Longitudinal trajectories of clinical knowledge performance in cardiology residency a mixed-effects analysis with psychometric adjustment of routine assessments

In-service examinations are widely used to monitor knowledge acquisition during postgraduate medical training. However, longitudinal interpretation of examination scores is limited by heterogeneity in test difficulty and the lack of psychometric calibration across assessments. Without appropriate adjustment, observed score changes may reflect examination variability rather than true learning progression. To evaluate longitudinal clinical knowledge performance among cardiology residents using a p