# Factors Influencing Pediatric Residency Graduates' Decisions to Take the Initial Board Examination and Their Likelihood of Success

## TL;DR

This study explores factors affecting pediatric residency graduates' decisions to take and pass their initial board exam, highlighting the impact of training during the pandemic and in-training exam scores.

## Contribution

This is the first study to examine the impact of the pandemic and residency program factors on pediatric board exam outcomes.

## Key findings

- Residents with lower third-year in-training exam scores were more likely to not take or not pass the ABP-CE.
- Exposure to the pandemic during training increased the likelihood of failing the ABP-CE by nearly four times.
- Training during the pandemic did not significantly affect the decision to take the initial board exam.

## Abstract

Introduction

The American Board of Pediatrics Certifying Examination (ABP-CE) is not just a component, but the cornerstone of general pediatricians' professional training. Passing the ABP-CE on the first attempt is essential for maintaining the quality of residency programs and ensuring the successful practice of pediatric graduates.

Objectives

This study is the first to investigate how various individual factors and the residency program environment, particularly during the unprecedented challenges posed by the COVID-19 pandemic, impact the performance of pediatric residency graduates on the initial board examination, specifically regarding not taking or not passing the ABP-CE.

Methods

We conducted an analysis of graduates from a single pediatric residency program between 2014 and 2024. The analysis included various factors such as the graduates' age, sex, type of degree, medical school attended, fellowship acceptance, scores from the United States Medical Licensing Examination (USMLE) Step 1 and in-training examinations (ITEs), and the impact of training during the COVID-19 pandemic. We employed descriptive statistics and stepwise logistic regression models for our analysis. The findings are presented in terms of percentages, means, and odds ratios (ORs) with a 95% confidence interval (95% CI). A p-value of less than 0.05 was considered statistically significant.

Results

Among the 121 program graduates, 98 (80.9%) attempted the initial ABP-CE, with a pass rate of 85.7%. None of the demographic or educational characteristics of the residents were identified as predictors for not taking or not passing the initial ABP-CE. A lower score on the third-year ITE was associated with not taking the examination, with an OR of 0.96 (95% CI: 0.93, 0.99; P < 0.03), and not passing the examination, with an OR of 0.92 (95% CI: 0.88, 0.97; P < 0.01). Moreover, residents who did not pass the ABP-CE were more likely to have been exposed to COVID-19 during training than those who successfully passed the examination (OR: 4.06; 95% CI: 1.44, 11.5; P < 0.01). Training during COVID-19 did not significantly impact the decision of graduates to take the initial ABP-CE.

Conclusion

Our study offers valuable insights for pediatricians in training, educators, and researchers about the factors predicting outcomes on the initial ABP-CE for pediatric program graduates. It reveals that training during the COVID-19 pandemic had no effect on the decision of residents to skip taking the initial ABP-CE but increased the chance for ABP-CE failure by nearly four times compared to program graduates who successfully passed the initial ABP-CE. Furthermore, the study indicated that each point reduction in scores on the third-year ITE corresponded to an average increase of 4% in the likelihood of not taking the ABP-CE and an 8% increase in the likelihood of not passing it.