The American Board of Anesthesiology (ABA) mandates that anesthesiology resident physicians across the United States complete an annual in-training examination (ITE). The purpose of this exam is to prepare residents for the ABA written board examinations: the BASIC and ADVANCED exams. Each year, the resident receives personalized feedback on their low-scoring sections in order to study that content and improve. In fact, the ABA releases a “Gaps in Knowledge Report” each year documenting select topics that were most misunderstood by examinees or proved to be particularly difficult.1 Furthermore, success on the ITE has been found to correlate with success on the written boards.2 Although the ITE is made for anesthesiology residents, some residency programs may require physicians to take it during their internship in order to familiarize them with the exam content and format.
What is the ITE?
The ITE is a computer-based examination of 200 multiple choice questions administered to all anesthesiology residents across the United States each year. Examinees have four hours to take the exam.3 For the most part, the ITE is a standardized tool to assess clinical competency on an annual basis. It is not a pass-fail exam, but a scaled score that correlates to a percentile weighted against the score of other residents in the same post-graduate year. In addition, some fellowships may request the most recent ITE score as a means of objectifying applicants.
ITE Content and Structure
The ITE is structured as a computer-based examination of 200 multiple choice questions administered over a 4-hour time period at a site designated by each individual residency training program. These questions are described as A-type items: questions that are single best-answer multiple choice requiring critical thinking rather than simple recall. Some of these questions include a clinical vignette while some are more direct. Meanwhile, part of the ITE will include images such as an EKG or X-ray for the examinee to interpret. The examination covers a mixture of 50% basic and 50% advanced topics in anesthesiology. These topics are divided according to the ITE Blueprint published by the ABA.4 Basic topics include anatomy, anesthesia delivery devices, pharmacology, and pathophysiology. Advanced topics include anesthetic technique, disease states, subspecialties, and clinical complications.
Each resident examinee generally takes the same examination as his or her peer, regardless of post-graduate year. Meanwhile, each test score is weighted against examinees in the same post-graduate year. Thus, the exam is reported as a scaled score on a Personal Performance Report. This scaled score correlates with a national percentile based on the examinee’s post-graduate year. The Personal Performance Report also includes a percent score for basic items and a percent score for advance items along with their respective percentile correlate. Additionally, the examinee will receive data on their score in the following categories: basic sciences, clinical sciences, organ-based basic and clinical sciences, clinical subspecialties, and special problems or issues in anesthesiology.
Top 3 Things to Know Before You Take the ITE
- Know Your Foundations: Apart from a few additions and improvement each year, the ITE covers the same content each time you take it. Thus, it is imperative to become most familiar with the foundations of anesthesiology. Each resident may have their preferred source, but whether it is Miller’s Basics of Anesthesia or Morgan and Mikhail’s Clinical Anesthesiology, these books provide a good summary of the exam content. For a specific outline on the exam, see the ABA’s Content Outline: http://www.theaba.org/PDFs/BASIC-Exam/Basic-and-Advanced-ContentOutline
- Apply and Test Your Knowledge: The best way to study for a standardized exam is through active studying that mimics the exam format. An example of this would be TrueLearn’s ITE question bank, which includes over 1,000 ABA-style practice questions with detailed explanations. These questions are written by physicians who have recently taken the exam. These questions are then reviewed by faculty with an expertise in test questions who ensure proper and representative exam style as well as medical accuracy. The question bank is undergoing constant innovation through user feedback and mapping according to the ABA ITE Keywords and Content Outline. It also offers real-time benchmarking to compare your performance to that of your peers on a national level.
- Repetition is Key: Part of being a physician is to always strive to learn more in order to provide the best for our patients. The ABA uses standardized exams like the ITE to objectively incentivize and assess our medical education as providers. Although this can provoke anxiety at times, repetition in studying and test-taking helps familiarize the examinee and improve performance. The ITE covers practically the same content each year. By reviewing notes on the foundations of anesthesiology and its subspecialties and by taking and studying practice questions regularly, a resident physician can walk calmly and confidently to the test center on exam day.
Written By: Hassan Aboumerhi, MD, Anesthesia Fellow, Northwestern University Department of Anesthesiology
1In-Training Examination Gaps in Knowledge Reports. The American Board of Anesthesiology. http://www.theaba.org/PDFs/ITE-Exam/ITE-Gaps-in-Knowledge-Report.pdf
2 McClintock JC, Gravlee GP. Predicting success on the certification examinations of the American Board of Anesthesiology. Anesthesiology. 2010 Jan; 112(1):212-9.
3 In-Training Examination. The American Board of Anesthesiology. http://www.theaba.org/TRAINING-PROGRAMS/In-training-Exam/About-the-In-Training-Exam. 2016. Access April 9, 2020.
4 In-Training Examination (ITE) Blueprint. The American Board of Anesthesiology. http://www.theaba.org/PDFs/ITE-Exam/ITE-Exam-Blueprint. 2016. Access April 9, 2020.