{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:50:06Z","timestamp":1791352206249,"version":"4.3.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intensive care unit (ICU) rotations bring together residents from multiple specialties. Comparisons of exit performance may be distorted when departments differ in postgraduate-year (PGY) composition and when non-equivalent examination forms are used across PGY levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cross-sectional analysis of ICU exit examination records from 412 residents at a tertiary teaching hospital in China between November 2025 and April 2026. Three 100-item, 60-min examinations containing four question types were administered according to PGY. Departmental differences were evaluated using four complementary strategies: a same-examination subgroup of 227 PGY-2 residents, within-examination standardization, analysis of covariance adjusting for the combined PGY\/form grouping, and hierarchical regression. Item characteristics, version-specific reliability, and exploratory differential item functioning were assessed retrospectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the same-examination subgroup, the total-score effect size was\n                      <jats:italic>\u03b7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.098 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), with surgery having the lowest mean score (75.9; SD 9.1;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200977; 95% CI 73.9\u201378.0). Department explained an additional 7.6% of total-score variance after adjustment for PGY\/form. The descriptive attenuation ratio was 21.3% for total scores, ranging from 7.3% for case-series items to 80.2% for basic-knowledge items. These ratios do not identify separate training-year or examination-version effects. The largest negative case-analysis gaps occurred in surgery and anesthesiology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Specialty-associated differences in examination performance were observed within this single-center educational setting and using this assessment instrument. The absence of baseline scores and incomplete evidence of cross-form comparability preclude causal or inherent-specialty interpretations; prospective baseline-controlled studies are needed before specialty-tailored interventions are adopted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1960270","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:53:22Z","timestamp":1791348802000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Specialty-associated differences in intensive care unit rotation exit examination performance: a single-center retrospective cross-sectional study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yanche","family":"Lu","sequence":"first","affiliation":[{"name":"Wenzhou Medical University","place":["Wenzhou, China"]},{"name":"The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University","place":["Wenzhou, China"]},{"name":"Wenzhou Medical University Renji College","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruijie","family":"Lin","sequence":"additional","affiliation":[{"name":"Wenzhou Medical University","place":["Wenzhou, China"]},{"name":"Wenzhou Medical University Renji College","place":["Wenzhou, China"]},{"name":"The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Yu","sequence":"additional","affiliation":[{"name":"Wenzhou Medical University","place":["Wenzhou, China"]},{"name":"Wenzhou Medical University Renji College","place":["Wenzhou, China"]},{"name":"The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuyu","family":"Zheng","sequence":"additional","affiliation":[{"name":"Wenzhou Medical University","place":["Wenzhou, China"]},{"name":"Wenzhou Medical University Renji College","place":["Wenzhou, China"]},{"name":"The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianmin","family":"Ye","sequence":"additional","affiliation":[{"name":"Wenzhou Medical University","place":["Wenzhou, China"]},{"name":"The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","volume-title":"Guiding Opinions on Establishing a Standardized Residency Training System","year":"2014"},{"key":"B2","volume-title":"Guideline for 360-Degree Evaluation in Standardized Residency Training","year":"2022"},{"key":"B3","doi-asserted-by":"publisher","first-page":"17","DOI":"10.12290\/xhyxzz.2021-0755","article-title":"Consensus on core competency framework for residency education among China Consortium of Elite Teaching Hospitals for Residency Education","volume":"13","year":"2022","journal-title":"Med J Peking Union Med Coll Hosp"},{"key":"B4","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1111\/medu.12893","article-title":"Preparation for future learning: a missing competency in health professions education?","volume":"50","author":"Mylopoulos","year":"2016","journal-title":"Med Educ"},{"key":"B5","first-page":"6452","article-title":"Transfer of learning","volume-title":"The International Encyclopedia of Education","author":"Perkins","year":"1994"},{"key":"B6","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1007\/s12630-020-01850-x","article-title":"Resident competencies before and after short intensive care unit rotations: a multicentre pilot observational study","volume":"68","author":"Piquette","year":"2021","journal-title":"Can J Anaesth"},{"key":"B7","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1186\/s12909-023-04429-4","article-title":"Medical resident's pursuing specialty and differences in clinical proficiency among medical residents in Japan: a nationwide cross-sectional study","volume":"23","author":"Watari","year":"2023","journal-title":"BMC Med Educ"},{"key":"B8","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1186\/s12909-025-08451-6","article-title":"Assessment methods in graduate medical education in critical care: a scoping review","volume":"26","author":"Jaramillo-Villegas","year":"2026","journal-title":"BMC Med Educ"},{"key":"B9","doi-asserted-by":"publisher","first-page":"23821205231222084","DOI":"10.1177\/23821205231222084","article-title":"The impact of short intensive care rotation on residents\u2019 experience in the COVID-19 pandemic: a mixed-methods study","volume":"10","author":"Khan","year":"2023","journal-title":"J Med Educ Curric Dev"},{"key":"B10","doi-asserted-by":"publisher","first-page":"840721","DOI":"10.3389\/fmed.2022.840721","article-title":"Multimodal in-training examination in an emergency medicine residency training program: a longitudinal observational study","volume":"9","author":"Liu","year":"2022","journal-title":"Front Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1862688","DOI":"10.3389\/fmed.2026.1862688","article-title":"Course-specific performance and mentor characteristics in an undergraduate tutorial system in medical education","volume":"13","author":"Wu","year":"2026","journal-title":"Front Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1111\/medu.14882","article-title":"How argumentation theory can inform assessment validity: a critical review","volume":"56","author":"Kinnear","year":"2022","journal-title":"Med Educ"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1972505","DOI":"10.1080\/10872981.2021.1972505","article-title":"Using longitudinal progress test data to determine the effect size of learning in undergraduate medical education: a retrospective,\u00a0single-center, mixed model analysis of progress testing results","volume":"26","author":"G\u00f6rlich","year":"2021","journal-title":"Med Educ Online"},{"key":"B14","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1177\/00131644231176989","article-title":"Evaluating equating methods for varying levels of form difference","volume":"84","author":"Sun","year":"2024","journal-title":"Educ Psychol Meas"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"B16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5772\/intechopen.100138","article-title":"Item analysis: concept and application","volume-title":"Medical Education for the 21st Century","author":"Rezigalla","year":"2022"},{"key":"B17","doi-asserted-by":"publisher","first-page":"53","DOI":"10.5116\/ijme.4dfb.8dfd","article-title":"Making sense of Cronbach's alpha","volume":"2","author":"Tavakol","year":"2011","journal-title":"Int J Med Educ"},{"key":"B18","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988"},{"key":"B19","doi-asserted-by":"publisher","first-page":"S63","DOI":"10.1097\/00001888-199009000-00045","article-title":"The assessment of clinical skills\/competence\/performance","volume":"65","author":"Miller","year":"1990","journal-title":"Acad Med"},{"key":"B20","first-page":"5","article-title":"Overview: a six-step approach to curriculum development","volume-title":"Curriculum Development for Medical Education: A Six-Step Approach","author":"Kern","year":"2016"},{"key":"B21","volume-title":"Evaluating Training Programs: The Four levels","author":"Kirkpatrick","year":"2006"},{"key":"B22","doi-asserted-by":"publisher","first-page":"53","DOI":"10.34197\/ats-scholar.2023-0060OC","article-title":"Entrustment decision making in the intensive care unit: it's about more than the learner","volume":"5","author":"Conroy","year":"2024","journal-title":"ATS Sch"},{"key":"B23","doi-asserted-by":"publisher","first-page":"i","DOI":"10.1002\/j.2333-8504.2012.tb02290.x","article-title":"A review of ETS differential item functioning assessment procedures: flagging rules, minimum sample size requirements, and criterion refinement","volume":"2012","author":"Zwick","year":"2012","journal-title":"ETS Res Rep Ser"},{"key":"B24","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1186\/s12909-024-06540-6","article-title":"Are medical school preclinical tests biased for sex and race? A differential item functioning analysis","volume":"25","author":"Dale","year":"2025","journal-title":"BMC Med Educ"},{"key":"B25","doi-asserted-by":"publisher","first-page":"638","DOI":"10.3109\/0142159X.2010.501190","article-title":"Competency-based medical education: theory to practice","volume":"32","author":"Frank","year":"2010","journal-title":"Med Teach"},{"key":"B26","first-page":"38","article-title":"Trends in written assessment: a strangely biased perspective","volume-title":"Approaches to the Assessment of Clinical Competence. Part 1","author":"Swanson","year":"1992"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1960270\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:53:26Z","timestamp":1791348806000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1960270\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":26,"alternative-id":["10.3389\/fmed.2026.1960270"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1960270","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"1960270"}}