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.

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.

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.

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.

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.

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.

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.

Association between EMS Question Bank Completion and Passing Rates on the EMS Certification Examination.

INTRODUCTION: A board review question bank was created to assist candidates in their preparation for the 2015 EMS certification examination. We aimed to describe the development of this question bank and evaluate its successes in preparing candidates to obtain EMS subspecialty board certification. METHODS: An online question bank was developed by 13 subject matter experts who participated as item writers, representing eight different EMS fellowship programs. The online question bank consisted of four practice tests, with each of the tests comprised of 100 questions. The number of candidates who participated in and completed the question bank was calculated. The passing rate among candidates who completed the question bank was calculated and compared to the publicly reported statistics for all candidates. The relationship between candidates' performance on the question bank and subspecialty exam pass rates was determined. RESULTS: A total of 252 candidates took at least one practice test and, of those, 225 candidates completed all four 100-question practice tests. The pass rate on the 2015 EMS certification exam was 79% (95%CI 74-85%) among candidates who completed the question bank, which is 12% higher than the overall pass rate (p = 0.003). Candidates' performance on the question bank was positively associated with overall success on the exam (X2 = 75.8, p < 0.0001). Achieving a score of ≥ 70% on the question bank was associated with a higher likelihood of passing the exam (OR = 17.8; 95% CI: 8.0-39.6). CONCLUSION: Completing the question bank program was associated with improved pass rates on the EMS certification exam. Strong performance on the question bank correlated with success on the exam.

Cross-comparison of MRCGP & MRCP(UK) in a database linkage study of 2,284 candidates taking both examinations: assessment of validity and differential performance by ethnicity.

BACKGROUND: MRCGP and MRCP(UK) are the main entry qualifications for UK doctors entering general [family] practice or hospital [internal] medicine. The performance of MRCP(UK) candidates who subsequently take MRCGP allows validation of each assessment. In the UK, underperformance of ethnic minority doctors taking MRCGP has had a high political profile, with a Judicial Review in the High Court in April 2014 for alleged racial discrimination. Although the legal challenge was dismissed, substantial performance differences between white and BME (Black and Minority Ethnic) doctors undoubtedly exist. Understanding ethnic differences can be helped by comparing the performance of doctors who take both MRCGP and MRCP(UK). METHODS: We identified 2,284 candidates who had taken one or more parts of both assessments, MRCP(UK) typically being taken 3.7 years before MRCGP. We analyzed performance on knowledge-based MCQs (MRCP(UK) Parts 1 and 2 and MRCGP Applied Knowledge Test (AKT)) and clinical examinations (MRCGP Clinical Skills Assessment (CSA) and MRCP(UK) Practical Assessment of Clinical Skills (PACES)). RESULTS: Correlations between MRCGP and MRCP(UK) were high, disattenuated correlations for MRCGP AKT with MRCP(UK) Parts 1 and 2 being 0.748 and 0.698, and for CSA and PACES being 0.636. BME candidates performed less well on all five assessments (P < .001). Correlations disaggregated by ethnicity were complex, MRCGP AKT showing similar correlations with Part1/Part2/PACES in White and BME candidates, but CSA showing stronger correlations with Part1/Part2/PACES in BME candidates than in White candidates. CSA changed its scoring method during the study; multiple regression showed the newer CSA was better predicted by PACES than the previous CSA. CONCLUSIONS: High correlations between MRCGP and MRCP(UK) support the validity of each, suggesting they assess knowledge cognate to both assessments. Detailed analyses by candidate ethnicity show that although White candidates out-perform BME candidates, the differences are largely mirrored across the two examinations. Whilst the reason for the differential performance is unclear, the similarity of the effects in independent knowledge and clinical examinations suggests the differences are unlikely to result from specific features of either assessment and most likely represent true differences in ability.

Parameters of training, academic involvement, and practice setting predictive of retention in combined medical-psychiatric practice.

OBJECTIVE: The authors contrasted physicians trained in both psychiatry and another specialty who continue to practice both specialties vs. those who practice only psychiatry, in terms of their training, academic profile, and practice setting. METHOD: The authors analyzed survey responses from 132 doubly boarded physicians who vary in whether or not they continue to practice both specialties. Group results were compared using chi square, Fisher exact, and t tests. RESULTS: Of graduates of double-board programs, 79.2% continue in dual practice. Other factors associated with continued combined practice were training in neurology-psychiatry, greater academic involvement, high motivation, practice in a non-public hospital setting, and demonstrated leadership capacity. CONCLUSION: Double-board training programs have been successful in producing a group of clinicians committed to long-term combined medical-psychiatric practice, but this effect is stronger in psychiatry-neurology than in other types of combined practice. Future research should investigate other practice parameters that foster or impede integrated medical-psychiatric care.

[Women pioneers: first female cardiothoracic surgeons in the USA and in Israel].

At the beginning of the 1960's, three female doctors managed to break the glass ceiling and become the first female cardiothoracic surgeons in the USA. Since then, the number of certified female cardiothoracic surgeons has steadily increased. Nevertheless, females stilt only account for a minority of cardiothoracic surgeons in the USA. In Israel, three women have become specialists in cardiothoracic surgery over the last two decades, aLthough these surgeons are working as general thoracic surgery consultants, without any representative females in cardiac surgery.

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.

Ophthalmology Residency Match outcomes for 2011.

PURPOSE: To determine the match rate and predictors of matching into an ophthalmology residency. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: All 746 candidates who submitted an application for the 2011 ophthalmology residency match. METHODS: The Ophthalmology Residency Matching Program applicant database was reviewed to determine applicant characteristics and match outcomes. For US seniors, multivariate regression analysis was performed to determine predictors of matching. MAIN OUTCOME MEASURES: Match rate and predictors of US seniors matching. RESULTS: Rank lists were submitted by 622 applicants, among whom 458 (74%) matched. The match rate was higher for US seniors (83%) than for independent applicants (41%; P < 0.001). US seniors who matched were more likely to be Alpha Omega Alpha medical honor society members (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.16-7.29), to attend medical schools ranked in the top 40 according to National Institutes of Health funding (OR, 2.25; CI, 1.14-4.43), and to have ranked more programs (OR, 1.44; CI, 1.29-1.60). Those ranking 6 to 10 programs had an 80% to 90% chance of matching, and those ranking more than 10 programs had a greater than 90% chance of matching. No clear benefit was observed by ranking additional programs once 11 had already been ranked. Average US Medical Licensing Examination Step 1 scores were 239 ± 14 and 223 ± 18 for applicants who were matched and unmatched, respectively; this difference was significant by univariate analysis (P < 0.001) but not by multivariate regression (P = 0.163). CONCLUSIONS: Ophthalmology ranks among the most competitive specialties in medicine. Those most likely to match were US seniors who maintained academic excellence beginning in their preclinical years. A finite relationship exists between ranking a greater number of programs and having a greater chance of matching.

Factors affecting admission to anesthesiology residency in the United States: choosing the future of our specialty.

BACKGROUND: Admission to an anesthesiology residency in the United States is competitive, and the odds associated with a successful match based on the applicants' characteristics have not been determined. The objective of this study was to examine factors associated with admission to anesthesiology residency in the United States. METHODS: The study was a retrospective cohort evaluation of the 2010 to 2011 residency applicants. Applicants' characteristics and objective factors used to select trainees were extracted. The primary outcome was a successful match to an anesthesiology residency. Data were analyzed using conditional inference tree analysis and propensity score matching. RESULTS: Data available from 1,976 applications were examined corresponding to 58% of the national sample. The odds (99% CI) for successful match were 3.6 (3.1-4.2) for U.S. medical school graduates, 2.6 (2.3 to 3.0) for applicants with United States Medical Licensing Examination Step 2 scores more than 210, and 1.2 (1.1 to 1.3) for female applicants. The odds (99% CI) for a successful match for international and U.S. graduate applicants younger than 29 yr was 3.3 (2.0-5.4) and (1.9 to 4.2), respectively, even after propensity matching for medical school, exam scores, and gender. The average applicant had no peer-reviewed scholarly productivity. CONCLUSION: Although anesthesiology residency acceptance was primarily associated with U.S. medical school attendance and United States Medical Licensing Examination Step 2 scores, our study suggest an influence of age and gender bias in the selection process. Peer-reviewed scholarly production among applicants and prior graduate education did not appear to influence candidate selection.

The role of international medical graduate psychiatrists in the United States healthcare system.

OBJECTIVE: International medical graduates (IMGs) make up a substantial proportion of the United States physician workforce, including psychiatrists in practice. The purpose of this study was to describe, based on current data, the characteristics and qualities of IMG psychiatrists who provide patient care in the US. METHOD: Physician data from the Educational Commission for Foreign Medical Graduates, American Medical Association, and American Board of Medical Specialties were combined. Descriptive statistics provided an overview of the characteristics and qualities of IMG psychiatrists. The authors contrasted demographic and practice profiles of IMG and U.S. medical graduate (USMG) psychiatrists. RESULTS: International medical graduates make up almost one-third of the practicing psychiatrist workforce. Nearly one-quarter of these individuals attended medical school in India. Compared with USMG psychiatrists, IMG psychiatrists were more likely to be employed in a hospital and less likely to be Board-certified by the American Board of Psychiatry and Neurology. CONCLUSIONS: International medical graduate psychiatrists play an important role in the U.S. healthcare system. Given their numbers and their propensity to practice in settings and areas where USMGs do not, efforts to monitor their practice patterns and qualities, both cross-sectionally and longitudinally, are warranted.

Empirical findings on legal difficulties among practicing psychiatrists.

BACKGROUND: This article reviews the published literature on areas of legal difficulty among practicing psychiatrists. METHODS: A literature search using PubMed identified studies of malpractice lawsuits or medical board discipline of psychiatrists between 1990 and 2009. Eight studies of physician discipline in the United States and one from the United Kingdom were identified. Information from 3 insurance companies and 3 sets of aggregated insurance company data also were available. One follow-up study of hospitalized psychiatric patients also was reviewed. RESULTS: Studies of medical board discipline indicate that, compared with other specialties, psychiatrists are at an increased risk of disciplinary action. Psychiatrists who were female, board certified, and in practice for a short period of time had a lower chance of medical board discipline. Psychiatry claims accounted for a very small proportion of overall malpractice claims and settlements. The amount of patient disability secondary to alleged malpractice was the most important variable predicting insurance payout. CONCLUSIONS: Psychiatrists appear to be disciplined by medical boards at an above-average frequency compared with other medical specialties. However, few malpractice suits reach the courts, and psychiatry represents a very small proportion of overall physician malpractice claims and dollars of settlement.

Do men outperform women during orthopaedic residency training?

BACKGROUND: Orthopaedic surgery residency has one of the lowest percentages of women (13.1%) of all primary surgical specialties. There are many possible reasons for this, including bias during the selection process. QUESTIONS/PURPOSES: We therefore asked whether performance during residency might adversely bias the selection of future female orthopaedic residents by researching whether males and females perform equally in orthopaedic surgery residency. METHODS: Ninety-seven residents enrolled in our residency between 1999 and 2009; six males and one female left the program, leaving 90 residents (73 males, 17 females) as the study cohort. Resident performance was compared for OITE scores, ABOS results, faculty evaluations, and in a resident graduate survey. RESULTS: Males and females had similar faculty evaluations in all ACGME competency areas. Males and females had similar mean OITE scores for Years 2-5 of residency, although males had higher mean scores at Years 3 through 5. Males and females had similar mean ABOS Part 1 scores and ABOS Part 1 pass rates; however, fewer males than females took more than one attempt to pass. Males and females had similar Part 2 pass rates or attempts. For the 45 resident graduates surveyed, females pursued fellowships equally to males, worked slightly less hours in practice, and reported higher satisfaction with their career choice. CONCLUSIONS: For the 90 residents at one residency program, we observed no differences between males' and females' performance. Although females pursue orthopaedic residency less frequently than males, performance during residency should not bias their future selection.