Certification Examination Research Articles

The Association Between USMLE Step 2 Clinical Knowledge Scores and Residency Performance: A Systematic Review and Meta-Analysis.

With the change in Step 1 score reporting, Step 2 Clinical Knowledge (CK) may become a pivotal factor in resident selection. This systematic review and meta-analysis seeks to synthesize existing observational studies that assess the relationship between Step 2 CK scores and measures of resident performance. The authors searched MEDLINE, Web of Science, and Scopus databases using terms related to Step 2 CK in 2021. Two researchers identified studies investigating the association between Step 2 CK and measures of resident performance and included studies if they contained a bivariate analysis examining Step 2 CK scores' association with an outcome of interest: in-training examination (ITE) scores, board certification examination (BCE) scores, select Accreditation Council for Graduate Medical Education (ACGME) core competency assessments, overall resident performance evaluations, or other subjective measures of performance. For outcomes that were investigated by 3 or more studies, pooled effect sizes were estimated with random-effects models. Among 1,355 potential studies, 68 met inclusion criteria and 43 were able to be pooled. There was a moderate positive correlation between Step 2 CK and ITE scores (0.52, 95% CI 0.45-0.59, P < .01). There was a moderate positive correlation between Step 2 CK and ITE scores for both nonsurgical (0.59, 95% CI 0.51-0.66, P < .01) and surgical specialties (0.41, 95% CI 0.33-0.48, P < .01). There was a very weak positive correlation between Step 2 CK scores and subjective measures of resident performance (0.19, 95% CI 0.13-0.25, P < .01). This study found Step 2 CK scores have a statistically significant moderate positive association with future examination scores and a statistically significant weak positive correlation with subjective measures of resident performance. These findings are increasingly relevant as Step 2 CK scores will likely become more important in resident selection.

On the Predictive Power of the In-Training Examination for the Certification of Anesthesiologist Assistants.

In-training examinations (ITEs) are a popular teaching tool for certification programs. This study examines the relationship between examinees' performance on the National Commission for Certification of Anesthesiologist Assistants (NCCAA) ITE and the high-stakes NCCAA Certification Examination. We utilized a mixed-methods approach in our study. Before estimating the models for the predictive validity study, a series of interviews with program directors were conducted to discuss the role of the ITE in students' education. Multiple linear regression analysis was then used to assess the strength of the relationship between the ITE and Certification Examination scores, while considering the percentage of program examinees completed in their anesthesiologist assistant program between their ITE and Certification Examination attempts. Logistic regression analysis was used to estimate the probability of passing the Certification Examination as a function of ITE score. Interviews with program directors confirmed that the ITE provided a valuable testing experience for students and highlighted the areas where students need to focus. Moreover, both the ITE score and the percentage of the program between exams were deemed statistically significant predictors for Certification Examination scores. The logistic regression model indicated that higher scores on the ITE implied a higher probability of passing the Certification Examination. This research demonstrated the high predictive validity of the ITE examination scores in predicting the Certification Examination outcomes. Together with the proportion of the program covered between exams, the variables explain a significant amount of variability in Certification Examination scores. The ITE feedback helped students assess their preparedness and better focus their studies for the high-stakes certification examination for the profession.

PS-P14-7: IMPACTS OF CONSTRUCTING AND OPERATING “KARUSHIOH” CERTIFICATION SYSTEM TO PROMOTE DELICIOUS LOW-SALT MEALS ON THE JAPANESE LOW-SALT FOODS MARKET

Objective: From the viewpoint of preventing and prognosis cardiovascular disease, it was created by National Cerebral and Cardiovascular Center (NCVC) of Japan to create a new concept of low-salt meal that brings out the delicious by using salt lightly under the name of “Karushioh”. As a mechanism for consumers to easily obtain delicious low-salt foods, the “Karushioh” certification system linked to the economic activities of companies, has been promoted by NCVC. Under this system, NCVC examines whether foods meet the certification criteria such as low salt and deliciousness, and permits the labeling of “Karushioh”, which is registered as a trademark for passed foods. Therefore, the purpose of this study was to sort out the current status of this certification and was to verify the spread of “Karushioh” certified foods and their impact on salt reduction. Design and Methods: The market size of certified foods was tabulated from the fiscal year 2020 sales performance report submitted by companies that manufactures/sells certified foods in accordance with the trademark license agreement. In addition, the amount of salt reduction associated with the launch of certified foods were estimated from the comparison target products in the “Karushioh” certification examination. Results: As an initiative linked to the industry, the market for delicious low-salt foods through the operation of the certification system is expanding, and the market size of the certified foods will exceed 2.1 billion yen in fiscal year 2020, and the number of certifications so far has increased. At the end of 2021, a total of 166 applications were submitted by 52 companies. In addition, the amount of salt reduction in fiscal year 2020 due to the launch of the certified food to the market was estimated to be 51 tons. Conclusions: In the several years since the certification system started, it has formed a market of over 2 billion yen, whereas in the market of low-salt foods in Japan, which is estimated to exceed 70 billion yen. With the future development of the certification system, more promotion of salt reduction can be expected.

Acute Chest Syndrome.

Acute Chest Syndrome.

A correct answer and commentary of the certification examination questions problem for Medical Device Information Communicator

A correct answer and commentary of the certification examination questions problem for Medical Device Information Communicator

Applying Practice Analysis to Develop a New Test Content Outline for the Pediatric Cardiology Certification Examination.

The evolving breadth and complexity of the contemporary pediatric cardiology specialty requires regular, systematic analysis of the practice to ensure that training and certification requirements address the demands of real-world clinical experience. We report the process of the American Board of Pediatrics (ABP) for conducting such a practice analysis and revising the test content outline (TCO) for the pediatric cardiology subspecialty certification exam. A panel of 15 pediatric cardiologists conducted seven 2-h virtual meetings, during which they identified 37 unique tasks that represent the work a pediatric cardiologist may reasonably expect to perform within the first 5years after training. These tasks were grouped into nine performance domains, similar to the entrustable professional activities (EPA), previously endorsed by the ABP in collaboration with the pediatric cardiology education community, and which represent the critical activities of the profession. The panel then enumerated the knowledge, skills, and abilities necessary to perform each task. These deliberations resulted in two work products: a practice analysis document (PAD) and subspecialty board TCO based on testable knowledge, skills, and abilities. Survey assessments of the panel's work were then distributed to pediatric cardiology fellowship program directors and to practicing pediatric cardiologists for their input, which largely aligned with the panel's recommendations. Survey responses were considered in the final revisions of the PAD and TCO. This approach to practice analysis proved to be an efficient process for describing the work performed by today's pediatric cardiologists and the knowledge, skills, and abilities needed to competently perform that work.

An exploration of registered dietitian accreditation system development in China

The registered dietitian system started late in China, and since 2014 a working committee of registered dietitians has been formed by the Chinese Nutrition Society to establish a national accreditation system in accordance with the international standard academic and internship requirements. The data from the certification examinations and registrations were collected and analyzed. 8,328 registered dietitians were included in the study, with 5,673 registered dietitians (RD) and 2,655 registered dietetic technicians (DTR). Among them, 45.27% of RDs have master degree or above, and 66.44% of DTRs have bachelor or above. 53.25% RDs work in medical institutions, 14.77% in colleges and universities, and 14.56% in enterprises; 48.21% DTRs work in the medical institutions, 30.28% in enterprises, and 7.34% in the community. Although six years of work has initially established a foundation of standardized registered dietitian accreditation system, the problems of limited resources for academic education and the lack of legislative protection for the profession remain prominent.

Effective Following: A Counterpart to Leadership

Effective Following: A Counterpart to Leadership

Readiness Tests: A Strategy to Boost Certification Success.

Certification of nursing staff has been associated with improved patient outcomes; however, time, cost, and test anxiety are barriers to achieving it. Readiness tests can reduce test anxiety related to certification examinations. A readiness test helps nurses prepare by providing a simulated experience that matches the actual testing environment and identifying knowledge gaps. These tests can be added to other steps nurse leaders can take to encourage certification and support staff professional development.

The vascular surgery in-training examination predicts performance on qualifying examination.

Vascular surgery trainees participate in the vascular surgery in-training examination (VSITE) during each year of their training. Although the VSITE was developed as a low-stakes, formative examination, performance on that examination might correlate with the pass rates for the Vascular Surgery Board written qualifying examination (VQE) and oral certifying examination (VCE) and might, therefore, guide both trainees and program directors. The present study was designed to examine the ability of the VSITE to predict trainees' performance on the VQE and VCE. All first-time candidates of the Vascular Surgery Board VQE and VCE were analyzed from 2016 to 2020, including those from both the integrated and independent training pathways. VSITE scores from the final year of training were associated with the VQE scores and the probability of passing the VQE and VCE both. Linear and logistic regression models were used to determine the ability of VSITE results to predict the VQE scores and the probability of passing each board examination. VSITE scores available for the 559 candidates (69.3% male; 30.7% female) who had completed the VQE and 369 candidates (66.7% male; 33.3% female) who had completed both the VQE and the VCE. The linear regression model results for the final year of training showed that the VSITE scores explained 34% of the variance in the VQE scores (29% for the integrated and 37% for the independent trainees). Logistic regression demonstrated that the final year VSITE scores were a significant predictor of passing the VQE for both integrated and independent trainees (P< .001). A VSITE score of 500 during the final year of training predicted a VQE passing probability of >90% for each group of candidates. The probability of passing the VQE decreased to 73% for candidates from integrated programs, 61% for candidates from independent programs, and 64% for the whole cohort when the score was 400. The VSITE scores were a significant predictor of passing the VCE only for the candidates from independent programs (odds ratio, 1.01; 95% confidence interval, 1.00-1.02; P< .01), for whom a VSITE score of 400 correlated with an 82% probability of passing the VCE. VSITE performance is predictive of passing the VQE for trainees from both integrated and independent training paradigms. Vascular surgery trainees and training programs should optimize their preparation and educational efforts to maximize performance on the VSITE during their final year of training to improve the likelihood of passing the VQE. Further analysis of the predictive value of VSITE scores during the earlier years of training might allow the board certification examinations to be administered earlier in the final year of training.

An Examination of Predictors of Attrition in Physician Assistant Programs

The purpose of this study was to explore the relationship between program characteristics and attrition rates. Program graduation rates, attrition rates, and Physician Assistant National Certifying Examination (PANCE) pass rates were extracted from program websites from February-March 2021 and summarized for 2018, 2019, and 2020. Means were compared across categories of independent variables. Attrition rates and PANCE pass rates were correlated. Prerequisites and attrition rate were evaluated with multiple regression. Mean attrition rates varied little across years. Significant differences in mean attrition were limited to a few US Census Bureau regions or divisions. No significant correlation between the total number of prerequisite courses or total prerequisite credits and attrition existed. In 2020, mean attrition rate was statistically significantly greater when biochemistry was required (M = 6.89, SD = 7.04) than when not required (M = 4.91, SD = 4.75) and was statistically significantly lower when an additional chemistry course was required (M = 3.65, SD = 4.00) than when not required (M = 5.93, SD = 5.82). No significant predictors of attrition were found with regression. The mean attrition rates have been relatively stable from 2018-2020, suggesting that the presence of prerequisite coursework has no significant impact on attrition rates. This suggests that specific prerequisites may not predict success in a program, supporting the idea of decreasing or eliminating prerequisites. Additional studies are needed to understand the factors, including specific combinations of prerequisites, that predict completion of a physician assistant program.

Getting Ready for Wound Certification: Factors Impeding Wound Healing.

Getting Ready for Wound Certification: Factors Impeding Wound Healing.

Feasibility and Acceptability of Web-Based Structured Oral Examinations for Postgraduate Certification: Mixed Methods Preliminary Evaluation.

The COVID-19 pandemic disrupted postgraduate certification examinations globally. The Colleges of Medicine of South Africa continued hosting certification examinations through the pandemic. This was achieved by effecting a rapid transition from in-person to web-based certification examinations. This formative evaluation explored candidates' acceptability of web-based structured oral examinations (SOEs) hosted via Zoom (Zoom Communications Inc). We also reported the audiovisual quality and technical challenges encountered while using Zoom and candidates' overall experience with these examinations conducted during the early part of the COVID-19 pandemic. Additionally, performance in web-based certification examinations was compared with previous in-person certification examinations. This mixed methods, single-arm evaluation anonymously gathered candidates' perceptions of web-based SOE acceptability, audiovisual quality, and overall experience with Zoom using a web-based survey. Pass rates of web-based and previous in-person certification examinations were compared using chi-square tests, with a Yates correction. A thematic analysis approach was adopted for qualitative data. Between June 2020 and June 2021, 3105 candidates registered for certification examinations, 293 (9.4%) withdrew, 2812 (90.6%) wrote, and 2799 (99.9%) passed, and 1525 (54.2%) were invited to a further web-based SOE. Examination participation was 96.2% (n=1467). During the first web-based examination cycle (2020), 542 (87.1%) of 622 web-based SOE candidates completed the web-based survey. They reported web-based SOEs as fair (374/542, 69%) and adequately testing their clinical reasoning and insight (396/542, 73.1%). Few would have preferred real patient encounters (173/542, 31.9%) or in-person oral examinations (152/542, 28%). Most found Zoom acceptable (434/542, 80%) and fair (396/542, 73.1%) for hosting web-based SOEs. SOEs resulted in financial (434/542, 80%) and time (428/542, 79%) savings for candidates. Many (336/542, 62%) supported the ongoing use of web-based certification examinations. Only 169 technical challenges in using Zoom were reported, which included connectivity-related issues, poor audio quality, and poor image quality. The thematic analysis identified 4 themes of positive and negative experiences related to web-based SOE station design and content, examination station environment, examiner-candidate interactions, and personal benefits for candidates. Our qualitative analysis identified 10 improvements for future web-based SOEs. Candidates achieved high pass rates in web-based certification examinations in 2020 (1583/1732, 91.39%) and 2021 (850/1067, 79.66%). These were significantly higher (2020: N=8635; χ21=667; P<.001; 2021: N=7988; χ21=178; P<.001) than the previous in-person certification examination pass rate of 58.23% (4030/6921; 2017-2019). Web-based SOEs conducted by the Colleges of Medicine of South Africa during the COVID-19 pandemic were well received by candidates, and few technical difficulties were encountered while using Zoom. Better performance was observed in web-based examinations than in previous in-person certification examinations. These early findings support the ongoing use of this assessment method.

Plan and Then Act: The Moderated Moderation Effects of Profession Identity and Action Control for Students at Arts Universities during the Career Development Process.

Preservice teachers at universities of arts have more than 10 years of professional training before admission, but in their senior year, they face the pressure of the graduation exhibition and performances and the teacher certification examination at the same time. This process is dissimilar to that for preservice teachers at general universities. Such a difference, however, has not been taken seriously in the past. In order to avoid burnout, preservice teachers at universities of arts, when they are under the pressure of limited time, may choose to identify with the departments they are more familiar with for their future careers, rather than identifying with their educational program, in order to increase hope for their career and reduce the chance of burnout. In addition, we believe that the use of action control/state control would also show different adaptation situations in the face of pressure. Therefore, this study focuses on the role of profession identity and action control as moderating variables in the process of becoming preservice teachers at arts universities. We recruited 304 art-major preservice teachers to establish a path model to explore their future time perspective and grit, detecting how the mediation of career decision self-efficacy affects learning burnout and career hope. Secondly, we inspected the moderating effect of profession identity and action control on learning burnout and career hope. We found that profession identity moderates the relationships between future time perspective and career decision self-efficacy as well as between career decision self-efficacy and learning burnout, all of which exhibited ordinal interactions. Furthermore, preservice teachers with high decision-making efficacy had lower burnout than those with low efficacy, but the high-efficacy advantage in preservice teachers under state control in reducing burnout would disappear. Lastly, although professional identification was important, action control regulated the relationship between career decision self-efficacy and learning burnout with ordinal interaction; that is, action control could effectively reduce their learning burnout.

Dealing With Failure.

Dealing With Failure.

Preliminary User Evaluation of a New Dental Technology Virtual Simulation System: Development and Validation Study.

BackgroundWith the advancements in the dental health care industry, the demand for dental technicians has increased. Dental technicians should be thoroughly assessed and trained in practical skills and pass professional certification examinations to ensure that they are competent to work closely with dentists. Unfortunately, such training courses and tests are in short supply worldwide. The use of virtual simulation technology can help solve these problems.ObjectiveThis study presents a new strategic framework design for a certified dental technician practical examination called as the certified Objective Manipulative Skill Examination of Dental Technicians (OMEDT), which is based on the Objective Structured Clinical Examination (OSCE). We present the development and validation of the OMEDT system, a new virtual simulated training system, to meet the demands of the OMEDT framework. The combination of OMEDT and the OMEDT system can solve the complex problems encountered in the certified dental technician practical examination with excellent efficiency, high quality, and low cost.MethodsThe OMEDT framework design was constructed according to the OSCE guide and the Chinese vocational skill standards for dental technicians. To develop the OMEDT system, we organized a new framework based on the virtual learning network platform, the haptic feedback system, and the real-time dental training and evaluation system. The effectiveness evaluation of the OMEDT system was divided into 2 phases: in the first phase, 36 students were recruited to use the test module to finish the task and their performance data were collected and analyzed; and in the second phase, a questionnaire was administered to 30 students who used the system for their studies and graduation exams.ResultsThe OMEDT and the corresponding skill training virtual simulation OMEDT system were developed, and preliminary user evaluation was performed to assess their effectiveness and usefulness. The OMEDT system was found to improve students’ practical skills by training with the evaluation results. In addition, several key research topics were explored, including the effects of positive feedback of the knowledge of results on the improvement of the students’ skill level and the common sense transformation of educators in the virtual simulation technology environment.ConclusionsThe development of OMEDT and the OMEDT system has been completed and their effectiveness has been verified.

The Predictive Value of the Residency AOBFP In-Service Exam, Produced and Administered by ACOFP.

Board certification is acknowledged as the mainstay for ensuring quality physician-delivered health care within medical specialties. The American College of Osteopathic Family Physicians (ACOFP) administers the American Osteopathic Board of Family Physicians' (AOBFP) In-Service Examination (ISE) to provide residents and program directors with a formative examination to assess competency and preparation for successful completion of the AOBFP certifying examination (CE). Unique assessment processes are integral to monitoring development of the osteopathic family physician throughout training and into practice, and to verify their competency for the safety and protection of the public. This study sought to investigate whether performance on the AOBFP ISE predicted performance on the AOBFP CE, and thereby successfully equipped residents to safely enter medical practice. In 2020, data from 1,893 PGY-1 through PGY-3 residents (2016-2018), whose ISE scores could be matched with scores on the AOBFP initial board CE, were analyzed for this study. Correlations among ISE administrations across 3 years of postgraduate medical education were in the mid-to-high .6 range; the ISE scores correlated with CE scores in the mid .4 to high .5 range. Less reliable measures of positive predictive value were 0.99, and sensitivity was 0.91. Results suggest that ISE administrations during residency training are effective in developing remediation strategies for subsequent successful CE performance. The inclusion of osteopathic principles in the AOBFP CE necessitates inclusion of osteopathic content in resident training exams like ISE.

A Novel Mock Oral Curriculum for Senior Surgery Residents: Results of a Pilot Study.

The oral general surgery certifying examination (CE) is required for board certification. A curriculum was designed to improve CE passage rates at an academic residency program. Limited literature exists that evaluates a long-term mock oral curriculum for senior residents. This study aims to evaluate the impact of this curriculum on essential elements for clinical practice and CE preparedness. The curriculum consisted of weekly meetings with postgraduate year four and postgraduate year five residents (n=10). Two residents were selected for a video-recorded board-style mock examination with a faculty examiner and peer audience. Each attendee completed a standard evaluation form that assessed score, anxiety, confidence, and medical knowledge. Blood pressure, pulse, and unused time were assessed. A postcurriculum survey was conducted. Medical knowledge had the greatest correlation with overall scores (R2=0.733). Positive correlations were seen between confidence and case number for faculty, self, and peer scores (R2=0.671, R2=0.566, and R2=0.729, respectively). There was a positive correlation between confidence and medical knowledge (R2=0.575). There was a significant difference between the overall score of nontachycardic versus tachycardic residents (P=0.00994). Residents demonstrated increasing confidence as they progressed through the curriculum by self-reported and objective measures. Residents demonstrated improvements in overall scores. Future directions will examine results of the 2-y curriculum experience and CE passage rates to verify that a standardized, structured, weekly, longitudinal curriculum is beneficial for CE preparedness and clinical practice.

Lifestyle Medicine Core Competencies: 2022 Update.

The lifestyle medicine core competencies were developed by a committee of physicians from several medical specialties to provide guidance on the knowledge and skills needed for physicians to provide high quality lifestyle interventions that optimize chronic disease outcomes. These competencies were published in the Journal of the American Medical Association (JAMA) in 2010 and used as the foundation for the first lifestyle medicine course and for the lifestyle medicine board certification examination. In the ensuing years, interest in the field and application has expanded to a variety of health professionals. With evolution of the lifestyle medicine evidence-base, the competencies have been updated. This article sums up the changes in their organization and content. Regular updates are anticipated to align with the ongoing scientific studies and evolution of the field.

Adult-Gerontology Nurse Practitioners: A Discussion of Scope and Expertise

Adult-gerontology primary care nurse practitioners (NPs) deliver longitudinal primary care in outpatient settings from adolescence to older adulthood, and adult-gerontology acute care NPs provide care to critically ill adults and older adults. Family NP programs vastly outnumber adult-gerontology NP programs nationwide, despite a rapidly aging population. This report discusses the differences in education and scope of practice of adult-gerontology primary care NPs, adult-gerontology acute care NPs, and family NPs and highlights the crucial and unique assets adult-gerontology NPs bring to any health care system or practice. Differences in competencies, certification examinations, and practice settings are discussed in depth.