Trends in Pediatric In-Training Exam Scores and Association With Clinical Encounters Across the COVID-19 Pandemic

Pediatric In-Training Exam (ITE) scores dropped during the pandemic and prior work showed this drop was unrelated to clinical volume. It remained unclear how ITE scores would change post pandemic peak. We compared ITE scores with data on patient notes for five classes of pediatric residents matriculating from 2018 through 2022 at four residency programs which included a total of 391 residents. Post-graduate year (PGY) 2 ITE was 11.6 points lower for residents starting in 2020 compared to other classes (95% CI 8.3-14.8 points). While number of inpatient admission notes (p = 0.012) and progress notes (p = 0.0044) were associated with statistically significant gains in PGY2 ITE scores, clinical note volume only accounted for a small amount of the cohort effect (4.8%). There are some types of clinical encounters that are statistically associated with ITE score gains and while there was partial recovery of scores compared to pre-pandemic cohorts, total PGY3 scores remain lower than the 2018 class.