A first-of-its-kind set of questions included in the Internal Medicine In-Training Examination (IM-ITE) illustrates the need to better evaluate resident proficiency in high-value care (HVC), according to a new study published in Annals of Internal Medicine. HVC, which balances the benefits of tests and treatments with the potential harms and costs, minimizes overall patient harms and incorporates patient preferences into care decisions.

As part of this study, lead author Kira Ryskina, MD, a general internal medicine fellow in the Perelman School of Medicine at the University of Pennsylvania, and a team of medical education experts led by Cynthia Smith, MD, senior physician educator at the American College of Physicians, validated a set of 38 HVC questions incorporated into the October 2012 IM-ITE administered to more than 18,000 internal medicine residents throughout the United States. The HVC questions pertained to issues such as managing conservatively when appropriate and identifying low-value care. The study found that scores on these questions measured a unique aspect of resident knowledge and were inversely associated with the training hospital’s care intensity—a measure of hospital days and doctor visits for Medicare recipients in the last two years of life.