Background

Achieving board certification is a critical marker of baseline clinical competence in early career hematologists. However, due to the rapid pace of medical advancements in recent years, the volume of knowledge required to successfully practice hematology has grown exponentially. Consequently, passing the hematology board exam is a challenging task, with an average failure rate of 7% for first-time test takers since 2020 (American Board of Internal Medicine - ABIM). Hematology/Oncology fellowship programs should strive to adequately prepare their trainees for this crucial exam.

A needs assessment performed within our large academic Hematology/Oncology fellowship program demonstrated that a limited number of fellows agreed that the existing curriculum adequately prepared them for hematology board exam topics (53% for classical and 63% for malignant hematology). Thus, we sought to develop and assess the effectiveness of a longitudinal, structured board review curriculum that could run parallel to the standard fellow didactic series.

Methods

A novel structured hematology focused board review curriculum was implemented for Hematology/Oncology fellows at The Ohio State University from August 2024 through May 2025. The curriculum included monthly faculty-led Zoom sessions, with each session dedicated to content review and interactive question practice for specific high-yield hematology topic areas as detailed in the ABIM Hematology exam blueprint. Existing board review materials including those supplied by the American Society of Hematology and American Society of Clinical Oncology were utilized in session creation.

Fellows were surveyed before and after the longitudinal board review series using a 5-point Likert scale to assess their satisfaction with the curriculum and their confidence across specific hematology content domains. Attendance data and In-Training Exam (ITE) scores were collected. Analyses included descriptive statistics of fellow satisfaction and confidence scores (pre/post), correlation and regression analysis of attendance and ITE performance, and interaction modeling to assess whether the effect of attendance varied by training year.

Results

A total of 21/29 (72%) fellows completed the pre-survey and 25/29 (86%) completed the post-survey. The percentage of fellows who somewhat or strongly agreed that the fellowship curriculum was adequately preparing them for the classical and malignant hematology content on the board exam increased from 53% to 83% and 63% to 92% respectively. In the post-survey, 92% of fellows were satisfied or very satisfied with the new curriculum. Fellow confidence improved in 16 of the 18 assessed hematology topic domains, with an average increase of 0.38 on a 5-point Likert scale.

Among the 22 fellows with matched attendance and Hematology ITE score data, both pre-ITE and all-session attendance were positively correlated with test performance. Pre-ITE attendance showed a moderate positive correlation with ITE scores (r = 0.61, p = 0.0027), while all-session attendance also demonstrated a significant association (r = 0.44, p = 0.040). In a multiple linear regression model including fellowship year and attendance, both year (β = +47.3, p = 0.031) and all-session attendance (β = +1.86, p = 0.021) were independent predictors of test performance. Interaction modeling did not reveal a statistically significant interaction between attendance and year (p = 0.80), suggesting that the positive effect of attendance on test scores persisted across all training levels, without meaningful variation in magnitude by year.

Conclusions

The implementation of a longitudinal, structured board review series for Hematology/Oncology fellows at our single academic center led to improvements in overall trainee satisfaction with their board exam preparation and confidence regarding most testable hematology topic areas. Further, attendance was correlated with higher scores on the ITE – an exam used as a surrogate for predicting successful board certification. This intervention strategy offers a model for other fellowship programs, Hematology/Oncology or otherwise, seeking ways to improve board exam readiness for their fellow-level learners.

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2025
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