Medical Specialty Board Research Articles

MO‐D‐350‐01: Professional Comportment: Professional Is as Professional Does

Medical Physics is an odd specialty in the constellation of healthcare providers and allied health professionals. We hold the distinction of being the only exclusively non‐physician specialty that is certified by a Medical Specialty Board in the US, consistent with our unique role as independent thinkers in the clinical decision‐making and provision of care. At the same time, there has been more of an ingathering than a pathway for those entering the field, and our education and training has been, to be kind, systematically ad hoc. Many if not most of us spend our education and training years communing closely with machinery into the wee hours and spend precious little business‐hour time in a clinic learning under the wing of professional role models how to act, and how to interact in the healthcare workplace. We largely enter practice with nowhere near adequate preparation or “people skills” to take on the leadership role that our work demands.Sometimes we act badly.In this session we will explore several aspects of what it means to comport oneself professionally. Certainly it means to do one's technical work independently with a degree of craftsmanship and skill, cognizant of the impact that each decision has on patients who rely on our services. It means treating our colleagues and co‐workers with respect, no doubt. But beyond that, the perception of an individual as a professional — and by extension, of Medical Physics as a profession rather than a trade — hinges on those nebulous‐seeming skills of leadership and sagacity that seem to be the very antithesis of the analytic skills we learned in school.Respect in the workplace as a professional is not an object that comes wrapped in a diploma or certificate, nor is it the least bit determined by Medicare reimbursement policy. Professional stature is something that we each build or fail to build for ourselves every day by the way we act toward other people. Professionalism is political, not analytical.We've assembled a distinguished panel to speak to the topic of professional comportment from a variety of perspectives and will be providing ample time for questions and comments from the audience.James Purdy, PhD is Professor and Vice Chair in the Department of Radiation Oncology at the University of California, Davis Medical Center, where he has been since 2004. Prior to that he spent 31 years at Washington University School of Medicine in St. Louis where he rose to the rank of Professor and served as both Director of the Radiation Physics Division and Associate Director of the Mallinckrodt Institute of Radiology's Radiation Oncology Center. Dr. Purdy is a Fellow of the AAPM, ACMP, and ACR, and was one of the inaugural group selected to become an ASTRO Fellow in 2006. He was recipient of the 1996 ACMP Marvin M.D. Williams Professional Achievement Award and the 1997 AAPM William D. Coolidge Award. He was awarded the 2000 ASTRO Gold Medal and the 2002 ACR Gold Medal. He will share with us some about his long professional experience working effectively as a Medical Physicist within the medical establishment.Peggy Landrum, PhD, RN is Associate Clinical Professor in College of Nursing at Texas Woman's University where she participates in the training of health care professionals. She is, among other distinctions, a trainer in a technique called “Motivational Interviewing” (MI) which is a formal approach to working with people to resolve their ambivalence about making behavioral changes that they know are good for them but they resist nonetheless. MI is a useful technique for providers in many healthcare settings such as psychotherapy, substance abuse therapy, medical management compliance, etc. and can also have a role in the workplace as a tool of change agency.Sam Keen, PhD, ThM is a freelance thinker, lecturer, seminar leader, consultant, and author. His career has included decades in academia teaching Philosophy and Religion, as well as 20 years as a Contributing Editor of Psychology Today. He is distinguished by having been a sage of the “Men's Movement” who brought a great deal of value to that moment's zeitgeist without making it a career. His work is about asking the questions, and he is pleased to note that he has been an amateur at everything he has done professionally. He has taken some interest over time in the question of what it means to be “professional,” particularly in healthcare. That in addition to the constant question of what it means to live a human life fully.George W. Sherouse, PhD, is President and Chief Medical Physicist of Sherouse Systems, Inc., a North Carolina based boutique Medical Physics service company. He is a popular lecturer and contributor to the public discourse, speaking frequently on the important distinction between “gadfly” and “curmudgeon.” He strives to comport himself professionally and has learned much from many failures.

Accreditation, Certification, and Licensure: How Six General Competencies are Influencing Medical Education and Patient Care

ABSTRACT Lifelong learning and self-assessment are tenets of medical education and health care improvement; quality and patient safety care are essential to the accreditation of organizations providing either continuing medical education (CME) or patient care; accredited CME providers must assess the learning needs of physicians: Accredited health care organizations must document physician participation in education that relates to the nature of care, treatment and services provided by the hospital. The credentialing and privileging of medical staff requires ongoing focused professional practice evaluation based on six general competencies, including compassionate care, medical knowledge, practice-based learning and improvement, effective communication, demonstrated professionalism and coordinated systems-based practice. As those charged with assessment and program evaluation are challenged to produce valid and reliable results to improve education and health care, United States licensing authorities are defining good medical practice and considering competency-based maintenance of licenses. The present paper offers a framework to advance the discussion of relative value credits for gains assessed in knowledge, competence and performance of physicians. A more synchronized and aligned consortium of medical licensing boards, specialty boards and organizations granting practice privileges is recommended to inform the design of education and physician assessment to assure quality and patient safety.

Subspecialty certification in transplant hepatology

Subspecialty certification in transplant hepatology

Educational Commission for Foreign Medical Graduates Certification and Specialty Board Certification Among Graduates of the Caribbean Medical Schools

To determine the variability among Caribbean medical schools in the performance of their students against markers of quality. The Educational Commission for Foreign Medical Graduates (ECFMG) database and the American Medical Association (AMA) Masterfile were linked. Analyses were restricted to ECFMG applicants, from 1980 to 2000, who attended the 12 Caribbean medical schools that produced 200 or more U.S. International Medical School Graduates (USIMGs). The schools produced 17,049 USIMG (48% of all USIMGs) and 5,840 non-USIMG (5% of all non-USIMGs) applicants for ECFMG certification. By school, the ECFMG certification rate ranged from 28% to 86% for USIMGs and from 27% to 82% for non-USIMGs. Specialty Board certification for graduates of these schools also varied widely. Medical schools in the Caribbean play an increasingly important role in supplying the U.S. workforce. There is considerable variability among them, both in the numbers of physicians they produce and the performance of their students against indicators of quality such as ECFMG and specialty Board certification.

Problem Doctors: Is There a System-Level Solution?

Letters6 June 2006Problem Doctors: Is There a System-Level Solution?Lucian L. Leape, MD and John A. Fromson, MDLucian L. Leape, MDFrom the Harvard School of Public Health, Boston, MA 02215, and Metro West Medical Center, Natick, MA 01760.Search for more papers by this author and John A. Fromson, MDFrom the Harvard School of Public Health, Boston, MA 02215, and Metro West Medical Center, Natick, MA 01760.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-144-11-200606060-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with Dr. Kuhn that much more attention needs to be paid to assessing medical students and residents for their suitability and fitness to practice medicine, and that failure to do so is a breach of the fiduciary responsibility of schools and hospitals. These are issues that the Association of American Medical Colleges and specialty boards should address.However, Dr. Kuhn's dismissal of the need for additional testing is diametrically opposed to every specialty board's strong (and, we think, laudable) initiative to develop much more rigorous and effective assessment of physician performance. Although we are sensitive to ... Author, Article, and Disclosure InformationAuthors: Lucian L. Leape, MD; John A. Fromson, MDAffiliations: From the Harvard School of Public Health, Boston, MA 02215, and Metro West Medical Center, Natick, MA 01760.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoProblem Doctors: Is There a System-Level Solution? Lucian L. Leape and John A. Fromson Problem Doctors: Is There a System-Level Solution? Duncan M. Kuhn Problem Doctors: Is There a System-Level Solution? Mark S. Gold and Kimberly Frost-Pineda Problem Doctors: Is There a System-Level Solution? Martin T. Donohoe Problem Doctors: Is There a System-Level Solution? David R. Gifford , Robert S. Crausman , and Bruce W. Mcintyre Metrics Cited bySurgeons in Difficulty: An Exploration of Differences in Assistance-Seeking Behaviors between Male and Female SurgeonsDISRUPTIVE BEHAVIOUR AMONGST DOCTORS, MYTH OR REALITY?The creation of risk‐related information 6 June 2006Volume 144, Issue 11Page: 863KeywordsConflicts of interestDrug policyDrugsHospital medicineHospitalsRural areas ePublished: 6 June 2006 Issue Published: 6 June 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Professionalism

Professionalism is the skill, competence, and character expected of members of highly trained occupations, including physicians. The public assumes that its physicians are highly professional. However, as health care technology expands and health care consumes a larger and larger percentage of our gross domestic product, governmental agencies and many medical specialty societies and specialty boards (including the American Board of Radiology [ABR]) have expressed concern that the basic concepts of professionalism are threatened.

The American Board of Orthodontics: Diplomate recertification

Although some specialty certifying boards began recommending or requiring recertification of their "boarded" specialists as early as 1986, recertification is a relatively new concept for the specialty of orthodontics. In the mid 1990s, the American Board of Orthodontics (ABO) recognized that many other medical and dental specialty boards had already established voluntary or mandatory recertification policies and decided to establish its own time-limited certifying policy. After a series of field tests involving former directors, council members of the College of Diplomates of the ABO, and volunteer diplomates, the ABO instituted a recertification policy for candidates who applied for initial certification after January 1, 1998. Since then, the total number of diplomates who have been recertified has steadily increased. Surveys of successfully recertified diplomates reflect a positive feeling about the process. When medical and dental specialists are expected to be more accountable, recertification has been shown to be a valid method to help ensure continued competency. The ABO believes that the formulation of educational and certifying processes to document a diplomate's clinical competency throughout his or her career will help to serve the public welfare. The ABO is attempting to make initial certification and periodic recertification attainable for more orthodontists and, in so doing, to provide a standard by which we exist as a specialty.

US graduate medical education, 2001-2002: changing dynamics.

The National Graduate Medical Education (GME) Census, jointly administered by the American Medical Association and the Association of American Medical Colleges, completed its second year as an online survey of all GME programs accredited by the Accreditation Council for Graduate Medical Education as well as combined specialty programs approved by their corresponding medical specialty boards. Continuing trends include the growing number of subspecialty programs, which increased by 65 since last year to 3822, and a smaller number of specialty programs, which decreased by 25 to 4203. There were corresponding shifts in the number of residents training in them. The number of graduates from osteopathic medical schools in allopathic GME has increased from 3288 in 1996-1997 to 4658 in 2001-2002, an increase of 42%. Overall, the total number of residents in GME has declined slightly, to an estimated 96 410 this year. The number of residents in graduate year 1 (GY1) positions (entry positions in GME, for which prior training is not required) has also decreased, although the proportion of residents in GY1 positions who have not had prior GME has increased. The number of international medical graduates (IMGs) in GY1 positions has decreased from a high of 6727 in 1999-2000 to 5898 in 2001-2002, a decrease of 12.3%. However, the number who have entered GME immediately on graduation has grown from 310 in 1996-1997 to 936 in 2001-2002. Most of these IMGs were citizens or permanent residents of the United States and attended medical schools in the Caribbean. New race and ethnicity questions, which parallel those of the US Census, continue to reveal disparities in the racial/ethnic distribution of the training physician population relative to the US population. Despite continued interest in resident work hours, there was no decrease in reported hours worked between 2000-2001 and 2001-2002. Physicians training in surgical specialties are reported to work the most hours per week, while internal medicine and pediatrics allow for the most consecutive time on duty, at 30 hours or more. Specialties and subspecialties with limited on-call schedules, such as forensic psychiatry and pediatric pathology, have, on average, the lowest number of duty hours.

The oral examination: awesome or awful?

Medical and surgical specialty boards are constantly striving to insure that those seeking certification in their specialty are adequately trained and sufficiently evaluated to guarantee the highest quality of patient care. One traditional component of the evaluation process, the oral examination, has been discontinued by some specialty boards but is still retained by most. A review of the history of the oral examination, combined with personal experiences of the author, suggests that this particular rite of passage may have outlived its usefulness in all but a few areas of medical specialization. Addressing the most pressing problems of patient mismanagement in the most visible area of practice, the hospital environment, requires that major emphasis be on the improvement of hospital practices rather than on doctors' qualifications. Only in this way can we ensure patient safety and restore patients' confidence in the care they receive and in the doctors responsible for administering it.

Why maintenance of certification?

Why maintenance of certification?

State Medical Associations and Examinations and Licensure: I. State Boards of Medical Examiners II. Medical Specialty Boards

State Medical Associations and Examinations and Licensure: I. State Boards of Medical Examiners II. Medical Specialty Boards

Career pathways of graduates of general surgery residency programs: an analysis of graduates from 1983 to 1990.

Approximately 1,000 individuals complete graduate surgical education in general surgery each year. Their subsequent career pathways have not been described but may have relevance to the supply of general surgeons available to provide a broad range of surgical care to the population of the USA. Data for this study were obtained from the American College of Surgeons's Surgery Resident Masterfile, developed for the annual Longitudinal Study of Surgery Residents, and the American Board of Medical Specialties's Official Directory of Board Certified Medical Specialists. For verification purposes, the American Medical Association's Physician Masterfile and the American Board of Surgery's certified database were searched. Yearly analyses of certified general surgery graduates from 1983 to 1990 were conducted, and rates of certification between US or Canadian medical school graduates and international medical school graduates (IMG) were compared. Ten to 18 years after completion of a residency program in general surgery, 93.6% of graduates had been certified in general surgery or by another American Board of Medical Specialties board. A total of 43.7% of the 8,068 graduates were certified, in addition, in a general surgery-based specialty. Overall, evidence of certification was not available for 6.4% of graduates. The certification rate for US or Canadian graduates was 95.8% of general surgeons and increased for IMG surgeons from 69.4% for 1983 graduates to 94.7% for 1990 graduates. The number of IMGs in general surgery residency programs declined from 19.7% of 1983 graduates to 7.8% of 1990 graduates. The rates of American Board of Surgery certification are 96.1% for male and 93.6% for female US or Canadian graduates; 79.2% of male IMG graduates and 83.7% of female IMG graduates became certified. Most surgeons who completed a general surgery residency program from 1983 to 1990 are certified and presumably have met high standards for knowledge and experience. More than half of the graduates specialize further.

Liposuction Safety: Who Is Responsible?

International Journal of Cosmetic Surgery and Aesthetic DermatologyVol. 3, No. 1 Original PapersLiposuction Safety: Who Is Responsible?Robert del JuncoRobert del JuncoSearch for more papers by this authorPublished Online:5 Jul 2004https://doi.org/10.1089/15308200152057452AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byMedical Liability Claims for Liposuction — Improving the Odds Volume 3Issue 1Mar 2001 To cite this article:Robert del Junco.Liposuction Safety: Who Is Responsible?.International Journal of Cosmetic Surgery and Aesthetic Dermatology.Mar 2001.3-7.http://doi.org/10.1089/15308200152057452Published in Volume: 3 Issue 1: July 5, 2004PDF download

International survey of training and certification in physical medicine and rehabilitation

Brandstater ME. International survey of training and certification in physical medicine and rehabilitation. Arch Phys Med Rehabil 2000;81:1234-5. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Certification processes and models to measure professional competence (recertification) among physiatrists are issues facing medical specialty boards in most countries where boards accredit specialists in physical medicine and rehabilitation. In the interest of discussing certification and recertification standards generally—with an eye on learning from the systems established across the globe—the American Board of Physical Medicine and Rehabilitation (ABPMR) convened a meeting on November 13, 1999, in Washington, DC. The meeting was chaired by Joel DeLisa with Murray Brandstater, Jay Subbarao, and Nic Walsh serving as the organizing committee. The meeting focused specifically on (1) how the training procedures and (re)certification processes in rehabilitation medicine in different countries could lead to better practices and (2) how the community of rehabilitation medicine could collaborate more fully. The collection of articles appearing here derive from presentations given at the ABPMR meeting and offer insights from the United States, Great Britain and Europe, Australia and New Zealand, Japan, South Korea, Philippines, Israel, and Canada. It begins with a discussion of a 1999 international survey of all countries with established programs in physical medicine and rehabilitation. On behalf of the meeting organizers, I would like to thank all participants for their time and commitment to this project. Nicolas E. Walsh, MD

American Board of Radiology computer test center.

In 1997, the American Board of Radiology (ABR) determined to develop a computer-based examination and to create a test center for administration of computer-based examinations. In implementation of its plan, the Board has developed a flexible examination platform, well-adapted to the graphics needs of an image-based examination, and at the same time, compatible with test centers being developed by other medical specialty boards in terms of hardware, software, and candidate surroundings. A test center for secure proctored examination of up to 33 candidates has been created at the Board's headquarters in Tucson, AZ. The decision of the ABR to employ computer-based testing as a part of its recertification process represents an important step of significance to the entire field of radiology, embracing methods that are rapidly becoming integral to the practice of radiology in the acquisition, display, and management of diagnostic imaging information.

THE ORGANIZATION AND FINANCING OF MEDICINE IN THE NEW MILLENNIUM

Medicine stands at the threshold of the twenty-first century on two and a half millennia in the traditions of our art (since the founding of his school of medicine by Hippocrates on the Isle of Cos in the Aegean Sea in the fifth century bc); one century of scientific achievement (the development of diphtheria antitoxin in 1891 and the discovery of x-rays by Wilhelm Conrad Roentgen in 1895); and one decade of economic turmoil (managed care in the 1990s). At the turn of the last century, physicians outnumbered nurses, comprising 60% of the labor force. Physicians were predominantly general practitioners. The American Board of Ophthalmology was established in 1917 as the first medical specialty board. In 1890, the patient paid the physician out of pocket or by barter in the form of poultry, produce, or the promise of some services in an agrarian economy. Notwithstanding the organization of medical services by rail and mining companies in the second half of the nineteenth century, the practice of medicine was predominantly a solo endeavor. The American Medical Association joined with organized labor (American Association for Labor Legislation) in 1916 to support health insurance, but organized medicine became increasingly hostile to compulsory national health insurance after World War I. The Committee on the Costs of Medical Care was established in 1927 by a consortium of eight private foundations. After the completion of more than two dozen research papers, most of the Committee published five recommendations in Medical Care for the American People in 1932. 1 1Medical services, both preventive and therapeutic, should be furnished largely by organized groups of physicians, dentists, nurses, pharmacists, and other associated personnel. 2All basic public health services—whether provided by governmental or nongovernmental agencies—should be available to the entire population according to its needs. 3The cost of medical care should be addressed on a group payment basis, through the use of insurance and taxation. 4Studies, evaluation, and coordination of medical services should be considered important functions for every state and local government. 5The breadth, depth, and focus of education and training for the health professions should be expanded. These recommendations would be largely implemented during the remainder of the twentieth century. Early developments in the 1930s included the beginnings of Blue Cross and Blue Shield to finance health services. The Social Security Act of 1935 included Title V to fund maternal and child health programs and Title VI to provide federal subsidies for public health services. Employer funding of health insurance can be traced to a decision of the War Labor Board in 1942. Although wages were frozen, fringe benefits would be negotiable. The subsequent decision by the Department of the Treasury that fringe benefits would not be taxable to the employer or employee brought us to an estimated annual $90 billion of government subsidy of health insurance by the end of the century. Beginning in the mid-1930s, a relentless succession of legislative proposals culminated in Medicare (Title XVIII) and Medicaid (Title XIX) of the Social Security Amendments of 1965. This movement began in the drafting of Social Security in the Roosevelt Administration and signed into law as Public Law 89–97 by President Lyndon B. Johnson in the Truman Library in Independence, Missouri, on July 30, 1965. In the 1990s, the Clinton health program sought a national restructuring and refinancing of health care. It failed for a plethora of programmatic, political, professional, and priority circumstances. With the expiration of the Clinton health care reform, the nation's health care enterprise turned, more reluctantly than enthusiastically, to the managed care sought by corporate America, primarily to control costs.

Critical care medicine education of surgeons: recommendations from the Surgical Section of the Society of Critical Care Medicine.

The role of surgeons in critical care medicine has a long and esteemed past. The presence of surgeons in intensive care units provides specific insights and perspectives to the care of surgical patients sometimes not fully appreciated by the non-surgical practitioners caring for the same patients. The training and education of surgeons is becoming more complex, fragmented, and lengthy. The knowledge base and skill set required to manage critically ill or injured surgical patients is also becoming more extensive but has the potential of becoming lost in the process of providing the overall educational program for surgical trainees. Simultaneously, nonsurgical specialties are continuing to train individuals with special skills in critical care medicine and the concept of "hospitalists" is becoming more accepted by institutions across the United States. The certification exams in critical care medicine remain under the aegis of the individual medical specialty boards, and there is still not a unified examination process in critical care. Surgeons, in particular, have tremendous pressures these days to spend more clinical time in the operating room, and the task of consistently conducting high quality research is also becoming arduous. This list of reasons could continue but are simply examples for why surgeons need to spend focused attention on how best to train and educate upcoming surgical trainees in regards to the principles of critical care medicine. The critically ill or injured patients need this focused attention and the specialty of surgical critical care medicine needs this attention. The Surgical Section of the Society of Critical Care Medicine has developed this position statement in the hopes that ongoing discussion and refinement of this particular aspect of surgery will continue on several levels.

<title>State Medical Associations and Examinations and Licensure</title>I. State Boards of Medical Examiners<BREAK />II. Medical Specialty Boards

<title>State Medical Associations and Examinations and Licensure</title>I. State Boards of Medical Examiners<BREAK />II. Medical Specialty Boards

Vascular Disease in the Elderly

There are now many texts on heart disease in the elderly. To the best of my knowledge, however, this is the first on vascular disease in the elderly. Vascular disease is a major cause of morbidity and mortality in older Americans and one that has been largely ignored or treated as an orphan of mainstream cardiology. This deficiency in the specialty of cardiovascular disease is beginning to be addressed by medical specialty boards and training programs. …

Use of practice tracks in the medical specialties.

To evaluate the use of practice tracks by each of the 24 medical specialty boards and to compare this with the experience in emergency medicine (EM). Scripted telephone surveys were conducted with representatives of each of the specialty boards. Of 24 specialties currently recognized by the American Board of Medical Specialties (ABMS), 14 (58%) reported a history of a practice track. Eight boards reported never having a practice track and 2 were unsure. All practice tracks have been limited in duration, most commonly closing after a specified period. The mean duration of the practice tracks was 9.8 years, the median was 7.5 years, and the range was 3-27 years. The practice track in EM was open for 9 years. Practice tracks were common in the early years of most specialties and most were limited by duration. The history of the practice track in EM is not dissimilar to those of other specialties.