Editor's Note: The online version of this article contains the examination questions used in the study.;Introduction Individuals 65?years and older currently represent approximately 13% of the US population, and this number is expected to grow to 1 in 5 by 2030.1 The increasing number of chronically ill, older adults will require experienced primary care and geriatrics physicians. However, the number of medical students matching to primary care internal medicine programs and family medicine programs has dropped 33% and 35%, respectively,2 and just 22% of the graduating internal medicine residents from October 2009 through October 2011 planned to pursue a career in general internal medicine.3 Given these figures, it is important to ensure that all medical residents, even those who intend to subspecialize in other areas, have a strong background in geriatric medicine. Recognizing this need, the American Board of Internal Medicine (ABIM) has placed greater emphasis on education in geriatrics. The current ABIM Certification Examination devotes 10% of the questions to geriatrics, compared with 2% in 1980.4 Several attempts have been made to create tools to evaluate geriatrics knowledge, among them Palmore's Facts on Aging Quiz (1977); the University of California, Los Angeles, Geriatrics Knowledge Examination (1997); and the University of Michigan Geriatrics Clinical Decision-Making Assessment (2006).5–8 Although each of these assessments serves a unique purpose, updates are needed, and none focuses on the ambulatory care of the older adult. Our goal was to develop and validate a novel knowledge-assessment tool with a deliberate focus on ambulatory geriatrics medical care.;Results Item Analysis of Resident Examinations The 25-item examination had a Cronbach coefficient α of 0.48 based on examinations administered to interns and residents. However, it was not considered a homogenous test for which a Cronbach coefficient α is fully applicable, given the large variety of clinical topics on which the questions were based. These findings were congruent with other published geriatrics examinations.5,6;Discussion Our goal was to fill a gap in existing methods to assess residents' knowledge of ambulatory care for older adults. Given the importance of ambulatory care for primary care and subspecialty medicine, residency programs should have a reliable and validated tool to assess residents' knowledge in this area. Our 25-question examination meets those requirements and should be applicable to internal medicine and family medicine residencies. The average score among residents was 15 (60%), leaving ample room for improvement on the same examination given as a postrotation assessment. Content validity was supported by the instrument-development process as described, including use of items from validated examinations and topic selection by local experts.12,13 In general, the postgraduate year (PGY)-1 group had a lower score than did a combined PGY-2 and PGY-3 group. Our study has several limitations. It was conducted at a single institution with a single set of students and residents, limiting generalizability. We also grouped all learners together in our analyses despite differing amounts of experience in medicine.;Conclusion Overall, our examination is a promising tool to assess knowledge and should be evaluated at other institutions among internal medicine and family medicine residents to further establish its validity in varied settings. Future work should establish the examination's ability to measure knowledge gained during a 1-month ambulatory geriatrics rotation for internal medicine residents.
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