03:41am Saturday 07 December 2019

Penn Study Evaluates Medical Resident Assessment Tool to Reduce Unnecessary Tests and Treatments

PHILADELPHIA — A first-of-its-kind set of questions included in the Internal Medicine In-Training Examination (IM-ITE) illustrates the need to better evaluate resident proficiency in high-value care (HVC), according to a new study published in Annals of Internal Medicine. HVC, which balances the benefits of tests and treatments with the potential harms and costs, minimizes overall patient harms and incorporates patient preferences into care decisions.

As part of this study, lead author Kira Ryskina, MD, a general internal medicine fellow in the Perelman School of Medicine at the University of Pennsylvania, and a team of medical education experts led by Cynthia Smith, MD, senior physician educator at the American College of Physicians, validated a set of 38 HVC questions incorporated into the October 2012 IM-ITE administered to more than 18,000 internal medicine residents throughout the United States. The HVC questions pertained to issues such as managing conservatively when appropriate and identifying low-value care. The study found that scores on these questions measured a unique aspect of resident knowledge and were inversely associated with the training hospital’s care intensity—a measure of hospital days and doctor visits for Medicare recipients in the last two years of life.

“Although the findings don’t point to a clear answer on how best to test resident knowledge of high-value care, the HVC sub-score represents a first step in this effort,” said Dr. Ryskina. “Institutional culture appears to play a role in how well physicians in training recognize situations when ordering more tests or treatments is unnecessary or even harmful to patients.”

For more details about this study, please refer to the American College of Physicians’ press release.


Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report‘s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year.

The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania — recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital — the nation’s first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2013, Penn Medicine provided $814 million to benefit our community.

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