Trends in medical knowledge as assessed by the certifying examination in internal medicine

The past decade has seen less competition for medical school positions accompanied by the declining interest of medical students in internal medicine. At the same time, the number of first postgraduate-year positions in internal medicine residencies has increased, as has the number of first-year residents who take those positions. The purpose of this study was to examine trends in the medical knowledge of internal medicine residents during the past 6 years. Comparison of performance on the items common to pairs of the certifying examinations of the American Board of Internal Medicine from 1983 to 1988 revealed that the scores of candidates in the reference group have declined, but not dramatically. This trend has occurred among candidates from the top residency programs as well as all other residency programs, and it is present in candidates of all levels of overall clinical competence. Continuing declines in this area could ultimately affect patient care.