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Resident Proficiency in High-Value Care Is Hard to Test

Subscore on internal medicine training exam is better for measuring knowledge than practice

TUESDAY, Oct. 14, 2014 (HealthDay News) -- The high-value care (HVC) subscore on the Internal Medicine In-Training Examination (IM-ITE) helps assess resident knowledge of HVC, but additional tools are needed to measure proficiency in practice, according to research published online Oct. 14 in the Annals of Internal Medicine.

Kira L. Ryskina, M.D., of the University of Pennsylvania in Philadelphia, and colleagues analyzed data for the IM-ITE from 362 residency programs in the United States. The relationship of program-level performance on the HVC subscore with overall performance on the IM-ITE and the Dartmouth Atlas hospital care intensity (HCI) index was evaluated.

The researchers found that 41 percent of the residency programs were assigned to a different quartile when ranked by the HVC subscore versus overall performance on the IM-ITE. When ranked by HVC subscore and HCI index, 30 percent of the residency programs were assigned to the same quartile.

"Although the HVC subscore has face validity and can contribute to evaluation of residents' HVC knowledge, additional tools are needed to accurately measure residents' proficiency in HVC," the authors write.

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