Initial Certification Examination Research Articles

Associations of Internal Medicine Residency Milestone Ratings and Certification Examination Scores With Patient Outcomes

Despite its importance to medical education and competency assessment for internal medicine trainees, evidence about the relationship between physicians' milestone residency ratings or the American Board of Internal Medicine's initial certification examination and their hospitalized patients' outcomes is sparse. To examine the association between physicians' milestone ratings and certification examination scores and hospital outcomes for their patients. Retrospective cohort analyses of 6898 hospitalists completing training in 2016 to 2018 and caring for Medicare fee-for-service beneficiaries during hospitalizations in 2017 to 2019 at US hospitals. Primary outcome measures included 7-day mortality and readmission rates. Thirty-day mortality and readmission rates, length of stay, and subspecialist consultation frequency were also assessed. Analyses accounted for hospital fixed effects and adjusted for patient characteristics, physician years of experience, and year. Certification examination score quartile and milestone ratings, including an overall core competency rating measure equaling the mean of the end of residency milestone subcompetency ratings categorized as low, medium, or high, and a knowledge core competency measure categorized similarly. Among 455 120 hospitalizations, median patient age was 79 years (IQR, 73-86 years), 56.5% of patients were female, 1.9% were Asian, 9.8% were Black, 4.6% were Hispanic, and 81.9% were White. The 7-day mortality and readmission rates were 3.5% (95% CI, 3.4%-3.6%) and 5.6% (95% CI, 5.5%-5.6%), respectively, and were 8.8% (95% CI, 8.7%-8.9%) and 16.6% (95% CI, 16.5%-16.7%) for mortality and readmission at 30 days. Mean length of stay and number of specialty consultations were 3.6 days (95% CI, 3.6-3.6 days) and 1.01 (95% CI, 1.00-1.03), respectively. A high vs low overall or knowledge milestone core competency rating was associated with none of the outcome measures assessed. For example, a high vs low overall core competency rating was associated with a nonsignificant 2.7% increase in 7-day mortality rates (95% CI, -5.2% to 10.6%; P = .51). In contrast, top vs bottom examination score quartile was associated with a significant 8.0% reduction in 7-day mortality rates (95% CI, -13.0% to -3.1%; P = .002) and a 9.3% reduction in 7-day readmission rates (95% CI, -13.0% to -5.7%; P < .001). For 30-day mortality, this association was -3.5% (95% CI, -6.7% to -0.4%; P = .03). Top vs bottom examination score quartile was associated with 2.4% more consultations (95% CI, 0.8%-3.9%; P < .003) but was not associated with length of stay or 30-day readmission rates. Among newly trained hospitalists, certification examination score, but not residency milestone ratings, was associated with improved outcomes among hospitalized Medicare beneficiaries.

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Implications of Medical Board Certification Practices on Family Planning and Professional Trajectory for Early Career Female Radiation Oncologists

PurposeOur purpose was to evaluate the effect of the current structure and schedule of the American Board of Radiology (ABR) radiation oncology initial certification (RO-IC) examinations, with a primary focus on implications for family planning and early professional barriers among female radiation oncologists. Methods and MaterialsA survey was conducted of crowdsourced ABR candidates and diplomates for radiation oncology between June and July of 2020. The primary study cohort was early career female radiation oncologists of the 2016 through 2021 graduating classes. ResultsThe survey response rate of early career female radiation oncologists was 37% (126 of an estimated 337). Among this cohort, 58% (73 of 126) reported they delayed or are currently delaying/timing pregnancy or adoption to accommodate the annual schedule of the 4 qualifying and certifying examinations required to achieve board certification in radiation oncology. One in every 3 respondents who had attempted to become pregnant reported experiencing infertility (25 of 79, 32%). Women who reported intentionally delaying pregnancy to accommodate the ABR RO-IC examination schedule were significantly more likely to experience infertility (46% vs 18%, P = .008). Seven women (6%) reported at least a 1-year delay in sitting for a RO-IC examination due to an unavoidable scheduling conflict related to childbirth and/or the peripartum period. A majority reported that full board certification had a significant effect on achieving academic promotion or professional partnership (52%), annual compensation (54%), and nonclinical professional commitments (58%) — these rates mirror those of surveyed early career male counterparts (n = 101). ConclusionsThe current structure and scheduling of the ABR RO-IC examinations imposes noteworthy hurdles for many female radiation oncologists when entering the workforce. The recent transition to virtual examination platforms creates an important opportunity to increase flexibility in the structure and scheduling of the board examination process to improve equitable board certification practices.

Academic Achievement, Professionalism, and Burnout in Family Medicine Residents.

Physician burnout has been shown to have roots in training environments. Whether burnout in residency is associated with the attainment of critical educational milestones has not been studied, and is the subject of this investigation. We used data from a cohort of graduating family medicine residents registering for the 2019 American Board of Family Medicine initial certification examination with complete data from registration questionnaire, milestone data, in-training examination (ITE) scores, and residency characteristics. We used bivariate and multilevel multivariate analyses to measure the associations between four professionalism milestones ratings and ITE performance with burnout. Our sample included 2,509 residents; 36.8% met the criteria for burnout. Multilevel regression modeling showed a correlation between burnout and failure to meet only one of four professionalism milestones, specifically professional conduct and accountability (OR 1.41, 95% CI 1.07-1.87), while no statistically significant relationship was demonstrated between burnout and being in the lowest quartile of ITE scores. Other factors negatively associated with burnout included international medical education (OR 0.60, 95% CI 0.48-0.76) and higher salary compared to cost of housing (OR 0.62, 95% CI 0.46-0.82). We found significant association between self-reported burnout and failing to meet expectations for professional conduct and accountability, but no relationship between burnout and medical knowledge as measured by lower ITE performance. Further investigation of how this impacts downstream conduct and accountability behaviors is needed, but educators can use this information to examine program-level interventions that can specifically address burnout and development of physician professionalism.

First-Year Results of the American Board of Anesthesiology's Objective Structured Clinical Examination for Initial Certification.

In 2018, the American Board of Anesthesiology (ABA) became the first US medical specialty certifying board to incorporate an Objective Structured Clinical Examination (OSCE) into its initial certification examination system. Previously, the ABA's staged examination system consisted of 2 written examinations (the BASIC and ADVANCED examinations) and the Standardized Oral Examination (SOE). The OSCE and the existing SOE are now 2 separate components of the APPLIED Examination. This report presents the results of the first-year OSCE administration. A total of 1410 candidates took both the OSCE and the SOE in 2018. Candidate performance approximated a normal distribution for both the OSCE and the SOE, and was not associated with the timing of the examination, including day of the week, morning versus afternoon session, and order of the OSCE and the SOE. Practice-based Learning and Improvement was the most difficult station, while Application of Ultrasonography was the least difficult. The correlation coefficient between SOE and OSCE scores was 0.35 ([95% confidence interval {CI}, 0.30-0.39]; P < .001). Scores for the written ADVANCED Examination were modestly correlated with scores for the SOE (r = 0.29 [95% CI, 0.25-0.34]; P < .001) and the OSCE (r = 0.15 [95% CI, 0.10-0.20]; P < .001). Most of the candidates who failed the SOE passed the OSCE, and most of the candidates who failed the OSCE passed the SOE. Of the 1410 candidates, 77 (5.5%) failed the OSCE, 155 (11.0%) failed the SOE, and 25 (1.8%) failed both. Thus, 207 (14.7%) failed at least 1 component of the APPLIED Examination. Adding an OSCE to a board certification examination system is feasible. Preliminary evidence indicates that the OSCE measures aspects of candidate abilities distinct from those measured by other examinations used for initial board certification.

Association of Regional Practice Environment Intensity and the Ability of Internists to Practice High-Value Care After Residency

Use of health care services and physician practice patterns have been shown to vary widely across the United States. Although practice patterns-in particular, physicians' ability to provide high-quality, high-value care-develop during training, the association of a physician's regional practice environment with that ability is less well understood. To examine the association between health care intensity in the region where physicians practice and their ability to practice high-value care, specifically for physicians whose practice environment changed due to relocation after residency. This cohort study included a national sample of 3896 internal medicine physicians who took the 2002 American Board of Internal Medicine initial certification examination followed approximately 1 decade (April 21, 2011, to May 7, 2015) later by the Maintenance of Certification (MOC) examination. At the time of the MOC examination, 2714 of these internists were practicing in a new region. Data were analyzed from March 6, 2016, to May 21, 2018. Intensity of care in the Dartmouth Atlas hospital referral region (HRR), measured by per-enrollee end-of-life physician visits (primary) and current practice type (secondary). The outcome, a physician's ability to practice high-value care, was assessed using the Appropriately Conservative Management (ACM) score on the MOC examination, measuring performance across all questions for which the correct answer was the most conservative option. The exposure, regional health care intensity, was measured as per-enrollee end-of-life physician visits in the Dartmouth Atlas HRR of the physician's practice. Among the 3860 participating internists included in the analysis (2030 men [52.6%]; mean [SD] age, 45.6 [4.5] years), those who moved to regions in the quintile of highest health care intensity had an ACM score 0.22 SD lower (95% CI, -0.32 to -0.12) than internists who moved to regions in the quintile of lowest intensity, controlling for postresidency ACM scores. This difference reflected scoring in the 44th compared with the 53rd percentile of all examinees. This association was mildly attenuated (0.18 SD less; 95% CI, -0.28 to -0.09) after adjustment for physician and practice characteristics. This study found that practice patterns of internists who relocate after residency training appear to migrate toward norms of the new region. The demands of practicing in high-intensity regions may erode the ability to practice high-value conservative care.

Exploring the relationship between examination pass rates and eligibility pathways among pharmacist candidates for initial board certification

ObjectivesTo compare examination pass rates among different eligibility cohorts for initial board certification in 6 recognized pharmacy practice specialties. DesignRetrospective observational cohort study. Setting and participantsPracticing U.S. pharmacists who were approved candidates for initial board certification examinations in the following Board of Pharmacy Specialties (BPS)–recognized specialties: ambulatory care pharmacy, critical care pharmacy, oncology pharmacy, pediatric pharmacy, pharmacotherapy, and psychiatric pharmacy. Outcome measuresThe number and percentage of BPS-approved candidates that pass initial board certification examinations differentiated by specialty and eligibility pathway (i.e., completion of postgraduate residency training or demonstration of postlicensure specialized practice experience). ResultsInitial board certification examination outcome (i.e., pass or fail) was assessed for a total of 15,171 candidates from Fall 2015 to Fall 2018. Pass rates for that period based on eligibility pathway (e.g., completion of a PGY-2 specialty residency, completion of a PGY-1 residency plus 1–2 years of postlicensure specialized practice experience, or 3–4 years of postlicensure specialized practice experience) were, respectively as follows: ambulatory care pharmacy (n = 2081): 94%, 84%, and 55% (P < 0.0001); critical care pharmacy (n = 2111): 99%, 94%, and 79% (P < 0.0001); oncology pharmacy (n = 1195) 93%, 75%, and 50% (P < 0.0001); pediatric pharmacy (n = 1119): 87%, 73%, and 57%; (P < 0.0001); pharmacotherapy (n = 8368): 88%, 59% (P < 0.0001); and psychiatric pharmacy (n = 477): 93%, 72%, 49% (P < 0.0001). ConclusionFrom 2015 to 2018, the percentage of BPS-approved candidates that passed initial board certification examinations in ambulatory care pharmacy, critical care pharmacy, oncology pharmacy, pediatric pharmacy, pharmacotherapy, and psychiatric pharmacy was significantly higher for cohorts deemed to be board eligible based on completion of postgraduate residency training.

Does Performance on the American Board of Physical Medicine and Rehabilitation Initial Certification Examinations Predict Future Physician Disciplinary Actions?

The aim of the study was to determine the relationship between performance on the American Board of Physical Medicine and Rehabilitation primary certification examinations and the risk of subsequent disciplinary actions by state medical boards over a physician's career. The hypothesis is that physicians who do not pass either or both of the two initial specialty certification examinations are at higher risk of disciplinary action from a state medical licensing board. This is a retrospective cohort study that analyzed board certification examination data from all physicians who completed physical medicine and rehabilitation residency between 1968 and 2017. Matching examination and license data were available for 9889 physical medicine and rehabilitation physicians, who received a total of 547 disciplinary action reports through the Federation of State Medical Boards. The results showed a significant correlation between failing an American Board of Physical Medicine and Rehabilitation certification examination and the risk of subsequent disciplinary action by a state medical board. Failure to pass either the written (Part I) or oral (Part II) examination increased the risk of subsequent disciplinary action by 5.77-fold (P < 0.0001, 95% confidence interval = 4.07-8.18). Physicians in physical medicine and rehabilitation who do not pass initial certification examinations and become board certified are at higher risk of disciplinary action from a state medical licensing board throughout their careers.

Effects and Unforeseen Consequences of Accessing References on a Maintenance of Certification Examination: Findings From a National Study

Increasing criticism of maintenance of certification (MOC) examinations has prompted certifying boards to explore alternative assessment formats. The purpose of this study was to examine the effect of allowing test takers to access reference material while completing their MOC Part III standardized examination. Item response data were obtained from 546 physicians who completed a medical subspecialty MOC examination between 2013 and 2016. To investigate whether accessing references was related to better performance, an analysis of covariance was conducted on the MOC examination scores with references (access or no access) as the between-groups factor and scores from the physicians' initial certification examination as a covariate. Descriptive analyses were conducted to investigate how the new feature of accessing references influenced time management within the test day. Physicians scored significantly higher when references were allowed (mean = 534.44, standard error = 6.83) compared with when they were not (mean = 472.75, standard error = 4.87), F(1, 543) = 60.18, P < .001, ω(2) = 0.09. However, accessing references affected pacing behavior; physicians were 13.47 times more likely to finish with less than a minute of test time remaining per section when reference material was accessible. Permitting references caused an increase in performance, but also a decrease in the perception that the test has sufficient time limits. Implications for allowing references are discussed, including physician time management, impact on the construct assessed by the test, and the importance of providing validity evidence for all test design decisions.

Performance of Pediatric Rehabilitation Medicine Candidates on the Subspecialty Board Certification Examination from 2003 to 2015

BackgroundPediatric rehabilitation medicine (PRM) physicians enter the field via several pathways. It is unknown whether different training pathways impact performance on the American Board of Physical Medicine and Rehabilitation (ABPMR) PRM Examination and Maintenance of Certification (MOC) Examination. ObjectivesTo describe the examination performance of candidates on the ABPMR PRM Examination according to their type of training (physiatrists with a clinical PRM focus, accredited or unaccredited fellowship training, separate pediatric and physical medicine and rehabilitation residencies, or combined pediatrics/physical medicine and rehabilitation residencies) and to compare candidates’ performance on the PRM Examination with their initial ABPMR certification and MOC Examinations. DesignA retrospective cohort study. SettingAmerican Board of Physical Medicine and Rehabilitation office. ParticipantsA total of 250 candidates taking the PRM subspecialty certification examination from 2003 to 2015. MethodsScaled scores on the PRM Examination were compared to the examinees’ initial certification scores as well as their admissibility criteria. Pass rates and scaled scores also were compared for those taking their initial PRM certification versus MOC. Main Outcome MeasurementsBoard pass rates and mean scaled scores for initial PRM Examination and MOC. ResultsThe 250 physiatrists who took the subspecialty PRM Examination had an overall first-time pass rate of 89%. There was no significant difference between first-time PRM pass rates or mean scaled scores for individuals who completed an Accreditation Council for Graduate Medical Education–accredited fellowship versus those who did not. First time PRM pass rates were greatest among those who were also certified by the American Board of Pediatrics (100%). Performance on Parts I and II of the initial ABPMR Certification Examination significantly predicted PRM Examination scores. There was no difference in mean scaled scores for initial PRM certification versus taking the PRM Examination for MOC. ConclusionsSeveral pathways to admissibility to the PRM Examination afforded similar opportunity for diplomates to gain the knowledge necessary to pass the PRM Examination. Once certified, physicians taking the PRM Examination for MOC have a high success rate of passing again in years 7-10 of their certification cycle. Level of EvidenceIII

Evaluation of American Board of Orthodontics certification protocols in postgraduate orthodontic programs in the United States and Canada.

The objective of this study was to identify the board certification protocols that hospital and university-based postgraduate orthodontic programs have in place to prepare residents for the American Board of Orthodontics (ABO) certification examination. An electronic survey was sent to the program directors of each of the 72 postgraduate orthodontic programs in the United States and Canada. The survey consistedof 49 questions about demographics, resident case assignment protocols, and ABO examination preparation methods. The response rate was 81%. Most programs were 30 to 36months in length (72.7%). Many residents had a case load of 51 to 75 during their first year (50.9%), with an average maximum case load of 70 to 109. There was a positive correlation with both the number of cases that first-year residents start and the length of the program (Spearman correlation coefficient=0.379; P<0.01) when compared with maximum case load. Approximately 72% of the programs do not offer a written mock board examination; however, 72% reported offering a clinical mock board examination. ABO cases are identified within the first 6months of most programs. About 88% of respondents believe that residents take advantage of the banking system, and that over the past 5years ABO Initial Certification Examination applications have increased. Most program directors (89.1%) believe that their program length is sufficient for board preparation. Subjects tested in the written examination are integrated into the didactic curriculum and strengthened with ongoing literature reviews, with a passing rate over 90%. Clinical examination preparation varies, with most programsrequiring a mock board examination for graduation. Total participation in both the Initial Certification Examination and banking has increased since 2010; better follow-up protocols are needed to track residents after graduation.

How Do Candidates Perform When Repeating the American Board of Physical Medicine and Rehabilitation Certification Examinations?

The objective of this study was to examine the likelihood of passing the Part I and Part II American Board of Physical Medicine and Rehabilitation (ABPMR) certification examinations after initially failing. This was a retrospective review of candidates who had taken the ABPMR initial certification examinations between 2010 and 2014. Passing rates declined markedly with repeated attempts for both part I and part II. Passing rates (mean [95% confidence interval]) for part I were first attempt, 90% (87%-92%); second attempt, 58% (52%-66%); third attempt, 41% (26%-54%); fourth or greater attempt, 17% (3%-31%). For part II, the passing rates were first attempt, 87% (82%-92%); second attempt, 65% (56%-75%); third attempt, 41% (17%-65%); fourth or greater attempt, 20% (0%-59%). Those who were closer to the passing score on their initial attempt had a greater chance of passing on successive attempts. Passing rates for the ABPMR certification examination decline markedly with greater numbers of attempts. Those who fail again after one repeat attempt should rethink their examination preparation strategy before attempting the examination again.

Does Delay in Taking the American Board of Physical Medicine and Rehabilitation Certification Examinations Affect Passing Rates?

The objective of this study was to examine whether a delay in initially taking the Part I or Part II American Board of Physical Medicine and Rehabilitation certification examinations influences the score or passing rates of candidates and whether enrollment in a subspecialty fellowship influences performance on the Part II certification examination. This was a retrospective review of first-time candidates taking the American Board of Physical Medicine and Rehabilitation initial certification examinations from 2010 to 2014. Passing rates declined as candidates delayed the examination past the time of initial eligibility. Passing rates for Part I were as follows (mean [95% confidence interval]): no delay, 91% (89%-94%); 1-yr delay, 68% (56%-82%); and more that 2 yrs' delay, 59% (55%-68%). For Part II, passing rates were as follows: no delay, 90% (85%-94%); 1-yr delay, 83% (72%-94%); and more than 2 yrs' delay, 68% (50%-83%). Those completing an accredited fellowship performed better (92% pass rate) on the Part II examination than did those who did not (81% pass rate), but they also had higher final year evaluations from their residency program directors. It seems preferable to take both Part I and Part II examinations as soon as one is eligible. Enrollment in an accredited fellowship may be associated with a higher chance of passing the examination.

The American Society for Radiation Oncology's 2015 Core Physics Curriculum for Radiation Oncology Residents

The American Society for Radiation Oncology (ASTRO) Physics Core Curriculum Subcommittee (PCCSC) has updated the recommended physics curriculum for radiation oncology resident education to improve consistency in teaching, intensity, and subject matter. The ASTRO PCCSC is composed of physicists and physicians involved in radiation oncology residency education. The PCCSC updated existing sections within the curriculum, created new sections, and attempted to provide additional clinical context to the curricular material through creation of practical clinical experiences. Finally, we reviewed the American Board of Radiology (ABR) blueprint of examination topics for correlation with this curriculum. The new curriculum represents 56hours of resident physics didactic education, including a 4-hour initial orientation. The committee recommends completion of this curriculum at least twice to assure both timely presentation of material and re-emphasis after clinical experience. In addition, practical clinical physics and treatment planning modules were created as a supplement to the didactic training. Major changes to the curriculum include addition of Fundamental Physics, Stereotactic Radiosurgery/Stereotactic Body Radiation Therapy, and Safety and Incidents sections, and elimination of the Radiopharmaceutical Physics and Dosimetry and Hyperthermia sections. Simulation and Treatment Verification and optional Research and Development in Radiation Oncology sections were also added. A feedback loop was established with the ABR to help assure that the physics component of the ABR radiation oncology initial certification examination remains consistent with this curriculum. The ASTRO physics core curriculum for radiation oncology residents has been updated in an effort to identify the most important physics topics for preparing residents for careers in radiation oncology, to reflect changes in technology and practice since the publication of previous recommended curricula, and to provide practical training modules in clinical radiation oncology physics and treatment planning. The PCCSC is committed to keeping the curriculum current and consistent with the ABR examination blueprint.

Simulation for Medical Specialty Initial Certification and Maintenance of Certification in the United States of America

Surgical skills simulation (SSS) tests the application of factual knowledge and shows how knowledge is applied, representing the second and third levels of Miller’s Pyramid of Learning. SSS permits high-stakes scenario testing in safe environments. Therefore, SSS incorporation into initial specialty certification began in 2002 in Australia and New Zealand. The United States began SSS incorporation into specialty certification in 2008. This paper will determine where the United States stands in the process of SSS incorporation into specialty certification. Google scholar Internet and PubMed searches phrased “medical board certification surgical skills simulation”, performed on September 1, 2016 yielded 16 relevant articles. Hand search on September 1, 2016 yielded 7 additional articles. In 2008, cardiac catheterization simulation was required for interventional cardiology maintenance of certification (MOC). In 2010 the American Board of Anesthesiology (ABA) required SSS as part of the MOC program. In 2014, the summative assessment, Colorectal Objective Assessment of Technical Skills became part of the American Board of Colon and Rectal Surgery certification. In 2017, SSS will be added to the ABA initial certification examination. The United States has been slow to incorporate SSS into initial certification and MOC. Assessment validation, capital and recurring costs, personnel, physical facility and time requirements are barriers limiting SSS expansion into specialty certification processes. As SSS allows rapid technical skill assessment, without posing a threat to patients, expansion of SSS into initial certification and MOC programs represents non-maleficence and beneficence, and should be encouraged.

Program Director Survey: Attitudes Regarding Child Neurology Training and Testing

BackgroundAs a result of major clinical and scientific advances and changes in clinical practice, the role of adult neurology training for Child Neurology and Neurodevelopmental Disability (NDD) certification has become controversial. The most recently approved requirements for board eligibility for child neurology and neurodevelopmental disability residents still include 12 months in adult neurology rotations. The objective of this study was to assess United States child neurology and neurodevelopmental disability residency program directors' opinions regarding optimal residency training. MethodsThe authors developed an 18-item questionnaire and contacted all 80 child neurology and neurodevelopmental disability program directors via e-mail, using SurveyMonkey. ResultsA total of 44 program directors responded (55%), representing programs that train 78 categorical and 94 total resident positions, approximately 70% of those filled in the match. Respondents identified multiple areas where child neurology residents need more training, including genetics and neuromuscular disease. A substantial majority (73%) believed child neurology and neurodevelopmental disability residents need less than 12 adult neurology training months; however, most (75%) also believed adult hospital service and man-power needs (55%) and finances (34%) would pose barriers to reducing adult neurology. Most (70%) believed reductions in adult neurology training should be program flexible. A majority believed the written initial certification examination should be modified with more child neurology and fewer basic neuroscience questions. Nearly all (91%) felt the views of child neurology and neurodevelopmental disability program directors are under-represented within the Accreditation Council for Graduate Medical Education Residency Review Committee. ConclusionsThe requirement for 12 adult neurology months for Child Neurology and Neurodevelopmental Disability certification is not consistent with the views of the majority of program directors, who favor more training in subspecialized fields of child neurology.

Is the iPad suitable for image display at American Board of Radiology examinations?

The study aimed to determine the acceptability of the iPad 3 as a display option for American Board of Radiology (ABR) examinations. A set of 20 cases for each of nine specialties examined by the ABR was prepared. Each comprised between one and seven images and case information and had been used in previous ABR Initial Certification examinations. Examining radiologists (n = 119) at the ABR oral Initial Certification examinations reviewed sets from one or more specialties on both a 2 MP LED monitor and on the iPad 3 and rated the visibility of the salient image features for each case. The Wilcoxon signed rank test was performed to compare ratings. In addition, a thematic analysis of participants' opinions was undertaken. When all specialties were pooled, the iPad 3 ratings were significantly higher than the monitor ratings (p = 0.0217). The breast, gastrointestinal, genitourinary, and nuclear medicine specialties also returned significantly higher ratings for the visibility of relevant image features for the iPad 3. Monitor ratings were significantly higher for the vascular and interventional specialty, although no images were rated unacceptably poor on the iPad in this specialty. The relevant image features were rated more visible on the iPad 3 than on the monitors overall. The iPad 3 was well accepted by a large majority of examiners and can be considered adequate for image display for examination in most or all specialties.

The Development of the Emergency Medicine Milestones

The Accreditation Council for Graduate Medical Education (ACGME) has outlined its "Next Accreditation System" (NAS) that will focus on resident and residency outcome measurements. Emergency medicine (EM) is one of seven specialties that will implement the NAS beginning July 2013. All other specialties will follow in July 2014. A key component of the NAS is the development of assessable milestones, which are explicit accomplishments or behaviors that occur during the process of residency education. Milestones describe competencies more specifically and identify specialty-specific knowledge, skills, attitudes, and behaviors (KSABs) that can be used as outcome measures within the general competencies. The ACGME and the American Board of Emergency Medicine (ABEM) convened an EM milestone working group to develop the EM milestones. This article describes the development, use within the NAS, and challenges of the EM milestones.

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.

ABPN Leaders Explain Goals, Background of MOC Program

Back to table of contents Previous article Next article Education & TrainingFull AccessABPN Leaders Explain Goals, Background of MOC ProgramPatricia A. Vondrak, B.A., and Larry R. Faulkner, M.D.Patricia A. VondrakSearch for more papers by this author, B.A., and Larry R. FaulknerSearch for more papers by this author, M.D.Published Online:20 Apr 2012https://doi.org/10.1176/pn.47.8.psychnews_47_8_6-aAbstractThe American Board of Psychiatry and Neurology (ABPN) Maintenance of Certification (MOC) Program reflects the ABPN’s commitment to lifelong learning. The mission of the MOC Program is to advance the clinical practice of psychiatry and neurology by promoting the highest evidence-based guidelines and standards to ensure excellence in all areas of care and practice improvement.In keeping with the evolving nature of the MOC requirements for all physicians, the ABPN’s must remain consistent with the American Board of Medical Specialties’ (ABMS) guidelines. In sensing the growing threats from outside the medical field, the ABMS determined that ABMS specialists within every discipline should be required to meet the highest standards of quality patient health care. In response, the ABMS designed the MOC process. The goal of MOC is for diplomates to reflect on their personal knowledge and performance and commit to a process of improvement and reevaluation of performance measures over a specified time, ultimately leading to improved care for their patients.Each specialty board within the ABMS adheres to four components in their programs. The four components are designed to assess important physician characteristics: Professional Standing (Part 1), Self-Assessment and CME (Part 2), Cognitive Expertise (Part 3), and Performance in Practice (Part 4). These components are outlined in detail on the ABPN Web site at www.abpn.com, along with a list of ABPN-approved MOC products for self-assessment, CME, and performance in practice.Continuous Pathway to Lifelong LearningBeginning in 2012, diplomates who pass their initial certification or MOC examination will enter into the Continuous Pathway to Lifelong Learning (CP-MOC). Diplomates who passed their initial certification or MOC examination prior to 2012 will not be required to participate in this program, but they may elect to do so.This year, the ABPN is required to begin reporting diplomates as “Meeting” or “Not Meeting” MOC requirements. Lifetime certificate holders will be listed as “Certified but Not Meeting MOC requirements.” There will be a special note that meeting MOC requirements is not mandatory for lifetime certificate holders. However, lifetime certificate holders may elect to enter the CP-MOC Program by passing an MOC cognitive examination in their specialty.The CP-MOC Program will assist diplomates to comply with MOC requirements and time frames to facilitate the required annual recording and reporting of MOC participation. Instead of paying a higher fee at the time of the MOC examination, diplomates will pay a much smaller annual fee. This annual fee covers participation in ABPN Physician Folios and includes one MOC cognitive examination in a 10-year period.The focal point of the Continuous Pathway to Lifelong Learning Program is the ABPN Physician Folios, which offer a single source for personalized information regarding certification and MOC status. There is a large catalog of ABPN-approved MOC products in self-assessment, CME, and performance in practice listed on the ABPN Web site. We strongly recommend diplomates use ABPN-approved products to ensure they meet ABPN MOC Program requirements. For protection against incorrectly advertised MOC products, a diplomate will be required to utilize only ABPN-approved products beginning in 2014. This policy change was in response to diplomates’ frustration at misleading advertised products.While passing the cognitive examination is still required at least every 10 years, a diplomate’s certification status is dependent upon fulfillment of all four MOC Program components, along with annually logging into the ABPN’s Physician Folios and payment of an annual MOC registration fee.Future PlansThe ABPN continues to monitor the landscape and gather feedback from our diplomates on the MOC Program. The ABPN strives to give MOC credit to diplomates who are already participating in practice-improvement activities that meet the ABPN MOC Program requirements.Here are some examples of ABPN’s responses to diplomates’ feedback on MOC:Our acceptance of institutional quality assurance programs and patient surveys that meet our requirements.Our plan to ultimately provide Part IV credit for team projects completed at institutions that join a formal Institutional Recognition Program.Our plan to give credit for one stage of MOC activities (as outlined on the ABPN Web site) for diplomates who complete ACGME-accredited/ABPN-approved subspecialty training and sit for and pass an ABPN subspecialty examination. MOC information, ABPN Physician Folios, and ABPN-approved MOC products are posted at www.abpn.com/moc.Patricia Vondrak, B.A., is director of Examination Administration and MOC at ABPN; Larry Faulkner, M.D., is ABPN’s president and CEO. ISSUES NewArchived