Experiences of the International In-Training Examination (I-ITE) by Rwandan pediatric residents – a mixed-methods description of candidate feedback

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Abstract
Background:The University of Rwanda is the only African residency to have implemented the pediatric International In-Training Examination (I-ITE) as a tool to monitor resident knowledge acquisition. The objective of this study was to better understand the acceptance and relevance of this exam to residents from this setting and their perceptions regarding this assessment tool. Methods:This is amixed-methods study describing candidate feedback. Immediately on completing the I-ITE residents provided feedback by filling in an electronic questionnaire comprised of four closed Likert questions and an open text box for free-text feedback. Participants were pediatric residents from the University of Rwanda, the only university in Rwanda with a pediatric residency program. Quantitative analysis of the Likert questions was undertaken descriptively using SPSS. Free-text feedback was coded and analysed. No specific guiding theory was used during the qualitative analysis, with coding and analysis undertaken by two researchers. Results:Eighty-four residents completed a total of 213 I-ITE sittings during the five exam cycles undertaken during the study period. Quantitative and qualitative feedback was given by residents during 206 and 160 sittings, giving a response rate of 97% and 75%, respectively. Five themes emerged from the qualitative analysis; 1) undertaking the I-ITE was a positive experience; 2) exam content; 3) formative nature of the assessment; 4) challenges to completing the exam; 5) practicalities to undertaking the exam. Conclusion:Qualitative feedback demonstrates that the I-ITE, a standardized, and independent exam, produced by the American Board of Pediatrics, was valued and well accepted by Rwanda pediatric residents. Its formative nature and the breadth and quality of the questions were reported to positively contribute to the residents' formative development.
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