Physician Certification Research Articles

Arterial hypertension and sport. Related aspects to certification for physical activity and contraindications to sports practice in hypertensive child and adolescent.

The control of blood pressure during exercise is a complex process as it involves increases in stroke volume and heart rate, changes in peripheral vascular resistance and in sympathetic tone; it is related to the type of exercise practiced as its intensity and duration, ratio of lean mass/fat mass, depending on the sex. We distinguish two main types of exercise, aerobic or dynamic and isometric or static. The first is a type of exercise that involves an increase in cardiac output associated with rapid increases in heart rate and systolic BP (with a minimum decrease in diastolic BP) but with a significant decrease in peripheral vascular resistance. The isometric exercise, or static, involves a sharp increase in both systolic and diastolic blood pressure, a modest increase in heart rate with a range stable or slightly reduced but no decrease in peripheral vascular resistance. In Figure ​Figure11 are shown the modifications and interactions between the various parameters [1]. Figure 1 Cardiovascular response to physical exercise Legend: (A) Response to dynamic exercise gradually to the increase in workload to the maximum oxygen consumption; (B) Response to static exercise (handgrip at 30% of maximum voluntary contraction); VO2 (ml/min/kg); ... From these premises it emerges therefore the need to start young people suffering for arterial hypertension to play a type of sport that is suitable for the individual cardiovascular status. In Italy, compared to the US, to practice a sport activity is required medical certification that involves a civil and criminal liability on the part of the physician certification and which is regulated by specific decrees, in particular the latest amendments to the Balduzzi Decree [2]. In the case of healthy children, or apparently healthy, it is scheduled to perform at least once a 12-lead ECG at rest and blood pressure measurement (as specifically stated on the label of certification then signed at the bottom by a doctor). In the case of children and adolescents with arterial hypertension, both for primary and secondary hypertension, you need to pay more attention and care, both in relation to cardiovascular stresses that this entails as previously exposed, both in relation to the importance of implementing the changes in lifestyle who are always the first step, no drugs, which will contribute to the maintenance of blood pressure in the normal range. For what concerns instead the practice of competitive sports activities, please refer to specialists in Sports Medicine, which is reserved for the certification.

Association of Physician Certification in Interventional Cardiology With In-Hospital Outcomes of Percutaneous Coronary Intervention.

The value of American Board of Internal Medicine certification has been questioned. We evaluated the Association of Interventional Cardiology certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010. We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined interventional cardiology (ICARD) certification status using American Board of Internal Medicine data. We compared in-hospital outcomes of patients treated by certified and noncertified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary end points were all-cause in-hospital mortality and bleeding complications. Secondary end points included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510,708 PCI procedures performed by 5175 physicians, case mix and unadjusted outcomes were similar among certified and noncertified physicians. The adjusted risks of in-hospital mortality (odds ratio, 1.10; 95% confidence interval, 1.02-1.19) and emergency coronary artery bypass grafting (odds ratio, 1.32; 95% confidence interval, 1.12-1.56) were higher in the non-ICARD-certified group, but the risks of bleeding and vascular complications and the composite end point were not statistically significantly different between groups. We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency coronary artery bypass grafting in patients treated by non-ICARD-certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes and indicate a need to enhance the value of subspecialty certification.

A Significant Number of Charter Diplomates Participate in American Board of Family Medicine (ABFM) Maintenance of Certification.

Considerable controversy about the value of participating in Maintenance of Certification has recently arisen within the medical community. Despite this controversy, large numbers of family physicians certified by the American Board of Family Medicine participate in Maintenance of Certification for Family Physicians. Surprisingly, a small but significant number of charter diplomats--those initially certified by the American Board of Family Medicine at its founding--are engaged in the process.

More Comprehensive Care Among Family Physicians is Associated with Lower Costs and Fewer Hospitalizations.

Comprehensiveness is lauded as 1 of the 5 core virtues of primary care, but its relationship with outcomes is unclear. We measured associations between variations in comprehensiveness of practice among family physicians and healthcare utilization and costs for their Medicare beneficiaries. We merged data from 2011 Medicare Part A and B claims files for a complex random sample of family physicians engaged in direct patient care, including 100% of their claimed care of Medicare beneficiaries, with data reported by the same physicians during their participation in Maintenance of Certification for Family Physicians (MC-FP) between the years 2007 and 2011. We created a measure of comprehensiveness from mandatory self-reported survey items as part of MC-FP examination registration. We compared this measure to another derived from Medicare's Berenson-Eggers Type of Service (BETOS) codes. We then examined the association between the 2 measures of comprehensiveness and hospitalizations, Part B payments, and combined Part A and B payments. Our full family physician sample consists of 3,652 physicians providing the plurality of care to 555,165 Medicare beneficiaries. Of these, 1,133 recertified between 2007 and 2011 and cared for 185,044 beneficiaries. There was a modest correlation (0.30) between the BETOS and self-reported comprehensiveness measures. After adjusting for beneficiary and physician characteristics, increasing comprehensiveness was associated with lower total Medicare Part A and B costs and Part B costs alone, but not with hospitalizations; the association with spending was stronger for the BETOS measure than for the self-reported measure; higher BETOS scores significantly reduced the likelihood of a hospitalization. Increasing family physician comprehensiveness of care, especially as measured by claims measures, is associated with decreasing Medicare costs and hospitalizations. Payment and practice policies that enhance primary care comprehensiveness may help "bend the cost curve."

ABFM to Simplify Maintenance of Certification (MOC) for Family Physicians and Make It More Meaningful: A Family Medicine Registry.

The American Board of Family Medicine (ABFM) launches the start of a family medicine registry with a study called the Trial of Aggregate Data Exchange for Maintenance of Certification and Raising Quality (TRADEMaRQ). This study is supported by the US Agency for Healthcare Research and Quality and is

Why is diagnosing brain death so confusing?

Although detailed practice parameters have been developed to help guide physicians in brain death determination, guidelines based on these parameters widely vary. The recent case of Jahi McMath not only highlights social misconceptions but also serves as a call to action to decrease medical variability and confusion regarding brain death determination. This review discusses common sources of variations in brain death determination - we divide these sources into before, during, and after brain death declaration. We use four key studies to elucidate variable practice in brain death determination. Poor training of examiners and patient qualifications for brain death examination prior to testing, incomplete apnea testing, repeat examinations during testing, and the sometimes unjustified use of ancillary testing are highlighted as main areas for improvement. Improved physician training and certification, as well as better standardization of hospital protocols, may be answers to more universal practice. Diagnosing brain death is confusing because of numerous variations in practice, but this variation can be improved. Improved and standardized physician training can help create a formal certification process for examiners and help create uniformity in brain death determination. National standards will also help decrease variability of practice.

Association of Physician Certification Policy and Quality of Care: Evidence of percutaneous coronary intervention certification program in Taiwan

ObjectivesThe aim of this study was to compare procedural, short-term and two-year outcomes of percutaneous coronary intervention (PCI) between board-certified and non-board certified interventional cardiologists in Taiwan. BackgroundMost studies of associations between quality and certification have analyzed populations in the Western developed countries. MethodsThis retrospective population-based study analyzed 2057 patients who had received PCI in 11 hospitals in 2007. The outcome measures were procedural, 30-day, and 2-year adverse events. ResultsSixty certified physicians performed 1771 PCI procedures whereas 84 non-certified physicians performed 286 procedures. Patients treated by non-certified physicians had significantly higher rates of in-hospital mortality (6.99% vs. 2.82%, respectively; p≤0.001) and same-stay CABG (1.40% vs. 0.06%, respectively; p≤0.001). The results of multilevel logistic regression and Cox multivariate regression indicated that patients treated by non-certified physicians also had higher probabilities of in-hospital death (OR=2.92, 95% CI: 1.20–7.08) and two-year death (hazard ratio, 1.63; 95% confidence interval, 1.18–2.24). ConclusionsThis is the first study in Asia in investigating the association between board certification policy and surgical outcomes, and the results confirmed that the board certification policy is also effective for Asian population. The policy implications of these findings are discussed.

Low-dose Computed Tomography Screening in Japan

Lung cancer is a leading cause of cancer death in both male and female individuals in Japan. The effect of screening using chest radiography is assumed to be limited. In Japan, screening using low-dose computed tomography (CT) was initiated in 1993, and its dissemination has progressed with studies evaluating its efficacy, although it is not officially recommended. In addition to the academic activities of the Japanese Society of CT Screening, certification of physicians and radiologic technologists by the Japan Accreditation Council for CT Screening has been progressing. Currently, several hundred thousand low-dose CT screenings are performed annually in Japan. In Hitachi City, Ibaraki Prefecture, low-dose CT screening among employees and in communities started in 2001, and it was estimated that 40% of 50- to 69-year-old citizens had undergone screening at least once by March 2009. The lung cancer mortality rate in citizens in this age group decreased by 24% in 2005 to 2009 compared with the national statistics. Low-dose CT screening targeting the general population may be effective, but it is necessary to consider the target and interval of screening separately from those for the high-risk group. Observational study may play a role in evaluating the efficacy of screening in Japan.

Family physicians' scope of practice and American Board of Family Medicine recertification examination performance.

Previous research indicated that rural family physicians were more likely to pass the American Board of Family Medicine (ABFM) Maintenance of Certification for Family Physicians (MC-FP) examination. One possible explanation is that rural family physicians may have a broader scope of practice. This was a cross-sectional study of family physicians taking the ABFM MC-FP examination in 2013. Examination results were linked with the Scope of Practice for Primary Care (SP4PC) scale. Linear and logistic regression models, with and without SP4PC score, determined associations between scope of practice and examination results. Among 10,978 examinees, rural physicians had a higher passing rate (90.7% vs 86.8%, P < .05) and higher SP4PC score (16.1 vs 14.3 P < .05) compared with urban physicians. Regression models without SP4PC score confirmed that urban physicians were less likely to pass (OR = 0.73; 95% CI, 0.62-0.87) and scored lower, -15.6 points, compared with rural physicians. Including SP4PC score completely attenuated the relationship between practice location and passing (OR = 0.86; 95% CI, 0.73-1.02) and decreased the relationship between score and practice location (-5.8 points). Each point increase on the SP4PC score was associated with 9% higher odds of passing (OR = 1.09; 95% CI, 1.07-1.11) and 4.9 more points. A broader scope of practice rather than rural or urban practice location, was associated with increased likelihood of passing the MC-FP examination. If higher board scores are associated with providing higher quality of care, then maintaining a broad scope of practice may enable the delivery of higher quality primary care.

Performance on the Maintenance of Certification for Family Physicians (MC-FP) examination: comparison of initial certfiers with experienced physicians.

The perception that state-of-the-art clinical knowledge declines as a physician moves further away from formal training is prevalent.[1][1] This perception is reinforced by a significant body of research.[2][2][⇓][3][⇓][4][⇓][5][⇓][6][⇓][7]–[8][8] As a result, seasoned family physicians

Strategy for Revising and Updating Maintenance of Certification Self-Assessment Modules (SAMs)

In 2004 the first Self-Assessment Modules (SAMs) went online as a resource for fulfilling the part II requirement of Maintenance of Certification for Family Physicians. As time has gone by, Diplomates have occasionally asked about the process the American Board of Family Medicine uses to revise and

Discussion: clinicians performing cosmetic surgery in the community: a nationwide analysis of physician certification.

Discussion: clinicians performing cosmetic surgery in the community: a nationwide analysis of physician certification.

Palliative care development in the Asia-Pacific region: an international survey from the Asia Pacific Hospice Palliative Care Network (APHN)

BackgroundAlthough palliative care is an important public healthcare issue worldwide, the current situation in the Asia-Pacific region has not been systematically evaluated.ObjectivesThis survey aimed to clarify the current status of...

The Evolution of Maintenance of Certification for Family Physicians (MC-FP) Part IV, Performance in Practice

With the first recertification examination offered by the American Board of Family Medicine (ABFM) in 1976, the board required a patient record review to assess performance in practice. The initial records reviews required physicians to assess 4 patient records in each of 5 disease categories; these

Educational backgrounds and quality of training of surgeons performing coronary artery bypass graft procedures in the state of Florida in 2010.

Quality of care is in part a result of the medical education practitioners receive. To date, little research has been conducted to assess the relationship between type, quantity, and quality of postgraduate residency and fellowship training and patient outcomes. This article explores the relationship of physician training and certification and surgical outcomes of patients undergoing coronary artery bypass grafting procedures in Florida during 2010. The data set includes 246 surgeons who, as a group, trained at nearly 48% of all thoracic surgery residency programs in the country. There were significant differences in board certifications for general surgery and thoracic surgery among physicians in different quality segmentations. Additionally, statistically significant differences were observed for mortality as a percentage of surgical volume as well as length of stay. These differences in characteristics and outcomes among segmentations of physicians warrant future exploration to identify underlying contributors to quality.

THE CONSEQUENTIAL VALIDITY OF ABFM EXAMINATIONS

THE CONSEQUENTIAL VALIDITY OF ABFM EXAMINATIONS

Improving quality of care and guideline adherence for asthma through a group self-assessment module.

The quality of care for asthma remains suboptimal. Compliance with guidelines remains low, but improved adherence to guidelines may increase the quality of care. but. We conducted a trial to determine whether group Self-Assessment Module (SAM) activities led by a facilitator and conducted as part of Maintenance of Certification for Family Physicians (MC-FP) would increase knowledge of and adherence to asthma guidelines. Participating physicians completed audits of the charts of patients with asthma before and 6 months after a group SAM. Surveys of physicians' knowledge of asthma guidelines were administered immediately before, immediately after, and 6 months after the group SAM. We tested for differences in knowledge of and adherence to guidelines before and after the SAM using χ(2) and t tests. Thirty-eight physicians in Virginia completed the SAM and had complete data. Participants completed more MC-FP activities than other physicians but were comparable in other characteristics. Except for prescribing controller medications for persistent asthma, all other quality measures significantly improved 6 months after the group SAM. Diagnosis by severity improved from 48.3% to 80.2%, and the use of action plans increased from 8.1% to 54.1%. Physicians' knowledge of guidelines improved immediately after the SAM and was sustained at 6 months. Increased knowledge translated into clinical skills: 30% of participants reported comfort with assessing control after the SAM, which increased to 97.5% 6 months after the SAM. Group SAMs may be an effective method to increase physicians' knowledge of and adherence to clinical guidelines.

Virtual Meetings: Improving Impact and Accessibility of CME

Historically, continuing medical education (CME) has been the primary way for medical health professionals to gain up-to-date knowledge and skills to improve health care and patient outcomes [ 1 Moore D.J. Needs assessment in the new health care environment: combining discrepancy analysis and outcomes to create more effective CME. J Contin Educ Health Prof. 1998; 18: 133-141 Crossref Scopus (31) Google Scholar ]. CME educational credits are required for physician certification in most states. In California, the annual requirement is approximately 25 hours of credit [ 2 American College of Physicians. State Continuing Medical Education Requirements. 2013 Available at: http://www.acponline.org/education_recertification/cme/state_requirements/. Accessed December 13, 2013. Google Scholar ]. The typical format of CME has been attendance at an in-person meeting, where experts give didactic lectures on a focused topic. Recent educational research has questioned whether this method of physician education improves medical care. Criticisms of the traditional didactic model include concerns that there is little opportunity for audience interaction or discussion, which improves retention [ 3 Forsetlund L. Bjørndal A. Rashidian A. et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009; http://dx.doi.org/10.1002/14651858.CD003030.pub2 PubMed Google Scholar , 4 Bloom B.S. Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews. Int J Technol Assess Health Care. 2005; 21: 380-385 Crossref PubMed Scopus (359) Google Scholar , 5 Marinopoulos S.S. Dorman T. Ratanawongsa N. et al. Effectiveness of continuing medical education. Evid Rep Technol Assess (Full Rep). 2007; 149: 1-69 PubMed Google Scholar ]; little formal assessment of the impact on participant knowledge and actual practice [ 5 Marinopoulos S.S. Dorman T. Ratanawongsa N. et al. Effectiveness of continuing medical education. Evid Rep Technol Assess (Full Rep). 2007; 149: 1-69 PubMed Google Scholar ]; and a lack of audit and feedback tools to characterize optimal versus actual care provided, shown to be an effective educational intervention [ 4 Bloom B.S. Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews. Int J Technol Assess Health Care. 2005; 21: 380-385 Crossref PubMed Scopus (359) Google Scholar , 5 Marinopoulos S.S. Dorman T. Ratanawongsa N. et al. Effectiveness of continuing medical education. Evid Rep Technol Assess (Full Rep). 2007; 149: 1-69 PubMed Google Scholar ].

Usefulness of the Population Health Metrics Research Consortium gold standard verbal autopsy data for general verbal autopsy methods

BackgroundVerbal Autopsy (VA) is widely viewed as the only immediate strategy for registering cause of death in much of Africa and Asia, where routine physician certification of deaths is not widely practiced. VA involves a lay interview with family or friends after a death, to record essential details of the circumstances. These data can then be processed automatically to arrive at standardized cause of death information.MethodsThe Population Health Metrics Research Consortium (PHMRC) undertook a study at six tertiary hospitals in low- and middle-income countries which documented over 12,000 deaths clinically and subsequently undertook VA interviews. This dataset, now in the public domain, was compared with the WHO 2012 VA standard and the InterVA-4 interpretative model.ResultsThe PHMRC data covered 70% of the WHO 2012 VA input indicators, and categorized cause of death according to PHMRC definitions. After eliminating some problematic or incomplete records, 11,984 VAs were compared. Some of the PHMRC cause definitions, such as ‘preterm delivery’, differed substantially from the International Classification of Diseases, version 10 equivalent. There were some appreciable inconsistencies between the hospital and VA data, including 20% of the hospital maternal deaths being described as non-pregnant in the VA data. A high proportion of VA cases (66%) reported respiratory symptoms, but only 18% of assigned hospital causes were respiratory-related. Despite these issues, the concordance correlation coefficient between hospital and InterVA-4 cause of death categories was 0.61.ConclusionsThe PHMRC dataset is a valuable reference source for VA methods, but has to be interpreted with care. Inherently inconsistent cases should not be included when using these data to build other VA models. Conversely, models built from these data should be independently evaluated. It is important to distinguish between the internal and external validity of VA models. The effects of using tertiary hospital data, rather than the more usual application of VA to all-community deaths, are hard to evaluate. However, it would still be of value for VA method development to have further studies of population-based post-mortem examinations.

Physician Certification Statement: Long-Term Consequences

Physician Certification Statement: Long-Term Consequences