Association Between Resident In-Service Exam Scores by Postgraduate Year and Subsequent Board Qualifying Exam

Prior work notes the AUA In-Service Exam (ISE) percentile ranking of chief residents correlates with the American Board of Urology Qualifying Exam (QE) performance. We present a 5-year analysis of resident performance on the ISE and subsequent QE to determine if earlier time points in training may identify those needing additional educational support.

Participant ISE scores over a 5-year period from 2014 to 2018 and subsequent QE scores in 2019 were recorded. Pearson's correlation coefficient measured the association between percentage questions correct for each ISE year and QE. Youden Index calculated the optimal cut point for yearly ISE percentage correct that would predict scoring greater than the lowest quartile and decile on the QE.

Median percent questions correct on ISE increased over postgraduate year (PGY) 1 (47%), PGY2 (56.5%), and PGY3 (70%) but remained stable thereafter (PGY4-PGY5) at approximately 70%. Median QE percent correct in 2019 was 66% (SD 7.6%). Correlation of percent questions correct between ISE and QE improved from 0.31 to 0.53 over training duration. The lowest decile and quartile percent correct scores on the QE were 56% and 60%, respectively. Percent correct ISE score predicting performance above the lowest decile 2019 QE score increased from 38% in PGY1 to 57% in PGY2 and leveled off after PGY3 (∼70%). Similar observations were noted with lowest quartile QE score.

Scoring approximately 70% of questions correct on the ISE during PGY3 and later years was associated with a low risk of failing the QE. Such information provides benchmarks for residency programs to offer targeted educational content for at-risk candidates.