Current practice focus trends in physical medicine and rehabilitation.

BACKGROUND: Physical medicine and rehabilitation (PM&R) is a diverse specialty, growing and evolving over a variety of subspecialty and practice focus areas. Accurate data regarding practice patterns of physiatrists are essential for updating requirements in training and certification, particularly as the Accreditation Council for Graduate Medical Education begins its process to update of the PM&R core residency training requirements. This study analyzes practice trends for nearly 98% of physiatrists in active practice, the largest study to date. OBJECTIVE: To update current demographics of physicians specializing in PM&R, including current areas of practice focus, to analyze the alignment of practice focus with subspecialty certification, and to determine the extent that electromyography is a component of current physiatric practice. DESIGN: Retrospective analysis of deidentified responses from American Board of Physical Medicine and Rehabilitation (ABPMR) board-certified PM&R physicians (diplomates) on annual enrollment in the ABPMR Continuing Certification program. PARTICIPANTS: A total of 9543 ABPMR diplomates. MAIN OUTCOME MEASURES: Demographics - age, gender, years in practice, practice setting(s) and area(s). Practice focus, subspecialty certifications. RESULTS: The majority of practicing physiatrists are men (62%) although the percentage of women in the field is growing (38%). Nearly 80% of physiatrists report more than one practice focus area, with pain medicine and sports medicine/musculoskeletal practices most commonly reported. CONCLUSIONS: This study confirms the growth trends in PM&R in pain and sports medicine but also highlights the substantial number of physiatrists focusing their practices in areas related to neurorehabilitation and medical rehabilitation. The large majority of physiatrists incorporate multiple focus areas into their practices. Electromyography is a focus for a declining percentage of practicing physiatrists.

Performance on the American Board of Physical Medicine and Rehabilitation certifying examinations: Rural and urban physicians.

BACKGROUND: Over 60 million people in the United States live in a rural community making up approximately 20% of the population. Data are minimal about the physiatrists who serve this rural population, their performance on certification examinations and how the American Board of Physical Medicine and Rehabilitation (ABPM&R) serves their ongoing educational, assessment, and practice needs. OBJECTIVE: To compare the performance of rural and urban physicians on the Part I, Part II, and maintenance of certification (MOC) examinations along with subspecialty preference and continuance of primary certification. DESIGN: Retrospective cross-sectional study. SETTING: Board-eligible PM&R physicians and certified diplomates of the ABPM&R. PARTICIPANTS: Physicians who participated in an initial certification or maintenance of certification examination with the ABPM&R between 2010 and 2019. METHODS: Comparisons of physician pass rates, mean scaled scores (aggregates), and program pass rates on ABPM&R certifying examinations were completed. Cross-reference to national database and ABPM&R practice site zip codes provided sociogeographic linkage. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Physician mean scaled scores, pass rates, subspecialty preferences, and primary certification status. RESULTS: There were no meaningful differences in performance on the ABPM&R Part I, II, and MOC examinations between rural and urban physiatrists. Most common subspecialty is the pain medicine certification whose diplomates most frequently drop their primary certification. Pediatric rehabilitation medicine certification is rare in rural localities and a health care disparity. CONCLUSION: The study found no meaningful differences in the performance of rural and urban physicians on the ABPM&R certifying examinations.

Current status and trends in subspecialty certification in physical medicine and rehabilitation.

BACKGROUND: There is a need to better understand the overall state of sub-specialization in physical medicine and rehabilitation (PM&R). OBJECTIVE: To examine the status and trends in subspecialty certification for each of the seven subspecialties approved for American Board of Physical Medicine and Rehabilitation (ABPMR) diplomates. DESIGN/SETTING: Retrospective analysis of deidentified information from the ABPMR database. PARTICIPANTS: Physicians certified by ABPMR through 2019. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: For each subspecialty, we examined: (1) the number of certificates issued to ABPMR diplomates; (2) the recertification rate; (3) the yearly trends for total active, new, and expired certificates; and (4) for ABPMR-administered subspecialties, recertification rates for those entering the subspecialty through fellowship completion versus a "grandfathered" practice pathway. RESULTS: Of 11,421 ABPMR diplomates in the United States in 2019, a total of 3560 (31.2%) had 3985 active subspecialty certificates. Pain Medicine (PM) was the most common subspecialty certification (15.5% of all ABPMR diplomates) followed by Sports Medicine (SM, 6.6%), Brain Injury Medicine (BIM, 4.8%), Spinal Cord Injury Medicine (SCIM, 4.2%), Pediatric Rehabilitation Medicine (PRM, 2.5%), Neuromuscular Medicine (NMM, 0.7%), and Hospice and Palliative Medicine (HPM, 0.5%). For diplomates with more than one subspecialty certification, PM and SM was the most frequent combination. Both the recertification rate and the end of practice track eligibility influenced certification trends differently for individual subspecialties. The average number of new certificates added annually for every subspecialty was higher before than after the temporary practice track-based eligibility ended; the difference was statistically significant (p < .05) for SCIM, PM, SM, and NMM. The recertification rate for all subspecialties combined was 73.4%. For the subspecialties (SCIM, PRM) for which these data were available, fellowship candidates had higher recertification rates than those grandfathered through a practice track. CONCLUSION: This report informs stakeholders about the state and evolution of subspecialty certification in PM&R over time.

Why Do Physical Medicine and Rehabilitation Physicians Lose American Board of Physical Medicine and Rehabilitation Board Certification?

OBJECTIVE: Physicians can lose board certification through revocation related to professionalism violations or expiration due to failure to complete continuing certification requirements. The purpose of this study was to analyze the causes of board certification loss for physicians with board certification through the American Board of Physical Medicine and Rehabilitation. DESIGN: This retrospective cohort study analyzed the certification status of 5541 American Board of Physical Medicine and Rehabilitation diplomates between 1993 and 2019 to determine reasons for certification loss. A focused analysis of diplomates with expired certificates in 2019 was conducted to further examine reasons for certificate expiration. RESULTS: Of 5541 physicians, 496 (9%) had certification expiration due to failure to meet continuing certification requirements and 60 (1%) had certification revocation due to disciplinary actions, without regaining certification across the study years. A focused analysis of physicians with expired certificates in 2019 revealed that the majority had failed to complete multiple components of continuing certification. Practice improvement was the single most common incomplete requirement. Failure to pass the knowledge assessment was an uncommon cause for certification loss. CONCLUSIONS: Certification expiration through failure to complete all continuing certification requirements, versus revocation, is responsible for most instances of board certification loss. Practice improvement was the most common incomplete requirement.

American Board of Physical Medicine and Rehabilitation Diplomate Customization Choices on the Longitudinal Assessment for Physical Medicine and Rehabilitation: A First-Year Experience.

ABSTRACT: The American Board of Physical Medicine and Rehabilitation began administering the longitudinal assessment for physical medicine and rehabilitation for continuing certification in 2020. The longitudinal assessment for physical medicine and rehabilitation digitally delivers quarterly short assessments of content and repeats missed items to facilitate learning as well as serve as a summative certification assessment. With a goal of offering content relevant to an individual's practice and learning needs, diplomates choose how to customize the domains or topic areas of their question content on an annual basis. This report describes the first year of experience with customization of longitudinal assessment for physical medicine and rehabilitation. The American Board of Physical Medicine and Rehabilitation diplomate customization data are grouped and compared in a variety of ways to ascertain whether there are differences in customization choices. While customization choices were similar across several domains, significant differences were seen when comparing groups with specific areas of practice or subspecialty certification. Smaller differences were also seen when comparing question domain allocation choice between sexes, age groups, and practice setting. The results from this first full year of experience confirm an alignment of this innovative assessment approach to individual physician practice, a significant step in improving the relevance of continuing certification overall for participating physicians.

Comparison of State Board Disciplinary Actions in Board-Certified Versus Non-Board-Certified Physical Medicine and Rehabilitation Physicians.

OBJECTIVES: Our goals were to estimate how many physicians who were enrolled in a physical medicine and rehabilitation residency program are licensed to practice medicine without American Board of Physical Medicine and Rehabilitation board certification and to compare risk of state medical board disciplinary action with those who are board certified. DESIGN: We matched physicians who completed training in physical medicine and rehabilitation before 2019 with the Federation of State Medical Boards database. We compared certified versus noncertified physicians registered with Federation of State Medical Boards and frequencies of disciplinary action. RESULTS: There were 14,729 physicians with matched American Board of Physical Medicine and Rehabilitation and Federation of State Medical Boards data. Of these, 13,707 (93.1%) had attained initial American Board of Physical Medicine and Rehabilitation certification and 1022 (6.9%) had not. Certification status predicted a disciplinary action (odds ratio = 2.76; 95% confidence interval = 2.202-3.463; P < 0.001). Compared with the board-certified physicians, those who never passed part I (attempted once or more) were 4.68 times more likely to have a disciplinary action (P < 0.001), and those who passed part I with multiple attempts but failed part II (1 or more times) were 3.26 times more likely to have a disciplinary action (P = 0.013). CONCLUSIONS: Absence of American Board of Physical Medicine and Rehabilitation certification is noted in approximately 7% of physicians who undertook physical medicine and rehabilitation residency training and obtained medical licensure. These individuals are at higher risk for state medical board disciplinary action.

Taking Leave During Residency: Types of Absences and Subsequent Delays and Variations in Physical Medicine and Rehabilitation Medical Board Pass Rates.

ABSTRACT: There is limited literature examining the reasons physical medicine and rehabilitation residents take an extended leave of absence during residency and the impact of leave on board examination performance. Such information could better inform leave policies, help guide residency program directors, and potentially destigmatize taking leave. Study objectives were to describe the characteristics of physical medicine and rehabilitation residents who take leave during residency, compare differences in part I (written) and part II (oral) certification examination performance, and determine the prevalence of delays in taking board examinations. Study methodology was a retrospective analysis of deidentified information from the American Board of Physical Medicine and Rehabilitation database between 2008 and 2020. Results indicated four reasons for extended leave of absence: medical, parental, academic/remediation, and unspecified personal reasons. Residents who took an extended leave of absence for medical or parental reasons had similar or better odds of passing their part I and part II examinations compared with those without leave. Residents who took leave for academic/remediation concerns or unspecified personal reasons had lower odds of passing their board examinations. Examination delays for those taking parental or personal health leaves did not affect board pass rates. Further investigation is needed to identify how to support residents on academic/remediation and unspecified leaves during training.

Key Findings From Peer-Reviewed Published Research by the American Board of Physical Medicine and Rehabilitation in Review.

ABSTRACT: Recognizing the dearth of published research on board certification in physical medicine and rehabilitation and its subspecialties, the American Board of Physical Medicine and Rehabilitation has increased efforts to conduct and disseminate research in this area. This report summarizes key findings of peer-reviewed studies published by American Board of Physical Medicine and Rehabilitation staff and leadership in the past 6 yrs, including those conducted in partnership with other entities. The reported studies are organized in three main categories: initial certification, continuing certification, and subspecialty certification in physical medicine and rehabilitation. Related findings are further grouped into subsections that include psychometric evaluation of certification examinations, association of candidate characteristics with certification performance, relationship of certification performance to other measures, and candidate reaction and feedback. Collectively, the summarized results provide evidence that the board certification process is reliable, statistically valid, and predictive of the risk of disciplinary action in subsequent years. These studies also describe facets of our specialty including degree of subspecialization, burnout, and how people maintain certification over time. We hope that physical medicine and rehabilitation trainees, diplomates, institutions, programs, and other stakeholders find this information useful and look forward to continuing research in these and other areas in the spirit of constant evidence-based improvement and feedback to our specialty.

Current and projected workforce of spinal cord injury medicine board-certified physicians through 2040.

Care delivered by physicians experienced and trained in spinal cord injury medicine (SCIM) offers benefit to individuals with spinal cord injury (SCI). The American Board of Physical Medicine and Rehabilitation (ABPMR) offers board certification (BC) to physicians who have met eligibility requirements. Enough individuals must earn and maintain BC in order to maintain a SCIM specialty-trained workforce. This study used demographic data of physicians with SCIM BC obtained from the ABPMR, American Board of Internal Medicine, American Board of Medical Specialties, and National Resident Matching Program. Since the SCIM Examination was first offered, 723 physicians received initial certification, and 464 physicians held BC in 2020. Peak workforce size is estimated to have occurred in 2007, and SCIM fellowship trained-BC physicians began to make up the majority of all current SCIM board-certified physicians in 2019. Models for best fit were developed with known data. Projections suggest a continued decrease in total SCIM board-certified physicians until 2034, then only a slight increase until steady state is reached with 376 SCIM board-certified physicians. If the number of individuals receiving SCIM BC remains unchanged, there will be reductions in SCIM board-certified physicians for another 15 years. Whether this supply meets demand is unknown.

Interrater Reliability in the American Board of Physical Medicine and Rehabilitation Part II Certification Examination: Impact of a New Assessment Design.

OBJECTIVE: The design of medical board certification examinations continues to evolve with advances in testing innovations and psychometric analysis. The potential for subjectivity is inherent in the design of oral board examinations, making improvements in reliability and validity especially important. The purpose of this quality improvement study was to analyze the impact of using two examiners on the overall reliability of the oral certification examination in physical medicine and rehabilitation. DESIGN: This was a retrospective quality improvement study of 422 candidates for the American Board of Physical Medicine and Rehabilitation Part II Examination in 2020. Candidates were examined by examiner pairs, each of whom submitted independent scores. Training for all 116 examiners included examination case review, scoring guidelines, and bias mitigation. Examiner performance was analyzed for both internal consistency (intrarater reliability) and agreement with their paired examiner (interrater reliability). RESULTS: The reliability of the Part II Examination was high, ranging from 0.93 to 0.94 over three administrations. The analysis also demonstrated high interrater agreement and examiner internal consistency. CONCLUSIONS: A high degree of interrater agreement was found using a new, two-examiner format. Comprehensive examiner training is likely the most significant factor for this finding. The two-examiner format improved the overall reliability and validity of the Part II Examination.

Influence of Sex and Age on Ratings of Confidence and Relevance in Continuing Certification Longitudinal Assessment: A Pilot Study.

OBJECTIVE: Longitudinal assessments use spaced repetition of items to facilitate learning. Algorithms selecting repetition items can prioritize various properties for future presentation. The purpose of this pilot study was to evaluate the relationship between participant ratings of item-specific confidence and/or practice relevance and participant age, sex, and response correctness. DESIGN: This is a prospective quality improvement study of 403 American Board of Physical Medicine and Rehabilitation diplomates with time-limited certificates. Participants answered 20 items quarterly over four quarters, rating each item on its relevance to their practice and their confidence in their response. RESULTS: The relationship between sex and ratings of response confidence was significant, with women less likely than men to be confident in their responses, regardless of correctness. Younger physicians were significantly more confident in their responses and rated items as more practice relevant. CONCLUSIONS: Women physicians were less confident than men in their item-specific confidence ratings, regardless of correctness, on the American Board of Physical Medicine and Rehabilitation continuing certification longitudinal knowledge assessment. Older physicians were less confident in their responses than younger physicians. The findings supported the American Board of Physical Medicine and Rehabilitation prioritization of response correctness and practice relevance, rather than response confidence, to select items for spaced repetition in American Board of Physical Medicine and Rehabilitation's continuing certification longitudinal assessment.

Evaluation of Longitudinal Assessment for Use in Maintenance of Certification.

OBJECTIVE: The aim of the study was to evaluate a longitudinal assessment program for physical medicine and rehabilitation (LA-PM&R) as a replacement for the American Board of Physical Medicine and Rehabilitation maintenance of certification examination. DESIGN: In this quality improvement study, randomly selected American Board of Physical Medicine and Rehabilitation diplomates were invited to participate in the LA-PM&R. Participants' maintenance of certification scaled scores were compared with LA-PM&R nonparticipants. We examined the association between LA-PM&R scores and maintenance of certification scaled scores and performance on clone items placed on both examinations. RESULTS: There were 2222 American Board of Physical Medicine and Rehabilitation diplomates eligible to take the maintenance of certification examination from February 2018 to February 2019. Invitations were sent to 1050 randomly selected diplomates, of whom 448 initially agreed. Three hundred eighteen individuals completed more than two quarters of LA-PM&R participation and took the maintenance of certification examination. Two hundred sixty-six diplomates took the maintenance of certification examination in the same period who did not participate in LA-PM&R. The LA-PM&R group scored higher on the maintenance of certification examination than the control group (P < 0.05). Performance on the two examinations were highly correlated, r = .50, P < 0.0001. On clone items, LA-PM&R participants had 74% correct on the LA-PM&R but 86% correct on the maintenance of certification examination (P < 0.01). CONCLUSIONS: The LA-PM&R program leads to better learning and retention of information than the 10-yr maintenance of certification examination.

Association of Participation in the American Board of Physical Medicine and Rehabilitation Maintenance of Certification Program and Physician Disciplinary Actions.

OBJECTIVE: The study analyzed the relationship between participation in the American Board of Physical Medicine and Rehabilitation maintenance of certification program and the incidence of disciplinary actions by state medical boards over a physician's career. The hypothesis is that physicians who do not maintain their board certification have a higher likelihood of state medical board disciplinary actions. DESIGN: This retrospective cohort study analyzed American Board of Physical Medicine and Rehabilitation maintenance of certification data from all board-certified physiatrists who were enrolled in the American Board of Physical Medicine and Rehabilitation maintenance of certification program from 1993 to 2007. RESULTS: Matching examination and license data were available for 4794 physicians, who received a total of 212 disciplinary action reports through the Federation of State Medical Boards. The results showed that physicians who have a lapse in completing the American Board of Physical Medicine and Rehabilitation maintenance of certification program have a 2.5-fold higher incidence of receiving a disciplinary action report through the Federation of State Medical Boards (95% confidence interval = 1.76-3.63) and had higher severity violations (χ = 7.14, P < 0.05) than physicians whose certificate never lapsed. CONCLUSIONS: For physicians in physical medicine and rehabilitation, loss of board certification through failure to fulfill the maintenance of certification program requirements is associated with an increased risk of disciplinary action from a state medical licensing board.

Allopathic (MD) and Osteopathic (DO) Performance on the American Board of Physical Medicine and Rehabilitation Initial Certifying Examinations.

BACKGROUND: Osteopathic physicians (DOs) represent over 30% of residents in allopathic (MD) Accreditation Council for Graduate Medical Education (ACGME) accredited physical medicine and rehabilitation (PM&R) training programs. However, some have questioned the quality of osteopathic medical school training and the graduates of osteopathic medical schools. The performance of osteopathic physicians in allopathic PM&R training programs has not been assessed. OBJECTIVE: To compare allopathic (MD) and osteopathic (DO) physician performance on American Board of Physical Medicine and Rehabilitation (ABPMR) initial certifying examinations. DESIGN: Retrospective cross-sectional study. SETTING: Board-eligible PM&R physicians. PARTICIPANTS: MDs and DOs who completed an allopathic ACGME-accredited PM&R residency training program. METHODS: MD and DO pass rates and mean scaled scores on the ABPMR initial certifying examinations were compared. MD versus DO degrees and training program 6 years aggregate board pass rates were independent variables. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: MD and DO pass rates and mean scaled scores on the ABPMR initial certifying examinations. RESULTS: Of the 2187 physicians who were first-time ABPMR initial certifying examination takers, there were 1596 MDs (73%) and 591 DOs (27%). No statistically significant difference was found in pass rates between MDs and DOs on Part I (94.9% vs. 93.9%, P = .35) or Part II (87.8% vs. 88%, P = .83) of the ABPMR certifying examination. Analysis of mean scaled scores demonstrated higher MD scores on both Part I ( 526, SD = 31, vs. 516, SD = 67, P = .002) and Part II ( 6.73, SD = .83 vs. 6.62, SD = .77, P = .005), significant only in programs with a 90%-100% pass rate. These differences, however, were of very small magnitude and likely not meaningful from a clinical or educational perspective. CONCLUSION: This study did not find meaningful differences in performance on the ABPMR certifying examinations between MDs and DOs.

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

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

Burnout in Diplomates of the American Board of Physical Medicine and Rehabilitation-Prevalence and Potential Drivers: A Prospective Cross-Sectional Survey.

BACKGROUND: Physician burnout is of growing concern. Burnout among physical medicine and rehabilitation (PM&R) physicians has shown a significant increase, positioning PM&R as one of the most "burned out" of specialties. Little has been written about potential factors contributing to physiatrist burnout or potential interventions. OBJECTIVE: To determine the prevalence of burnout among physiatrists and identify risk factors for burnout and potential strategies to decrease burnout among physiatrists. DESIGN: Prospective cross-sectional survey. SETTING: National survey of board certified physiatrists. PARTICIPANTS: One thousand five hundred thirty-six physiatrists certified by the American Board of PM&R. OUTCOME: The Mini-Z Burnout Survey, 1 question from the Maslach Burnout Scale on callousness toward patients, and several potential drivers of burnout. The probability of burnout, identified by question 3 on the Mini-Z, was the dependent variable. Other questions on the Mini-Z were explored as independent variables using logistic regression. RESULTS: Seven hundred seventy physiatrists (50.7%) fulfilled the definition of burnout. Only 38% of physiatrists reported not becoming more callous toward patients. The top 3 causes of burnout identified by physiatrists were increasing regulatory demands, workload and job demands, and practice inefficiency and lack of resources. Higher burnout rate was associated with high levels of job stress and working more hours per week. Lower burnout rates were associated with higher job satisfaction, control over workload, professional values aligned with those of department leaders, and sufficient time for documentation. There was no significant association between burnout and sex, years in practice, practice focus, or practice area. CONCLUSION: Burnout is a significant problem among PM&R physicians and is pervasive throughout the specialty. Opportunities exist to address major contributing drivers of burnout relating to practice patterns and efficiency of care within PM&R. These opportunities are, to varying degrees, under the control of hospital leaders, practice administrators, and practitioners.

Is There Evidence of Gender Bias in the Oral Examination for Initial Certification by the American Board of Physical Medicine & Rehabilitation?

OBJECTIVE: Unconscious bias may result in a prejudicial evaluation of another person and lead to unfair treatment. Potential gender bias risk exists in the scoring process on the American Board of Physical Medicine and Rehabilitation oral examination (Part II) because of the face-to-face interactions between candidates and examiners. This study was undertaken to determine whether performance on the American Board of Physical Medicine and Rehabilitation Part II examination differed based on candidate gender or configuration of examiner/candidate gender pairings. The impact of examiner unconscious bias training on candidate performance was also assessed. DESIGN: This is a retrospective observational study of first-time Part II physical medicine and rehabilitation certification examination test takers between 2013 and 2018. RESULTS: There were significant differences in pass rates (men 84%, women 89%) and mean scaled scores (men 6.56, women 6.81) between men and women (P < 0.001) with the biggest domain score differences in data acquisition and interpersonal and communication skills. Implementation of examiner unconscious bias training did not impact candidate performance. CONCLUSIONS: Women candidates scored higher and had a higher pass rate than men candidates overall on the American Board of Physical Medicine and Rehabilitation Part II examination. This difference does not seem to be due to scoring gender bias by the Part II examiners or due to candidate aptitude as measured on the Part I examination.

Administration and performance on the Spinal Cord Injury Medicine Certification Examination over a 10-year period.

Context/Objective: The examination for Spinal Cord Injury (SCI) Medicine subspecialty certification has been administered since 1998, but published information about exam performance or administration is limited. Design: Retrospective review Setting/Participants: We examined de-identified information from the American Board of Physical Medicine and Rehabilitation (ABPMR) database for characteristics and performance of candidates (n = 566) who completed the SCI Medicine Examination over a 10-year period (2005-2014), during which the exam outline and passing standard remained consistent. Interventions: Not applicable Outcome Measures: We analysed candidate performance by candidate track, primary specialty, number of attempts, and domains being tested. We also examined candidate perception of the SCI Medicine Exam by analysing responses to a survey taken after exam completion. Results: Thirty-six percent of candidates who completed the exam during the study period took it for initial certification (23% in the fellowship track and 13% in the practice track offered during the initial "grandfathering" period) and 64% took it for maintenance of certification (MOC) in SCI Medicine. Factors associated with better exam performance included primary specialty certification in Physical Medicine and Rehabilitation (PM&R) and first attempt at passing the exam. For PM&R candidates, ABPMR Part I Examination scores and SCI Medicine Examination scores were strongly correlated. Candidate feedback about the exam was largely positive with 97% agreeing or strongly agreeing that it was relevant to the field and 90% that it was a good test of their knowledge. Conclusion: This study can inform prospective candidates for the SCI Medicine Examination as well as those guiding them. It may also provide useful information for future exam development.

Predictors of Performance on the American Board of Physical Medicine and Rehabilitation Maintenance of Certification Examination.

BACKGROUND: Maintenance of certification (MOC) in Physical Medicine and Rehabilitation is a process of lifelong learning that begins after successfully completing an Accreditation Council for Graduate Medical Education (ACGME)-accredited residency and passing the American Board of Physical Medicine and Rehabilitation (ABPMR) Part I and Part II Examinations. We seek to identify factors predictive of successful MOC Examination performance. OBJECTIVE: To identify characteristics predictive of successful completion on the ABPMR MOC Examination. DESIGN: Retrospective review. SETTING: American Board of Physical Medicine and Rehabilitation database review. PARTICIPANTS: 4,545 diplomates who completed the MOC Examination between January 2006 and December 2017. METHODS: MOC Examination performance was the primary outcome variable. Performance on Part I and Part II Examinations were independent variables. Additional potential predictors evaluated included year of MOC cycle in which examination was taken, years of practice since residency completion, age, and subspecialty certification. MAIN OUTCOME MEASURES: Performance on MOC Examination. RESULTS: Age at time of MOC Examination was inversely correlated with examination score (r = -0.14, P < .001). Similarly, as time since completion of residency training increased, MOC scores declined. Passing the Part I Examination on first attempt predicted a 98% MOC pass rate, compared to 90% for those who failed initially. MOC performance was highly correlated with Part I performance (r = 0.59, P < .001) and Part II performance (r = 0.32, P < .001). Although MOC performance was similar for those taking the examination in years 7 - 10 of their cycle (97% pass rate), those taking the examination after more than 10 years of the cycle had a significantly lower performance (85% pass rate, P < .01). CONCLUSIONS: Better performance on the MOC Examination is associated with better performance on Part I and Part II Examinations, taking the examination earlier in the 10 year cycle, younger age, and less time since completion of training. Diplomates who are at higher risk for failing the examination may need to prepare differently for MOC Exam than those who are more likely to pass. LEVEL OF EVIDENCE: III.

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

BACKGROUND: Pediatric rehabilitation medicine (PRM) physicians enter the field via several pathways. It is unknown whether different training pathways impact performance on the American Board of Physical Medicine and Rehabilitation (ABPMR) PRM Examination and Maintenance of Certification (MOC) Examination. OBJECTIVES: To describe the examination performance of candidates on the ABPMR PRM Examination according to their type of training (physiatrists with a clinical PRM focus, accredited or unaccredited fellowship training, separate pediatric and physical medicine and rehabilitation residencies, or combined pediatrics/physical medicine and rehabilitation residencies) and to compare candidates' performance on the PRM Examination with their initial ABPMR certification and MOC Examinations. DESIGN: A retrospective cohort study. SETTING: American Board of Physical Medicine and Rehabilitation office. PARTICIPANTS: A total of 250 candidates taking the PRM subspecialty certification examination from 2003 to 2015. METHODS: Scaled scores on the PRM Examination were compared to the examinees' initial certification scores as well as their admissibility criteria. Pass rates and scaled scores also were compared for those taking their initial PRM certification versus MOC. MAIN OUTCOME MEASUREMENTS: Board pass rates and mean scaled scores for initial PRM Examination and MOC. RESULTS: The 250 physiatrists who took the subspecialty PRM Examination had an overall first-time pass rate of 89%. There was no significant difference between first-time PRM pass rates or mean scaled scores for individuals who completed an Accreditation Council for Graduate Medical Education-accredited fellowship versus those who did not. First time PRM pass rates were greatest among those who were also certified by the American Board of Pediatrics (100%). Performance on Parts I and II of the initial ABPMR Certification Examination significantly predicted PRM Examination scores. There was no difference in mean scaled scores for initial PRM certification versus taking the PRM Examination for MOC. CONCLUSIONS: Several pathways to admissibility to the PRM Examination afforded similar opportunity for diplomates to gain the knowledge necessary to pass the PRM Examination. Once certified, physicians taking the PRM Examination for MOC have a high success rate of passing again in years 7-10 of their certification cycle. LEVEL OF EVIDENCE: III.