and the total number of clinical teachers (faculty and fellows) interacting with HOs (r=0.73; p=0.02). Academic development in pulmonary/critical care faculty has an important influence on medical HO interests in and knowledge of that discipline. Plans for the future structure of academic pulmonary/critical care sections must take into account this impact on the training of generalists. Although institutional priorities, resources, and shifting external forces will define how, where, and by whom respiratory medicine will be taught, an appropriate number of faculty members and sufficient commitment of their time to HO education must be preserved.