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Longitudinal Trends in Urology In-service Examination Performance: 2016-2023.

Jill S Patel1, Kayla M Keenan2, Erik B Lehman1

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Urology In-Service Examination (ISE) scores declined from 2016-2023 across all postgraduate years (PGY), particularly in general urology topics. Stable performance on repeated questions suggests factors beyond knowledge loss may be influencing these trends.

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Area of Science:

  • Medical Education
  • Urology
  • Assessment

Background:

  • The Urology In-Service Examination (ISE) is a key assessment tool for resident progress.
  • Longitudinal performance trends are crucial for understanding educational effectiveness and identifying areas for improvement.

Purpose of the Study:

  • To analyze trends in Urology In-Service Examination (ISE) performance from 2016 to 2023.
  • To identify changes in resident performance patterns across postgraduate years (PGY) and subtopics over time.

Main Methods:

  • Retrospective cohort analysis of aggregate ISE scores from the American Urological Association (2016-2023).
  • Analysis of mean percent-correct scores by PGY (1-5) and subtopics.
  • Subgroup analysis using 2020 as a marker for the COVID-19 pandemic onset.
  • Statistical significance determined using two-sample t-tests (α ≤ 0.05).

Main Results:

  • Mean ISE scores increased with PGY level but showed an overall decline from 2016-2023.
  • Statistically significant declines were observed for PGY2-5, with the steepest decline in PGY3-5.
  • Notable subtopic score decreases occurred in calculous disease and physiology/immunology/adrenal, affecting all PGY levels.

Conclusions:

  • Mean ISE performance has declined across all PGY levels from 2016-2023, particularly in general urology subtopics.
  • Post-2020 scores were lower, suggesting potential pandemic-related impacts, though performance on repeated questions remained stable.
  • Declining trends may reflect increased exam difficulty, content expansion, or evolving study strategies rather than diminished resident knowledge.