Request of CREOG In-Training Exam Scores: Current Practice Among Urogynecology Fellowships

Objectives: The Council on Resident Education in Obstetrics and Gynecology (CREOG) in-training examination (ITE) was designed as a formative educational tool for residency program directors to assess knowledge of their residents and programs. However, many obstetrics/gynecology fellowship programs use CREOG ITE scores in a summative manner to evaluate fellowship candidates. Program-specific requests for scores have led to increased heterogeneity and complexity in the fellowship application process. Our objective was to assess the current practice of requesting CREOG ITE scores among urogynecology fellowship programs and to examine the possible associations between this practice and program characteristics.

Methods: We performed a cross-sectional study on the 57 obstetrics/gynecology-based urogynecology fellowship programs accredited by the American Council for Graduate Medical Education for 2022-2023. In February 2022, fellowship program websites were queried for application requirements. For programs without a clear statement on their CREOG ITE score submissions policy, email correspondences were sent to program coordinators to obtain further clarity. Additionally, all programs that requested CREOG ITE scores were asked whether submission of scores was optional or mandatory; a mandatory requirement was defined to mean that candidates must submit scores to be considered for an interview invitation.

Fellowship program characteristics that could be associated with CREOG ITE score requests were also evaluated; these included geographic characteristics (geographic region and city/town population), attributes of the fellowship program directors (gender, gynecology or urology training, and era of subspecialty board certification), national prominence of faculty members (by proxy, active faculty serving as past-president of AUGS or SGS), and type of training environment (eg, university- or community-based). Chi-squared and Fisher’s exact tests were used to evaluate potential relationships between programs’ CREOG ITE score policies, online disclosure of policies, and program characteristics.

Results: Data was collected for all 57 fellowship programs. Thirty programs (53%) requested CREOG ITE scores to be submitted by applicants. Among those, 22 programs (73%) considered requests to be mandatory. Fellowship website statements on CREOG ITE score submission policies were more common among programs that requested scores (20/30, 66%) compared to programs that did not (3/27, 11%; p < 0.01). Notably, 10 programs that requested CREOG ITE scores did not list CREOG ITE scores among their fellowship application requirements on their websites. There were no associations between programs’ request of CREOG ITE scores and any program characteristics (Table 1).

Conclusions: Approximately half of obstetrics/gynecology-based urogynecology fellowship programs request applicants to submit CREOG ITE scores, but one-third of programs that request scores do not state their score submission policies online. All programs should re-examine and publicly disclose their policies to enhance transparency and information accessibility for fellowship applicants. Given known biases in standardized testing, further research is needed to investigate potential biases in fellowship recruitment that may result from use of CREOG ITE scores.