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AimThe American Board of Internal Medicine (ABIM) exam's pass rate is considered a quality measure of a residency program, yet few interventions have shown benefit in reducing the failure rate. We developed a web-based Directed Reading (DR) program with an aim to increase medical knowledge and reduce ABIM exam failure rate.MethodsInternal medicine residents at our academic medical center with In-Training Examination (ITE) scores ≤35th percentile from 2007 to 2013 were enrolled in DR. The program matches residents to reading assignments based on their own ITE-failed educational objectives and provides direct electronic feedback from their teaching physicians. ABIM exam pass rates were analyzed across various groups between 2002 and 2013 to examine the effect of the DR program on residents with ITE scores ≤35 percentile pre- (2002–2006) and post-intervention (2007–2013). A time commitment survey was also given to physicians and DR residents at the end of the study.ResultsResidents who never scored ≤35 percentile on ITE were the most likely to pass the ABIM exam on first attempt regardless of time period. For those who ever scored ≤35 percentile on ITE, 91.9% of residents who participated in DR passed the ABIM exam on first attempt vs 85.2% of their counterparts pre-intervention (p<0.001). This showed an improvement in ABIM exam pass rate for this subset of residents after introduction of the DR program. The time survey showed that faculty used an average of 40±18 min per week to participate in DR and residents required an average of 25 min to search/read about the objective and 20 min to write a response.ConclusionsAlthough residents who ever scored ≤35 percentile on ITE were more likely to fail ABIM exam on first attempt, those who participated in the DR program were less likely to fail than the historical control counterparts. The web-based teaching method required little time commitment by faculty.

The effect of clomiphene administration on steroid and gonadotrophin output has been studied in three male patients with adrenocortical insufficiency and in three castrate men. In the patients with adrenocortical insufficiency the main effect of clomiphene was to produce a marked increase in the output of urinary testosterone and of its metabolites, androsterone and aetiocholanolone. It is concluded that this effect results from testicular stimulation. In the castrate males clomiphene caused a less marked rise in the excretion of dehydroepiandrosterone (DHA), androsterone and aetiocholanolone, presumably indicating adrenocortical stimulation. Testosterone levels may have fallen slightly during the administration of the compound. Little or no effect on the output of »total gonadotrophic activity« or of follicle-stimulating hormone (FSH) was produced by clomiphene.

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The effect of clomiphene on hormone excretion in four normal males has been investigated.In all subjects there was a marked rise in the urinary excretion of oestrone and oestradiol both during and after administration of the drug. The rise in oestrone excretion preceded and was more marked than the increase in oestriol output.All subjects showed an increase in total 17-oxosteroid excretion during and after clomiphene administration. This was associated with a rise in the output of dehydroepiandrosterone in 2 of the 4 men studied.The effect of clomiphene on steroid output occurred without any consistent change in the pattern of urinary gonadotrophin excretion.

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