RESIDENCY-IN-TRAINING EVALUATION (RITE)

ANNUAL WRITTEN EXAMINATION &

INTERNAL MEDICINE ADMISSIONS
TEST(IMAT)
2013

Lenora Fernandez, MD, FPCP

 OVERVIEW on RITE
• RITE/REE held yearly 1987-2003 then stopped
when validity & reliability in doubt
• Voluntary on-line format 2009-2011: very few
takers
• Annual written exam format resumed 2013 =
OCTOBER 13, 2013, Sunday
 OBJECTIVES of RITE
General Objective:
• To determine the cognitive skills of internal medicine residents in all
PCP-accredited training programs.

Specific Objectives:
– To compare the cognitive skills of IM residents among all accredited
internal medicine training programs in the Philippines.
– To compare the cognitive skills between 2nd and 3rd year IM residents
within the institution and all other institutions.
– To determine the areas of strengths and weaknesses of the examinees
and serve as guide in maintaining and improving their training
programs.
– To provide a tool in setting standards for accreditation of IM training
programs to the Committee on Accreditation in (future)
– To determine if this examination can predict the performance of the
residents in the PSBIM.
 OVERVIEW on RITE
• Multidisciplinary committee
Cardiology Allergology-Immunology
Pulmonary Medicine Rheumatology
Endocrinology Medical Oncology
Gastroenterology Neurology
Nephrology Dermatology
Infectious Diseases Ethics
Hematology

• Tried to simulate the PSBIM

• 200 items: 175 MCQs, 25 Modified True or False
Recall - 30% Based on PCP Glossary of Top
Comprehension – 30% Diseases
Analysis – 40%
• Chapters hosted and conducted the RITE
 23 RITE TEST SITES
Fatima College of Medicine, Quezon City
Valenzuela City (CAMANAVA) Manila City
Laoag City Marikina City
Dagupan City Makati City (MATAPAT)
Baguio City Las Pinas City (PAMUNLAS)
Tuguegarao City Pasay City
Legaspi City Pasig City (PASJMAN)
Lipa City Angeles City, Pampanga
Tacloban City Cebu City
Davao City Tagbilaran City
Cagayan de Oro City Iloilo City
Zamboanga City Bacolod City
 RITE DEMOGRAPHICS
Total number of examinees 1264, 94 training institutions
Year Level 2 examinees N = 476
Mean score = 102.38/200
Year Level 3 and 4 examinees (no.) 469
Mean score = 106.1/200
Post-residency examinees (no.) 319
Mean score = 94.7
Set minimum passing level*:
Year Level 2 86 out of 200
Year Level 3, 4 and post-residency level 107 out of 200
RITE exam analysis:
Range: 65.2-153.8
Mean: 101.8
Median: 100.8
Mode: 108.2
Reliability index: 0.83 (vs 0.63-0.78 in previous)
* MPL pre-determined: YL 2 – 10% lower than YL3/4 (71% of 200 items); MPL lowered by 1 SD after
results collated
 RITE TEST INDICES

Difficulty index: Discrimination Index:

10% very easy < 1% very poor

25% easy 50% poor
15% moderate 30% good
30% difficult 20% excellent
20% very difficult
 MEAN RITE SCORES IN 3 GROUPS
p < 0.001
p < 0.001
106.7 + 15.3
110
102.4 + 14.6
105
Mean RITE Scores
(over 200 items)

100
94.7 + 11.67
95

90

85

80
2nd year 3-4th year Postgraduate
N = 476 469 319
 PERFORMANCE IN DIFFERENT TOPICS
OF THE 3 GROUPS
YL2 YL3-4 PGRAD
% mean score
in topic
80.00%

60.00%

40.00%

20.00%
0.00%
TOP 25 TRAINING INSTITUTIONS IN PERCENTILE RANK, RITE
UP-PGH
National Kidney & Transplant Institute
University of Santo Tomas
Premiere Medical Center
Cardinal Santos Medical Center
Zamboanga City Medical Center
Ospital ng Maynila Medical Center
FEU-NRMF Medical Center
Makati Medical Center
Davao Doctors Hospital
Western Mindanao Medical Center
St Lukes Medical Center
UERM Memorial Medical Center
SLU-Hospital of the Sacred Heart
Chong Hua Hospital
West Visayas State University Medical Center
University of Perpetual Help Dr. Jose G. Tamayo Medical Center-Binan, Laguna
Southern Philippines Medical Center
Divine Word Hospital
Chinese General Hospital and Medical Center
St. Paul's Hospital
AFP Medical Center
Manila Adventist Medical Center
Mary Mediatrix Medical Center
Dr. Pablo O. Torre Memorial Hospital
 YEAR LEVEL 3 RITE - PSBIM
114.41 + 12.84
120 94.45 + 9.38 98.79 + 13.64

100
Mean RITE Scores
(over 200 items)

80
p < 0.001
60

40

20

0
Passed PSBIM Failed PSBIM Did not take PSBIM
N = 232 51 186
 POSTGRADUATE EXAMINEES:
RITE - PSBIM
102.7 + 10.4
104
102 p < 0.001
100
Mean RITE Scores
(over 200 items)

98 93.5 + 10.16
96
90.75 + 10.4
94
92
90
88
86
84
Passed PSBIM Failed PSBIM Did not take
PSBIM
N = 79 116 124
FEEDBACK OF EXAMINERS/PROCTORS
• Clear instructions? YES- 100%
• Enough time to prepare for organization of RITE? YES – 96.1%
• Conflicts in the instructions given? NONE 78.7%
• Do you agree to the involvement of PCP chapters in the conduct of
RITE? YES – 99%
• Will you be willing to serve again as proctor or organizer for the
RITE in the coming years? YES- 98%
• Further comments:
– Role of RITE in regular evaluation of residents?
– Notify earlier, orientation meeting, minimize conflicts in instructions
– Separate exam for 2nd and 3rd years
– Include first years
– Chairmen to encourage post-residency members who want to take PSBIM
– Compensation to staff?
 FEEDBACK OF EXAMINEES
• Was RITE given at the right time of your training? YES 86.7%
• For residents-in-training, test questions relevant and appropriate to your
level of training? YES 98.3%
• For post-graduate examinees, test questions serve as a “good review” for
your coming PSBIM exam? YES 98.4%
• Enough time allotted to answer all questions? YES 96.2%
• Enough time to review for the exam? YES 55.33%
• Details provided beforehand sufficient? YES 87.6%
• Venue conducive to answering exam well? YES 91.2%
• Proctors helpful in clarifying your questions during the exam? YES 99.7%
• Will you recommend that RITE be regularly conducted on an annual basis?
YES 95.1%
• Would you prefer RITE to be conducted on-line? YES 37.4%
 FEEDBACK OF EXAMINEES

• Must include first years, more often

• Venue issues (temp, announcement, chairs/desk,
comfort room, crowding)
• Questions (different from PSBIM, relevance)
• No questions allowed
• Coverage/blueprint not announced earlier
• Must be paired with a post-exam review
CONCLUSIONS ON RITE ANNUAL WRITTEN EXAM:
• The RITE 2013 met most of specific objectives it aimed for:
– compare the cognitive skills of IM residents among all IM
training programs. – DONE
– compare cognitive skills between 2nd and 3rd year IM residents
within the institution and all other institutions. - DONE
– determine the areas of strengths and weaknesses of the
examinees and serve as guide in maintaining and improving
their training programs. – DONE
– determine if this examination can predict the performance of
the residents in the PSBIM.  Based on the results, it seems it
can predict the performance in the PSBIM.
• Reliability index high at 82.9% + opinion of majority among
the examiners and examinees to continue with RITE.
• The RITE is recommended to be continued.
 RECOMMENDATIONS
• Reformulation of RITE Committee examiner composition .
• More training in test construction.
• Next date: October 12, 2014, Sunday.
• More test sites nearer to examinees to be manned by Chapters.
• Better and earlier coordination with the PCP chapters.
• Test blueprint given today:
– ALL MCQ’s
– 250 items – include questions on research and principles on critical
appraisal of literature
– Integrative questions across different topics;subdiv to ambulatory,
emergency, or critical care dimensions.
• Scantron machine already available at PCP
• More efficient system of dissemination and recording/collating
• Data to be continually analyzed
• Discussion on bearing on internal evaluation of resident will be
opened?
 INTERNAL MEDICINE ADMISSIONS
TEST
Objectives of IMAT:
• Provide a uniform assessment standard for
entrance into IM training programs
• Create a profile of aspiring entrants
• Determine baseline knowledge of individual
aspiring entrants in comparison to the general
pool of aspirants through normative statistical
analysis.
 OVERVIEW & CONDUCT
• 100-item MCQ written exam
• Questions to cover only pathophysiologic basis of
disease, general diagnostic and therapeutic
principles of general disease categories (cardio,
pulmo, endo, IDS, nephro, etc.)
• No MPL set
• Given to TI’s with answer key for immediate
utilization in their screening process; can
administer at any time
 CORRELATION OF IMAT WITH
MEDICAL BOARD EXAM RATING
90
N = 266 evaluable results
Overall Medical Boards Rating (%)
80 75 85

20 40 60 80 100
IMAT Score (raw over 100 items)

Pearson’s correlation coefficient = 0.687

 CHALLENGES:
• Lack of security of the exam:
– Leakages unavoidable since administered at
different dates
• Provision for applicants to different
institutions
• Relevance in screening process?
– What is/are main factor/s in accepting new
residents into training program?
 RECOMMENDATION:
• CONSENSUS decision among Regents and
Training Institutions to STANDARDIZE
SCREENING PROCESS for IM training
applicants with a written standardized
examination as just ONE of the screening tools
– Uniformity in time of screening can then be
ensured
– Security and confidentiality then of IMAT can be
ensured
 Thank you!
Dr. Lenora Fernandez Chair
Dr. Adrian Rabe Assistant Chair
Dr. RontgeneSolante IDS
Dr. Sonia Salamat IDS
Dr. Beatriz Concepcion Nephrology
Dr. Elaine Cunanan Endocrinology
Dr. Heizel Reyes Rheumatology/Ethics
Dr. Norman Maghuyop Pulmonary Medicine
Dr. Jesus Relos Hematology
Dr. Dennis Sacdalan Oncology
Dr. Richard Tiongco Cardiology
Dr. Eternity Labio Gastroenterology
Dr. Cherie Cervantes Immunology-Allergology
Adviser: Regent Nenita Collantes, MD, FPCP