Certification Examination Research Articles

Environmental Issues in Global Pediatric Health: Policy Statement.

Pediatricians and pediatric trainees in North America are increasingly involved in caring for children and adolescents in or from low- and middle-income countries (LMICs). In many LMICs, hazardous environmental exposures-notably outdoor and household air pollution, water pollution, lead, pesticides, and other manufactured chemicals-are highly prevalent and account for twice the proportion of disease and deaths among young children as in North America. Climate change will likely worsen these exposures. It is important that pediatricians and other pediatric health professionals from high-income countries who work in LMICs be aware of the disproportionately severe impacts of toxic environmental hazards, become knowledgeable about the major local/regional environmental threats, and consider environmental factors in their differential diagnoses. Likewise, pediatricians in high-income countries who care for patients who have emigrated from LMICs need to be aware that these children may be at elevated risk of toxic environmental diseases from past exposures to toxic environmental hazards in their countries of origin as well as ongoing exposures in products imported from their home countries, including traditional foods, medications, and cosmetics. Because diseases of toxic environmental origin seldom have unique physical signatures, pediatricians can utilize the environmental screening history, supplemented by laboratory testing, as a diagnostic tool. To prepare pediatricians to care for children in and from LMICs, pediatric organizations could increase the amount of environmental health and climate change content offered in continuing medical education (CME) credits, maintenance of certification (MOC) credits, and certification and recertification examinations. Broadly, it is important that governments and international agencies increase resources directed to pollution prevention, strengthen the environmental health workforce, and expand public health infrastructure in all countries.

Developing and Implementing a Milestone System: Experience of the Taiwan Association of Obstetrics and Gynecology

<p>台灣婦產科醫學會於1961年成立，1987年度辦理第一屆專科醫師考試，建立四年專科訓練規範。由於畢業後一般醫學訓練亦可抵扣專科醫師訓練資格，加上住院醫師工時規範，恐影響住院醫師訓練，故自2017年底開始規劃里程碑制度。參考美國畢業後醫學教育評鑑委員會(Accreditation Council for Graduate Medical Education, ACGME)及美國婦產科醫學會(americancollege of obstetricians and gynecologists, ACOG)聯合修訂、發表訓練內容，完成台灣婦產科醫學會住院醫師訓練里程碑初版，內容依照六大核心能力建立28項勝任能力5個層級。然而2023年透過線性回歸統計方式分析專科醫師考試成績與里程碑分數，發現兩者無顯著相關性。未來將透過即時分析，回饋各醫院，盼透過同儕比較，改善跨院際評核不一致現象，在執行面上，希望導入電子化表單，建立學生的學習歷程及分析。</p> <p> </p><p>The Taiwan Association of Obstetrics and Gynecology(TAOG)was established in 1961 and conducted its first board certification examination in 1987, formally establishing a structured 4-year training program for Taiwanese specialists.To provide postgraduate general medical training, which could be credited toward specialist training qualifications, and address challenges introduced by resident work-hour regulations, the TAOG subsequently developed a milestone-based evaluation system for residents. On the basis of training content collaboratively revised and published by the Accreditation Council for Graduate Medical Education and the American College of Obstetricians and Gynecologists, the TAOG produced the first version of its residency milestone framework in late 2017. This framework comprised6 core competencies segmented into 28 key competencies across five proficiency levels. Nevertheless, the results of a linear regression conducted in 2023 revealed no significant correlation between milestone scores and specialist examination results. In response, the TAOG will provide feedback to training hospitals,using peer comparisons to address discrepancies in interhospital evaluations. Additionally, the TAOG will implement electronic forms to streamline the documentation and analysis of residents’ learning progress.</p> <p> </p>

USMLE Performance, Subsequent Standardized Testing, and ABIM Certification Exam Preparation for Internal Medicine Residency Programs: A Narrative Review.

Standardized examinations measure progress throughout medical education. Successful completion of the American Board of Internal Medicine Certification Examination (ABIM-CE) benchmarks completion of internal medicine (IM) residency training. Recent declines in initial ABIM-CE pass rates may prompt residency programs to examine strategies to improve learner performance. We synthesized published literature on associations between the United States Medical Licensing Examination (USMLE), in-training examination (ITE), and board preparation to support residents for ABIM-CE. We searched MEDLINE for test performance and preparation strategies for IM board certification during training. Relevant articles published until March 15, 2024, were screened using pre-defined criteria for narrative review, then codified into three domains (USMLE, ITE, curriculum/program strategies). Findings were grouped by theme into considerations for training programs seeking guidance on learning augmentation plans to improve resident performance on ABIM-CE. Themes drawn from articles focused on USMLE include validity in predicting CE performance, noting (1) failing USMLE Step 1 is associated with failing ABIM-CE, (2) any USMLE score < 220 increases failure probability, and (3) a mean USMLE ≥ 250 approximates ~ 100% pass rates on board examination. Inferences from ITE-focused articles support use as a predictive tool; specifically, a score < 35th percentile signals a resident at risk for failing the ABIM-CE while > 70th percentile is predictive of passing. Lastly, inferences from curriculum- and program-focused articles suggest standard contents (conferences) do not correlate with CE passage, while targeted clinical reasoning and remediation plans do. IM residency programs should consider adopting learning augmentation strategies targeted to at-risk residents to support CE passage.

Trends and Complications of Medial Patellofemoral Ligament Reconstruction Among Applicants for the American Board of Orthopaedic Surgery Part II and Maintenance of Certification Examinations: Analysis of Data Over a 15-Year Period.

Medial patellofemoral ligament reconstruction (MPFLR) and tibial tubercle osteotomy (TTO) are commonly performed surgical procedures that often have a high learning curve. To review the American Board of Orthopaedic Surgery (ABOS) Part II oral examination case list and the Maintenance of Certification (MOC) examination case list databases for trends in MPFLR (isolated and with concurrent TTO) and complication rates. Cross-sectional study; Level of evidence, 3. We reviewed the ABOS Part II and MOC case list databases for diagnosis codes relating to patellar instability and Current Procedural Terminology codes specific to MPFLR and TTO regarding cases submitted by applicants for these examinations between 2003 and 2017 (for ABOS Part II) and between 2010 and 2017 (for MOC). Data were analyzed using generalized estimating equations with a binomial distribution and logit link to determine how trends in MPFLR changed over the study period in these applicant groups (ABOS vs MOC) as well as any influence on complication rates. In the ABOS group, the number of MPFLRs performed by surgeons increased a mean 3% each year, ranging from 66 in 2003 to 184 in 2015 (injury rate ratio, 1.03; 95% CI, 1.02-1.04; P < .001). In the MOC group, the mean number of MPFLRs did not change significantly (range, 119 in 2011 vs 230 in 2013; P = .772). In the ABOS group, after adjusting for patient age and examination year, MPFLR combined with TTO was associated with 92% greater odds of having a complication versus isolated MPFLR (odds ratio, 1.92; 95% CI, 1.24-2.98; P = .004), whereas the MOC group demonstrated no significant difference in the odds of having a complication between cases with versus without a concurrent TTO (P = .214). In the current study, the number of MPFLRs performed by the less experienced surgeons in the ABOS group increased a mean 3% each year, whereas this number remained stable for the more experienced MOC group. Additionally, there were significantly more complications with MPFLR and concomitant TTO among the ABOS Part II candidates compared with the MOC candidates. These findings may be helpful in surgical decision making and education in patellofemoral instability.

Flexibility in Surgical Training Does Not Affect American Board of Surgery Board Eligibility or Certification: Long-term Outcomes from a Prospective, Multi-Institutional Study of General Surgery Residents.

In 2011, the American Board of Surgery (ABS) implemented a policy to permit greater flexibility in the structure of general surgery (GS) residency training. Our goal was to investigate the impact of flexibility in surgical training (FIST) on resident success in obtaining ABS board eligibility and certification. A prospective, multi-institutional study was conducted to examine the feasibility of incorporating flexibility tracks across residency programs and measure educational outcomes including ABS In-service Training Exam (ABSITE) scores, Accreditation Council for Graduate Medical Education (ACGME) Milestones, operative case log volumes, and ABS Qualifying (QE) and Certifying (CE) Examinations scores. We compared residents participating in flexibility tracks ("FIST residents") to contemporaneous residents not involved in subspecialty tracks ("non-FIST residents"). Seven academic GS residency programs. GS residents at participating institutions were granted the opportunity to customize up to 12 of the final 24 months of residency with subspecialty rotations. From 2013 to 2019, 186 (52.2%) of 356 residents participated in a flexibility track. The most frequently selected subspecialty tracks were hepatobiliary (26.9%), gastrointestinal (15.1%), and cardiothoracic surgery (15.1%). There was no significant difference in ABSITE scores (573.0 vs. 562.0; p = 0.191) or total major operations performed (1056.5 vs 1018.0; p = 0.074) between FIST and non-FIST post-graduate year 5 residents. Residents participating in FIST scored significantly higher on 15 of 16 ACGME Milestones when compared to non-FIST residents. The first-time pass rate for the ABS QE was 92.2% and 91.1% for FIST and non-FIST residents, respectively (p = 0.756). The first-time pass rate for the ABS CE was 85.8% and 83.6% for FIST and non-FIST residents, respectively (p = 0.687). Overall, FIST residents had a higher first-time pass on both the QE (92.2% vs. 90.6%) and CE (85.8% vs. 81.7%), when compared to the national average. Despite spending more time on subspecialty-focused flexible rotations, residents participating in FIST perform similarly to their peers in multiple measures, including on the ABS QE and CE. Incorporating integrated subspecialty training within GS residency does not interfere with the future success of trainees in obtaining ABS board certification. These findings could help inform modifications to the structure of surgical training, including allowing for earlier entry into subspecialty training.

Current Requirements and Qualification Criteria for Habilitation and Extraordinary Professorship at German University Hospitals

Achieving a medical professorship marks a significant step in a doctor's academic career, associated with a significant level of responsibility and obligations. The requirements to obtain a medical professorship in Germany vary significantly. Based on an online search, we studied the statutes and regulations of medical faculties in Germany to determine the requirements for habilitation and an extraordinary professorship within Germany. All 38 German medical faculties were included. The evaluation was carried out for performance requirements in the areas of teaching and research. The general requirement for a habilitation application is the completion of the medical specialist certification examination. On average, 2.3 years of teaching activity are expected. The minimum number of teaching hours averages 2.6 weekly semester hours. An average of at least 11 publications are required. Of these, an average of 7 must be written as first or last author. For an extraordinary professorship, an average of 4.4 years (min. 2, max. 6) of teaching activity after habilitation is required. The minimum number of teaching hours in semester hours averages 1.9 hours (min. 1, max. 2). The minimum number of publications averages 9 publications (min. 4, max. 24), of which an average of 6.3 must be written as first or last author. The requirements for habilitation and extraordinary professorship in Germany vary, especially with a view to publications and teaching. Depending on the faculty, lower publication numbers can be compensated by higher "impact factors". Furthermore, there is no national standardisation and comparability in the field of medical academic graduations.

Estimation of Air Travel-Related Greenhouse Gas Emissions for the In-Person Anesthesiology Oral Board Examination.

Background With an increased focus on climate change in graduate medical education (GME), the environmental implications of travel for board certification examinations remain poorly described. The return to the mandatory in-person applied examination (AE) for board eligible anesthesiologists presents potentially sizeable greenhouse gas (GHG) emissions when compared to the virtual format administered during the COVID-19 pandemic. Objective To estimate the GHG emissions from air travel to the in-person AE and discuss its implications for various specialties as they return to in-person examinations. Methods An estimate of the GHG emissions was conducted using data from the 2023 NRMP Main Residency Match: Match Rates by Specialty and State report, utilizing residency training site as a proxy for anesthesiologists' home. An alternative estimate was made using the anesthesiologists' predicted state distribution postgraduation. We estimated annual GHG emissions, expressed as metric tons of carbon dioxide equivalent (MTCO2e), produced from graduating residents flying to The American Board of Anesthesiology testing center in Raleigh, North Carolina, USA. We collected emissions using the International Civil Aviation Organization emissions calculator. Results Annual emissions of examinee travel from their respective residency training state was estimated to be 517.37 MTCO2e. The alternative estimate using anesthesiologists' predicted postgraduation state was 568.05 MTCO2e. This estimate of CO2e roughly equates to the average annual emissions produced by 112 passenger vehicles. Conclusions The AE in-person format results in an estimated 517 to 568 MTCO2e.

Difficulty With Board Certification in Urology Is Associated With Adverse Medical License Actions.

Board certification in urology is a multistep process including a written qualifying examination (QE), followed by an oral certifying examination (CE) approximately 2 years after residency or fellowship completion. The goal of this process is to ensure that urologists are well trained, have an extensive fund of knowledge, demonstrate professionalism and competence in practice, and are safe to practice urology. Board certification in urology serves to both establish and confirm physician competence and ultimately protect the public. We sought to examine the relationship between board certification in urology and adverse medical license actions. We retrospectively studied deidentified physicians who attempted initial ABU certification between 1980 and 2022. The primary outcome was adverse state medical license action, defined as severe (surrendered, suspended, or denied licenses) or moderate (required CME, imposed conditions, fines, reprimands, and probations). Statistical analyses were conducted using χ2 and Fisher exact tests. Five thousand five physicians were included in analyses. One hundred nineteen physicians did not obtain board certification. Only 1.4% of physicians who certified on initial attempt received disciplinary action compared with 3.0% who obtained certification on repeated attempts (Fisher exact test 0.013, P < .05) and 5.9% who never obtained certification (Fisher exact test 0.0018, P < .05). Failure to complete or repeated attempts at board certification was associated with increased rates of disciplinary actions. This association highlights the continued relevance of ABU certification in protecting the public.

Analyzing trends and practices: A survey of procedures performed by nurse practitioners

ABSTRACT Background: Nurse practitioners (NPs) provide essential patient care services. Most (88%) are primary care certified, and 70% practice in primary care settings. National NP organizations and state practice authority regulations influence the training and level of independence of performing procedures common in primary care practice. National standards reference the ability to select and interpret appropriate diagnostic tests related to clinical reasoning or management functions, but not competency in the procedures. Although the blueprint for certification examinations includes procedures as part of evidence-informed practice, none are specifically named. Purpose: There are limited data concerning procedural training for NPs. The study aims were to describe the training practicing NPs received for procedures they perform, define areas of research concerning the development of uniform training, and identify advocacy initiatives for competency acquisition for procedures. Methodology: Practicing NPs completed a survey concerning the procedures they perform in their practice. In addition, they reported their level of perceived competency, independence in performing, and method of training. Results: The majority of respondents (87.8%) hold certifications in primary care specialties. In this sample of practicing NPs, 74% of the respondents perform procedures independently, but only 67% had procedure training as part of their initial NP education. Additional training (60%) was completed through professional development programs. Conclusions: Many NPs surveyed perform procedures independently. Training occurred in their NP programs and through continuing education. Implications: Further studies are needed concerning procedural training and the setting that is most appropriate for competency achievement.

Performance Evaluation of GPT-4o and o1-Preview Using the Certification Examination for the Japanese 'Operations Chief of Radiography With X-rays'.

Purpose The purpose of this study was to assess the ability of large language models (LLMs) to comprehend the safety management, protection methods, and proper handling of X-rays according to laws and regulations. We evaluated the performance of GPT-4o (OpenAI, San Francisco, CA, USA) and o1-preview (OpenAI) using questions from the 'Operations Chief of Radiography With X-rays' certification examination in Japan. Methods This study engaged GPT-4o and o1-preview in responding to questions from this Japanese certification examination for 'Operations Chief of Radiography With X-rays'. A total of four sets of exams published from April 2023 to October 2024 were used. The accuracy of each model was evaluated across the subjects, including knowledge about the control of X-rays, relevant laws and regulations, knowledge about the measurement of X-rays, and knowledge about the effects of X-rays on organisms. The results were compared between the two models, excluding graphical questions due to o1-preview's inability to interpret images. Results The overall accuracy rates of GPT-4o and o1-preview ranged from 57.5% to 70.0% and from 71.1% to 86.5%, respectively. The GPT-4o achieved passing accuracy rates in the subjects except for relevant laws and regulations. In contrast, o1-preview met the passing criteria across all four sets, despite graphical questions being excluded from scoring. The accuracy of all questions and relevant laws and regulations in o1-preview were significantly higher than those in GPT-4o (p = 0.03 for all questions and p = 0.03 for relevant laws and regulations, respectively). No significant differences in accuracy were found across the other subjects. Conclusions In the Japanese 'Operations Chief of Radiography With X-rays' certification examination, GPT-4o demonstrated a competent performance in the subjects except for relevant laws and regulations, while o1-preview showed a commendable performance across all subjects. When graphical questions were excluded from scoring, the performance of o1-preview surpassed that of GPT-4o in all questions and relevant laws and regulations.

Heart valve clinics: an expanding role for the clinical scientists - validation of a framework for competency and certification

BackgroundValvular heart disease (VHD) represents a significant burden on healthcare systems worldwide, necessitating specialised care through multidisciplinary valve clinics. However, there is a lack of a standardised training and certification...

Recognizing and Advancing Leadership in Dermatology: Promoting the Health Care Administration, Leadership, and Management Subspecialty.

The recognition and development of leadership training within dermatology has taken on new importance in recent years. In Spring 2023, the American Board of Medical Specialties announced the launch of the Health Care Administration Leadership and Management (HALM) subspecialty, co-sponsored by multiple American Boards, including the American Board of Dermatology. The skills and credentials earned through HALM can enhance career opportunities for dermatologists seeking to achieve executive positions in large practice groups and industries while fostering interprofessional partnerships. Dermatologists are uniquely poised to integrate health care leadership and health systems approaches into clinical practice given broad exposure to diverse patient populations, care delivery settings, and payer contexts. Two pathways have been proposed for achieving HALM certification: a "practice-only" pathway and a fellowship pathway that provides a specialized post-residency curriculum. A HALM certification examination will be the final requirement for certification under both pathways. The HALM certification represents a valuable opportunity for dermatologists to enhance their ability to be physician leaders within the health care landscape. HALM also offers an institutionalized and structured avenue with protected time for physicians to develop leadership skills. Dermatologists taking on management roles within health care can both shape the current system from their unique vantage points and elevate the specialty's presence. Leadership training such as HALM can not only foster individual career prospects - including qualifying for executive roles in larger practices and industry - but also boost intersectoral collaborations between dermatologists and providers, payers, industry, and policymakers broadly. J Drugs Dermatol. 2024;23(12):e191-e194. doi:10.36849/JDD.8482e.

Duties, tasks, knowledge and skills of an obesity medicine physician: A practice analysis

BackgroundGiven the evolving nature of obesity medicine, periodic evaluation of its clinical practice is needed to ensure that certification requirements address real-world experience. Practice analysis is a systematic approach to define a field's body of knowledge, and its results can inform the content outline and examination blueprint for a certification examination. This study describes the 2023 practice analysis conducted by the American Board of Obesity Medicine (ABOM). MethodsInitially, 14 obesity medicine physicians participated in a practice analysis panel, resulting in 3 duties and 30 tasks required for competent practice of obesity medicine physicians. Each task included steps, knowledge, skills, and abilities needed to perform the task. ABOM then recruited 645 certified obesity medicine physicians from its database to participate in a validation survey to rate the frequency [scale: never (0) to very frequently (5)] and importance [scale: not important (0) to very important (3)] of each task. Survey participants could also provide open-ended comments. ResultsAmong validation survey participants (n = 645), the most common primary medical specialties reported were internal medicine (46.0 %), family medicine (33.8 %), and pediatrics (11.2 %). Years practicing obesity medicine varied with 45.3 % reporting 1–4 years, 26.0 % 5–9 years, and 28.7 % ≥ 10 years in practice. Most tasks were performed frequently (mean score ≥4.0) and rated as important (mean score ≥2.0). All tasks were retained based on the frequency and importance ratings. Survey results informed the weighting in the examination blueprint. ConclusionThere was consensus among practicing ABOM-certified physicians who participated in the validation survey in the tasks required for competent obesity medicine practice. Our practice analysis approach was a structured process that engaged obesity medicine physicians and captured the breadth and depth of knowledge required for obesity medicine. The new content outline and examination blueprint developed will be implemented with the 2025 ABOM certification exam administration.

Urologic oncology case volume among early career urologists: An analysis of certification data from the American board of urology between 2003 and 2019

IntroductionThe incidence of urologic cancer is expected to increase as the U.S. population ages, but the size of the urologic workforce is not expected to increase at a commensurate rate. To understand this growing imbalance, we explored the extent to which early career urologists performed oncology cases, particularly open surgical cases, between 2003 and 2019. Materials and MethodsWe examined case logs submitted by early career urologists applying for their oral American Board of Urology Certifying Examination (Part 2) between 2003 and 2019. We included case logs spanning at least 120 days between the first and last record. We used CPT® codes to identify urologists who performed an open radical cystectomy, nephrectomy, or prostatectomy, as well as those who performed a minimally invasive (MIS) radical nephrectomy or prostatectomy. We calculated the annual percentage of urologists who performed each procedure. Multivariable logistic regression analysis analyzed the association between performing each procedure and specialization or fellowship training in oncology, adjusting for gender, practice type, and year of case log submission. ResultsWe identified 4,166 unique urologists submitting case logs between 2003 and 2019. Their average age was 34.9 years, 81.3% were male, 14.2% specialized in oncology, and 8.2% reported oncology fellowship training. From 2003 to 2019, the percentage of urologists who performed open oncologic procedures decreased, while the percentage who performed MIS oncologic procedures increased. Fellowship training in oncology significantly increased the odds of performing the following procedures: open radical cystectomy (72.5% with fellowship training vs. 30.0% without fellowship training, OR 2.51, 95% CI 0.63–0.92, P < 0.001), open radical nephrectomy (74.3% with fellowship training vs 42.4% without fellowship training, OR 2.02, 95% CI 1.48–2.78, P < 0.001), open radical prostatectomy (42.1% with fellowship training vs. 26.9% without fellowship training, OR 1.86, 95% CI 1.34–2.58, P < 0.001) and MIS radical prostatectomy (80.4% with fellowship training vs. 45.0% without fellowship training, OR 1.69, 95% CI 1.16–2.48, P = 0.006). When comparing those with solely oncology specialization to those with both oncology specialization and fellowship training, we found that those with oncology fellowship training had over 2 times higher odds of performing open radical cystectomy (OR 2.58, CI 1.78–3.74, P < 0.001), open radical nephrectomy (OR 2.06, CI 1.42–2.99, P < 0.001) and open radical prostatectomy (OR 2.12, CI 1.44–3.12, P < 0.001). Female urologists had significantly lower odds of performing each oncologic procedure. ConclusionsIn this analysis of early career urologist case logs, the proportion of urologists performing a radical cystectomy, radical nephrectomy, and open prostatectomy declined between 2003 and 2019. Oncology specialization or fellowship training, however, significantly increased the odds of performing the procedures. Specifically, oncology fellowship alone was associated with over 2 times the odds of performing major open oncologic procedures. These findings reflect ongoing specialization among early career urologists, such that an oncology fellowship or practice focus has likely become necessary for access to open urologic procedures and to become a high-volume urologic oncology surgeon.

Assessment of ChatGPT-4 in Family Medicine Board Examinations Using Advanced AI Learning and Analytical Methods: Observational Study.

This research explores the capabilities of ChatGPT-4 in passing the American Board of Family Medicine (ABFM) Certification Examination. Addressing a gap in existing literature, where earlier artificial intelligence (AI) models showed limitations in medical board examinations, this study evaluates the enhanced features and potential of ChatGPT-4, especially in document analysis and information synthesis. The primary goal is to assess whether ChatGPT-4, when provided with extensive preparation resources and when using sophisticated data analysis, can achieve a score equal to or above the passing threshold for the Family Medicine Board Examinations. In this study, ChatGPT-4 was embedded in a specialized subenvironment, "AI Family Medicine Board Exam Taker," designed to closely mimic the conditions of the ABFM Certification Examination. This subenvironment enabled the AI to access and analyze a range of relevant study materials, including a primary medical textbook and supplementary web-based resources. The AI was presented with a series of ABFM-type examination questions, reflecting the breadth and complexity typical of the examination. Emphasis was placed on assessing the AI's ability to interpret and respond to these questions accurately, leveraging its advanced data processing and analysis capabilities within this controlled subenvironment. In our study, ChatGPT-4's performance was quantitatively assessed on 300 practice ABFM examination questions. The AI achieved a correct response rate of 88.67% (95% CI 85.08%-92.25%) for the Custom Robot version and 87.33% (95% CI 83.57%-91.10%) for the Regular version. Statistical analysis, including the McNemar test (P=.45), indicated no significant difference in accuracy between the 2 versions. In addition, the chi-square test for error-type distribution (P=.32) revealed no significant variation in the pattern of errors across versions. These results highlight ChatGPT-4's capacity for high-level performance and consistency in responding to complex medical examination questions under controlled conditions. The study demonstrates that ChatGPT-4, particularly when equipped with specialized preparation and when operating in a tailored subenvironment, shows promising potential in handling the intricacies of medical board examinations. While its performance is comparable with the expected standards for passing the ABFM Certification Examination, further enhancements in AI technology and tailored training methods could push these capabilities to new heights. This exploration opens avenues for integrating AI tools such as ChatGPT-4 in medical education and assessment, emphasizing the importance of continuous advancement and specialized training in medical applications of AI.

Association Between Pandemic-Related Instructional Delivery Modifications and Emergency Medical Technician (EMT) First Attempt Pass Rates

Background: The COVID-19 pandemic represents a sentinel event for healthcare and healthcare education alike. Mandatory shutdowns of educational institutions, combined with increased demand for skilled healthcare personnel, highlighted pre-existing challenges surrounding how to maintain a stable workforce. To ensure continuity of educational opportunities, many emergency medical services (EMS) educational institutions were forced to modify existing learning method to digital learning formats. This emergent transition unearthed concerns regarding the impacts alternative learning methods would have on entry-level EMS providers' learning outcomes and overall competency levels. The objective of this study was to investigate the impact of alternative instructional methods used for EMT education during the COVID-19 pandemic. Methods: The study is a retrospective review of prospectively collected data for EMT candidates from a single community college-based EMT program who completed a first attempt of the National Registry EMS Certification examination for EMT candidates from course sections ending between January 1, 2019, and December 31, 2020. Historical pre-COVID first attempt exam outcomes were compared to the first attempt outcomes of two alternative instructional methods –Emergency Remote (ER) and COVID Distance Learning Hybrid (DL). Results: The outcomes of 237 EMT students were evaluated. Remote and COVID Hybrid DL models compared to the traditional pre-COVID learning format. There was no significant difference in first attempt pass rates between students who participated in traditional learning, the Emergency Remote model (1.53 odds ratio), or the Distance Learning model (2.98 odds ratio). Conclusions: This study suggests that virtual learning is at least as effective as traditional formats in preparing students for the NREMT examination. Additional research is warranted regarding best practices for applying virtual learning modalities in EMS education.

The Path to Certification for Emergency Nurse Practitioners.

Certification serves to validate the knowledge, skills, and experience required for clinical practice. Availability of a certification for emergency nurse practitioners (ENPs) has had an arduous path. This article examines the history of ENP certification in the United States, its territories and Canada, and how the certification examination has arrived at its current state.

The American Academy of Emergency Nurse Practitioners: The First Years.

In 2014, Dr. Elda Ramirez, alongside Dr. Arlo Weltge and Dr. Kyle Kincaid, founded the American Academy of Emergency Nurse Practitioners (AAENP) to support nurse practitioners working in emergency care. With initial support from 39 dedicated individuals, AAENP was incorporated in Texas and received pro bono management from an association management company. Over the years, AAENP has focused on defining the emergency nurse practitioner (ENP) role, developing a board certification examination, and creating standardized curricula for ENP programs. Strong collaborations with organizations such as the American Association of Nurse Practitioners (AANP) and the American College of Emergency Physicians (ACEP) have been pivotal. AAENP has grown significantly, now boasting over 1100 members, and has produced numerous evidence-based position statements and publications. This article highlights AAENP's achievements, and the challenges faced in its formative years, showcasing its commitment to advancing the ENP profession and ensuring quality care in emergency settings.

Paramedic educational programs maintain entry level competency throughout the COVID-19 pandemic.

The COVID-19 pandemic required unprecedented changes to emergency medical services (EMS) educational frameworks in the United States. It is unclear if pandemic-related changes impacted paramedic educational outcomes. We aimed to evaluate curricular and performance changes resulting from the initial COVID-19 pandemic on paramedic educational programs. We performed a retrospective cross-sectional evaluation of paramedic educational programs in 2019 and 2020 using the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions annual reports. These reports contain detailed program components and measures of program success. We included programs reporting at least one graduate in the study period. Descriptive statistics (proportions [%], median [interquartile range, IQR]) were calculated for paramedic program characteristics in 2019 and 2020, as well as pandemic specific curriculum changes. Wilcoxon rank-sum and Fisher's exact tests were used to evaluate differences in characteristics by year. The number of paramedic educational programs in our population decreased from 640 programs in 2019 to 612 in 2020, with a statistically significant decrease in clinical hours (2019: 219 [IQR 168‒272]; 2020: 200.5 [IQR 157‒261]). There was no difference in first or third-attempt certification examination success between years. Temporary shutdown was experienced in 34% of programs (duration: 3weeks [2‒7]) and 72% of required curricular changes. Curricular changes commonly included decreased in-person education (86%), traditional classroom lectures (78%), number of clinical sites (78%), and increased online didactic education (92%). Only 20% of programs decreased laboratory simulation or total training hours. During the pandemic, paramedic educational programs changed educational delivery with no observed differences on overall program performance. Identifying key curricular changes and best practices for implementation may be necessary to better optimize future educational delivery.

Proposed Nutrition Competencies for Medical Students and Physician Trainees: A Consensus Statement.

In 2022, the US House of Representatives passed a bipartisan resolution (House of Representatives Resolution 1118 at the 117th Congress [2021-2022]) calling for meaningful nutrition education for medical trainees. This was prompted by increasing health care spending attributed to the growing prevalence of nutrition-related diseases and the substantial federal funding via Medicare that supports graduate medical education. In March 2023, medical education professional organizations agreed to identify nutrition competencies for medical education. To recommend nutrition competencies for inclusion in medical education to improve patient and population health. The research team conducted a rapid literature review to identify existing nutrition-related competencies published between July 2013 and July 2023. Additional competencies were identified from learning objectives in selected nutrition, culinary medicine, and teaching kitchen curricula; dietetic core competencies; and research team-generated de novo competencies. An expert panel of 22 nutrition subject matter experts and 15 residency program directors participated in a modified Delphi process and completed 4 rounds of voting to reach consensus on recommended nutrition competencies, the level of medical education at which they should be included, and recommendations for monitoring implementation and evaluation of these competencies. A total of 15 articles met inclusion criteria for competency extraction and yielded 187 competencies. Through review of gray literature and other sources, researchers identified 167 additional competencies for a total of 354 competencies. These competencies were compiled and refined prior to voting. After 4 rounds of voting, 36 competencies were identified for recommendation: 30 at both undergraduate and graduate levels, 2 at the undergraduate level only, and 4 at the graduate level only. Competencies fell into the following nutrition-related themes: foundational nutrition knowledge, assessment and diagnosis, communication skills, public health, collaborative support and treatment for specific conditions, and indications for referral. A total of 36 panelists (97%) recommended nutrition competencies be assessed as part of licensing and board certification examinations. These competencies represent a US-based effort to use a modified Delphi process to establish consensus on nutrition competencies for medical students and physician trainees. These competencies will require an iterative process of institutional prioritization, refinement, and inclusion in current and future educational curricula as well as licensure and certification examinations.