Interpretation of the American Board of Family Practice In-Training Examination
William H. Replogle, PhD

The American Board of Family Practice (ABFP) In-training Examination (ITE) is the most frequently used method of evaluation among accredited family practice programs. Despite its common use, there are still misunderstandings regarding the proper interpretation of the ABFP ITE results. The ABFP ITE is a norm-referenced test that allows for comparison of a resident’s performance relative to other residents in the same year of training; it does not measure absolute performance. There is a paucity of evidence supporting the validity of the ABFP ITE. The eight speciality areas and clinical set problems lack sufficient reliability to be interpreted per individual resident. The composite score of the ABFP ITE has sufficient reliability to be used as part of a formal and comprehensive evaluation system. Group comparisons using the 10 ABFP ITE measures are appropriate. (Fam Med 2001;33(2):98-103.)

The Effect of the Teaching Physician Rule on Residency Education
James J. Stevermer, MD, MSPH; Michael N. Stiffman, MD, MSPH

Background and Objectives: In 1996, the Health Care Finance Administration implemented the Teaching Physician Rule (TPR) to clarify the responsibilities of attending physicians when they are supervising residents and billing Medicare for that service. We measured some of the effects of the TPR on family practice residency training. Methods: After pilot testing, a questionnaire was mailed to the directors of all family practice residency programs in the United States. The directors were asked to provide a similar questionnaire to a senior resident. Results: Of 449 residency directors, 310 (69%) responded. Eighty percent of residencies apply the TPR to at least some patient encounters. Residency directors reported that the TPR had an overall negative effect on their residency. Residents reported a more negative impression of the rule than did the directors. On average, residency directors reported that the mandated level of supervision in the outpatient setting increased faculty attending time by .24 FTE. Conclusions: The TPR was perceived by residency directors and senior residents to have some negative effect on family practice residency programs, at least in part by increasing the need for more faculty time for supervision. (Fam Med 2001;33(2):104-10.)

Fetal Biometry: A Comparison of Family Physicians and Radiologists
R Keith; L Frisch

Background and Objectives: While performance and reading of obstetric sonograms is a skill widely taught in family practice residency programs, no prior studies have compared ultrasound performance and interpretation in residency programs with that of hospital radiologists. This study compares results of fetal biometry for gestational age determination performed sequentially by faculty-supervised residents and radiologists. Methods: This retrospective chart review selected cases from among all gravidas who had ultrasound performed in a family practice residency clinic between January 1992 and April 1999. Biometry was performed by residents under the supervision of faculty preceptors who had ultrasound training and experience. A patient was included if (1) results of both a family practice ultrasound and a radiologist-read hospital ultrasound were present in the chart, (2) both studies were done before 36 weeks gestation, and (3) the family practice examination preceded the hospital study. The difference in expected date of confinement between resident and radiologist ultrasound was calculated, and this difference was evaluated for statistical significance by a paired sample t test. Results: Ninety-two ultrasound pairs were assessed, a sample size that provided .90 power to detect a gestational age estimate difference of 3 days between family practice and radiologist interpretations. The normally distributed observed mean difference in gestational age estimates was only 1.5 days. Conclusions: This study found no difference in gestational age assessment performed by closely supervised family practice residents in comparison to radiologists. (Fam Med 2001;33(2):111-4.)