Eventual Certification Research Articles

Analysis of Surgeon and Program Characteristics Associated with Success on American Board of Surgery Exam Outcomes.

Existing research exploring predictors of success on American Board of Surgery (ABS) exams focused on either resident or residency program characteristics, but limited studies focus on both. This study examines relationships between both resident and program characteristics and ABS Qualifying (QE) and Certifying Exam (CE) outcomes. Multilevel logistic regression was used to analyze the relationship between resident and program characteristics and ABS QE and CE 1st attempt pass and eventual certification. Resident characteristics were gender, IMG status, and prior performance, measured by 1st attempt USMLE Step 2 CK and Step 3 scaled scores. Program characteristics were size, %female, %International Medical Graduate (IMG), and program type. The sample included surgeons with QE and CE data from 2007-2019 and matched USMLE scores. Controlling for other variables, prior medical performance positively related to all ABS exam outcomes. The relationships between USMLE scores and success on ABS exams varied but were generally strong. Other resident characteristics that predicted ABS exam outcomes were gender and IMG (QE 1st attempt pass). The only program characteristic that significantly predicted ABS outcomes was %IMG (QE and CE 1st attempt pass). Despite statistical significance, gender, IMG, and %IMG translated to small differences in predicted probabilities of ABS exam success. This study highlights resident and program characteristics that predict success on ABS exams. USMLE scores consistently and strongly related to ABS exam success, providing evidence that USMLE scores relate to future high-stakes consequences like board certification. After controlling for prior performance, gender, IMG, and program %IMG significantly related to ABS exam success, but effects were small.

In Situ Strain Measurements Within Helmet Padding During Linear Impact Testing.

Drop and Impact testing of helmets are used extensively in the design process and eventual certification of helmets. These techniques have traditionally relied heavily on the measurement of the kinematic response to impact, which provides an indirect measurement of the liner response that is subject to interpretation during the design process. In the present work, we introduce an in situ experimental technique that provides a time-resolved measurement of the deformation of the helmet and its components during an impact event. The data collected from a high-speed X-ray imaging system can provide a full description of the deformation at the component level, which provides a helmet designer further insight into the performance of their helmet, while also returning the traditional kinematic metrics. The data presented focuses on the deformation of a commercial hockey helmet subjected to a series of linear impacts with three different impactor caps at speeds ranging from 2.4 to 4.5m/s. Deformation of the liner was monitored in the midsagittal and a parasagittal plane of the helmet. The results show that there is a clear dependence on the maximum strain achieved in the foam that is dependent on the impact type, the impactor shape, and the resulting strain rate of deformation in the foam liner. These techniques can provide the first data for a direct validation and calibration of finite element helmet deformation models, while also providing a new tool-set to improve the efficacy of helmet design.

A Pilot Evaluation of Portfolios for Quality Attestation of Clinical Ethics Consultants

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step on the pathway to an eventual certification process for clinical ethics consultants.

Performance of Physicians Trained Through the Research Pathway in Internal Medicine

Educators in internal medicine are concerned that reducing clinical training from three years to two could negatively affect physicians' ability to provide good patient care. Physician-scientists already follow a short-track research pathway that shortens clinical training to two years. The authors examine whether this shortened training affects ability. The authors use a national sample of 101,031 physicians who took their first internal medicine certification examination between 1993 and 2008 and trained in either a traditional or research pathway. They collected data, including demographics, exam information, and maintenance of certification (MOC) return rates. They used regression models to assess the relationship between training pathway and MOC exam scores and eventual certification status, adjusting for physician characteristics. In this study, research pathway training did not adversely impact internal medicine certification status. Although the scores of physicians who followed the research pathway were slightly lower, the effect size was small. In a subset of research pathway physicians, 63% remained in academic medicine and 37% continued to spend a substantial portion of time in medical research 10 years later. Different training pathways can lead to similar achievements in clinical judgment. The educational model, competency-based rather than time-dependent, that works for research pathway physicians could be extended to other talented trainees who would benefit by customizing training to meet career goals.

Training, competency, and certification in cardiac CT: A summary statement from the Society of Cardiovascular Computed Tomography

Training and competency criteria in cardiac CT were developed to guide practitioners in the process of achieving and maintaining skills in performing and interpreting cardiac CT studies. Appropriate training and eventual certification in cardiac CT angiography may be obtained by adhering to the recommendations for competency as set forth by either the American College of Cardiology Foundation (ACCF) or the American College of Radiology (ACR). Competency under either pathway requires both knowledge and experience-based components, with benchmarks set for level of experience on the basis of the extent of training experience. Although these recommended parameters are substantial, meeting these training criteria does not guarantee competence or expertise, which is the responsibility of the individual practitioner and may require further training and experience. Separate from satisfying initial training for the achievement of competency, certification in cardiac CT may be achieved through formal certification under the Certification Board of Cardiovascular Computed Tomography. Eligibility for certification generally follows the ACCF/American Heart Association Level 2 or ACR competency pathways. The ACR also conducts a certificate program related to advanced proficiency in cardiac CT. This official document of the Society of Cardiovascular Computed Tomography summarizes the present criteria for competency and certification in the field of cardiac CT.

DEVELOPING A NEXT GENERATION COLONOSCOPY SIMULATOR

Colonoscopy is considered the gold standard for detection and removal of precancerous polyps in the colon. Being a difficult procedure to master, exposure to a large variety of patient and pathology scenarios is crucial for gastroenterologists' training. Currently, most training is done on patients under supervision of experienced gastroenterologists. Being able to undertake a majority of training on simulators would greatly reduce patient risk and discomfort. A next generation colonoscopy simulator is currently under development, which aims to address the shortfalls of existing simulators. The simulator consists of a computer simulation of the colonoscope camera view and a haptic device that allows insertion of an instrumented colonoscope to drive the simulation and provide force feedback to the user. The simulation combines physically accurate models of the colonoscope, colon and surrounding tissues and organs with photorealistic visualization. It also includes the capability to generate randomized case scenarios where complexity of the colon physiology, pathology and environmental factors, such as colon preparation, can be tailored to suit training requirements. The long term goal is to provide a metrics based training and skill evaluation system that is not only useful for trainee instruction but can be leveraged for skills maintenance and eventual certification.

First-Time Failure Rates of Candidates for Board Certification

Few objective standards are available to assess the educational effectiveness of ophthalmology residency programs. As a possible measure, we evaluated the first-time failure (FTF) rate in the examinations of the American Board of Ophthalmology, defined as a first-attempt failure in the written examination or a first-attempt failure in the oral examination after having passed the written examination on the first attempt. We tracked data on all residents who graduated between June 30, 1999, and December 31, 2003, from commencement of training to certification, including rates of overall FTF, written and oral FTF, and program FTF. Performance was analyzed for several factors, including program size. The FTF rate was 28% overall and ranged from 0% to 89% across 118 programs (median, 27%). Programs with fewer than 16 graduates per 5 years were significantly more likely to have higher FTF rates than larger programs. Thirty-two programs accounted for 50% of the FTF rate. The FTF rate is a potentially useful measure. However, the small size of many programs contributes to some imprecision. Therefore, this measure should be used in conjunction with other factors when assessing the educational effectiveness of ophthalmology residency programs. Although the eventual certification rate was high, graduates from a few programs appeared inadequately prepared to take the examinations.

Improved Testing Results for International Medical Graduates

Although it is well known that low scores by residents in their in-training examinations predict failure at eventual certification, there is a paucity of information regarding results with focused intervention. Over a two-year period, international medical graduates (IMGs) accepted as CA-1 residents in the Department of Anesthesiology were provided an intensive one-month text-based teaching program focusing on anesthesia-specific medical knowledge. The Anesthesia Knowledge Test® (Metrics Associates, Inc., Chelmford, MA) as a surrogate for the American Board of Anesthesiology In-training Examination was administered on the first day (AKT-1), after the one-month training period (AKT-1), and after six months (AKT-6). AKT test results were reported as percentiles of all anesthesia residents taking the test. After two years, a retrospective review of test results was performed with repeated measures ANOVA. IMG residents increased their percentile test performance on the AKT-1 from 31.2 ± 6.3% baseline (mean ± SEM) to 56.8 ± 6.4 % after the one month session (p<0.05). This increased performance was maintained with the AKT-6 at six months: 62.8 ± 7.8 %. An intensive anesthesia text-based one-month didactic program can improve the test performance of IMGs. This effect is sustained after six months.

“I Gotta Push. Please Let Me Push!” Social Interactions During the Change from First to Second Stage Labor

Background: Forms of social interaction may occur among the participants in medicalized births, in which a woman in labor is experiencing strong involuntary urges to push but has not yet been found to have a completely dilated cervix. This article examines the social events and communications that occur at the change between first and second stages of labor. Method: Three cases are described from videotapes of women in the second stage of labor and their caregivers. Results: Several social and interactive features occurred, in which (1) the caregiver, usually a nurse, by invoking the “no pushing rule,” insisted that the woman suppress her involuntary urges to push; (2) both the caregiver and the parturient displayed an orientation toward the future and the eventual certification of full cervical dilation by a designated authority, usually a physician, regardless of the actual state of the woman's cervix or her involuntary urges to push; and (3) the certification process marked a ritual transition to “official” second stage labor, in which the woman's involuntary urges were considered appropriate and actively encouraged. Conclusion: A discrepancy between a laboring woman's sensations and caregivers' ideas about how labor should be conducted has implications for clinical care of women, wherein the goal should be to facilitate the woman's accomplishment rather than to direct the “delivery.” (BIRTH 24:3, September 1997)

The Quest for Competence, Confidence, and Certification: Mentors and Peers in Industrial Hygiene Education

Industrial hygiene work experiences that promote technical competence, professional confidence, and eventual certification are not easily obtained by novices. Industrial hygiene mentor and peer relationships can facilitate finding work experiences as well as reduce the shock of entry into the profession by supporting, coaching, and providing guidance to novices. Established industrial hygienists who take on the responsibility of mentor-based teaching must recognize it as a bona fide method of adult education in need of both personal preparation and understanding. Employers and industrial hygiene professional organizations play important peer roles in nurturing talent, instilling professional values, developing professional competence, and encouraging individual growth and confidence in the early career years and throughout life. Finally, individual industrial hygienists need to be proactive and take responsibility for their own continued professional development.

THE QUEST FOR COMPETENCE, CONFIDENCE, AND CERTIFICATION: MENTORS AND PEERS IN INDUSTRIAL HYGIENE EDUCATION

Industrial hygiene work experiences that promote technical competence, professional confidence, and eventual certification are not easily obtained by novices. Industrial hygiene mentor and peer relationships can facilitate finding work experiences as well as reduce the shock of entry into the profession by supporting, coaching, and providing guidance to novices. Established industrial hygienists who take on the responsibility of mentor-based teaching must recognize it as a bona fide method of adult education in need of both personal preparation and understanding. Employers and industrial hygiene professional organizations play important peer roles in nurturing talent, instilling professional values, developing professional competence, and encouraging individual growth and confidence in the early career years and throughout life. Finally, individual industrial hygienists need to be proactive and take responsibility for their own continued professional development.

Training and Certification Program of the Ontario Ministry of the Environment

The creation of an extensive training program has prepared Ontario for eventual certification of plant operators.

Competency-Based Teacher Certification Programs in Florida -- MYTH or Reality?

What is competency-based teacher education and what implications does it hold for inservice teacher preparation and eventual certification? According to Houston^, it is best defined as a program that has emphasis on objectives which are known to the student prior to instruction. Activities are then designed to contribute to the student's demonstration of the objec tives, and evaluation is in terms of accomplishment of these objectives. This implies that a series of com petency requirements could increase in complexity and scope as the teacher gains experience. More simply stated, competency-based programs involve preparing teachers for specific performance competencies and certifying them on the basis of collected evidence^.