1
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Ehrlich H, Sutherland M, McKenney M, Elkbuli A. Letter re: US Medical Licensing Examination Step 1: To Grade or Not to Grade?: Response. Am Surg 2023; 89:5034-5035. [PMID: 33615844 DOI: 10.1177/0003134821997432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Haley Ehrlich
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
- Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
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2
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Cortez N. The Law of Licensure and Quality Regulation. N Engl J Med 2022; 387:1053-1056. [PMID: 36121060 DOI: 10.1056/nejmp2201802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Nathan Cortez
- From Dedman School of Law, Southern Methodist University, Dallas
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3
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Abstract
This survey study examines the perspectives of residency program directors regarding reporting the US Medical Licensing Examination (USMLE) Step 1 as pass/fail and discontinuing Step 2 Clinical Skills.
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Affiliation(s)
- Andrew Wang
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | | | - Jacob D. Story
- David Geffen School of Medicine, University of California, Los Angeles
| | - Edward L. Ha
- David Geffen School of Medicine, University of California, Los Angeles
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4
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Abstract
The discontinuation of the United States Medical Licensing Examination Step 2 Clinical Skills (CS) in 2020 in response to the COVID-19 pandemic marked the end of a decades-long debate about the utility and value of the exam. For all its controversy, the implementation of Step 2 CS in 2004 brought about profound changes to the landscape of medical education, altering the curriculum and assessment practices of medical schools to ensure students were prepared to take and pass this licensing exam. Its elimination, while celebrated by some, is not without potential negative consequences. As the responsibility for assessing students' clinical skills shifts back to medical schools, educators must take care not to lose the ground they have gained in advancing clinical skills education. Instead, they need to innovate, collaborate, and share resources; hold themselves accountable; and ultimately rise to the challenge of ensuring that physicians have the necessary clinical skills to safely and effectively practice medicine.
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Affiliation(s)
- Timothy K Baker
- T.K. Baker is senior associate dean for academic affairs and associate professor, Department of Internal Medicine, University of Nevada, Reno, School of Medicine, Reno, Nevada
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5
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Arnhart KL, Cuddy MM, Johnson D, Barone MA, Young A. Multiple United States Medical Licensing Examination Attempts and the Estimated Risk of Disciplinary Actions Among Graduates of U.S. and Canadian Medical Schools. Acad Med 2021; 96:1319-1323. [PMID: 34133346 DOI: 10.1097/acm.0000000000004210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The United States Medical Licensing Examination (USMLE) recently announced 2 policy changes: shifting from numeric score reporting on the Step 1 examination to pass/fail reporting and limiting examinees to 4 attempts for each Step component. In light of these policies, exam measures other than scores, such as the number of examination attempts, are of interest. Attempt limit policies are intended to ensure minimum standards of physician competency, yet little research has explored how Step attempts relate to physician practice outcomes. This study examined the relationship between USMLE attempts and the likelihood of receiving disciplinary actions from state medical boards. METHOD The sample population was 219,018 graduates from U.S. and Canadian MD-granting medical schools who passed all USMLE Step examinations by 2011 and obtained a medical license in the United States, using data from the NBME and the Federation of State Medical Boards. Logistic regressions estimated how attempts on Steps 1, 2 Clinical Knowledge (CK), and 3 examinations influenced the likelihood of receiving disciplinary actions by 2018, while accounting for physician characteristics. RESULTS A total of 3,399 physicians (2%) received at least 1 disciplinary action. Additional attempts needed to pass Steps 1, 2 CK, and 3 were associated with an increased likelihood of receiving disciplinary actions (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.01, 1.13; OR: 1.09, 95% CI: 1.03, 1.16; OR: 1.11, 95% CI: 1.04, 1.17, respectively), after accounting for other factors. CONCLUSIONS Physicians who took multiple attempts to pass Steps 1, 2 CK, and 3 were associated with higher estimated likelihood of receiving disciplinary actions. This study offers support for licensure and practice standards to account for physicians' USMLE attempts. The relatively small effect sizes, however, caution policy makers from placing sole emphasis on this relationship.
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Affiliation(s)
- Katie L Arnhart
- K.L. Arnhart is senior research analyst, Research and Data Integration, Federation of State Medical Boards, Euless, Texas; ORCID: http://orcid.org/0000-0001-9975-6358
| | - Monica M Cuddy
- M.M. Cuddy is measurement scientist, Center for Advanced Assessment, NBME, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-5756-9113
| | - David Johnson
- D. Johnson is chief assessment officer, Federation of State Medical Boards, Euless, Texas; ORCID: http://orcid.org/0000-0003-3669-1838
| | - Michael A Barone
- M.A. Barone is vice president, Competency Based Assessment, NBME, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-4724-784X
| | - Aaron Young
- A. Young is vice president, Research and Data Integration, Federation of State Medical Boards, Euless, Texas; ORCID: http://orcid.org/0000-0002-5517-5874
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6
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Katsufrakis PJ, Chaudhry HJ. Evolution of Clinical Skills Assessment in the USMLE: Looking to the Future After Step 2 CS Discontinuation. Acad Med 2021; 96:1236-1238. [PMID: 34166234 DOI: 10.1097/acm.0000000000004214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic interrupted administration of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam in March 2020 due to public health concerns. As the scope and magnitude of the pandemic became clearer, the initial plans by the USMLE program's sponsoring organizations (NBME and Federation of State Medical Boards) to resume Step 2 CS in the short-term shifted to long-range plans to relaunch an exam that could harness technology and reduce infection risk. Insights about ongoing changes in undergraduate and graduate medical education and practice environments, coupled with challenges in delivering a transformed examination during a pandemic, led to the January 2021 decision to permanently discontinue Step 2 CS. Despite this, the USMLE program considers assessment of clinical skills to be critically important. The authors believe this decision will facilitate important advances in assessing clinical skills. Factors contributing to the decision included concerns about achieving desired goals within desired time frames; a review of enhancements to clinical skills training and assessment that have occurred since the launch of Step 2 CS in 2004; an opportunity to address safety and health concerns, including those related to examinee stress and wellness during a pandemic; a review of advances in the education, training, practice, and delivery of medicine; and a commitment to pursuing innovative assessments of clinical skills. USMLE program staff continue to seek input from varied stakeholders to shape and prioritize technological and methodological enhancements to guide development of clinical skills assessment. The USMLE program's continued exploration of constructs and methods by which communication skills, clinical reasoning, and physical examination may be better assessed within the remaining components of the exam provides opportunities for examinees, educators, regulators, the public, and other stakeholders to provide input.
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Affiliation(s)
- Peter J Katsufrakis
- P.J. Katsufrakis is president and CEO, NBME, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-9077-9190
| | - Humayun J Chaudhry
- H.J. Chaudhry is president and CEO, Federation of State Medical Boards, Euless, Texas; ORCID: https://orcid.org/0000-0003-3356-1106
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7
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Dougherty PJ. CORR® Curriculum-Orthopaedic Education: Changing USMLE Step 1 Scores to Pass/Fail Removes an Objective Measure of Medical Knowledge. Clin Orthop Relat Res 2021; 479:1194-1196. [PMID: 33944805 PMCID: PMC8133170 DOI: 10.1097/corr.0000000000001765] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Paul J Dougherty
- P. J. Dougherty, Professor and Chairman, Department of Orthopaedic Surgery, University of Florida, Jacksonville, FL, USA
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8
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Saddawi-Konefka D, Brown A, Eisenhart I, Hicks K, Barrett E, Gold JA. Consistency Between State Medical License Applications and Recommendations Regarding Physician Mental Health. JAMA 2021; 325:2017-2018. [PMID: 34003231 PMCID: PMC8132137 DOI: 10.1001/jama.2021.2275] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines the consistency of medical license applications with recommendations from the Federation of State Medical Boards on physician wellness and burnout.
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Affiliation(s)
- Daniel Saddawi-Konefka
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston
| | - Ariel Brown
- The Emotional PPE Project Inc, Arlington, Massachusetts
| | | | | | - Eileen Barrett
- Department of Medicine, University of New Mexico, Albuquerque
| | - Jessica A. Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
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9
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Mun F, Scott AR, Cui D, Chisty A, Hennrikus WL, Hennrikus EF. Internal medicine residency program director perceptions of USMLE Step 1 pass/fail scoring: A cross-sectional survey. Medicine (Baltimore) 2021; 100:e25284. [PMID: 33847625 PMCID: PMC8052063 DOI: 10.1097/md.0000000000025284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/08/2021] [Indexed: 01/04/2023] Open
Abstract
The United States Medical Licensing Examination Step 1 will transition to a pass/fail exam starting no earlier than January 2022. Internal medicine residency programs will need to adapt to these changes. The purpose of this study was to investigate: 1. internal medicine residency program directors’ perceptions on the change of Step 1 to a pass/fail exam, and 2. the impact on other factors considered for internal medicine residency selection. A validated REDCap survey was sent to 548 program directors at active Accreditation Council for Graduate Medical Education internal medicine residency programs. Contact information from the American Medical Association's Fellowship and Residency Electronic Interactive Database was used. The survey had 123 respondents (22.4%). Most internal medicine program directors do not support the pass/fail change. A greater importance will be placed on Step 2 Clinical Knowledge exam, personal knowledge of the applicant, clerkship grades, and audition electives. Allopathic students from less highly regarded medical schools, as well as osteopathic and international students, will be disadvantaged. About half believe that schools should adopt a graded pre-clinical curriculum (51.2%) and that there should be residency application caps (54.5%). Internal medicine program directors mostly disagree with the pass/fail Step 1 transition. Residency programs will need to reevaluate how applicants are evaluated. Other factors, such as Step 2 Clinical Knowledge score, personal knowledge of the applicant, grades in clerkships, and audition rotations will now be emphasized more heavily.
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Affiliation(s)
| | | | - David Cui
- Pennsylvania State University College of Medicine
| | - Alia Chisty
- Pennsylvania State University College of Medicine
- Department of Internal Medicine
| | - William L. Hennrikus
- Pennsylvania State University College of Medicine
- Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Eileen F. Hennrikus
- Pennsylvania State University College of Medicine
- Department of Internal Medicine
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10
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Healy MG, Gray BM, Duhigg LM, O'Rourke M, Marchwinski L, Elmore M, Phitayakorn R. Association of Use of the NEJM Knowledge+ Product and Performance on the ABIM IM-MOC Exam. Teach Learn Med 2021; 33:21-27. [PMID: 32928000 DOI: 10.1080/10401334.2020.1811095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Phenomenon: Internal medicine physicians in the United States must pass the American Board of Internal Medicine Internal Medicine Maintenance of Certification (ABIM IM-MOC) examination as part of their ABIM IM-MOC requirements. Many of these physicians use an examination product to help them prepare, such as e-Learning products, including the ACP's MKSAP, UpToDate, and NEJM Knowledge+, yet their effectiveness remains largely unstudied. Approach: We compared ABIM IM-MOC examination performance among 177 physicians who attempted an ABIM IM-MOC examination between 2014-2017 and completed at least 75% of the NEJM Knowledge+ product prior to the ABIM IM-MOC examination and 177 very similar matched control physicians who did not use NEJM Knowledge+. Our measures of ABIM IM-MOC exam performance for NEJM Knowledge+ users were based on the results of the first attempt immediately following the NEJM Knowledge+ use and for non-users were based on the applicable matched examination performance. The three dichotomous examination performance outcomes measured on the first attempt at the ABIM IM-MOC examination included pass rate, scoring in the upper quartile, and scoring in the lower quartile. Findings: Use of NEJM Knowledge+ was associated with a regression adjusted 10.6% (5.37% to 15.8%) greater likelihood of passing the MOC examination (p < .001), 10.7% (2.61% to 18.7%) greater likelihood of having an examination score in the top quartile (p = .009), and -10.8% (-16.8% to -4.86%) lower likelihood of being in the bottom quartile of the MOC examination (p < .001) as compared to similar physicians who did not use NEJM Knowledge+. Insight: Physicians who used NEJM Knowledge+ had better ABIM IM-MOC exam performance. Further research is needed to determine what aspects of e-Learning products best prepare physicians for MOC examinations.
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Affiliation(s)
- Michael G Healy
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- NEJM Group, Waltham, Massachusetts, USA
| | - Bradley M Gray
- American Board of Internal Medicine, Philadelphia, Pennsylvania, USA
| | - Lauren M Duhigg
- American Board of Internal Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | - Roy Phitayakorn
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
- NEJM Group, Waltham, Massachusetts, USA
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11
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Caesar S, Layer G, Alexander R, Banks V, Barasi S, Bews S, Chaudhury B, Cockman P, Conlon M, Dasan S, Feltbower T, Fox D, Hughes S, Jani B, Jelley D, Lewis-Barned N, Mead S, Qureshi K, Twomey P, van Woerden H, Woodhouse J, Yuille F. Appraisal needs to re-start now so doctors can reflect on coronavirus experiences. BMJ 2020; 371:m3987. [PMID: 33077426 DOI: 10.1136/bmj.m3987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Susi Caesar
- Professional Development Committee, Academy of Medical Royal Colleges, 10 Dallington Street, London EC1V 0DB, UK
- Medical Appraisal 2020 Task and Finish Group, Academy of Medical Royal Colleges, London, UK
| | - Graham Layer
- Professional Development Committee, Academy of Medical Royal Colleges, 10 Dallington Street, London EC1V 0DB, UK
| | - Regi Alexander
- Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, UK
| | - Vicky Banks
- Faculty of Medical Leadership and Management, 6 St Andrews Place, London NW1 4LB, UK
| | | | - Susan Bews
- Faculty of Pharmaceutical Medicine, 19 Angel Gate, 326a City Road, London EC1V 2PT, UK
| | - Basant Chaudhury
- Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ, UK
| | - Philippa Cockman
- NHS England and Improvement London, London, UK
- St Stephen's Health Centre, London E3 5ED, UK
| | - Maurice Conlon
- Professional Standards Team, NHS England and Improvement, Quarry House, Quarry Hill, Leeds LS2 7UE, UK
| | - Sunil Dasan
- Sustainable Working Practices Committee, Royal College of Emergency Medicine, 7-9 Bream's Buildings, Chancery Lane, London EC4A 1DT, UK
| | - Tony Feltbower
- Association of Surgeons in Primary Care and Faculty of Sexual and Reproductive Health, 27 Sunningdale Avenue, Kenilworth, Warwickshire CV82BY, UK
| | - David Fox
- Faculty of Occupational Medicine, 2 Lovibond Lane, London SE10 9FY, UK
| | - Steph Hughes
- Health Education England, Wessex Appraisal Service, Southern House, Otterbourne, Hampshire SO21 2RU, UK
| | - Bov Jani
- Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London WC1X 8SH, UK
| | - Di Jelley
- NHS England and Improvement Cumbria and North East, UK
- Health Education England (North East and Cumbria), Continuing Practice Department, Waterfront, 4 Goldcrest Way, Newburn Riverside, Newcastle Upon Tyne NE15 8NY, UK
| | - Nick Lewis-Barned
- Patient Feedback Project, Academy of Medical Royal Colleges, 10 Dallington Street, London EC1V 0DB, UK
| | | | - Kashif Qureshi
- Royal College of Ophthalmologists, 18 Stephenson Way, London NW1 2HD, UK
| | - Paul Twomey
- NHS England and Improvement North East and Yorkshire, Health House, Grange Park Lane, Willerby HU10 6DT, UK
| | - Hugo van Woerden
- Public Health Agency, 12-22 Linenhall Street, Belfast BT2 8BS, UK
| | - John Woodhouse
- Faculty of Public Health, 4 St Andrews Place, London NW1 4LB, UK
| | - Frances Yuille
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London WC2A 3JW, UK
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12
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Abstract
This Invited Commentary is an independent opinion piece and companion to the Perspective by Carmody and Rajasekaran that appears in this issue of Academic Medicine. The National Board of Medical Examiners (NBME), a 501(c)(3) nonprofit, is a powerful gatekeeper to the medical profession in the United States. According to publicly available tax data, the NBME, which has increased its number of income-enhancing products, had revenues of $153.9 million (M) and net assets of $177.6M in 2017, earnings (revenue less expenses) of $39.7M in 2013-2017, and a highly compensated management team. Medical students are ultimately the source of nearly all the NBME's revenue, and the NBME has contributed to the growth of medical student debt. The NBME has operated as a monopoly since its agreement in the early 1990s with the Federation of State Medical Boards to cosponsor the United States Medical Licensing Examination (USMLE). Although the NBME has developed valuable products and is ostensibly governed by a capable board, the NBME has inherent financial conflicts of interest and may be benefiting from the current "Step 1 mania" undermining undergraduate medical education. Here, the author makes 4 recommendations to reestablish the trust of the U.S. medical education community in the NBME: (1) the NBME should recuse itself from current discussions and policy-making decisions related to changes in the score reporting of the USMLE Step 1 exam; (2) the NBME should disclose and be transparent about all aspects of its finances; (3) new NBME products, changes in pricing, and changes to pass thresholds should be approved by an oversight committee, independent of the NBME; and (4) the NBME (and USMLE) should not charge students or residents for retaking any of its licensing examinations.
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Affiliation(s)
- Neil Gesundheit
- N. Gesundheit is professor of medicine and senior associate dean for medical education, Stanford University School of Medicine, Stanford, California
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13
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Delman KA, Srinivasan JK. "What Is Old Is New Again" Commentary on "Ensuring That Step 1 Isn't the Next 'Back in My Day"'. Ann Surg 2020; 272:240. [PMID: 32675535 DOI: 10.1097/sla.0000000000004046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Keith A Delman
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
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14
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Takaku R. How is increased selectivity of medical school admissions associated with physicians' career choice? A Japanese experience. Hum Resour Health 2020; 18:38. [PMID: 32460757 PMCID: PMC7251850 DOI: 10.1186/s12960-020-00480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND During the long-lasting economic stagnation, the popularity of medical school has dramatically increased among pre-medical students in Japan. This is primarily due to the belief that medicine is generally a recession-proof career. As a result, pre-medical students today who want to enter medical school have to pass a more rigorous entrance examination than that in the 1980s. This paper explores the association between the selectivity of medical school admissions and graduates' later career choices. METHODS A unique continuous measure of the selectivity of medical school admissions from 1980 to 2017, which is defined as the deviation value of medical schools, was merged with cross-sectional data of 122 990 physicians aged 35 to 55 years. The association between the deviation value of medical schools and various measures of physicians' career choices was explored by logistic and ordinary least square regression models. Graduates from medical schools in which the deviation value was less than 55 were compared with those from more competitive medical schools, after controlling for fixed effects for the medical school attended by binary variables. RESULTS From 1980 to 2017, the average deviation value increased from 58.3 to 66.3, indicating a large increase in admission selectivity. Empirical results suggest that increasing selectivity of a medical school is associated with graduates having a higher probability of choosing a career in an acute hospital as well as having a lower probability of opening their own clinic and choosing a career in primary health care. Graduating from a highly competitive medical school (i.e., deviation value of more than 65) significantly increases the probability of working at typical acute hospitals such as so-called 7:1 hospitals (OR 1.665 2, 95%CI 1.444 0-1.920 4) and decreases the probability of working at primary care facilities (OR 0.602 6, 95%CI 0.441 2-0.823 0). It is also associated with graduates having a higher probability of becoming medical board certified (OR 1.294 6, 95%CI 1.108 8-1.511 4). CONCLUSION Overall, this paper concludes that increased selectivity of medical school admissions predicts a higher quality of physicians in their own specialty, but at the same time, it is associated with a lower supply of physicians who go into primary care.
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Affiliation(s)
- Reo Takaku
- Graduate School of Economics, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, 186-8601, Japan.
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15
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Affiliation(s)
- Matthew A Crane
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Howard A Chang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Razvan Azamfirei
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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16
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Affiliation(s)
| | | | - Alfred F Tallia
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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17
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Affiliation(s)
- Aakash Desai
- Department of Medicine, University of Connecticut, Farmington
| | - Aparna Hegde
- Department of Hematology and Oncology, University of Alabama at Birmingham
| | - Devika Das
- Department of Hematology and Oncology, University of Alabama at Birmingham
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18
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Affiliation(s)
- Harris Ahmed
- Fourth-year medical student, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico. Assistant professor, Department of Pediatrics, Division of Nephrology, Eastern Virginia Medical School, Norfolk, Virginia;
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19
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MacLean SA. The Gender Gap in Medical Eponyms: A USMLE Step 1 Content Analysis. Acad Med 2020; 95:666-667. [PMID: 32345875 DOI: 10.1097/acm.0000000000003204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Sarah A MacLean
- Third-year student, Icahn School of Medicine at Mount Sinai, New York, New York;
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20
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Affiliation(s)
| | - Allison C Hu
- University of California, Irvine School of Medicine, Irvine, Calif
| | - Zeshaan N Maan
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, Calif
| | - Michael S Hu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
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21
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Busche K, Elks ML, Hanson JT, Jackson-Williams L, Manuel RS, Parsons WL, Wofsy D, Yuan K. The Validity of Scores From the New MCAT Exam in Predicting Student Performance: Results From a Multisite Study. Acad Med 2020; 95:387-395. [PMID: 31425189 DOI: 10.1097/acm.0000000000002942] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE The new Medical College Admission Test (MCAT) was introduced in April 2015. This report presents findings from the first study of the validity of scores from the new MCAT exam in predicting student performance in the first year of medical school (M1). METHOD The authors analyzed data from the national population of 2016 matriculants with scores from the new MCAT exam (N = 7,970) and the sample of 2016 matriculants (N = 955) from 16 medical schools who volunteered to participate in the validity research. They examined correlations of students' MCAT total scores and total undergraduate grade point averages (UGPAs), alone and together, with their summative performance in M1, and the success rate of students with different MCAT scores in their on-time progression to the second year of medical school (M2). They assessed whether MCAT scores provided comparable prediction of performance in M1 by students' race/ethnicity, socioeconomic background, and gender. RESULTS Correlations of MCAT scores with summative performance in M1 ranged from medium to large. Although MCAT scores and UGPAs provided similar prediction of performance in M1, using both metrics provided better prediction than either alone. Additionally, students with a wide range of MCAT scores progressed to M2 on time. Finally, MCAT scores provided comparable prediction of performance in M1 for students from different sociodemographic backgrounds. CONCLUSIONS This study provides early evidence that scores from the new MCAT exam predict student performance in M1. Future research will examine the validity of MCAT scores in predicting performance in later years.
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Affiliation(s)
- Kevin Busche
- K. Busche is assistant dean for undergraduate medical education and assistant professor of clinical neurosciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada. M.L. Elks is senior associate dean for educational affairs and professor of medical education and medicine, Morehouse School of Medicine, Atlanta, Georgia. J.T. Hanson is associate dean for student affairs and associate professor of medicine, University of Texas Health San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, Texas. L. Jackson-Williams is vice dean for medical education and professor of emergency medicine, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi. R.S. Manual was associate dean for medical school admissions and associate professor of family medicine, University of Mississippi School of Medicine, Jackson, Mississippi, at the time this work was completed. W.L. Parsons is associate professor of family medicine, and past assistant dean for admissions, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada. D. Wofsy is associate dean for admissions and professor of medicine, University of California, San Francisco, School of Medicine, San Francisco, California. K. Yuan is director, Medical College Admission Test Research, Association of American Medical Colleges, Washington, DC
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Ouyang W, Harik P, Clauser BE, Paniagua MA. Investigation of answer changes on the USMLE® Step 2 Clinical Knowledge examination. BMC Med Educ 2019; 19:389. [PMID: 31647012 PMCID: PMC6806526 DOI: 10.1186/s12909-019-1816-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Examinees often believe that changing answers will lower their scores; however, empirical studies suggest that allowing examinees to change responses may improve their performance in classroom assessments. To date, no studies have been able to examine answer changes during large scale professional credentialing or licensing examinations. METHODS In this study, we expand the research on answer changes by analyzing responses from 27,830 examinees who completed the Step 2 Clinical Knowledge (CK) examination between August of 2015 and August of 2016. RESULTS The results showed that although 68% of examinees changed at least one item, the overall average number of changes was small. Among the examinees who changed answers, approximately 45% increased their scores and approximately 28% decreased their scores. On average, examinees spent shortest time on the item changes from wrong to right and they were more likely to change their scores from wrong to right than right to wrong. CONCLUSIONS Consistent with previous studies, these findings support the beneficial effects of answer changes in high-stakes medical examinations and suggest that examinees who are overly cautious about changing answers may put themselves at a disadvantage.
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Affiliation(s)
- Wenli Ouyang
- National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA, 19104, USA.
| | - Polina Harik
- National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA, 19104, USA
| | - Brian E Clauser
- National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA, 19104, USA
| | - Miguel A Paniagua
- National Board of Medical Examiners, 3750 Market Street, Philadelphia, PA, 19104, USA
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Lertwilaiwittaya P, Sitticharoon C, Maikaew P, Keadkraichaiwat I. Factors influencing the National License Examination step 1 score in preclinical medical students. Adv Physiol Educ 2019; 43:306-316. [PMID: 31246510 DOI: 10.1152/advan.00197.2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The National License Examination step 1 (NLE1), which tests basic medical sciences knowledge in Thailand, is considered to be tough and stressful for medical students due to the large amount of content. This study aimed to determine factors influencing the NLE1 score (NLE1S). The NLE1S, academic achievement, and class attendance were obtained officially. Other factors, including study habits, were obtained via a questionnaire, with 81.97% (241/294) being returned. Students were divided into four groups according to the central passing score and Z-score of the NLE1S, including the fail (<52%; n = 13), low-pass (52 to <70%; n = 121), high-pass (70 to <80%; n = 89), and excellent (≥80%; n = 18) groups. Men had higher NLE1S (P < 0.001) and comprehensive examination scores (P < 0.001) than women. Students with high motivation to study medicine had higher NLE1S. Daily preparation time (h/day) was lower, but stress was higher, in the fail group. In the excellent group, internet for academic use and achievement of study targets were higher; internet for nonacademic use, instance of absence, and stress were lower; and check-in time was earlier. The NLE1S had strong positive correlations with the comprehensive examination score and academic achievement during preclinical studies. By setting the NLE1S as a dependent variable in multivariate regression analyses, models of significant interactions were observed by setting behavioral factors, the comprehensive examination score, and academic achievement during a regular class as independent variables. Thus exhibiting good study habits and showing good academic performance throughout preclinical studies should be encouraged among students to achieve a good NLE1S.
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Affiliation(s)
- Pongtawat Lertwilaiwittaya
- Department of Physiology, Faculty of Medicine, Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Chantacha Sitticharoon
- Department of Physiology, Faculty of Medicine, Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Pailin Maikaew
- Department of Physiology, Faculty of Medicine, Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Issarawan Keadkraichaiwat
- Department of Physiology, Faculty of Medicine, Siriraj Hospital, Mahidol University , Bangkok , Thailand
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Schollin J, Lindgren S. [A new internationally harmonized Swedish basic medical education]. Lakartidningen 2019; 116:FR4S. [PMID: 31454058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Swedish Parliament and Government has recently sanctioned a new 6 year undergraduate medical degree leading directly to license, followed by a 12 month introduction to work as a certified doctor. The undergraduate education is internationally harmonized and the 23 learning outcomes address competence needs in future Swedish and international health-care. Particular attention is given to professional competence, critical thinking, team-work and health promotion. All 23 learning outcomes must be documented before the University can issue a MD degree. After license, the doctor applies for a 12 month introduction to employment as doctor in the Swedish health-care system. This introduction is mandatory for all, regardless of the country where the license was issued. The introduction comprises clinical service in general medicine, emergency medicine and elective disciplines. Assessment of 10 learning outcomes is carried out in a formative wav by experienced and trained clinicians during the clinical service. After the introduction, the doctor is duly qualified to apply for specialist training.
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Affiliation(s)
- Jens Schollin
- Örebro Universitet Institutionen för Medicinska Vetenskaper - Orebro, Sweden Örebro Universitet Institutionen för Medicinska Vetenskaper - Orebro, Sweden
| | - Stefan Lindgren
- Lund University - Clinical Sciences, Malmö Malmö, Sweden Lund University - Clinical Sciences, Malmö Malmö, Sweden
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Sharma A, Schauer DP, Kelleher M, Kinnear B, Sall D, Warm E. USMLE Step 2 CK: Best Predictor of Multimodal Performance in an Internal Medicine Residency. J Grad Med Educ 2019; 11:412-419. [PMID: 31440335 PMCID: PMC6699543 DOI: 10.4300/jgme-d-19-00099.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/26/2019] [Accepted: 06/04/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Internal medicine (IM) residency programs receive information about applicants via academic transcripts, but studies demonstrate wide variability in satisfaction with and usefulness of this information. In addition, many studies compare application materials to only 1 or 2 assessment metrics, usually standardized test scores and work-based observational faculty assessments. OBJECTIVE We sought to determine which application materials best predict performance across a broad array of residency assessment outcomes generated by standardized testing and a yearlong IM residency ambulatory long block. METHODS In 2019, we analyzed available Electronic Residency Application Service data for 167 categorical IM residents, including advanced degree status, research experience, failures during medical school, undergraduate medical education award status, and United States Medical Licensing Examination (USMLE) scores. We compared these with post-match residency multimodal performance, including standardized test scores and faculty member, peer, allied health professional, and patient-level assessment measures. RESULTS In multivariate analyses, USMLE Step 2 Clinical Knowledge (CK) scores were most predictive of performance across all residency performance domains measured. Having an advanced degree was associated with higher patient-level assessments (eg, physician listens, physician explains, etc). USMLE Step 1 scores were associated with in-training examination scores only. None of the other measured application materials predicted performance. CONCLUSIONS USMLE Step 2 CK scores were the highest predictors of residency performance across a broad array of performance measurements generated by standardized testing and an IM residency ambulatory long block.
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Pock A, Daniel M, Santen SA, Swan-Sein A, Fleming A, Harnik V. Challenges Associated With Moving the United States Medical Licensing Examination (USMLE) Step 1 to After the Core Clerkships and How to Approach Them. Acad Med 2019; 94:775-780. [PMID: 30768466 DOI: 10.1097/acm.0000000000002651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An increasing number of medical schools have moved away from traditional 2 + 2 curricular structures toward curricula that intentionally integrate basic, clinical, and health systems science, with the goal of graduating physicians who consistently apply their foundational knowledge to clinical practice to improve the care of patients and populations. These curricular reforms often include a shortened preclerkship phase with earlier introduction of learners into clinical environments. This has led schools to reconsider the optimal timing of United States Medical Licensing Examination Step 1. A number of schools have shifted the exam to the period immediately after core clerkships. Although this shift can provide pedagogical advantages, there are potential challenges that must be anticipated and proactively addressed. As more institutions consider making this change, key educational leaders from five schools that repositioned the Step 1 exam after core clerkships share strategies for mitigating some of the potential challenges associated with this approach. The authors describe six possible challenges: lack of readiness without consolidation of basic science knowledge prior to clerkships; risk that weaker students will not be identified and provided academic support early; clerkship or clinical shelf exam performance weaknesses; extension of Step 1 study time; an increase in student anxiety about residency specialty choices; and/or a reduced time frame to take and pass board exams. These potential challenges may be addressed using three main strategies: effective communication with all stakeholders; curricular design and assessments that facilitate integration of basic and clinical sciences; and proactive student coaching and advising.
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Affiliation(s)
- Arnyce Pock
- A. Pock is associate dean for curriculum and associate professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. M. Daniel is assistant dean of curriculum and associate professor of emergency medicine and learning health sciences, University of Michigan School of Medicine, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0001-8961-7119. S.A. Santen is senior associate dean of evaluation, assessment, and scholarship of learning and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia. A. Swan-Sein is director, Center for Educational Research and Evaluation, and assistant professor of educational assessment, Columbia Vagelos College of Physicians and Surgeons, New York, New York. A. Fleming is associate dean for medical student affairs and professor of pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. V. Harnik is associate dean of curriculum and associate professor of cell biology, NYU School of Medicine, New York, New York
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Hirshfield LE, Yudkowsky R, Park YS. Pre-medical majors in the humanities and social sciences: impact on communication skills and specialty choice. Med Educ 2019; 53:408-416. [PMID: 30549067 DOI: 10.1111/medu.13774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/13/2018] [Accepted: 10/16/2018] [Indexed: 06/09/2023]
Abstract
CONTEXT Medical school admissions committees use a variety of criteria to determine which candidates to admit to their programmes. Effective communication is increasingly considered a key requisite to the practice of effective medicine. Medical students with pre-medical backgrounds in the humanities and social sciences may be more likely to acquire skills relevant to patient-centred communication, either prior to or during medical school. OBJECTIVES The purpose of this study was to investigate the relationship between pre-medical backgrounds in the humanities and social sciences and outcomes in medical school, including in communication and interpersonal skills (CIS), licensure examination results and postgraduate specialty choice (primary care versus non-primary care specialties). METHODS The American Medical College Application Service database was used to identify pre-medical college majors, demographic characteristics, Medical College Admission Test scores and college grade point averages for medical students at a large, midwestern medical school. Data were obtained for 465 medical students across three cohorts (classes of 2014-2016). Correlation and regression analyses were used to examine relationships between pre-medical background, performance on graduation competency examination standardised patient encounter CIS scores and on United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge scores, and postgraduate specialty choice. RESULTS Graduating medical students with pre-medical humanities or social sciences majors performed significantly better in terms of CIS than those with natural science majors (Cohen's d = 0.28, p = 0.011). There were no significant associations between pre-medical majors and USMLE Step 1 and Step 2 Clinical Knowledge scores or postgraduate specialty choice. CONCLUSIONS These results suggest that considering humanistic factors as part of admissions criteria may promote the selection and training of physicians with good communication skills.
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Affiliation(s)
- Laura E Hirshfield
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Sociology, College of Liberal Arts & Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Rachel Yudkowsky
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yoon Soo Park
- Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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Rubright JD, Jodoin M, Barone MA. Examining Demographics, Prior Academic Performance, and United States Medical Licensing Examination Scores. Acad Med 2019; 94:364-370. [PMID: 30024473 DOI: 10.1097/acm.0000000000002366] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To examine whether demographic differences exist in United States Medical Licensing Examination (USMLE) scores and the extent to which any differences are explained by students' prior academic achievement. METHOD The authors completed hierarchical linear modeling of data for U.S. and Canadian allopathic and osteopathic medical graduates testing on USMLE Step 1 during or after 2010, and completing USMLE Step 3 by 2015. Main outcome measures were computer-based USMLE examinations: Step 1, Step 2 Clinical Knowledge, and Step 3. Test-taker characteristics included sex, self-identified race, U.S. citizenship status, English as a second language, and age at first Step 1 attempt. Covariates included composite Medical College Admission Test (MCAT) scores, undergraduate grade point average (GPA), and previous USMLE scores. RESULTS A total of 45,154 examinees from 172 medical schools met the inclusion criteria. The sample was 67% white and 48% female; 3.7% non-U.S. citizens; and 7.4% with English as a second language. Hierarchical linear models examined demographic variables with and without covariates including MCAT scores and GPA. All Step examinations showed significant differences by gender after adding covariates, varying by Step. Racial differences were observed for each Step, attenuated by the addition of covariates. CONCLUSIONS Demographic differences in USMLE performance were tempered by previous examination performance and undergraduate performance. Additional research is required to identify factors that contribute to demographic differences, can aid educators' identification of students who would benefit from assistance preparing for USMLE, and can assist residency program directors in assessing performance measures while meeting diversity goals.
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Affiliation(s)
- Jonathan D Rubright
- J.D. Rubright is senior psychometrician, National Board of Medical Examiners, Philadelphia, Pennsylvania. M. Jodoin is vice president of psychometrics and data analysis, National Board of Medical Examiners, Philadelphia, Pennsylvania. M.A. Barone is vice president of licensure, National Board of Medical Examiners, Philadelphia, Pennsylvania
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Seo DG, Kim MG, Kim NH, Shin HS, Kim HJ. Liner programming method to construct equated item sets for implementation of periodical computer-based testing of Korean medical licensing examination. J Educ Eval Health Prof 2018; 15:26. [PMID: 30336541 PMCID: PMC6318553 DOI: 10.3352/jeehp.2018.15.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/18/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE This study aimed to find the best way of developing equivalent item sets and to propose a stable and effective management plan for the periodical licensing examinations. METHODS Five pre-equated item sets were developed based on the predicted correct answer rate of each item by using linear programming. These pre-equated item sets were compared to the ones that were developed with random item selection method based on the actual answer rate and difficulty from item response theory (IRT). Also, the results with and without common items were compared in the same way. ACAR and the IRT difficulty was used to determine whether there is a significant difference between pre-equating conditions. RESULTS There was a statistically significant difference in IRT difficulty among the results from different pre-equated conditions. As predicted correct answer rate was divided into 2 or 3 difficulty boundaries, the actual answer rate and IRT difficulty parameters of the 5 item sets were equally constructed. Comparing item sets conditions with common items and without common items, including common items did not contribute much for the equating of 5 item sets. CONCLUSION This study suggested the linear programming method is applicable to construct equated-item sets that reflect each content area. The best method to construct equated item sets suggested is to divide the predicted correct answer rate into 2 or 3 difficulty boundaries regardless of common items. If pre-equated item sets are required to construct a test based on the actual data, several optimal methods should be considered by simulation studies before administrating a real test.
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Affiliation(s)
- Dong Gi Seo
- Department of Psychology, College of Social Science, Hallym University, Chuncheon, Korea
| | - Myeong Gi Kim
- Department of Psychology, College of Social Science, Hallym University, Chuncheon, Korea
| | - Na Hui Kim
- Department of Psychology, College of Social Science, Hallym University, Chuncheon, Korea
| | - Hye Sook Shin
- Department of Education, College of Education, Kangwon National University, Chuncheon, Korea
| | - Hyun Jung Kim
- Division of Nursing, Hallym University, Chuncheon, Korea
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Price T, Lynn N, Coombes L, Roberts M, Gale T, de Bere SR, Archer J. The International Landscape of Medical Licensing Examinations: A Typology Derived From a Systematic Review. Int J Health Policy Manag 2018; 7:782-790. [PMID: 30316226 PMCID: PMC6186476 DOI: 10.15171/ijhpm.2018.32] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 03/26/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND National licensing examinations (NLEs) are large-scale examinations usually taken by medical doctors close to the point of graduation from medical school. Where NLEs are used, success is usually required to obtain a license for full practice. Approaches to national licensing, and the evidence that supports their use, varies significantly across the globe. This paper aims to develop a typology of NLEs, based on candidacy, to explore the implications of different examination types for workforce planning. METHODS A systematic review of the published literature and medical licensing body websites, an electronic survey of all medical licensing bodies in highly developed nations, and a survey of medical regulators. RESULTS The evidence gleaned through this systematic review highlights four approaches to NLEs: where graduating medical students wishing to practice in their national jurisdiction must pass a national licensing exam before they are granted a license to practice; where all prospective doctors, whether from the national jurisdiction or international medical graduates, are required to pass a national licensing exam in order to practice within that jurisdiction; where international medical graduates are required to pass a licensing exam if their qualifications are not acknowledged to be comparable with those students from the national jurisdiction; and where there are no NLEs in operation. This typology facilitates comparison across systems and highlights the implications of different licensing systems for workforce planning. CONCLUSION The issue of national licensing cannot be viewed in isolation from workforce planning; future research on the efficacy of national licensing systems to drive up standards should be integrated with research on the implications of such systems for the mobility of doctors to cross borders.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), University of Plymouth, Plymouth, UK
- Peninsula Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UK
| | - Nick Lynn
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), University of Plymouth, Plymouth, UK
- Peninsula Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UK
| | - Lee Coombes
- School of Medicine, Cardiff University, Wales, UK
| | - Martin Roberts
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), University of Plymouth, Plymouth, UK
- Peninsula Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UK
| | - Tom Gale
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), University of Plymouth, Plymouth, UK
- Peninsula Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UK
| | - Sam Regan de Bere
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), University of Plymouth, Plymouth, UK
- Peninsula Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UK
| | - Julian Archer
- Collaboration for the Advancement of Medical Education Research & Assessment (CAMERA), University of Plymouth, Plymouth, UK
- Peninsula Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UK
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Abstract
OBJECTIVE To evaluate the effect of state continuing medical education (CME) requirements on physician clinical knowledge. DATA SOURCES Secondary data for 19,563 general internists who took the Internal Medicine Maintenance of Certification (MOC) examination between 2006 and 2013. STUDY DESIGN We took advantage of a natural experiment resulting from variations in CME requirements across states over time and applied a difference-in-differences methodology to measure associations between changes in CME requirements and physician clinical knowledge. We measured changes in clinical knowledge by comparing initial and MOC examination performance 10 years apart. We constructed difference-in-differences estimates by regressing examination performance changes against physician demographics, county and year fixed effects, trend-state indicators, and state CME change indicators. DATA COLLECTION Physician data were compiled by the American Board of Internal Medicine. State CME policies were compiled from American Medical Association reports. PRINCIPAL FINDINGS More rigorous CME credit-hour requirements (mostly implementing a new requirement) were associated with an increase in examination performance equivalent to a shift in examination score from the 50th to 54th percentile. CONCLUSIONS Among physicians required to engage in a summative assessment of their clinical knowledge, CME requirements were associated with an improvement in physician clinical knowledge.
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Affiliation(s)
| | | | - Weifeng Weng
- American Board of Internal MedicinePhiladelphiaPA
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Ecker DJ, Milan FB, Cassese T, Farnan JM, Madigosky WS, Massie FS, Mendez P, Obadia S, Ovitsh RK, Silvestri R, Uchida T, Daniel M. Step Up-Not On-The Step 2 Clinical Skills Exam: Directors of Clinical Skills Courses (DOCS) Oppose Ending Step 2 CS. Acad Med 2018; 93:693-698. [PMID: 28834843 DOI: 10.1097/acm.0000000000001874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Recently, a student-initiated movement to end the United States Medical Licensing Examination Step 2 Clinical Skills and the Comprehensive Osteopathic Medical Licensing Examination Level 2-Performance Evaluation has gained momentum. These are the only national licensing examinations designed to assess clinical skills competence in the stepwise process through which physicians gain licensure and certification. Therefore, the movement to end these examinations and the ensuing debate merit careful consideration. The authors, elected representatives of the Directors of Clinical Skills Courses, an organization comprising clinical skills educators in the United States and beyond, believe abolishing the national clinical skills examinations would have a major negative impact on the clinical skills training of medical students, and that forfeiting a national clinical skills competency standard has the potential to diminish the quality of care provided to patients. In this Perspective, the authors offer important additional background information, outline key concerns regarding the consequences of ending these national clinical skills examinations, and provide recommendations for moving forward: reducing the costs for students, exploring alternatives, increasing the value and transparency of the current examinations, recognizing and enhancing the strengths of the current examinations, and engaging in a national dialogue about the issue.
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Affiliation(s)
- David J Ecker
- D.J. Ecker is assistant professor of medicine, assistant director of education, Hospital Medicine Group, and director, Integrated Clinicians Course, University of Colorado School of Medicine, Aurora, Colorado, and chair, Advocacy and Advancement Subcommittee, Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0002-1530-0079. F.B. Milan is professor of medicine and director, Ruth L. Gottesman Clinical Skills Center and Introduction to Clinical Medicine Program, Albert Einstein College of Medicine, Bronx, New York, and president, Directors of Clinical Skills Courses (DOCS). T. Cassese is associate professor of medical science and director, Clinical Arts and Sciences Course, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, and president-elect, Directors of Clinical Skills Courses (DOCS). J.M. Farnan is assistant dean, Curricular Innovation and Evaluation, associate professor of medicine, and director, Clinical Skills Education, University of Chicago Pritzker School of Medicine, Chicago, Illinois, and secretary, Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0002-1138-9416. W.S. Madigosky is associate professor of family medicine and director, Foundations of Doctoring Curriculum, University of Colorado School of Medicine, Aurora, Colorado, and chair, Nominations Subcommittee, Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0003-0714-4114. F.S. Massie Jr is professor of medicine, director, Introduction to Clinical Medicine Curriculum, and director, Clinical Skills Scholars Program, University of Alabama School of Medicine, Birmingham, Alabama, and past president (2014-2015), Directors of Clinical Skills Courses (DOCS). P. Mendez is associate dean, Clinical Curriculum, associate professor of medicine, and director, Clinical Skills Program, University of Miami Miller School of Medicine, Miami, Florida, and representative, Southern Group on Educational Affairs, Directors of Clinical Skills Courses (DOCS). S. Obadia is associate dean, Clinical Education and Services, associate professor of internal medicine, and codirector, Medical Skills Courses, A.T. Still University, School of Osteopathic Medicine, Mesa, Arizona, and chair, Program Planning Subcommittee, Directors of Clinical Skills Courses (DOCS). R.K. Ovitsh is assistant dean, Clinical Competencies, and assistant professor of pediatrics, State University of New York Downstate School of Medicine, Brooklyn, New York, and representative, Northeast Group on Educational Affairs, Directors of Clinical Skills Courses (DOCS). R. Silvestri is assistant professor of medicine and site director, Practice of Medicine Clinical Skills Course, Harvard Medical School, Boston, Massachusetts, and chair, Research Subcommittee, Directors of Clinical Skills Courses (DOCS). T. Uchida is associate professor of medicine and medical education and director, Clinical Skills Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and treasurer, Directors of Clinical Skills Courses (DOCS). M. Daniel is assistant dean, Curriculum, and assistant professor of emergency medicine and learning and health sciences, University of Michigan Medical School, Ann Arbor, Michigan, and past president (2015-2016), Directors of Clinical Skills Courses (DOCS); ORCID: http://orcid.org/0000-0001-8961-7119
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Musábir R. [The knowledge test for physicians from non-EU countries – redo and do it right]. Lakartidningen 2017; 114:EW3U. [PMID: 29292935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Gajewski J, Mweemba C, Cheelo M, McCauley T, Kachimba J, Borgstein E, Bijlmakers L, Brugha R. Non-physician clinicians in rural Africa: lessons from the Medical Licentiate programme in Zambia. Hum Resour Health 2017; 15:53. [PMID: 28830528 PMCID: PMC5568330 DOI: 10.1186/s12960-017-0233-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/14/2017] [Indexed: 05/04/2023]
Abstract
BACKGROUND Most sub-Saharan African countries struggle to make safe surgery accessible to rural populations due to a shortage of qualified surgeons and the unlikelihood of retaining them in district hospitals. In 2002, Zambia introduced a new cadre of non-physician clinicians (NPCs), medical licentiates (MLs), trained initially to the level of a higher diploma and from 2013 up to a BSc degree. MLs have advanced clinical skills, including training in elective and emergency surgery, designed as a sustainable response to the surgical needs of rural populations. METHODS This qualitative study aimed to describe the role, contributions and challenges surgically active MLs have experienced. Based on 43 interviewees, it includes the perspective of MLs, their district hospital colleagues-medical officers (MOs), nurses and managers; and surgeon-supervisors and national stakeholders. RESULTS In Zambia, MLs play a crucial role in delivering surgical services at the district level, providing emergency surgery and often increasing the range of elective surgical cases that would otherwise not be available for rural dwellers. They work hand in hand with MOs, often giving them informal surgical training and reducing the need for hospitals to refer surgical cases. However, MLs often face professional recognition problems and tensions around relationships with MOs that impact their ability to utilise their surgical skills. CONCLUSIONS The paper provides new evidence concerning the benefits of 'task shifting' and identifies challenges that need to be addressed if MLs are to be a sustainable response to the surgical needs of rural populations in Zambia. Policy lessons for other countries in the region that also use NPCs to deliver essential surgery include the need for career paths and opportunities, professional recognition, and suitable employment options for this important cadre of healthcare professionals.
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Affiliation(s)
- Jakub Gajewski
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
| | - Carol Mweemba
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
| | - Mweene Cheelo
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
| | - Tracey McCauley
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
| | - John Kachimba
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Nationalist Road, Lusaka, Zambia
| | - Eric Borgstein
- College of Medicine, Malawi, Mahatma Gandhi, Blantyre, Malawi
| | - Leon Bijlmakers
- Radboud University Medical Centre Netherlands, Geert Grooteplein Zuid 10, 6525 Nijmegen, GA Netherlands
| | - Ruairi Brugha
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
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Sonoda M, Syhavong B, Vongsamphanh C, Phoutsavath P, Inthapanith P, Rotem A, Fujita N. The evolution of the national licensing system of health care professionals: a qualitative descriptive case study in Lao People's Democratic Republic. Hum Resour Health 2017; 15:51. [PMID: 28784154 PMCID: PMC5547512 DOI: 10.1186/s12960-017-0215-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 06/15/2017] [Indexed: 05/08/2023]
Abstract
BACKGROUND The introduction of a systematic framework for the licensing of health care professions, which is a crucial step in ensuring the quality of human resources for health (HRH), is still evolving in Lao People's Democraic Republic. The aim of this study was to review and document the evolution of Lao HRH policies and the development of its national licensing system. CASE PRESENTATION A qualitative descriptive case study methodology was applied to document and describe how Lao People's Democratic Republic laid the foundation for the development of a licensing system. The results demonstrate that Lao People's Democratic Republic is currently in the process of transitioning the focus of its HRH policies from the quantity and deployment of services to remote areas to improvements in the quality of services. The key events in the process of developing the licensing system are as follows: (1) the systematic development of relevant policies and legislation, (2) the establishment of responsible organizations and the assignment of responsible leaders, (3) the acceleration of development efforts in response to the Association of Southeast Asian Nations Mutual Recognition Arrangement for standard qualifications, (4) the strengthening of educational systems for fostering competent health care professionals, (5) the introduction of a 3-year compulsory service component in rural areas for newly recruited government servants, and (6) the introduction of a requirement to obtain a professional health care certificate to work in a private hospital. The Lao Ministry of Health (MOH) has endorsed a specific strategy for licensing to realize this system. CONCLUSION The need for licensing systems has increased in recent years due to regional economic integration and a shift in policy toward achieving universal health coverage. A national licensing system would be a significant milestone in health system development, helping to ensure the competency of health care professionals by means of a national examination, continuing professional development, and the revoking of licenses when appropriate.
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Affiliation(s)
- Miwa Sonoda
- JICA Project for Sustainable Development of Human Resources for Health to Improve MNCH Services, 2nd Floor, Sacombank Building, 044 Haengboun Rd, Ban Haisok, Chanthabouly District, Vientiane, Lao People’s Democratic Republic
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjyuku, Tokyo, 162-8655 Japan
- Japan Agency for Medical Research and Development, 1-7-1 Otemachi, Chiyoda, Tokyo, 100-0004 Japan
| | - Bounkong Syhavong
- Ministry of Health, Ban thatkhao, Sisattanack District, Rue Simeuang, Vientiane, Lao People’s Democratic Republic
| | - Chanphomma Vongsamphanh
- Ministry of Health, Ban thatkhao, Sisattanack District, Rue Simeuang, Vientiane, Lao People’s Democratic Republic
| | - Phisith Phoutsavath
- Ministry of Health, Ban thatkhao, Sisattanack District, Rue Simeuang, Vientiane, Lao People’s Democratic Republic
| | - Phengdy Inthapanith
- Ministry of Health, Ban thatkhao, Sisattanack District, Rue Simeuang, Vientiane, Lao People’s Democratic Republic
| | - Arie Rotem
- University of New South Wales, 11/17 Sutherland Crs, Darling Point, Sydney, NSW 2027 Australia
| | - Noriko Fujita
- National Center for Global Health and Medicine, 1-21-1 Toyama Shinjyuku, Tokyo, 162-8655 Japan
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Rimmer A. Revalidation plan could reduce burden on doctors, says BMA. BMJ 2017; 358:j3562. [PMID: 28733291 DOI: 10.1136/bmj.j3562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lujan HL, DiCarlo SE. Fool's gold and chasing unicorns: USMLE Step 1 has no clothes! Adv Physiol Educ 2017; 41:244-245. [PMID: 28442475 DOI: 10.1152/advan.00016.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 02/15/2017] [Accepted: 02/27/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Heidi L Lujan
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Stephen E DiCarlo
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
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Green EP, Gruppuso PA. Justice and care: decision making by medical school student promotions committees. Med Educ 2017; 51:621-632. [PMID: 28488300 PMCID: PMC5431287 DOI: 10.1111/medu.13280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/24/2016] [Accepted: 01/11/2017] [Indexed: 05/30/2023]
Abstract
CONTEXT The function of medical school entities that determine student advancement or dismissal has gone largely unexplored. The decision making of 'academic progress' or student promotions committees is examined using a theoretical framework contrasting ethics of justice and care, with roots in the moral development work of theorists Kohlberg and Gilligan. OBJECTIVES To ascertain promotions committee members' conceptualisation of the role of their committee, ethical orientations used in member decision making, and student characteristics most influential in that decision making. METHODS An electronic survey was distributed to voting members of promotions committees at 143 accredited allopathic medical schools in the USA. Descriptive statistics were calculated and data were analysed by gender, role, institution type and class size. RESULTS Respondents included 241 voting members of promotions committees at 55 medical schools. Respondents endorsed various promotions committee roles, including acting in the best interest of learners' future patients and graduating highly qualified learners. Implementing policy was assigned lower importance. The overall pattern of responses did not indicate a predominant orientation toward an ethic of justice or care. Respondents indicated that committees have discretion to take individual student characteristics into consideration during deliberations, and that they do so in practice. Among the student characteristics with the greatest influence on decision making, professionalism and academic performance were paramount. Eighty-five per cent of participants indicated that they received no training. CONCLUSIONS Promotions committee members do not regard orientations of justice and care as being mutually exclusive and endorse an array of statements regarding the committee's purpose that may conflict with one another. The considerable variance in the influence of student characteristics and the general absence of committee member training indicate a need for clear delineation of the medical profession's priorities in terms of justice and care, and of the specific student characteristics that should factor into deliberations.
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Affiliation(s)
- Emily P. Green
- Section of Medical Education, The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02912
| | - Philip A. Gruppuso
- Section of Medical Education, The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02912
- Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903
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40
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Överlien C. [Relatives wants debate on the right to keep the medical licence for life]. Lakartidningen 2017; 114:EHIA. [PMID: 28267194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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41
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Magnusson E. [Umeå university and the National Board of Health and Welfare: Extended time to finish and new opportunities in the new knowledge test for physicians]. Lakartidningen 2017; 114:EH69. [PMID: 28221410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Abstract
BACKGROUND Use of social media (SM) by physicians has exposed issues of privacy and professionalism. While guidelines have been created for SM use, details regarding specific SM behaviors that could lead to disciplinary action presently do not exist. OBJECTIVE To compare State Medical Board (SMB) directors' perceptions of investigation for specific SM behaviors with those of emergency medicine (EM) physicians. METHODS A multicenter anonymous survey was administered to physicians at 3 academic EM residency programs. Surveys consisted of case vignettes, asking, "If the SMB were informed of the content, how likely would they be to initiate an investigation, possibly leading to disciplinary action?" (1, very unlikely, to 4, very likely). Results were compared to published probabilities using exact binomial testing. RESULTS Of 205 eligible physicians, 119 (58%) completed the survey. Compared to SMB directors, EM physicians indicated similar probabilities of investigation for themes involving identifying patient images, inappropriate communication, and discriminatory speech. Participants indicated lower probabilities of investigation for themes including derogatory speech (32%, 95% confidence interval [CI] 24-41 versus 46%, P < .05); alcohol intoxication (41%, 95% CI 32-51 versus 73%, P < .05); and holding alcohol without intoxication (7%, 95% CI 3-13 versus 40%, P < .05). There were no significant associations with position, hospital site, years since medical school, or prior SM professionalism training. CONCLUSIONS Physicians reported a lower likelihood of investigation for themes that intersect with social identity, compared to SMB directors, particularly for images of alcohol and derogatory speech.
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Affiliation(s)
- William Soares
- Corresponding author: William Soares, MD, MS, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, 617.749.8111,
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Gauer JL, Jackson JB. The association of USMLE Step 1 and Step 2 CK scores with residency match specialty and location. Med Educ Online 2017; 22:1358579. [PMID: 28762297 PMCID: PMC5653932 DOI: 10.1080/10872981.2017.1358579] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/17/2017] [Indexed: 05/25/2023]
Abstract
BACKGROUND For future physicians, residency programs offer necessary extended training in specific medical specialties. Medical schools benefit from an understanding of factors that lead their students to match into certain residency specialties. One such factor, often used during the residency application process, is scores on the USA Medical Licensing Exam (USMLE). OBJECTIVES To determine the relationship between USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores and students' residency specialty match, and the association between both USMLE scores and state of legal residency (Minnesota) at the time of admission with students staying in-state or leaving the state for residency program. DESIGN USMLE scores and residency match data were analyzed from five graduating classes of students at the University of Minnesota Medical School (N = 1054). RESULTS A MANOVA found significant differences (p < 0.001) between residency specialties and both USMLE Step 1 and Step 2 CK scores, as well as the combination of the two. Students who matched in Dermatology had the highest mean USMLE scores overall, while students who matched in Family Medicine had the lowest mean scores. Students who went out of state for residency had significantly higher Step 1 scores (p = 0.027) than students who stayed in-state for residency, while there was no significant difference between the groups for Step 2 scores. A significant positive association was found between a student who applied as a legal resident of Minnesota and whether the student stayed in Minnesota for their residency program. CONCLUSIONS Residency specialty match was significantly associated with USMLE Step 1 and USMLE Step 2 CK scores, as was staying in-state or leaving the state for residency. Students who were legal residents of the state at the time of application were more likely to stay in-state for residency, regardless of USMLE score. ABBREVIATIONS CK: Clinical knowledge; COMLEX: Comprehensive Osteopathic Medical Licensing Examination; GME: Graduate medical education; NRMP: National Resident Matching Program; UME: Undergraduate medical education; USMLE: United States Medical Licensing Examination.
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44
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Sjövall H. [All physicians must master the language of cell biology and biochemistry]. Lakartidningen 2016; 113:EECC. [PMID: 27997026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Henrik Sjövall
- Institute of Medicine - Göteborg, Sweden Institute of Medicine - Göteborg, Sweden
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O'Neill TR, Peabody MR, Song H. The Predictive Validity of the National Board of Osteopathic Medical Examiners' COMLEX-USA Examinations With Regard to Outcomes on American Board of Family Medicine Examinations. Acad Med 2016; 91:1568-1575. [PMID: 27254014 DOI: 10.1097/acm.0000000000001254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To examine the predictive validity of the National Board of Osteopathic Medical Examiners' Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) series with regard to the American Board of Family Medicine's (ABFM's) In-Training Examination (ITE) and Maintenance of Certification for Family Physicians (MC-FP) Examination. METHOD A repeated-measures design was employed, using test scores across seven levels of training for 1,023 DOs who took the MC-FP for the first time between April 2012 and November 2014 and for whom the ABFM had ITE scores for each of their residency years. Pearson and disattenuated correlations were calculated; Fisher r to z transformation was performed; and sensitivity, specificity, and positive and negative predictive values for the COMLEX-USA Level 2-Cognitive Evaluation (CE) with regard to the MC-FP were computed. RESULTS The Pearson and disattenuated correlations ranged from 0.55 to 0.69 and from 0.61 to 0.80, respectively. For MC-FP scores, only the correlation increase from the COMLEX-USA Level 2-CE to Level 3 was statistically significant (for Pearson correlations: z = 2.41, P = .008; for disattenuated correlations: z = 3.16, P < .001). The sensitivity, specificity, and positive and negative predictive values of the COMLEX-USA Level 2-CE with the MC-FP were 0.90, 0.39, 0.96, and 0.19, respectively. CONCLUSIONS Evidence was found that the COMLEX-USA can assist family medicine residency program directors in predicting later resident performance on the ABFM's ITE and MC-FP, which is becoming increasingly important as graduate medical education accreditation moves toward a single aligned model.
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Affiliation(s)
- Thomas R O'Neill
- T.R. O'Neill is vice president of psychometric services, American Board of Family Medicine, Lexington, Kentucky. M.R. Peabody is a psychometrician, American Board of Family Medicine, Lexington, Kentucky. H. Song is senior director for psychometrics and research, National Board of Osteopathic Medical Examiners, Chicago, Illinois
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Gulland A. GMC relaunches language test for overseas doctors, but concerns remain over equivalence. BMJ 2016; 354:i5104. [PMID: 27651345 DOI: 10.1136/bmj.i5104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ikeda S, Sugita S, Tanaka S. Japanese Medical Education Reforms during the Allied Forces Occupancy; Roles Played by the Public Health and Welfare Section of the Supreme Commander for the Allied Powers. Nihon Ishigaku Zasshi 2016; 62:273-284. [PMID: 30549791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The health and welfare of the Japanese people were of a lower standard compared to other developed countries at the end of the World War II in 1945. Crawford F. Sams, Chief, the Public Health and Welfare Section of the Supreme Commander for the Allied Powers thought that medical care in a wartom country could be improved not by building new hospitals and providing more medical equipment, but through professional education and training. He founded the Council on Medical Education to reform the Japanese medical education. The Council shaped Japanese medical education by establishing the standards for medical school education and initiating internship and a national medical licensure examination. In the early 1950s, the Unitarian Service Committee Medical Mission was invited to teach to medical school professors and students American medicine. This medical mission was also a contribution of the Public Health and Welfare Section to Japanese medical education. This article explores how Public Health and Welfare Section played vital roles in transforming Japanese medical education and postgraduate training during the occupation.
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Archer J, Lynn N, Coombes L, Roberts M, Gale T, Price T, Regan de Bere S. The impact of large scale licensing examinations in highly developed countries: a systematic review. BMC Med Educ 2016; 16:212. [PMID: 27543269 PMCID: PMC4992286 DOI: 10.1186/s12909-016-0729-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/08/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND To investigate the existing evidence base for the validity of large-scale licensing examinations including their impact. METHODS Systematic review against a validity framework exploring: Embase (Ovid Medline); Medline (EBSCO); PubMed; Wiley Online; ScienceDirect; and PsychINFO from 2005 to April 2015. All papers were included when they discussed national or large regional (State level) examinations for clinical professionals, linked to examinations in early careers or near the point of graduation, and where success was required to subsequently be able to practice. Using a standardized data extraction form, two independent reviewers extracted study characteristics, with the rest of the team resolving any disagreement. A validity framework was used as developed by the American Educational Research Association, American Psychological Association, and National Council on Measurement in Education to evaluate each paper's evidence to support or refute the validity of national licensing examinations. RESULTS 24 published articles provided evidence of validity across the five domains of the validity framework. Most papers (n = 22) provided evidence of national licensing examinations relationships to other variables and their consequential validity. Overall there was evidence that those who do well on earlier or on subsequent examinations also do well on national testing. There is a correlation between NLE performance and some patient outcomes and rates of complaints, but no causal evidence has been established. CONCLUSIONS The debate around licensure examinations is strong on opinion but weak on validity evidence. This is especially true of the wider claims that licensure examinations improve patient safety and practitioner competence.
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Affiliation(s)
- Julian Archer
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
| | - Nick Lynn
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
| | - Lee Coombes
- Centre for Medical Education, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - Martin Roberts
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
| | - Tom Gale
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
| | - Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
| | - Sam Regan de Bere
- Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, Devon UK
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Östgren CJ, Krook-Brandt M, Carlborg A. [Internship-test reveals increased knowledge gaps]. Lakartidningen 2016; 113:DXH7. [PMID: 27070392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We present the results of the medical knowledge test after fulfilled internship for Swedish medical authorization during the years 2009 to the spring of 2015. A total of 7,613 tests were analyzed. Interns graduated from Swedish universities failed in 2.7% to 3.8% of the test moments. Interns who graduated from countries within the European Union (EU) failed in 21.2% and interns graduated from a non-EU country failed in 41.6%. The results from those who graduated from EU and non-EU countries have worsened compared to an earlier study in 2009. Proper measures have now to be implemented for doctors graduated from a non-Swedish university to improve the outcome and introduction to the Swedish health care system.
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Affiliation(s)
- Carl-Johan Östgren
- Allmänmedicin/IMV - Linköping, Sweden Allmänmedicin/IMV - Linköping, Sweden
| | - Margareta Krook-Brandt
- LIME/MedStat - Karolinska Institutet Stockholm, Sweden LIME/MedStat - Karolinska Institutet Stockholm, Sweden
| | - Andreas Carlborg
- Norra Stockholms Psykiatri - Akutpsykiatri 11281, Sweden Norra Stockholms Psykiatri - Akutpsykiatri 11281, Sweden
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Hultberg P, Karlberg I. [Patient safety requires a better certification process. Immediate reforms needed for physicians trained outside the EU]. Lakartidningen 2016; 113:DY4F. [PMID: 27070395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Pernilla Hultberg
- Goteborgs universitet Sahlgrenska Akademin - Goteborg, Sweden Goteborgs universitet Sahlgrenska Akademin - Goteborg, Sweden
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