Sticks or Carrots? How an Easy-to-Implement Incentive Plan Improved Our Performance on the In-training Exam

In-training examinations (ITEs) are commonly used by residency programs to measure competency in their respective fields. It has been demonstrated that success on the ITE is correlated to First Time Pass Rate (FTPR) on the boards. Therefore, it is important to motivate residents to perform well on these exams. Previous studies indicate positive incentivization may contribute to improvement on examinations. The objective of our study was to determine whether introduction of a positive incentive could improve resident performance on the ITE and/or FTPR on the advanced certifying exam.

A positive incentive was introduced in 2017 (certificate of commendation, curriculum vitae honor, public recognition, and $500 in their books/travel allowance) to residents who achieved the target score on the ITE (80th percentile). A survey was then provided to these residents to determine which incentives contributed most to their motivation.

Before the incentivization, 21 (15.1%) of the previous 149 senior residents reached the target score on the annual ITE. After incentivization, this improved to 28 (30.9%) of 81 (P = .0056). The FTPR on the advanced certifying exam was 90% before incentivization and 97.6% after (P = .14). The survey found that the primary motivators were extra funding, honor on their curriculum vitae, and public recognition.

We found that our residents had significant improvements on the annual ITE after the introduction of positive incentives. This incentivization may be easily implemented by program directors in their respective medical residencies to increase examination performance.