DOES THE NUMBER OF TRAINEES IN A POSTGRADUATE TRAINING-PROGRAM INFLUENCE THE PASS RATES ON CERTIFYING EXAMINATIONS

We tested the hypothesis that small training programs (3 or fewer resi dents) lack the ''critical mass'' needed for an optimal learning exper ience, and thus graduates of small programs will have a lower pass rat e on the Royal College of Physicians and Surgeons of Canada (RCPSC) ce rtifying exams than graduates of large (10 or more residents) training programs. Pass rates on the RCPSC certifying exams (written and oral) were compared to the training program size for each of 6 years from 1 984/85 to 1989/90 within 10 of the 43 RCPSC (sub)specialties selected by meeting predefined program size requirements. These 10 specialties met the size variation requirements needed to test the hypothesis: neu rology, cardiology, emergency medicine, community medicine, neurosurge ry, urology, plastic surgery, dermatology, anatomical pathology, and r espiratory medicine. Of these, 3 specialties had a significantly lower written exam pass rate for candidates trained in small compared to la rge programs. The same 3 specialties (neurology, neurosurgery, and com munity medicine) had a higher proportion of International Medical Grad uates (IMGs) in small training programs. The significantly lower pass rate of IMGs, compared to Canadian/USA graduates, accounted for a port ion of the correlation of small program size with lower pass rates in these 3 specialties. By pooling the results from the 10 specialties ev aluated, candidates from small (3 or fewer residents) training program s have slightly lower pass rates (11%) on written certification examin ations compared to candidates from large (10 or more residents) traini ng programs. This small but statistically significant effect in the po oled results was due to averaging of a more marked program size effect from 3 of the 10 specialties. Analyzed individually, only candidates from these 3 specialties demonstrated a size effect on the written exa m. There is no effect of training program size on the pass rate for th e oral component of the certification exams. In conclusion, the number of trainees in postgraduate medical training programs has marginal pe dagogical significance as measured by the pass rates on certification exams. The need to have a ''critical mass'' of trainees to provide a s ound postgraduate medical education may have been overemphasized in th e past.