Hi everyone,
Please don’t sweat the In-Training Exam, which starts this week. It’s a low-stakes test, more or less.
To refresh, the ITE is an annual medical knowledge exam created by the American College of Physicians. If you’re a categorical resident, you’re going to take the test—unless you’re a PGY3 who scored at or above the 70th percentile last year. The ITE assesses your internal medicine knowledge: Can you interpret blood gases? Choose antibiotics? Identify red flags? Let’s find out.
By “low stakes” I mean the results don’t impact promotion, graduation, or matching into fellowship. Only you and program leadership will know your score.
The ITE gauges your knowledge, which is important: you wouldn’t want to delegate all information to external brains like UpToDate and OpenEvidence. You need to internalize core facts and concepts to develop clinical intuition and the ability to ask informed questions, navigate crises, and recognize when facts don’t fit.
While you shouldn’t study for the ITE, you should study to learn medicine. My favorite resources are UpToDate (full disclosure: I am an author); OpenEvidence; NEJM Clinician; and MKSAP. I tap into UpToDate for targeted reviews, for example to brush up on the causes of angioedema or management of hyponatremia. I use OpenEvidence for spot questions: for example, on rounds last week, I wanted to know if methylene blue improves survival in septic shock (it doesn’t). To test my knowledge, I do practice questions in MKSAP. To keep up with recent papers, I read NEJM Clinician and subscribe to publication alerts from the NEJM, JAMA, and other journals.
There is no best way to study. Many residents swear by UWorld, traditional textbooks, and podcasts like The Curbsiders and Clinical Problem Solvers. Everyone learns by engaging actively on rounds, attending teaching conferences, participating in simulation sessions, and reading about your patients.
Your ITE percentile compares your fund-of-knowledge to peers. Your detailed score report will highlight areas needing attention. If you purchase MKSAP, which I recommend, you can upload your report to direct your learning. Most of you will do well, but no worries if you don’t; your APD will work with you on a study plan.
The ITE is a nine-hour affair, so sleep well the night before, eat a healthy breakfast, and wear comfortable clothes. And remember, the stakes are low, so just relax and do your best.
Enjoy your Sunday, everyone. This weekend, I’m in Philadelphia, going for brunch this morning with my daughter and son-in-law and heading to the ballgame this afternoon with my brothers.
Mark
P.S. What I’m reading and listening to:
- Making the Most of Your Mistakes On Hidden Brain (Shankar Vedantam with Amy Edmondson)
- I’m Begging You: Never Write With A.I. By Bret Stephens
- I Told My Patient She’d Never Go Home. I Was Wrong. By Daniela J. Lamas
- The Human-Origin Story Is Being Radically Revised By Ross Anderson
- G.P.S. and the Lost Art of Getting Lost By Shayla Love