Program Director’s Corner – March 2022
A Commentary on the 2021 Endocrinology Subspecialty Exam ABIM Pass Rates
Greg Hong, MD, PhD
Associate Professor
Program Director, Endocrinology & Metabolism Fellowship
Pituitary Program, Division of Endocrinology, Department of Medicine
University of Virginia Health System
Program directors (PDs) across the nation read with alarm the recent publication of ABIM pass rates for the Endocrinology & Metabolism subspecialty exam (https://www.abim.org/Media/yeqiumdc/certification-pass-rates.pdf). Of note, the pass rate for 1st time test takers significantly decreased from a usual/typical range of 84-91% over 2017-2020 to a significant nadir of 74% for 2021. This represents the lowest pass rate in 2021 for any internal medicine subspecialty exam.
At this time the reasons behind the abrupt decline in pass rates remain unclear. There were no significant changes to the examination itself this year, although detailed analysis is ongoing at this time and may eventually yield more information. In the meantime we are left to speculate on many possibilities, 2 of which are described below:
1. COVID-19 significantly impacted the training experience (e.g. less endocrine patient volume during the height of the pandemic) or the education quality of fellowship (Zoom-based education potentially less effective due to less trainee engagement or higher trainee distractions).
2. This recent year simply represents an outlier in terms of trainee performance and a return to the mean will eventually occur. For example, a 7% drop in pass rate was noted between 2018-2019, followed by a 5% increase in pass rate in 2020. Furthermore, the ABIM extended Board Eligibility to 2021 for physicians opting not to test in 2020 due to COVID-19. As such, the pass rates for 2021 may not be perfectly comparable to prior years as a result as this group of test takers likely included those further removed from fellowship training than usual.
While #1 and #2 above are plausible theories, it should be noted that other medical subspecialties performed similarly in their pass rates compared to years past. It would seem unusual that the issues identified in #1 and #2 would selectively affect endocrinology fellowships, while not affecting other similarly outpatient based specialties (e.g. Rheumatology, which exhibited pass rates of 94%, 95%, and 93% over 2019, 2020, and 2021 respectively).
While we wait for further clarification from the ABIM on potential reasons for the pass rate decline, it seems prudent for endocrinology PDs everywhere to reevaluate what resources are in place to ensure adequate board preparation. Some potential strategies to consider are listed below:
1. Purchasing board review materials (ESAP & Endocrine Board Review books from Endocrine Society, ASAP from AACE) for the fellows early in the course of fellowship and encouraging ongoing study throughout the course of fellowship (at UVA I encourage our fellows to begin studying for the Endocrine Boards as soon as they are done with their ABIM internal medicine exam).
2. Ensuring that any structured didactics/lecture series covers the appropriate content material over the course of a fellow’s time in the program (a specific list of tested content for the ABIM exam can be found at https://www.abim.org/Media/wxbjt5o3/endocrinology-diabetes-metabolism.pdf
3. Using the ESAP-ITE exam performance as a prognostic indicator of future ABIM exam performance. Previous data (pre-2019) indicates that the ESAP-ITE score is the strongest predictor of future ABIM success (see Horton WB, et al, JES 2021). It is unclear whether this relationship still holds with the current iterations of the ESAP-ITE and ABIM exam. Regardless, poor performance on the ESAP-ITE can potentially identify fellows who would benefit from intervention and more intense board preparation than usual. At UVA we also devote several sessions each Spring to reviewing ITE performance with the fellows, including having content experts work through difficult questions (as judged by % of fellows answering correctly) with the fellows as a group.
4. Dedicating periodic case conferences to “high yield” board topics. At UVA we typically have a 1h clinical case conference weekly as a division where an interesting case is presented and a group discussion unfolds between faculty & fellows. At least once every 2 months we devote a discussion to a “high yield” board topic, often by using a board question as a discussion prompt for our faculty and fellows to share ideas on clinical pearls, test taking strategies, etc.
5. Consider funding additional board review options, e.g. in-person board review courses. While these can be costly, in certain cases it could be justified for select fellows who could use additional help.
I’m sure many of you have your own unique or innovative ideas on how to help our trainees succeed in their ABIM exam certification – let’s hear about them on the APDEM Facebook page or in a future PD corner!