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December 22, 2025

Early in 1976, J. Clay Goodman, MD, FAAN, filed into a testing center with his fellow residents to take a new assessment. It was called the Residency In-service Training Examination (RITE), and it was only in its second year. 

“Residents and program directors were clamoring for some kind of assessment that would allow them to see if a given resident was accumulating a foundation of essential knowledge during the course of their residency,” Goodman said. “And of course, we would expect them to get better and better. If they don’t, that’s a problem.”  

The RITE is the AAN’s annual self-assessment exam for residents. It helps them prepare for the ABPN Initial Certification Exam in Neurology—performance on the two exams has been shown to correlate—and serves as a “point-in-time” assessment of a resident’s neurology education. It also allows program directors to evaluate the strengths and weaknesses of their programs relative to other programs around the country. 2025 marks the RITE’s 50^th year of existence.

Goodman would continue to take the RITE each year of his residency—and of course, he did get better and better. After he became a full-fledged neurologist, he was asked to serve on the Residency Examination Advisory Panel, a group of expert volunteers who ensure accuracy, clarity, relevance to practice, and topical balance in the exam.

These neurologists would gather once per year in the Twin Cities, where the AAN’s headquarters are located, to sequester themselves with pen, paper, and the exam’s then-480 questions. They would spend whole days editing, debating whether new questions fit residents’ needs, and suggesting a final product for the next year. The RITE was still administered via testing centers, however, and it was difficult to make the timely adjustments needed for a modern neurology assessment. Test production and administration was moved in-house to the AAN, and the RITE later became the AAN’s largest computerized exam, proctored by test-takers’ institutions. Goodman called this “a watershed moment” for the RITE.

Today, in the RITE’s 50^th year, residents have taken the RITE countless times, and dozens of AAN member experts have lent their time and experience to produce it. In the last 20 years alone, the exam has been administered more than 50,000 times. It has become neurology’s recognized marker to challenge residents, assess their strengths, and provide discussions and references for further study—and its evolution has continued.

“With technology comes major opportunities,” said Raymond Price, MD, FAAN, who chairs the AAN’s RITE Work Group. “For years, this was a paper examination with printed glossy photos of MRIs or of pathology. There was no opportunity to hear a patient in their own words or show examination features—everything had to be written and described.”

For example, today’s RITE has videos of scrolling MRIs, where residents find the abnormality in a manner that more closely mimics clinical practice. It also uses video to show rather than tell physical examination findings, assessing a necessary patient care skill that can’t be measured through written descriptions alone.

Updating the test is its own science. The RITE’s expert panel carefully reassesses question performance after each examination period, and there’s a lot of painstaking effort behind every question and topic choice. There’s also a lot of passion—Price says the AAN members who volunteer their time for the exam care a lot about their role in preparing the next generation of neurologists.

“We’ve really tried to emphasize that only questions with clear clinical relevance, things that impact patients, can be included,” Price said. “Every question we write isn’t just to assess a random fact—it needs some clear reason why it’s important, how it’s going to impact the patients these trainees will eventually see.”

In a panel of neurologists, that often means not getting “too far into the weeds”—making sure a new question isn’t just there because one person finds it interesting. If one person writes a question in their subspecialty, someone else outside of that subspecialty always reviews it to see whether it’s relevant to the majority of neurologists. 

Another change is coming in 2027: The RITE will have a separate child neurology version, which the panel of experts is designing now. The goal is to optimize assessment of both child and adult neurology trainees and mirror the ABPN’s exams.

“This is a big lift that the AAN is investing in, but I think it’ll be a tremendous benefit to all of our trainees, giving them an even better assessment of their knowledge for their particular future clinical practice,” Price said. 

So now, as the RITE prepares for its 51^st year, it’s clear how much work and dedication have gone into making the exam what it is.

“I think it’s one of the best things the Academy ever did back in the old days,” Goodman said. “And I’m sure it was scary back then to create—there’s a lot of work involved, a lot of cost and labor to put this thing together. But I think it’s been well worth it.”