The Individual Progress Test of Gynecology and Obstetrics Residents (TPI-GO): The Brazilian Experience by FEBRASGO

The great expansion of Medical Residency Programs in Brazil in recent decades has made it difficult to properly evaluate the trained professionals and the quality of training offered.

Today, ∼53,776 physicians are registered at the National Medical Residency Commission enrolled in 4,862 Medical Residency Programs offered by 809 institutions. Only in Gynecology and Obstetrics (Ob-gyn), there are 312 Medical Residency Programs. Despite the recommendation that resident physicians undergo quarterly theoretical and practical evaluations by the programs, this has not been happening regularly. Therefore, there is no information about the performance of residents during their training and the quality of training programs. Evidently, this knowledge should be based on information obtained during ongoing evaluations of the programs, with visits, audits and reports, although this has not happened in practice.

According to current legislation, specialists graduated from Medical Residency Programs approved by the National Medical Residency Commission automatically receive the specialist certificate recognized by the Ministry of Education and the Federal Council of Medicine without any evaluation process of the students' competences at the end of the program.

In view of the fragility of the system, the Medical Specialties Societies in Brazil, with special authorization from the Brazilian Medical Association, started to grant the title of specialist for graduates of residency programs after an evaluation through a flexible exam, depending on the Society granting it. In this sense, the Title of Specialist in Gynecology and Obstetrics (Portuguese acronym: TEGO) given by the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) is only granted upon evaluation of the candidate through theoretical and practical tests carefully prepared by the National TEGO Commission of FEBRASGO.

In this evaluation process, important failures in the training of new specialists who completed the residency program have been observed, which has raised the failure rates for the TEGO. Thus, considering the need to qualify the training of Ob-gyn specialists in Brazil and understanding that the Individual Progress Test (IPT) represents a great reference for the self-assessment and improvement of resident physicians and Medical Residency Programs, as of 2018, FEBRASGO has implemented the Individual Progress Test for Ob-Gyn Residents (IPT-GO). Although the IPT is widely used internationally, in Brazil there is little experience reported on its use in Medical Residency.

The IPT is a comprehensive assessment that preferably uses multiple choice questions and is periodically applied to all students of the same curriculum or program,[1] aligned with modern constructivist education and promotes long-term knowledge. The longitudinality of this modality of assessment provides a unique and demonstrable measure of students cognitive progression.[2]

The functional purpose of the IPT is to provide reliable information for self-assessment of candidates and service providers of Medical Residency Programs hence, it is a formative assessment. For resident physicians who take the test, the IPT provides an accurate measure of their level of knowledge in relation to their peers and in relation to the final objectives of the specialty training, according to the Gynecology and Obstetrics Competence Matrix.[2] [3]

Furthermore, through the performance in serial evaluations, the individual progress of the cognitive component can be evaluated. After each assessment, it is possible to reaffirm and consolidate knowledge and identify learning gaps and points to be improved.[4]

For preceptors and supervisors of Medical Residency Programs, the IPT-GO provides information on the performance and progression of residents who have taken the exam. Through this information, the profile of residents admitted to each service, the added knowledge of residents throughout the training program and the level of knowledge of graduates in relation to the national average and in relation to the objectives of the Competence Matrix can be assessed. It also allows the identification of strengths and points of improvement or areas requiring reinforcement for learning.[4]

Since 2018, the IPT began to be offered annually to all resident physicians in the first (R1), second (R2) and third years (R3) of training regularly enrolled in Medical Residency Programs recognized by the Ministry of Education.

In 2018 and 2019, the test was applied in person and simultaneously in 11 Brazilian cities in regions with the highest concentration of Ob-Gyn Residency Programs. In 2020, due to the Covid-19 pandemic and in compliance with sanitary requirements, the IPT could not be applied in person. Faced with this new challenge, the choice was to apply the test online, since this measure is supported by the literature.[5]

The theoretical test for obtaining the TEGO, applied annually to newly graduated specialists in the field, is a comprehensive assessment of the skills provided for in the Gynecology and Obstetrics Competence Matrix[3] and used as a reference to the final level of Residency Programs. For these reasons, this test model was chosen to be applied in the IPT-GO.[6]

Criteria ranging from a bonus of points to exemption from the TEGO theoretical test in the year following the completion of the residency program were established as a form of encouraging residents' participation in the IPT-GO. These criteria are based on adherence and individual performance on the test. To be entitled to bonuses, it is an essential condition that the resident participates in all three versions of the IPT as R1, R2 and R3, with a progressive minimum performance established in accordance with the competition notice published each year.[7]

Publication History

Article published online:
27 July 2021

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