Certification Examination Performance Research Articles

Pathophysiology and pharmacology course grades and prediction of success in a graduate nurse practitioner program.

During a program review, faculty identified that nurse practitioner (NP) students who received a C grade in Advanced Pathophysiology (Patho) and Advanced Pharmacology (Pharm) appeared to perform poorly in the later NP management courses and on other program outcomes. The research aimed to determine whether grades in graduate Patho and Pharm courses could predict performance in NP management courses, program progression and completion, and certification pass rates. This research included deidentified student data from 2016 to 2018 across seven NP specialty tracks ( n = 4,575). Nonparametric and parametric tests were used in the analysis. A significant correlation ( p < .001) existed between Patho and Pharm grades. Lower grades in these two courses were significantly related to each other and to lower management course grades. Logistic regression showed that graduate pathophysiology grades significantly predicted certification examination performance, with lower grades associated with lower certification examination performance. Graduate pharmacology grades, pathophysiology grades, composite management course grades, and admission grade point average (GPA) significantly predicted final cumulative GPA, with lower grades associated with lower performance for all variables. Results of this research support the hypothesis that grades of C in Patho or Pharm courses significantly predict C performance in the management NP courses and lower certification success rates. The project model can be used in future research. Study findings can be helpful to NP faculty when considering curriculum decisions.

Path Analysis of Admission and Program Achievement Variables to Predict Physician Assistant National Certifying Examination Performance: Results of a 6-Year Study

Introduction The primary aim of this study was the examination of relationships between students' preadmission achievement, intraphysician assistant (PA) program achievement, and Physician Assistant National Certifying Examination (PANCE) performance using path analysis regression. Second, this study explored the extent to which the theoretical model differed based on several key demographic variables: sex and undergraduate major. Methods This retrospective, single-institution study examined data from 2015 to 2022 (n = 322). Analysis included descriptive statistics, bivariate correlations, and path analysis using structural equation modeling to examine direct, indirect, and total effects of all predictors on the primary outcome variable, PANCE. Results PACKRAT-I demonstrated the largest total effect size on PANCE total score (β = .45). Total effect size on PANCE was small yet significant for prerequisite grade point average (GPA), Graduate Record Exam verbal and quantitative subscores, a comprehensive didactic cardiology examination, didactic and clinical year GPAs, and End of Rotation examination mean score (β &lt; .25). The relationship between mean preceptor evaluation score and PANCE was nonsignificant. Subgroup analyses showed differences between female and male in the relationship between several didactic variables and preceptor evaluations. No differences were detected between groups based on undergraduate major. Discussion This PANCE analysis revealed relationships among pre-PA and intra-PA performance metrics that may subsequently support data-informed strategies for programs to identify at-risk students, aid student success, and support the assessment of curriculum. Future studies should replicate the approach using a larger, multi-institution sample that examines additional preprogram and intraprogram achievement variables.

American Board of Ophthalmology Certifying Examination Performance and Opioid Prescription Patterns

ABSTRACT: Purpose: To compare opioid prescription patterns of ophthalmologists based on performance on the American Board of Ophthalmology (ABO) written qualifying examination (WQE) and oral certifying examinations (OE). Design: All ophthalmologists within the Medicare Prescriber Part D Database from 2013 – 2018 who attempted the ABO, WQE, or OE were included. Opioid prescription data were analyzed based on ABO certification status: certified on first attempt, failed but then certified, and never certified. Results: There were 6822 ophthalmologists with 32258 records in the Medicare database during the study period with ABO data available. The point estimate for total opioid prescriptions per year was 7.3, standard error (SE) 0.3 for ophthalmologists who were certified on the first attempt (reference). The estimate for those who failed one or both qualifying examinations, but then became board certified (BC) was −1.7, SE 0.6 (p = 0.0031); and the estimate for those ophthalmologists who never became BC was +0.8, SE 1.5 (p = 0.5318). The point estimate for cost of opioids prescribed per year was $55.17, SE 4.4 for ophthalmologists who were certified on the first attempt, with the estimate for those who failed one or both qualifying examinations, but then became BC being $−12.29, SE 8.7 (p = 0.1581); and for those ophthalmologists who never became BC being +$69.54, SE 21.7 (p = 0.0014). Conclusions: Diplomates who initially failed one or both qualifying exams, but who ultimately became certified, prescribed less opioids, less costly opioids, and less supply of opioids within the Medicare Part D database compared to non-BC ophthalmologists.

The Association of ACGME Milestones With Performance on American Board of Surgery Assessments: A National Investigation of Surgical Trainees.

To determine the relationship between, and predictive utility of, milestone ratings and subsequent American Board of Surgery (ABS) vascular surgery in-training examination (VSITE), vascular qualifying examination (VQE), and vascular certifying examination (VCE) performance in a national cohort of vascular surgery trainees. Specialty board certification is an important indicator of physician competence. However, predicting future board certification examination performance during training continues to be challenging. This is a national longitudinal cohort study examining relational and predictive associations between Accreditation Council for Graduate Medical Education (ACGME) Milestone ratings and performance on VSITE, VQE, and VCE for all vascular surgery trainees from 2015 to 2021. Predictive associations between milestone ratings and VSITE were conducted using cross-classified random-effects regression. Cross-classified random-effects logistic regression was used to identify predictive associations between milestone ratings and VQE and VCE. Milestone ratings were obtained for all residents and fellows(n=1,118) from 164 programs during the study period (from July 2015 to June 2021), including 145,959 total trainee assessments. Medical knowledge (MK) and patient care (PC) milestone ratings were strongly predictive of VSITE performance across all postgraduate years (PGYs) of training, with MK ratings demonstrating a slightly stronger predictive association overall (MK coefficient 17.26 to 35.76, β = 0.15 to 0.23). All core competency ratings were predictive of VSITE performance in PGYs 4 and 5. PGY 5 MK was highly predictive of VQE performance [OR 4.73, (95% CI, 3.87-5.78), P <0.001]. PC subcompetencies were also highly predictive of VQE performance in the final year of training [OR 4.14, (95% CI, 3.17-5.41), P <0.001]. All other competencies were also significantly predictive of first-attempt VQE pass with ORs of 1.53 and higher. PGY 4 ICS ratings [OR 4.0, (95% CI, 3.06-5.21), P <0.001] emerged as the strongest predictor of VCE first-attempt pass. Again, all subcompetency ratings remained significant predictors of first-attempt pass on CE with ORs of 1.48 and higher. ACGME Milestone ratings are highly predictive of future VSITE performance, and first-attempt pass achievement on VQE and VCE in a national cohort of surgical trainees.

Taking Leave During Residency: Types of Absences and Subsequent Delays and Variations in Physical Medicine and Rehabilitation Medical Board Pass Rates.

There is limited literature examining the reasons physical medicine and rehabilitation residents take an extended leave of absence during residency and the impact of leave on board examination performance. Such information could better inform leave policies, help guide residency program directors, and potentially destigmatize taking leave. Study objectives were to describe the characteristics of physical medicine and rehabilitation residents who take leave during residency, compare differences in part I (written) and part II (oral) certification examination performance, and determine the prevalence of delays in taking board examinations. Study methodology was a retrospective analysis of deidentified information from the American Board of Physical Medicine and Rehabilitation database between 2008 and 2020. Results indicated four reasons for extended leave of absence: medical, parental, academic/remediation, and unspecified personal reasons. Residents who took an extended leave of absence for medical or parental reasons had similar or better odds of passing their part I and part II examinations compared with those without leave. Residents who took leave for academic/remediation concerns or unspecified personal reasons had lower odds of passing their board examinations. Examination delays for those taking parental or personal health leaves did not affect board pass rates. Further investigation is needed to identify how to support residents on academic/remediation and unspecified leaves during training.

An Online, Modular Curriculum Enhances Surgical Education and Improves Learning Outcomes in East, Central, and Southern Africa: A Mixed-Methods Study.

We aimed to determine the impact of a standardized curriculum on learning outcomes for surgical trainees in East, Central, and Southern Africa (ECSA). As surgical education expands throughout ECSA, there is a recognized need for a standardized curriculum. We previously described the design of a novel, large-scale, flipped-classroom, surgical curriculum for trainees in ECSA. In January 2020, the first year of curricular content for trainees of the College of Surgeons of ECSA was released, containing 11 monthly thematic topics, each with 2 to 5 weekly modular subtopics. We aimed to evaluate 3 outcomes utilizing data sources incorporated into the curriculum structure. Learner engagement was assessed by the number of trainees completing curriculum topics. User experience was evaluated using quantitative and qualitative feedback responses to embedded surveys for each content week. Curriculum impact on trainee examination performance was assessed by comparing certification examination scores stratified by the number of curricular topics each trainee completed. Two hundred seventy-one trainees (96%) in 17 countries accessed at least 1 weekly module. Trainees completed a median of 9 topics (interquartile range: 6-10). The feedback survey response rate was 92% (5742/6233). Quantitative and qualitative responses were positive in overall module value (93.7% + 2.6%), amount of learning experienced (97.9% + 1.4%), confidence in achieving learning objectives (97.1% + 2.4%), and ease of use of the module (77.6% + 5.98%). Topic-related certification examination performance improved significantly with increased completion of thematic topics. A standardized surgical curriculum in ECSA demonstrated excellent trainee usage, positive feedback, and improved examination scores.

Clinical Knowledge and Trends in Physicians' Prescribing of Opioids for New Onset Back Pain, 2009-2017

Opioid musculoskeletal pain overprescribing was widespread in the mid-2000s. The degree to which prescribing changed as awareness of the danger grew among physicians with different levels of clinical knowledge remains unstudied. To compare the association of clinical knowledge with opioid prescribing from 2009 to 2011 when prescribing peaked nationally with 2015 to 2017 when guidelines shifted away from opioid prescribing. This cross-sectional study included 10 246 midcareer general internal medicine physicians in the United States who saw patients who were Medicare beneficiaries with Part D enrollment from 2009 to 2017. Any opioid prescription and high dosage or long duration (HDLD) (>7 days or >50 daily morphine milligram equivalents) opioid prescriptions filled within 7 days of applicable visits for new low back pain concerns. Associations between opioid prescribing for new low back pain concerns during outpatient visits and clinical knowledge measured by prior year American Board of Internal Medicine (ABIM) Maintenance of Certification examination performance were estimated using serial cross-sectional logit regressions. Regression covariates included yearly examination quartile (ie, knowledge quartile) interacted with 3-year group dummies (ie, early: 2009-2011; middle: 2012-2014; late: 2015-2017), state and year dummies, physician, practice, patient characteristics, and state opioid regulations. Of the 55 387 low back pain visits included in this study, 37 185 (67.1%) were visits with female patients, 41 978 (75.8%) were with White patients, and the mean (SE) age of patients was 76.2 (<0.01) years. The rate of opioid prescribing was 21.6% (11 978) for any opioid prescription and 17.6% (9759) for HDLD prescriptions. From 2009 to 2011, visits with physicians in the highest and lowest knowledge quartiles had similar adjusted opioid prescribing rates with a 0.5 (95% CI, -1.9 to 3.0) percentage point difference. By 2015 to 2017, visits with physicians in the highest knowledge quartile prescribed opioids less frequently that physicians in the lowest knowledge quartile (4.6 percentage point difference; 95% CI, -7.5 to -1.8 percentage points). Visits in which HDLD opioids were prescribed showed no difference in the early period but showed a difference in the late period when comparing physicians in the highest and lowest knowledge quartiles (early period: difference -0.1; 95% CI, -2.4 to 2.2 percentage points; late period difference: 4.8; 95% CI, -7.4 to -2.1 percentage points). In this cross-sectional study, when the standard of care shifted away from routine opioid prescribing, physicians who performed well on an ABIM examination were less likely to prescribe opioids for back pain than physicians who performed less well on the examination.

Predictors of performance on the pediatric board certification examination

BackgroundExamining the predictors of summative assessment performance is important for improving educational programs and structuring appropriate learning environments for trainees. However, predictors of certification examination performance in pediatric postgraduate education have not been comprehensively investigated in Japan.MethodsThe Pediatric Board Examination database in Japan, which includes 1578 postgraduate trainees from 2015 to 2016, was analyzed. The examinations included multiple-choice questions (MCQs), case summary reports, and an interview, and the predictors for each of these components were investigated by multiple regression analysis.ResultsThe number of examination attempts and the training duration were significant negative predictors of the scores for the MCQ, case summary, and interview. Employment at a community hospital or private university hospital were negative predictors of the MCQ and case summary score, respectively. Female sex and the number of academic presentations positively predicted the case summary and interview scores. The number of research publications was a positive predictor of the MCQ score, and employment at a community hospital was a positive predictor of the case summary score.ConclusionThis study found that delayed and repeated examination taking were negative predictors, while the scholarly activity of trainees was a positive predictor, of pediatric board certification examination performance.

Association Between American Board of Surgery Initial Certification and Risk of Receiving Severe Disciplinary Actions Against Medical Licenses

Board certification is used as a marker of surgeon quality and professionalism. Although some research has linked certification in surgery to outcomes, more research is needed. To measure associations between surgeons obtaining American Board of Surgery (ABS) certification and examination performance with receiving future severe disciplinary actions against their medical licenses. Retrospective analysis of severe license action rates for surgeons who attempted ABS certification based on certification status and examination performance. Surgeons who attempted to become certified were classified as certified or failing to obtain certification. Additionally, groups were further categorized based on whether the surgeon had to repeat examinations and whether they ultimately passed. The study included surgeons who initially attempted certification between 1976 and 2017 (n = 44 290). Severe license actions from 1976 to 2018 were obtained from the Federation of State Medical Boards, and certification data were obtained from the ABS database. Data were analyzed between 1978 and 2008. Severe license action rates were analyzed across certified surgeons and those failing to obtain certification, as well as across examination performance groups. The final dataset included 36 197 men (81.7%) and 8093 women (18.3%). The incidence of severe license actions was significantly greater for surgeons who attempted and failed to obtain certification (incidence rate per 1000 person-years = 2.49; 95% CI, 2.13-2.85) than surgeons who were certified (incidence rate per 1000 person years = 0.77; 95% CI, 0.71-0.83). Adjusting for sex and international medical graduate status, the risk of receiving a severe license action across time was also significantly greater for surgeons who failed to obtain certification. Surgeons who progressed further in the certification examination sequence and had fewer repeated examinations had a lower incidence and less risk over time of receiving severe license actions. Obtaining board certification was associated with a lower rate of receiving severe license actions from a state medical board. Passing examinations in the certification examination process on the first attempt was also associated with lower severe license action rates. This study provides supporting evidence that board certification is 1 marker of surgeon quality and professionalism.

The American Board of Anesthesiology's Staged Examination System and Performance on the Written Certification Examination After Residency.

This study compared anesthesiology residency graduates' written certification examination performance before and after the American Board of Anesthesiology (ABA) introduced the staged examination system. After equating test scores using common test items, the first 2 cohorts (2013, 2014) in the staged system scored 7.1 points and 8.3 points higher than the 2011 baseline cohort in the former examination system. The 2013 and 2014 cohorts' pass rates (94.2% and 95.9%) were also higher than the 2011 and 2012 cohorts (91.9% and 92.6%) if a common standard had been applied. The staged examination system may be associated with improved knowledge of anesthesiology graduates.

Family Medicine Residents' Debt and Certification Examination Performance.

Previous studies have found that medical students and internal medicine residents with high educational debt perform less well on examinations. The purpose of this study was to examine the relationship between educational debt and family medicine residents' performance on initial in-training and board certification examinations. Our study was a cross-sectional secondary analysis of American Board of Family Medicine (ABFM) data collected from residents (N=5,828) who registered for the Family Medicine Certification Examination (FMCE) in 2014 and 2015, representing 85.8% of graduating family medicine residents in the United States in those years. Multivariable linear and logistic regression modeling was used to examine the relationship between debt level and examination scores, and also to explore the relationship between debt level and passing the initial FMCE. After controlling for demographic variables, residents with high debt ($150,000 to $249,999) and very high debt (more than $250,000) performed significantly worse than those with no debt on the initial in-training examination (score differences of 14.2 [CI 8.6, 19.8] and 15.8 [CI 10.3, 21.4] points, respectively) and FMCE (score differences of 19.3 points [CI 13.4, 25.3] and 30.4 points [CI 24.6, 36.3], respectively). Additionally, those with debt above $250,000 had half the odds of passing their initial FMCE (OR 0.45; CI 0.27-0.75). High educational debt is associated with lower examination performance among family medicine residents. This may be because residents with more debt have more stress or fewer day-to-day financial resources. However, confounding factors may also contribute to this association.

Reliability and Validity of National End of Rotation Examinations: An Update.

This study sought to evaluate the reliability of the PAEA End of Rotation™ exam scores used as a combined scale. The study also investigated how closely the individual exam scores and the combined scale correlate with Physician Assistant National Certifying Exam (PANCE) performance to validate their use as tools for assessing physician assistant (PA) students during their clinical training. Deidentified PAEA End of Rotation examination and PANCE scores were used to calculate Pearson correlations, Cronbach's alpha, and value of Cronbach's alpha if individual exams were removed from the analysis. A linear regression model was generated to predict certification exam scores. End of Rotation examinations are a reliable predictor of certification examination performance independent of PA program or test version, with Cronbach's alpha at 0.847. The mean of all 7 examinations may be used, but the mean of just 4 examinations (Emergency Medicine, Family Medicine, General Surgery, and Internal Medicine) is also a valid predictor of certification examination performance.

Medical Knowledge Assessment by Hematology and Medical Oncology In-Training Examinations Are Better Than Program Director Assessments at Predicting Subspecialty Certification Examination Performance.

The Accreditation Council for Graduate Medical Education's Next Accreditation System requires training programs to demonstrate that fellows are achieving competence in medical knowledge (MK), as part of a global assessment of clinical competency. Passing American Board of Internal Medicine (ABIM) certification examinations is recognized as a metric of MK competency. This study examines several in-training MK assessment approaches and their ability to predict performance on the ABIM Hematology or Medical Oncology Certification Examinations. Results of a Hematology In-Service Examination (ISE) and an Oncology In-Training Examination (ITE), program director (PD) ratings, demographic variables, United States Medical Licensing Examination (USMLE), and ABIM Internal Medicine (IM) Certification Examination were compared. Stepwise multiple regression and logistic regression analyses evaluated these assessment approaches as predictors of performance on the Hematology or Medical Oncology Certification Examinations. Hematology ISE scores were the strongest predictor of Hematology Certification Examination scores (β = 0.41) (passing odds ratio [OR], 1.012; 95% confidence interval [CI], 1.008-1.015), and the Oncology ITE scores were the strongest predictor of Medical Oncology Certification Examination scores (β = 0.45) (passing OR, 1.013; 95% CI, 1.011-1.016). PD rating of MK was the weakest predictor of Medical Oncology Certification Examination scores (β = 0.07) and was not significantly predictive of Hematology Certification Examination scores. Hematology and Oncology ITEs are better predictors of certification examination performance than PD ratings of MK, reinforcing the effectiveness of ITEs for competency-based assessment of MK.

Pulmonary and Critical Care In-Service Training Examination Score as a Predictor of Board Certification Examination Performance.

Most trainees in combined pulmonary and critical care medicine fellowship programs complete in-service training examinations (ITEs) that test knowledge in both disciplines. Whether ITE scores predict performance on the American Board of Internal Medicine Pulmonary Disease Certification Examination and Critical Care Medicine Certification Examination is unknown. To determine whether pulmonary and critical care medicine ITE scores predict performance on subspecialty board certification examinations independently of trainee demographics, program director competency ratings, fellowship program characteristics, and prior medical knowledge assessments. First- and second-year fellows who were enrolled in the study between 2008 and 2012 completed a questionnaire encompassing demographics and fellowship training characteristics. These data and ITE scores were matched to fellows' subsequent scores on subspecialty certification examinations, program director ratings, and previous scores on their American Board of Internal Medicine Internal Medicine Certification Examination. Multiple linear regression and logistic regression were used to identify independent predictors of subspecialty certification examination scores and likelihood of passing the examinations, respectively. Of eligible fellows, 82.4% enrolled in the study. The ITE score for second-year fellows was matched to their certification examination scores, which yielded 1,484 physicians for pulmonary disease and 1,331 for critical care medicine. Second-year fellows' ITE scores (β = 0.24, P < 0.001) and Internal Medicine Certification Examination scores (β = 0.49, P < 0.001) were the strongest predictors of Pulmonary Disease Certification Examination scores, and were the only significant predictors of passing the examination (ITE odds ratio, 1.12 [95% confidence interval, 1.07-1.16]; Internal Medicine Certification Examination odds ratio, 1.01 [95% confidence interval, 1.01-1.02]). Similar results were obtained for predicting Critical Care Medicine Certification Examination scores and for passing the examination. The predictive value of ITE scores among first-year fellows on the subspecialty certification examinations was comparable to second-year fellows' ITE scores. The Pulmonary and Critical Care Medicine ITE score is an independent, and stronger, predictor of subspecialty certification examination performance than fellow demographics, program director competency ratings, and fellowship characteristics. These findings support the use of the ITE to identify the learning needs of fellows as they work toward subspecialty board certification.

Using an Accountability Program to Improve Psychiatry Resident Scores on In-Service Examinations

The Psychiatry Resident-In-Training Examination (PRITE) is a standardized examination that measures residents' educational progress during residency training. It also serves as a moderate-to-strong predictor of later performance on the board certification examination. This study evaluated the effectiveness of an accountability program used by a public psychiatric hospital to increase its residents' PRITE scores. A series of consequences and incentives were developed based on levels of PRITE performance. Poor performance resulted in consequences, including additional academic assignments. Higher performance led to residents earning external moonlighting privileges. Standardized PRITE scores for all residents (N = 67) over a 10-year period were collected and analyzed. The PRITE examination consists of 2 subscales-psychiatry and neurology. Change in the overall level of PRITE scores following the implementation of the accountability program was estimated using a discontinuous growth curve model for each subscale. Standardized scores on the psychiatry subscale were 51.09 points, approximately 0.50 SD change, which was higher after the accountability program was implemented. Standardized scores on the neurology subscale did not change. An accountability program that assigns consequences based on examination performance may be moderately successful in improving scores on the psychiatry subscale scores of the PRITE. This likely has longer-term benefits for residents due to the relationship between PRITE and board certification examination performance.

City Population Size Is Associated with Examinee Outcomes on the American Board of Pediatrics Certifying Examination

The purpose of this article is to evaluate American Board of Pediatrics Certifying Examination performance based on city population, hypothesizing that larger cities are associated with higher exam performance. Pediatric residency programs were retrospectively evaluated from 2010 to 2012. The associated city populations were found using census data. Simple linear regression was performed for continuous variables, and χ(2) tests were performed for categorical variables, using α = .05. For 188 programs, the median pass rate was 79.5% (interquartile range = 69% to 90%). Regression showed that city size explains program size (P < .001). Examinees from larger cities had a higher pass rates than examinees from smaller cities, and examinees who are in cities that share residency programs had a higher pass rate than examinees from solo city programs (both P < .05). City size is associated with examinee performance on the American Board of Pediatrics Certifying Examination. City size should be a consideration of future residency applicants.

Relationship between internal medicine program board examination pass rates, accreditation standards, and program size.

Objectives: To determine Internal Medicine residency program compliance with the Accreditation Council for Graduate Medical Education 80% pass-rate standard and the correlation between residency program size and performance on the American Board of Internal Medicine Certifying Examination.MethodsUsing a cross-sectional study design from 2010-2012 American Board of Internal Medicine Certifying Examination data of all Internal Medicine residency programs, comparisons were made between program pass rates to the Accreditation Council for Graduate Medical Education pass-rate standard. To assess the correlation between program size and performance, a Spearman’s rho was calculated. To evaluate program size and its relationship to the pass-rate standard, receiver operative characteristic curves were calculated.ResultsOf 372 Internal Medicine residency programs, 276 programs (74%) achieved a pass rate of ≥80%, surpassing the Accreditation Council for Graduate Medical Education minimum standard. A weak correlation was found between residency program size and pass rate for the three-year period (ρ=0.19, p<0.001). The area underneath the receiver operative characteristic curve was 0.69 (95% Confidence Interval [0.63-0.75]), suggesting programs with less than 12 examinees/year are less likely to meet the minimum Accreditation Council for Graduate Medical Education pass-rate standard (sensitivity 63.8%, specificity 60.4%, positive predictive value 82.2%, p<0.001).ConclusionsAlthough a majority of Internal Medicine residency programs complied with Accreditation Council for Graduate Medical Education pass-rate standards, a quarter of the programs failed to meet this requirement. Program size is positively but weakly associated with American Board of Internal Medicine Certifying Examination performance, suggesting other unidentified variables significantly contribute to program performance.

The ACGME Duty Hour Standards and Board Certification Examination Performance Trends in Surgical Specialties

Duty hour limitations initiated by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 could improve resident education in surgical specialties. The purpose of this study was to evaluate national surgical board examination performance and its relationship to the ACGME duty hour standards. In this retrospective cohort study, electronically published website content was evaluated for examination statistics for the 10 surgical boards in the American Board of Medical Specialties. To evaluate examination trends over time, we performed simple linear regression. We also performed interrupted time series analyses, using segmented logistic regression. The secondary analyses consisted of a χ(2) test of passing and failing examinees before and after 2003. All statistics used α = .05. There were 8 of 10 (80%) surgical boards with examinations that met inclusion criteria and a total of 72 482 unique examination results. Of the 16 examinations evaluated (50% written, 50% oral), 13 (81%) had either significant pass rate trends on regression analyses and/or a significant pre-post pass rate surrounding the initiation of the ACGME duty hour standards in 2003 in the secondary analysis (P < .05). There are both increasing examination pass rates and some downward trends in examination performance on surgical board examinations since the initiation of the ACGME duty hour standards in 2003. The etiology of these trends is unclear, but trends are important to know for individual examinees, residency training programs, and surgical boards.

The American Board of Radiology Holman Research Pathway: 10-Year Retrospective Review of the Program and Participant Performance

In 1999, the American Board of Radiology (ABR) implemented an innovative training program track in diagnostic radiology (DR) and radiation oncology (RO) designed to stimulate development of a cadre of future academic researchers and educators in the 2 disciplines. The program was designated the Holman Research Pathway (HRP). An in-depth retrospective review of initial certification examination performance, post-training career choices, and academic productivity has not been written. This report represents a 10-year retrospective review of post-training performance of a cohort of trainees who have had sufficient time to complete their training and initial certification process and to enter practice. All pertinent proceedings of the ABR and Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committees for DR and RO between 1997 and May 2011 were reviewed. Thirty-four HRP candidates who fulfilled the established evaluation criteria were identified, and their ABR data files were analyzed regarding performance on the qualifying and certifying examinations. All candidates were contacted directly to obtain a current curriculum vitae. Twenty candidates in RO and 14 candidates in DR were identifiable for review. All candidates attained initial certification. At the time of analysis, 23 of 33 (66.6%) candidates were employed in full-time academic practice (1 DR candidate remained in a fellowship and was not evaluated regarding employment status). Fifteen of 20 (75%) RO candidates were in faculty positions compared with 7 of 13 (53.8%) DR trainees. Additional academic productivity metrics are reported. A high percentage of HRP trainees remained in academic practice and demonstrated significant academic productivity as measured by manuscript authorship and research support. Additional time and observation will be needed to determine whether these findings will be sustained by past, current, and future HRP trainees.

Relationship of electronic medical knowledge resource use and practice characteristics with Internal Medicine Maintenance of Certification Examination scores.

Maintenance of certification examination performance is associated with quality of care. We aimed to examine relationships between electronic medical knowledge resource use, practice characteristics and examination scores among physicians recertifying in internal medicine. We conducted a cross-sectional study of 3,958 United States physicians who took the Internal Medicine Maintenance of Certification Examination (IM-MOCE) between January 1, 2006 and December 31, 2008, and who held individual licenses to one or both of two large electronic knowledge resource programs. We examined associations between physicians' IM-MOCE scores and their days of electronic resource use, practice type (private practice, residency teaching clinic, inpatient, nursing home), practice model (single or multi-specialty), sex, age, and medical school location. In the 365days prior to the IM-MOCE, physicians used electronic resources on a mean (SD, range) of 20.3 (36.5, 0-265) days. In multivariate analyses, the number of days of resource use was independently associated with increased IM-MOCE scores (0.07-point increase per day of use, p = 0.02). Increased age was associated with decreased IM-MOCE scores (1.8-point decrease per year of age, p < 0.001). Relative to physicians working in private practice settings, physicians working in residency teaching clinics and hospital inpatient practices had higher IM-MOCE scores by 29.1 and 20.0 points, respectively (both p < 0.001). Frequent use of electronic resources was associated with modestly enhanced IM-MOCE performance. Physicians involved in residency education clinics and hospital inpatient practices had higher IM-MOCE scores than physicians working in private practice settings.