141 - Impact of ITE score driven curriculum changes in a Pediatric Residency Program

Publication Number: 4138.141

Joselyn Ye, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Gina French, Kapi'olani Medical Center for Women and Children, Kaneohe, HI, United States; Marissa Fakaosita, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States; Jennifer Di Rocco, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, United States

Background: Performance on the Pediatric In-Training Examination (ITE) is a commonly used predictor of readiness for board certification. To address variability in ITE performance across residency classes, our program implemented a structured board review curriculum integrated into protected educational time alongside academic half-day (AHD) restructuring to emphasize key exam domains.

Objective: To describe and evaluate the effect of implementing/restructuring a syllabus (longitudinal structured board review curriculum, MR board question and AHD curricula) on pediatric ITE performance across training levels.

Design/Methods: All pediatric residents were included (8 per PGY level) from 2021-2025 at a pediatric residency program. ITE scores were analyzed longitudinally across PGY levels. Interventions included:
-Board Review Friday: residents who scored less than 80% predicted pass on the ITE were required to attend and the rest of the residents were invited. Residents independently reviewed a focused topic, then completed approximately 10 board-style questions at the start of the session. Faculty facilitated group discussion emphasizing reasoning, differential diagnosis framework, and clinical decision pathways.
- Morning Report "High-Yield Question" Review: MedStudy or PREP questions were used to briefly reinforce a previous topic.
- Academic Half-Day restructuring: the core content was aligned with pediatric ABP content over a 3 year cycle, with additional emphasis placed on low scoring ITE domains
- Reinforcement of attendance to AHD and morning report.

Results: The current residents who experienced the implementation demonstrated a greater rate of ITE score improvement across three years of residency compared to that of the last class before the interventions (Figure 1). Improvement was particularly robust in the Universal task: "Management and Treatment", from an average of 60% to 75% (including PGY2 and PGY3).

Conclusion(s): A structured board review curriculum integrated into formal educational time, combined with targeted AHD content redesign, was associated with meaningful improvements in pediatric ITE performance across training levels in a community-based residency program. Gains were evident not only in overall scores and predicted pass rates, but also across cognitive skill domains essential to clinical decision-making. This model is feasible, resource-conscious, and transferable to other residency programs seeking to strengthen board preparation.

Figure1. Resident ITE scores before and after interventions
Increased rate of improvement of ITE scores in class exposed to interventions.