Board Certification Research Articles

Emergency medicine (EM) surgical critical care (SCC) trained physicians offer many advantages to SCC. However, several fields of critical care (CC) compete with SCC for EM intensivists. We hypothesized that there are definable and potentially modifiable factors related to the pathway selection. Cross-sectional survey. Four national EM societies. EM trainees (residents and fellows). None. The primary outcome included the top factors leading to pathway selection. Secondary outcomes included influential factors for entering CC and individual components of a CC fellowship that interest the EM trainee. One hundred eleven EM trainees responded-42 fellows and 69 residents. Median age was 32 (interquartile range, 30-35). Sixty-seven were matched (fellows + matched residents). Intended fields of practice: 49 anesthesiology CC (26 matched), 58 medicine CC (29 matched), two neurology CC (1 matched), six resuscitation (one matched), 15 SCC (eight matched), and five non-CC (two matched). Top factors for pathway selection included exposure to specialty units, geography and specialty multidisciplinary teams (p < 0.05). Ease of board certification was not influential. Only 28% of trainees had exposure to EM-SCC fellowships at their residency institution and only 42% had exposure to surgical intensivists during training. However, 41% envisioned practicing in a surgical ICU. Before application season, 8.2% did not have exposure to a surgical ICU/trauma ICU/trauma service that managed their ICU patients in contrast to the 3.2% of applicants not having medical ICU exposure. The highest-ranking factor for entering CC was intellectual appeal over job opportunities and lifestyle (p < 0.05). When assessing components of individual fellowship programs, CC knowledge, the institutional value of EM/critical care medicine, and extracorporeal membrane oxygenation exposure ranked highly. Given the complexity of the modifiable barriers for EM-SCC matriculation, a multifaceted approach is necessary to increase matriculants. Interventions specific to the specialty are required at professional societal, institutional, and training program levels.

Abstract: This research aims to examine the photography class learning process implemented by GSNP EDUPRO (Galeri Nila Photoworks Education Program) through a government assistance program. The study was conducted using a field research approach with qualitative research methods. Data collection was performed through direct observation and documentation of learning activities. The research findings indicate that the process of sharing photography knowledge at GSNP EDUPRO is implemented through a structured mentoring method by photography experts who possess competency certificates in their field. The curriculum encompasses both theoretical and practical aspects of photography, ranging from photography history, compositional fundamentals, exposure triangle, lighting techniques, photography occupational health and safety, digital image processing, to unique selling propositions. The learning process is conducted directly through field practice in various locations with diverse lighting conditions and subjects. Mentors provide intensive guidance throughout the learning process using personalized approaches tailored to the needs and comprehension levels of individual participants. Progress evaluations are conducted periodically to ensure the achievement of expected competency standards. The learning program concludes with a standardized photography competency examination through collaboration with the Photography Competency Certification Board of Indonesia (LESKOFI), providing added value in the form of official certification for participants who successfully complete the program. This research concludes that the photography education implemented by GSNP EDUPRO through the government assistance program has effectively transferred photography knowledge and skills, with success measured by participants' passing rates in the LESKOFI competency certification examination.

Background:Graduate-level licensed addiction counselors are a critical component of the substance use disorder workforce, yet their scope of practice, education and training requirements, and credentialing varies in the U.S.Objectives:To better understand the roles and functions of the graduate-level addiction counselor workforce across the U.S., this state-by state analysis sought to identify the titles, minimum education and training requirements, scope of practice, and supervisory opportunities for graduate-level addiction counselors.Design:This project conducted systematic abstraction and descriptive analysis of U.S. state Practice Acts, certification board rules, materials from behavioral health professional organizations, and state Medicaid plans, fee schedules, and provider manuals.Methods:Descriptive summaries were produced to describe trends across states. Tables synthesized aggregated data across the workforce domains of education and training, regulation and credentialing, supervision, and payment for graduate-level addiction counselors only.Results:Forty-one states offer a graduate-level addiction counselor credential, 18 of which offer multiple credentials for a total of 69 credentials. States varied in services permissible by scope of practice definition, including assessments (41 states), psychotherapy (28 states), telehealth (28 states), and diagnosis (16 states). Only 26 states allow for independent practice. States required an average of 2,887 practice hours and 143 post-graduate supervision hours. Sixteen states permitted all tiers of graduate-level addiction counselors to supervise others, and 10 states specifically offer a graduate-level supervisory credential.Conclusion:State graduate-level addiction counselor credentials widely vary, suggesting that states utilize this workforce differently based on differing training criteria, required competencies, scope of practice, and supervision. Strategies to support growth of this workforce include alignment of training competencies, additional substance use disorder training in behavioral health graduate programs, and expansion of supervisory pathways and credentials.

Binghamton University's Decker Sch‐ool of Nursing is stepping up to address the growing mental health crisis by training the next generation of providers, BingUNews reported Oct. 16. With a comprehensive curriculum and a board certification pass rate exceeding 90%, the school's family psychiatric mental health nurse practitioner (FPMHNP) program is preparing students to become leaders in education, clinical care, and policy. “Binghamton's program is highly regarded, and it's at a high level of skill,” says Susan Glodstein, program coordinator. “What distinguishes us is our flexibility and depth. People seek out our program because they know they'll be well‐prepared to make a difference.” The need is urgent. In 2020 alone, 21 million people around the country had a major depressive episode, and 40 million struggled with anxiety. Yet more than half of adults receive no treatment, and 60% of mental health practitioners are unable to take new patients. “Decker's program laid down the foundation for problem‐solving, investigating the problem in more depth and considering alternative approaches,” says Jean Van Kingsley, MS, who works for the Greater Binghamton Health Center in the Office of Mental Health and as a FPMHNP for Otsego County, N.Y. “I always say that from Decker, you will have a solid foundation. Some students build a small cabin of knowledge, but others build a mansion.” The program uses interdisciplinary methods, emphasizes field‐based skills, and requires scholarly writing. However, students also must maintain high and continuously improving skill sets in the subject itself, such as advanced physiology and pharmacology.

Multiple choice questions (MCQs) are an important and integral component of ophthalmology residency training evaluation and board certification; however, high-quality questions are difficult and time-consuming to draft. To evaluate whether general-domain large language models (LLMs), particularly OpenAI's Generative Pre-trained Transformer 4 (GPT-4), can reliably generate high-quality, novel, and readable MCQs comparable to those of a committee of experienced examination writers. This survey study, conducted from September 2024 to April 2025, assesses LLM performance in generating MCQs based on the American Academy of Ophthalmology (AAO) Basic and Clinical Science Course (BCSC) compared with a committee of human experts. Ten expert ophthalmologists, who were masked to the generation source, independently evaluated MCQs using a 10-point Likert scale (1 = extremely poor; 10 = criterion standard quality) across 5 criteria: appropriateness, clarity and specificity, relevance, discriminative power, and suitability for trainees. Relevant BCSC content and AAO question-writing guidelines were input into GPT-4o via Microsoft's Azure OpenAI Service, and structured prompts were used to generate MCQs. The primary outcomes were median scores and statistical comparisons using the bootstrapping method; string similarity scores based on Levenshtein distance (0-100, with 100 indicating identical content) between LLM-MCQs and the entire BCSC question bank; Flesch Reading Ease metric for readability; and intraclass correlation coefficient (ICC) for inter-rater agreement are reported. The 10 graders had between 1 and 28 years of clinical experience in ophthalmology (median [IQR] experience, 6 years [3-15 years]). Questions generated by GPT-4 and a committee of experts received median scores of 9 and 9 in combined scores, appropriateness, clarity and specificity, and relevance (difference, 0; 95% CI, 0-0; P > .99); 8 and 9 in discriminative power (difference, 1; 95% CI, -1 to 1; P = .52); and 8 and 8 in suitability for trainees (difference, 0; 95% CI, -1 to 0; P > .99), respectively. Nearly 95% of LLM-MCQs had similarity scores less than 60, indicating most LLM-MCQs had limited or no resemblance to existing content. Interrater reliability was moderate (ICC, 0.63; P < .001), and mean (SD) readability scores were similar across sources (37.14 [22.54] vs 42.60 [22.84]; P > .99). In this survey study, results indicate that an LLM could be used to develop ophthalmology board-style MCQs and expand examination banks to further support ophthalmology residency training. Despite most questions having a low similarity score, the quality, novelty, and readability of the LLM-generated questions need to be further assessed.

Point-of-care ultrasound (POCUS) is a valuable addition to the diagnostic armamentarium of internal medicine specialists, improving patient assessment and treatment guidance. Early acquisition and continuous development of ultrasound skills during clinical training are key to maintaining the high quality of POCUS. In Switzerland, POCUS Component 1 (basics of emergency medicine ultrasound) of the Swiss Society of Ultrasound in Medicine (SGUM) postgraduate certification programme will be a mandatory component of board certification in General Internal Medicine (GIM) after 2026. Clinical institutions face the challenge of integrating POCUS teaching into daily practice. The following article addresses this challenge by describing the current regulatory conditions of POCUS training and presenting the POCUS training programme at Stadtspital Zürich Triemli as a blueprint for other postgraduate education sites in Switzerland.

Despite a rising demand for geriatricians, fewer than 1% of physicians have achieved board certification in the subspecialty. Most geriatrics fellowship programs offer a traditional 1-year, full-time training model, which is often financially and logistically challenging for residency graduates who wish to pursue hospitalist careers. To address this challenge, we developed an innovative 2-year combined Geriatric Medicine Fellowship-Hospitalist track using an Accreditation Council For Graduate Medical Education- and American Board of Internal Medicine-approved interrupted training model. We describe the novel structure and implementation approach, offering a replicable framework for academic institutions seeking to strengthen their geriatrics workforce development and facilitate an age-friendly health system.

Prescribing Trends for Vaginal Estrogen: What Role Do Urogynecology and Reconstructive Pelvic Surgery Urologists Play?

Persistent regional and school-level inequities continue to shape students’ educational outcomes in Somaliland. Despite policy advances, empirical evidence quantifying how much variation in academic achievement is attributable to individual, school, and regional factors remains limited. This study applies the geography of opportunity framework to investigate how location and institutional context influence student performance across Somaliland’s secondary schools. A cross-sectional multilevel analysis was conducted using a comprehensive administrative dataset from the Somaliland National Examination and Certification Board (SLNECB), comprising 505,398 subject-level grade records from 186 secondary schools (2020-2023). Using linear mixed-effects models estimated in R (lme4), students (Level 1) were nested within schools (Level 2). Three models were fitted: a null model, a random intercept model (including sex, subject, and year as fixed effects), and a random slope model allowing the effect of sex to vary by school. Model comparison was based on AIC, BIC, and marginal/conditional R2 values. The Intraclass Correlation Coefficient (ICC = 0.234) indicated that 23.4% of total variance in student grade points stemmed from school-level factors, revealing a strong “school effect.” The random slope model demonstrated the best fit (AIC = 1,587,694.8; BIC = 1,587,895.2; R2_conditional = 0.348). Performance varied markedly across subjects: Mathematics (d = −0.73) and Chemistry (d = −0.66) showed the largest deficits, while History (d = +0.39) performed highest. Although the overall sex difference was trivial (d = 0.02), the effect varied significantly between schools. A negative correlation (r = −0.35) between school intercepts and gender slopes indicated that higher-performing schools reduced or reversed gender gaps. Results reveal a deeply unequal educational landscape in Somaliland where student achievement is strongly conditioned by school context. The substantial between-school variance confirms that location and institutional quality, rather than individual characteristics, are primary drivers of inequality. Strengthening underperforming schools—especially in regions such as Sool, Togdheer, and Xaysimo—and investing in STEM teaching capacity are crucial for equity. The findings underscore the importance of geographically targeted policies and reinforce that enhancing school quality also promotes gender equity.

BackgroundMultimodal large language models (LLMs) have the capability to process and integrate both text and image data, offering promising applications in the medical field. This study aimed to evaluate the performance of representative multimodal LLMs in the 2023 Japanese Surgical Specialist Examination, with a focus on image-based questions across various surgical subspecialties. MethodsA total of 98 examination questions, including 43 image-based questions, from the 2023 Japanese Surgical Specialist Examination were administered to three multimodal LLMs: GPT-4 Omni, Claude 3.5 Sonnet, and Gemini Pro 1.5. Each model’s performance was assessed under two conditions: with and without images. Statistical analysis was conducted using McNemar’s test to evaluate the significance of accuracy differences between the two conditions. ResultsAmong the three LLMs, Claude 3.5 Sonnet achieved the highest overall accuracy at 84.69%, exceeding the passing threshold of 80%, which is consistent with the standard set by the Japan Surgical Society for board certification. GPT-4 Omni closely approached the threshold with an accuracy of 79.59%, while Gemini Pro 1.5 scored 61.22%. Claude 3.5 Sonnet demonstrated the highest accuracy in four of six subspecialties for image-based questions and was the only model to show a statistically significant improvement with image inclusion (76.74% with images vs. 62.79% without images, p = 0.041). By contrast, GPT-4 Omni and Gemini Pro 1.5 did not exhibit significant performance changes with image inclusion.ConclusionClaude 3.5 Sonnet outperformed the other models in most surgical subspecialties for image-based questions and was the only model to benefit significantly from image inclusion. These findings suggest that multimodal LLMs, particularly Claude 3.5 Sonnet, hold promise as diagnostic and educational support tools in surgical domains, and that variation in visual reasoning capabilities may account for model-level differences in image-based performance.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-025-07938-6.

ABSTRACTEffective staff training and supervision are vital in human care services, influencing staff performance and the quality of care. This study explores the effectiveness of an 8 h training program for Board Certified Behavior Analysts (BCBA) in providing performance feedback, specifically in the context of a Paired Stimulus (PS) preference assessment. The training consisted of 5 h of instruction, exercises, and discussions, followed by 3 h of Behavioral Skills Training (BST), emphasizing performance feedback as a pivotal component. Using a concurrent multiple probe design across four supervisors, the results demonstrated substantial improvement in supervisors' ability to provide performance feedback, which in turn enhanced supervisees PS preference assessment skills. Furthermore, two of the four supervisees demonstrated mastery of feedback‐giving skills after receiving performance feedback and observing their supervisors being given feedback. The remaining two supervisees required direct instruction in feedback delivery in order to meet the mastery criteria. The study contributes to the limited literature on training supervisors to provide effective feedback and the importance of incorporating specific feedback‐giving skills in supervision training programs.

Abstract Introduction: Mental health conditions constitute a significant portion of disability burden worldwide. Despite the implementation of various rights-based progressive legislations in India, disability in general and mental health disabilities in particular remain highly stigmatized. Aim: We aimed to study the sociodemographic and clinical profile of patients receiving disability certification in a rural population after the abrogation of Article 370 when the Rights of Persons with Disabilities Act came into force. Materials and Methods: This cross-sectional observational study was conducted at the Disability Certification Board, District Budgam, Jammu and Kashmir, over a period of 6 months from October 2022 to March 2023. A total of 158 consecutive applicants were included using total enumeration sampling. Data were extracted from disability certification records, including sociodemographic details, clinical diagnoses, Indian Disability Evaluation and Assessment Scale scores, and IQ assessments where applicable. Results: A total of 158 certificates were issued in the time of 6 months. The majority of the patients were male, illiterate, and belonged to below-poverty line socioeconomic status. Intellectual developmental disorder (IDD) was the most common diagnosis. Conclusion: The study highlights the predominance of IDD and severe mental illness among those seeking certification, with poor awareness and underutilization of available disability benefits, especially in rural populations.

Supplemental Material for What Makes a Good Board Certified Behavior Analyst? Employer Opinions of Newly Credentialed Behavior Analysts

To ensure the Pediatric Infectious Diseases (ID) Certifying Examination remains aligned with current clinical practice, the American Board of Pediatrics (ABP) conducted a comprehensive practice analysis to update the exam content outline. A panel of nine pediatric ID physicians identified 34 core tasks across five performance domains to guide revisions to the existing outline. The panel identified relevant, testable knowledge areas aligned with these tasks and organized them into 22 domains and 186 initial subdomains. A nationwide validation survey of board-certified pediatric ID physicians collected relevance ratings, feedback on missing or outdated topics, and suggested exam weights, which was used to guide further revisions. Subsequently, the pediatric ID subboard conducted an item reclassification process, which resulted in additional refinement. The final content outline comprises 22 domains and 196 subdomains, with updated domain weights to better reflect the clinical landscape. Notably, domains such as cardiovascular, bone and joint, and urologic infections increased in weight, while antimicrobial principles decreased. This rigorous, inclusive process strengthens the exam's content validity and supports the ABP's goal of certifying physicians who possess the knowledge needed to deliver safe and effective care.

Abstract Background Laboratory professional credentials attained through the ASCP Board of Certification (ASCP BOC) play a pivotal role in addressing this challenge. By standardizing and enhancing the professional skills of laboratory professionals, ASCP BOC credentials open new avenues for recruitment, retention, and professional development. Stacking credentials, such as pairing Medical Laboratory Scientist, MLS(ASCP) with Specialist in Blood Banking, SBB(ASCP)or other specialized credentials, has emerged as a significant pathway for career growth, skill enhancement, and clear career progression. This study explores how credential stacking enhances individual expertise, supports career advancement, and contributes to creating a skilled and satisfied workforce, ultimately addressing operational challenges and workforce shortages in laboratory settings. Methods This study utilized a comprehensive analysis of ASCP BOC’s credentialing data, focusing on individuals with multiple credentials. Data were segmented by degree (e.g., Bachelor’s, Master’s, PhD), credential count (ranging from 2 to 10), and professional demographics. The analysis also included geographical distribution across the U.S. and internationally to identify patterns and growth trends. Metrics analyzed included the number of professionals holding multiple credentials, time elapsed between the attainment of the first and subsequent credentials and associated professional outcomes. In addition to credentialing data, insights from health and business literature were reviewed to contextualize the findings and explore intentional workforce strategies. Results The data revealed that approximately 9.7% of ASCP BOC credential holders now possess two or more credentials. Credential stacking demonstrates measurable benefits for professionals and employers alike, supporting continuous professional development and specialization. Key findings:Earning Potential: Research has shown stacked credential holders may see as much as a 9% return on average in their salaries.Workforce Strategies: Credential stacking supports clear career progression pathways and continuous professional development, which help attract new talent and retain skilled staff. These strategies foster a positive workplace culture, promote work-life balance, and contribute to greater employee satisfaction.Professional Skills Enhancement: Credential holders with stacked credentials demonstrated consistent scaled score performance (mean = 475), reflecting sustained professional excellence.Operational Impact: Employers noted increased versatility, leadership readiness, and adaptability among multi-credentialed professionals, particularly in specialized laboratory roles.Geographical analyses highlighted hotspots for laboratory professionals seeking multiple credentials in both domestic U.S. regions and internationally. These findings suggest that the ASCP BOC, and by extension the broader laboratory medicine and pathology community, can greatly benefit from promoting and facilitating the acquisition of multiple credentials. By doing so, the field ensures a workforce that is not only highly qualified but also adaptable to the changing dynamics of healthcare, thereby reinforcing the indispensable role of laboratory professionals in the broader healthcare ecosystem. Conclusion Stacking ASCP BOC credentials is a vital strategy for addressing workforce shortages in laboratory medicine and pathology laboratories worldwide. By enhancing professional skills, providing clear career progression pathways, and fostering workplace satisfaction, multi-credentialing supports recruitment and retention efforts while promoting continuous professional development. These strategies align with patient-centric expectations and contribute to a more sustainable and effective laboratory professional workforce.

Navigating radiology board certification and practice pathways in Canada: a guide for international medical graduates.

Defining Mohs Surgery Workforce: A Cross-Sectional Analysis of Centers for Medicare and Medicaid Services Current Procedural Terminology Code 17311 Billing from 2015 to 2020.

Surgical Residents' Experience With a Perinatal Resident Policy: A Qualitative Study.

We sought to determine the extent and distribution of workforce shortages within US medical laboratories. The survey was conducted through collaboration between the American Society for Clinical Pathology's (ASCP's) Institute for Science, Technology and Policy in Washington, DC, and the Evaluation, Measurement and Assessment Department and ASCP Board of Certification in Chicago, Illinois. Data were collected using an internet survey distributed to individuals in a position to report on staffing and certifications for their laboratories. Findings from the ASCP 2024 Vacancy Survey indicate that although vacancy rates have declined compared with 2022, they remain elevated relative to those observed before the COVID-19 pandemic. Retirement rates continue to rise, with 10 of the 17 laboratory departments surveyed reporting increases. Among surveyed laboratory departments, the most frequently cited concern regarding artificial intelligence was the challenge of adapting to emerging technologies. Despite this sentiment, the perceived potential of artificial intelligence to transform laboratory operations remains a major source of enthusiasm. Current vacancy survey data suggest continued challenges in recruitment of laboratory professionals. Qualitative analysis results show that there is an urgent need for advocacy for laboratory professionals, increased credentialing of laboratory professionals, and an increase in the number of laboratory education and training programs.

We sought to investigate the frequency of diagnostic changes in hematopathology cases referred to the University of Michigan during a 3-year period and explore which parameters contribute to diagnostic change. Pathology reports from hematology patients who came to the University of Michigan for a second opinion from 2017 to 2019 were reviewed. Diagnostic discrepancies were classified into major or minor. Specimen type, hematopathology board certification and practice time of the outside pathologists, referring practice type, and whether the second review was done at the referring institution were recorded too. Agreement in diagnosis by the above-listed specimen characteristics was analyzed. A total of 2786 cases were reviewed (2016 bone marrow and 770 tissue specimens). Disagreements in diagnosis were found in 263 cases (9.4% of total cases), and 163 (5.9%) were major disagreements. Among the major disagreements, 119 (73%) were in bone marrow specimens and 44 (27%) in tissue specimens. Among bone marrows, the most common revisions were myeloid neoplasm reclassifications (35.3%), whereas lymphoma subtype revisions comprised 70.4% of all changes in tissues. Univariate analysis showed that major disagreement rates were significantly higher in cases signed out by pathologists without hematopathology certification, those practicing for more than 10 years, and in cases from nonacademic institutions. When analyzing bone marrows and tissues separately, these differences remained significant only for bone marrows. Second review of pathology material serves as an important quality assurance and patient safety measure. Lack of hematopathology training of the referring pathologists may contribute to the rate of diagnostic discrepancy.