Scores on an exam that residents in Kansas University Medical Center’s internal medicine program take at the end of their residency have fallen below the threshold recommended by a national accrediting agency in graduate medical education.

KUMC’s first-time passage rate on the American Board of Internal Medicine’s certification exam fell to a three-year average of 78 percent in 2010. The year before, KU’s three-year passage rate was 89 percent, which is near the national average, said Lisa Vansaghi, KUMC’s residency program director in internal medicine.

Medical residency is a form of graduate medical education and is a period of training after students graduate from medical school. Residents practice medicine and are supervised by physicians in a process that can take from three to seven years, said Julie Jacob, a spokeswoman for the Accreditation Council for Graduate Medical Education, which accredits schools such as KU.

Doctors who wish to become specialists must take examinations in their field of specialty at the end of their residency. The ACGME uses the exam passage rates as one of its criteria when accrediting schools. Its current standard on the internal medicine test is a three-year average passing rate of 80 percent. Each specialty receives a separate accreditation score.

Accreditation process

In 2010, 61 percent of KUMC residents in internal medicine passed the exam, which lowered the three-year average to below the 80 percent.

But just because the scores are low now doesn’t mean KUMC will lose its accreditation. Jacob pointed to regulations that state a program can be put on probation if it “has failed to demonstrate substantial compliance with the requirements.” Vansaghi said that when an accreditation team visits, it weighs a number of factors and determines when it will visit for its next review. Depending on how many violations are found, the accreditation team decides to come back again in one to five years, she said.

The internal medicine program was reviewed last year, and the team decided to review the program again after three years. When they visited, KU’s exam scores were within the acceptable range.

“If they would have visited us this year, it would have been a citation for our program,” Vansaghi said.

Typically, in a given year, between 15 and 20 people take the test at KU, so percentages can fluctuate from year to year, which is why the ACGME uses a three-year average, she said.

Looking to 2011 scores

Though this year’s group of residents has already taken the 2011 exam, Vansaghi said scores won’t be available for several more months. She anticipates that they’ll go up, though, as the residents had been performing well on practice exams, she said.

“I am, I hope, appropriately concerned about it,” Vansaghi said. “I don’t think the sky is falling or the world is ending.”

She said the program has taken steps to ensure that residents, who are typically primarily focused on patient care, are prepared for the exam in the future.

“Prior to 2010, we kind of left it up to them as adult learners and that they’d follow up with it,” she said.

More exam preparation time has been worked into lectures for the residents, she said, and the school is giving students more test preparation materials and helping them with issues as they arise.

In the internal medicine program, about a third to a fourth of the residents are graduates of the KU School of Medicine, Vansaghi said. The majority come from elsewhere.

“We’re feeling good about this year’s results,” Vansaghi said. “Our accreditation is not in danger.”