Variation in Oral Board Examination Accommodations Among Specialties.

Importance: Board certification can have broad implications for candidates' career trajectories, and prior research has found sociodemographic disparities in pass rates. Barriers in the format and administration of the oral board examinations may disproportionately affect certain candidates. Objective: To characterize oral certifying examination policies and practices of the 16 Accreditation Council for Graduate Medical Education (ACGME)-accredited specialties that require oral examinations. Design, Setting, and Participants: This cross-sectional study was conducted from March 1 to April 15, 2023, using data on oral examination practices and policies (examination format, dates, and setting; lactation accommodations; and accommodations for military deployment, family emergency, or medical leave) as well as the gender composition of the specialties' boards of directors obtained from websites, telephone calls and email correspondence with certifying specialists. The percentages of female residents and residents of racial and ethnic backgrounds who are historically underrepresented in medicine (URM) in each specialty as of December 31, 2021, were obtained from the Graduate Medical Education 2021 to 2022 report. Main Outcome and Measures: For each specialty, accommodation scores were measured by a modified objective scoring system (score range: 1-13, with higher scores indicating more accommodations). Poisson regression was used to assess the association between accommodation score and the diversity of residents in that specialty, as measured by the percentages of female and URM residents. Linear regression was used to assess whether gender diversity of a specialty's board of directors was associated with accommodation scores. Results: Included in the analysis were 16 specialties with a total of 46 027 residents (26 533 males [57.6%]) and 233 members of boards of directors (152 males [65.2%]). The mean (SD) total accommodation score was 8.28 (3.79), and the median (IQR) score was 9.25 (5.00-12.00). No association was found between test accommodation score and the percentage of female or URM residents. However, for each 1-point increase in the test accommodation score, the relative risk that a resident was female was 1.05 (95% CI, 0.96-1.16), and the relative risk that an individual was a URM resident was 1.04 (95% CI, 1.00-1.07). An association was found between the percentage of female board members and the accommodation score: for each 10% increase in the percentage of board members who were female, the accommodation score increased by 1.20 points (95% CI, 0.23-2.16 points; P = .03). Conclusions and Relevance: This cross-sectional study found considerable variability in oral board examination accommodations among ACGME-accredited specialties, highlighting opportunities for improvement and standardization. Promoting diversity in leadership bodies may lead to greater accommodations for examinees in extenuating circumstances.

Specialty Board Certification Rate as an Outcome Metric for GME Training Institutions: A Relationship With Quality of Care.

Educational outcome measures, known to be associated with the quality of care, are needed to support improvements in graduate medical education (GME). This retrospective observational study sought to determine whether there was a relationship between the specialty board certification rates of GME training institutions and the quality of care delivered by their graduates. It is based on 7 years of hospitalizations in Pennsylvania (N = 354,767) with diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal hemorrhage, or pneumonia. The 2,265 attending physicians were self-identified internists, and they completed their training in 59 institutions. The percentage of board-certified physicians from each training institution, excluding the physician herself or himself, was calculated and an indicator of whether it exceeded 80% was created. This was analyzed against inhospital mortality and length of stay, adjusted for patient/physician/hospital characteristics. There were significantly lower odds of mortality (adjusted Odd's ratio [OR] = .92, 95% CI [0.86, 0.98]) and log length of stay (adjusted OR = .98, 95% CI [.94, .99]) when the attending physician trained in a residency program with an 80% or greater certification rate. The results suggest that specialty certification rates may be a useful educational outcome for residency training programs.

USMLE Scores and Clinical Rotation Role in Predicting ABSITE Performance Among Surgery Interns.

BACKGROUND: The American Board of Surgery In-training Examination (ABSITE) is an important marker of medical knowledge. It is unclear what factors predict or improve these scores. We evaluated demographics, United States Medical Licensing Examination (USMLE) step 1 and 2 scores, and surgical rotations during the intern year to determine if there were any correlations with the ABSITE performance. METHODS: This was a multicenter retrospective review during a 6-y period, investigating the correlation and association of demographics, USMLE scores, and types of rotations on the ABSITE percentile score of interns. Demographics included age, gender, race/ethnicity, U.S. versus international/foreign medical graduate for stratified analyses. Descriptive analysis was performed with ANOVA, correlation was evaluated with 95% confidence interval, and significance was defined as P < 0.05. RESULTS: Complete records obtained on 89 interns from six different general surgery programs over 6 y revealed that there was a significant correlation between USMLE 1 and 2 with the ABSITE. USMLE 2 correlation was the strongest (r = 0.44, 95% confidence interval = [0.25-0.60], P < 0.05). There was a significant difference in ABSITE performance (mean score difference of 17.3 percentile, P = 0.01) of interns who had an intensive care unit rotation before examination. Other surgical rotations were not associated with an ABSITE difference. Demographic factors such as age, gender, race/ethnicity, or medical graduate background status were not associated with ABSITE scores. CONCLUSIONS: USMLE step 2 scores had a higher correlation with intern ABSITE performance. An intensive care unit rotation before taking the ABSITE was associated with a significant difference in their percentile scores. Demographic factors were not correlated with ABSITE performance.

Prediction of success at UK Specialty Board Examinations using the mandatory postgraduate UK surgical examination.

Background: While performance in other mandatory examinations taken at the beginning of a doctor's career are predictive of final training outcomes, the influence early postgraduate surgical examinations might have on success at Specialty Board Exams in the UK is currently unknown. The aim was to investigate whether performance at the mandatory Membership of the Royal College of Surgeons (MRCS) examination, and other variables, are predictive of success at the Fellowship of the Royal College of Surgeons (FRCS) examination, thus potentially identifying those who may benefit from early academic intervention. Methods: Pearson correlation coefficients examined the linear relationship between both examinations and logistic regression analysis identified potential independent predictors of FRCS success. All UK medical graduates who attempted either section of FRCS (Sections 1 and 2) between 2012 and 2018 were included. Results: First attempt pass rates for Sections 1 and 2 FRCS were 87.4 per cent (n = 854) and 91.8 per cent (n = 797) respectively. In logistic regression analysis, sex (male: odds ratio (OR) 2.32, 95 per cent c.i 1.43 to 3.76), age (less than 29 years at graduation: OR 3.22, 1.88 to 5.51), Part B MRCS attempts (1 attempt: OR 1.77, 1.08 to 3.00), Part A score (OR 1.14, 1.09 to 1.89) and Part B score (OR 1.06, 1.03 to 1.09) were independent predictors of Section 1 FRCS success. Predictors of Section 2 FRCS success were age (less than 29 years at graduation: OR 3.55, 2.00 to 6.39), Part A score (OR 1.06, 1.02 to 1.11) and Section 1 FRCS score (OR 1.13, 1.07 to 1.18). Conclusion: Part A and B MRCS performance were independent predictors of FRCS success, providing further evidence to support the predictive validity of this mandatory postgraduate exam. However, future research must explore the reasons between the attainment gaps observed for different groups of doctors.

Antecedentes: Si bien el resultado obtenido en otros exámenes obligatorios efectuados al inicio de la formación médica son predictores de los resultados finales obtenidos al terminar la etapa de formación, se desconoce la influencia que podrían tener los resultados de primeros exámenes quirúrgicos de postgrado en el éxito de los exámenes de la Comisión de Especialidad del Reino Unido. El objetivo fue investigar si los resultados obtenidos en el examen obligatorio para ser miembro del Real Colegio de Cirujanos (membership of the Royal College of Surgeons, MRCS) y de otras variables son predictores de éxito en el examen de ingreso de licenciados universitarios del Real Colegio de Cirujanos (Fellowship of the Royal College of Surgeons, FRCS), de modo, que fuera posible identificar a aquellos colectivos de cirujanos que podrían beneficiarse de una acción formativa temprana. Métodos: Se utilizaron los coeficientes de correlación de Pearson para evaluar la relación lineal entre ambos exámenes, y un análisis de regresión logística para identificar posibles variables predictivas de éxito del examen del FRCS. Se incluyeron todos los graduados médicos del Reino Unido que intentaron cualquier sección del FRCS (secciones 1 y 2) entre los años 2012 y 2018. Resultados: Al primer intento, las tasas de superación de las secciones 1 y 2 del FRCS fueron del 87,4% (n = 854) y del 91,8% (n = 797), respectivamente. En el análisis de regresión logística, el sexo (masculino, razón de oportunidades, odds ratio, OR 2,32, i.c. del 95% 1,43­3,76), la edad (menos de 29 años en el momento de la graduación, OR 3,22, 1,88­5,51), el número de intentos para superar la Parte B del MRCS (un intento, OR 1,77, 1,08­3,00) y la puntuación obtenida en las Partes A (OR 1,14, 1,09­1,89) y B del MRCS (OR 1,06, 1,03­1,09), fueron predictores independientes de éxito en la Sección 1 del FRCS. Los factores predictivos del éxito en la Sección 2 del FRCS fueron la edad (menos de 29 años a la graduación, 3,55, 1,88­5,51), la puntuación de la Parte A del MRCS (1,06, 1,02­1,11) y la puntuación de la Sección 1 del FRCS (1,13, 1,07­1,18). Conclusión: Los resultados de las partes A y B del MRCS fueron factores predictivos independientes del éxito del FRCS, lo que supone una evidencia adicional en favor de la validez predictiva de este examen obligatorio de postgrado. Sin embargo, la investigación futura debe explorar las razones entre las diferencias de logros observadas para diferentes grupos de médicos.

Gender distribution in psychiatry journals' editorial boards worldwide.

Gender disparity has been documented in advanced doctoral degrees, research, and academic positions, and therefore, it can logically be deduced that the gender disparity would be found in journals' editorial boards. In this study, we sought to determine the gender distribution in editorial boards of psychiatry journals worldwide. We also studied the academic achievements of editorial board members by comparing professional background, education level, and research productivity indices. We analyzed the gender of editorial members of 119 psychiatry journals from Clarivate Analytics' Journal Citation Reports. Our data included 8423 editorial board members from which we randomly selected 10% editorial board members to represent the full sample for further analyses. Overall, women represented 30.4% of editorial board and approximately 30% in each category: (1) Editor-in-chief/deputies, (2) Associate/section editors, (3) Editorial board*, and (4) Advisory board. The majority (65%) of men were M.D. psychiatrists, and women (58%) were Ph.D. psychologists. Women in editorial leadership positions (Category 1 & 2) were correlated with fewer women in editorial or advisory boards. Women had half the mean number of publications than men while serving journals with approximately the same mean impact factor. Our study results show that, besides gender disparity, gender bias does not exist in the psychiatry journal editorial boards. Given the implication of the editorial board position on science, academic advancement, and networking, this disparity remains detrimental to achieving equity, diversity, and inclusion in academic psychiatry.

Who gets certified by the American Board of Professional Psychology and why: A diversity survey.

OBJECTIVE: To measure the profile of diversity among specialists certified by the American Board of Professional Psychology (ABPP). METHOD: A survey of ABPP specialists consisting of 18 demographic questions, and two questions regarding board certification and experience with diversity. RESULTS: Although ABPP specialists appear to be more diverse in certain aspects, especially regarding sex/gender (female, 43% vs 34% in prior survey), the majority remain non-Hispanic, White in race/ethnicity (87%), followed by only 3% Black, and 3% Hispanic/Latinx representation. Recognition as a specialist, job requirement, and professional expectations were the top three reasons for board certification. The top three themes regarding specialists' experiences with diversity were (a) Need for active outreach and mentoring, (b) ABPP does a good job regarding diversity, and (c) Make it more affordable. CONCLUSION: With the need for a competent and diverse workforce, ABPP will continue to conduct this survey to determine the progress that has been made in increasing the diversity of certified specialists.

Relation between the number of board-certified gynecologic oncologists per hospital and survival of cervical cancer.

AIMS: In cancer therapy, choice of treatment method has a tremendous influence on patient prognosis. We aimed to evaluate the impact of the number of Gynecologic Oncology (GO) Specialists on treatment outcomes of cervical cancer patients. METHODS: We used data for 5-year treatment outcomes obtained from the annual treatment reports of the Gynecologic Oncology Committee of Japan Society of Obstetrics and Gynecology (JSOG). We compared this to data posted on the Japanese Society of Gynecologic Oncology (JSGO) website regarding the enrollment of GO Specialists at each hospital. RESULTS: The 5-year survival ratio of cervical cancer patients treated in hospitals with 2-or-more GO Specialists was 79.0% (2010/2543). This was significantly higher than 75.4% (974/1292) for facilities with 0 or 1 specialist (P = 0.011); however, the number of GO Specialists was not an independent prognostic factor (P = 0.77, adjusted HR: 1.13 [0.38-2.03]). The 5-year survival ratio significantly increased in medical facilities whose number of GO Specialists increased from 0 to 1 or more, or from 1 to 2 or more (P = 0.045). CONCLUSION: This study demonstrates a causal relationship between the numbers of GO Specialists and treatment outcomes of cervical cancer patients for the first time. Our study suggests that although JSGO board-certified gynecologic oncologists do clearly contribute to improving treatment outcome, the number of specialists was not an independent factor for improving the prognosis of the patients. Thus, it was not clear whether simply increasing the number of GO Specialists, beyond two, will lead to any significant improvement in cervical cancer patient prognosis.

Current status of young urologists and residents' activity and academic training in Spain. National survey results. / Estado actual de la actividad y formación académica de residentes y urólogos jóvenes en España. Resultados de una encuesta nacional.

OBJECTIVE: To study the current status of the activity and academic training of residents and young urologists in Spain. MATERIAL AND METHODS: From the working group of residents and young urologists of the Spanish Association of Urology (AEU), an anonymous survey of 32 questions was designed. Its aim was to evaluate the academic activity of residents, defined by: number of communications to congresses, publications in national and international journals, clinical rotations within Spain and abroad, master's degree, Doctorate (PhD), applications to the European Board of Urology exam and language competences. The survey was sent via email and disseminated through social networks. RESULTS: Ninety-one respondents were obtained; 66% affirmed not having publications in scientific journals, 67% did not perform rotations abroad. Only 21% claimed to have taken the EBU exam. Only 2% of the respondents had completed a Fellowship. Although most of them (82%) had not done so, they would be interested. However, 67% of respondents believed that the relevance of academic/research activity is from high to very high. CONCLUSIONS: Our results indicate that academic activity, scientific production and publication of articles of the residents and young urologists in Spain is low. Moreover, participation in the EBU exam, the completion of a master's degree, PhD, rotations and fellowship is low. In contrast, the assessment of scientific activity is considered to be very relevant.

Is There Gender Bias on the American Board of Surgery General Surgery Certifying Examination?

BACKGROUND: When oral examinations are administered, examiner subjectivity may possibly affect ratings, particularly when examiner severity is influenced by examinee characteristics (e.g., gender) that are independent of examinee ability. This study explored whether the ratings of the general surgery oral certifying examination (CE) of the American Board of Surgery and likelihood of passing the CE were influenced by the gender of examinees or examiners. MATERIALS AND METHODS: Data collected from examinees who attempted the general surgery CE in the 2016-2017 academic year were analyzed. There were 1341 examinees (61% male) and 216 examiners (82% male). Factorial analysis of variance and logistic regression analyses were used to evaluate the effect of examinee and examiner gender on CE ratings and likelihood of passing the CE. RESULTS: Examinees received similar ratings and had similar likelihood of passing the CE regardless of examinee or examiner genders and different combinations of examiner gender pairs (all P values > 0.05). CONCLUSIONS: These results indicate that CE ratings of examinees are not influenced by examinee or examiner gender. There was no evidence of examiner bias due to gender on the CE.

Performance on the Plastic Surgery In-Service Examination Can Predict Success on the American Board of Plastic Surgery Written Examination.

BACKGROUND: Originally developed for resident self-assessment, the Plastic Surgery In-Service Examination has been administered for over 45 years. The Accreditation Council for Graduate Medical Education requires that at least 70 percent of graduates pass the American Board of Plastic Surgery Written Examination on their first attempt. This study evaluates the role of In-Service Exam scores in predicting Written Exam success. METHODS: In-Service Exam scores from 2009 to 2015 were collected from the National Board of Medical Examiners. Data included residency training track, training year, and examination year. Written Exam data were gathered from the American Board of Plastic Surgery. Multivariate analysis was performed and receiver operating characteristic curves were used to identify optimal In-Service Exam score cut-points for Written Exam success. RESULTS: Data from 1364 residents were included. Residents who failed the Written Exam had significantly lower In-Service Exam scores than those who passed (p < 0.001). Independent residents were 7.0 times more likely to fail compared with integrated/combined residents (p < 0.001). Residents who scored above the optimal cut-points were significantly more likely to pass the Written Exam. The optimal cut-point score for independent residents was the thirty-sixth percentile and the twenty-second percentile for integrated/combined residents. CONCLUSIONS: Plastic Surgery In-Service Exam scores can predict success on the American Board of Plastic Surgery Written Exam. Residents who score below the cut-points are at an increased risk of failing. These data can help identify residents at risk for early intervention.

Physician Opinions about American Board of Family Medicine Self-Assessment Modules (2006-2016).

INTRODUCTION: Maintenance of Certification (MOC) was implemented to help physicians remain current with evolving medical standards, but has been criticized for being irrelevant to practice. We assessed family physicians' (FPs') opinions about the content of American Board of Family Medicine (ABFM) self-assessment modules (SAMs). METHODS: We used ABFM administrative data from feedback surveys completed after each of the 16 SAMs from 2006 to 2016. FPs rated agreement with 2 statements-1) "Content is appropriate for my practice," and 2) "Content was presented at an appropriate level"-on a scale of 1 (strongly disagree) to 6 (strongly agree). We calculated mean ratings of each statement by year and stratified by Knowledge Assessment (KA) and Clinical Simulation (CS) portions of the SAM. We plotted mean ratings by FPs' age at their first SAM completion and the total number of SAMs completed. RESULTS: SAMs were completed (n = 633,198) from 2006 to 2016 with 448,408 (71%) feedback surveys completed. The annual mean ratings of both statements varied little (less than 0.5) and were above 4.5 for all SAMs. CS ratings were consistently lower than KA ratings. FPs of all ages at first SAM provided similar ratings and agreement with content appropriateness increased with repeated exposure to SAMs. CONCLUSION: Over 11 years, the content of ABFM SAMs was regarded by FPs as appropriate for practice and presented at an appropriate level. Continued monitoring of feedback is necessary to keep the content of MOC programs relevant for physicians' practice.

A 15-year residency program report card: Differences between the crème of the crop and the bottom of the barrel on the American Board of Surgery examinations.

BACKGROUND: American Board of Surgery examination performance represents an important residency metric. The hypothesis is that demographic differences exist between the most and least successful programs. METHODS: This was a retrospective fifteen-year study. Data focused on program Examination Index (EI). The first and tenth decile programs were compared across demographics, using an α = 0.05. RESULTS: The first decile had a higher EI than the tenth decile (91.0% ±â€¯2 .6% vs 51.4% ±â€¯5.4% [p < 0.001]). The first decile programs were larger (p = 0.001). The first decile had more military and academic programs, with fewer community programs (p = 0.01). More first decile programs were in the West with fewer in the Northeast (p = 0.02). CONCLUSION: There are clear differences in ABS examination performance based on program size, type, and location. These results essentially perform a national needs-assessment, and may evoke a spirit of competition and collaboration.

Tumor Board Conferences for Multidisciplinary Skin Cancer Management: A Survey of US Cancer Centers.

Background: Tumor board conferences (TBCs) are used by oncologic specialists to review patient cases, exchange knowledge, and discuss options for cancer management. These multidisciplinary meetings are often a cornerstone of treatment at leading cancer centers and are required for accreditation by certain groups, such as the American College of Surgeons' Commission on Cancer. Little is known regarding skin cancer TBCs. The objective of this study was to characterize the structure, function, and impact of existing skin cancer TBCs in the United States. Methods: A cross-sectional online survey was administered to physician leaders of skin cancer TBCs at NCI-designated Comprehensive and Clinical Cancer Centers. Results: Of the 59 centers successfully contacted, 14 (24%) reported not having a conference where skin cancer cases were discussed, and 45 (76%) identified 53 physician leaders. A total of 38 physicians (72%) completed the survey. Half of the meeting leaders were medical and/or surgical oncologists, and dermatologists led one-third of meetings. TBCs had a moderate to significant impact on patient care according to 97% of respondents. All respondents indicated that the meetings enhanced communication among physicians and provided an opportunity for involved specialists and professionals to discuss cases. The most frequently cited barrier to organizing TBCs was determining a common available date and time for attendees (62%). The most common suggestion for improvement was to increase attendance, specialists, and/or motivation. Conclusions: Results showed overall consistency in meeting structure but variability in function, which may be a reflection of institutional resources and investment in the conference. Future directions include defining metrics to evaluate changes in diagnosis or management plan after tumor board discussion, attendance, clinical trial enrollment, and cost analysis. Results of this survey may aid other institutions striving to develop and refine skin cancer TBCs.

El método para establecer el punto de corte en el examen clínico objetivo estructurado define el desempeño de los candidatos a la certificación como reumatólogo / The method used to set the pass mark in an objective structured clinical examination defines the performance of candidates for certification as rheumatologists

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The Characteristics of Physicians Who are Re-Disciplined by Medical Boards: A Retrospective Cohort Study.

BACKGROUND: Physician misconduct adversely affects patient safety and is therefore of societal importance. Little work has specifically examined re-disciplined physicians. A study was conducted to compare the characteristics of re-disciplined to first-time disciplined physicians. METHODS: A retrospective review of Canadian physicians disciplined by medical boards between 2000 and 2015 was conducted. Physicians were divided into those disciplined once and those disciplined more than once. Differences in demographics, transgressions, and penalties were evaluated. RESULTS: There were 938 disciplinary events for 810 disciplined physicians with 1 in 8 (n = 101, 12.5%) being re-disciplined. Re-disciplined physicians had up to six disciplinary events in the study period and 4 (4.0%) had events in more than one jurisdiction. Among those re-disciplined, 94 (93.1%) were male, 34 (33.7%) were international medical graduates, and 88 (87.1%) practiced family medicine (n = 59, 58.4%), psychiatry (n = 11, 10.9%), surgery (n = 9, 8.9%), or obstetrics/gynecology (n = 9, 8.9%). The proportion of obstetrician/gynecologists was higher among re-disciplined physicians (8.9% vs. 4.2%, p = 0.048). Re-disciplined physicians had more mental illness (1.7% vs. 0.1%, p = 0.01), unlicensed activity (19.2% vs. 7.2%, p <0.01), and less sexual misconduct (20.1% vs. 27.9%, p = 0.02). License suspension occurred more frequently among those re-disciplined (56.8% vs. 48.0%, p = 0.02) as did license restriction (38.4% vs. 26.7%, p <0.01). License revocation was not different between cohorts (10.9% vs. 13.5%, p = 0.36). CONCLUSION: Re-discipline is not uncommon and underscores the need for better identification of at-risk individuals and optimization of remediation and penalties. The distribution of transgression argues for a national disciplinary database that could improve communication between jurisdictional medical boards.