Monday, July 16, 2018

Examining the Effects of Financial Incentives on Emergency Medicine Resident In-Training Examination Performance: Is the only way a carrot?

Benjamin Schnapp
University of Wisconsin

Background: In-training exam (ITE) scores during residency training are important, since they predict future success on the Qualifying Exam that trainee physicians must pass to qualify for board certification and independent practice. To date, few interventions have been shown to be consistently effective for improving these scores.

Objective: The aim of this study was to evaluate how a financial incentive affects Emergency Medicine (EM) resident performance on the ITE.

Methods: Residents at the University of Wisconsin Emergency Medicine Residency Program were notified months in advance of their 2017 and 2018 ITE that financial incentives of $1000 and $350 were available for achieving 90th percentile and 50th percentile respectively. Residents were also incentivized with $1000 for improving their score by 20 percentile points nationally. Quantitative and qualitative data was collected and analyzed to evaluate the effectiveness of the intervention. Data from the 2017 and 2018 ITE was compared to 3 years of historical controls using 2 and the t-test of differences, and survey data from residents who took the 2018 ITE was analyzed using inductive analysis.

Results: While 71.6% of residents surveyed felt that the financial incentives affected their preparation for the ITE, there was no significant increase in the yearly improvement in scores, residents achieving the 90th percentile, 50th percentile, or improving by 20 percentile points when compared to historical controls.

Conclusion: Financial incentives based on performance do not appear to improve EM resident performance on the yearly ITE. Further research is necessary to determine whether other methods of deploying financial incentives would be more effective.