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Philadelphia, October 14, 2014 -- High Value Care sub-scores
from the Internal Medicine In-Training Examination (IM-ITE) reflect
the importance of training medical residents to understand the
benefits, harms, and costs of tests and treatments, according to a
published today in Annals of Internal Medicine.
The IM-ITE is a multiple-choice exam developed by the American
College of Physicians (ACP) in collaboration with the Alliance for
Academic Internal Medicine (AAIM) to help residents along with
their program directors assess their knowledge of internal medicine
and identify areas for improvement.
ACP has a High Value Care initiative, including a curriculum for
residents co-developed with AAIM, to help doctors and patients
understand the benefits, harms, and costs of tests and treatment
options for common clinical issues so they can pursue care together
that improves health, avoids harms, and eliminates wasteful
practices. ACP and AAIM identified 38 of 340 questions in the 2012
IM-ITE to create a High Value Care sub-score.
"While HVC sub-scores correlated strongly with overall IM-ITE
performance, we did find some association between medical resident
sub-scores and the care intensity of the training hospital," said
study co-author Dr. Cynthia Smith, a Senior Physician Educator at
ACP. "The HVC sub-score is an imperfect and partial reflection of
the residency program care environment. It is a helpful tool but
should not be used in isolation to assess resident competence in
High Value Care."
The most common associated HVC competency was managing
conservatively when appropriate (i.e., including allowing adequate
time for clinical improvement, observation and monitoring, or
comparison to prior studies rather than additional diagnostic
The study authors used the hospital care intensity (HCI) index
calculated by the Dartmouth Atlas group to characterize the
intensity of the care environment of each residency program's
primary training hospital. The HCI index is a composite measure of
hospital days and inpatient physician visits for Medicare
recipients in last two years of life.
"Future longitudinal studies are needed to evaluate how well HVC
sub-scores approximate actual resident and independent practice,
and focus on the development of stronger tools for measuring HVC in
practice," said Dr. Smith.
At the end of the 2012 IM-ITE, participants were asked complete
a voluntary two-page survey designed by ACP and AAIM that included
items about behaviors related to HVC. Residency programs in higher
quartiles of HVC sub-scores had a slightly larger proportion of
residents who reported avoiding ordering unnecessary tests and
treatments and incorporating patients' values into clinical
About the American College of Physicians
The American College of Physicians is the largest
medical specialty organization and the second-largest physician
group in the United States. ACP members include 141,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internal medicine physicians are specialists who
apply scientific knowledge and clinical expertise to the diagnosis,
treatment, and compassionate care of adults across the spectrum
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