Demographic Trends From 2005 to 2015 Among Physicians With Accreditation Council for Graduate Medical Education-Accredited Anesthesiology Training and Active Medical Licenses.

BACKGROUND: A temporary decrease in anesthesiology residency graduates that occurred around the turn of the millennium may have workforce implications. The aims of this study are to describe, between 2005 and 2015, (1) demographic changes in the workforce of physicians trained as anesthesiologists; (2) national and state densities of these physicians, as well as temporal changes in the densities; and (3) retention of medical licenses by mid- and later-career anesthesiologists. METHODS: Using records from the American Board of Anesthesiology and state medical and osteopathic boards, the numbers of licensed physicians aged 30-59 years who had completed Accreditation Council for Graduate Medical Education-accredited anesthesiology residency training were calculated cross-sectionally for 2005, 2010, and 2015. Demographic trends were then described. Census data were used to calculate national and state densities of licensed physicians. Individual longitudinal data were used to describe retention of medical licenses among older physicians. RESULTS: The number of licensed physicians trained as anesthesiologists aged 30-59 years increased from 32,644 in 2005 to 36,543 in 2010 and 36,624 in 2015, representing a national density of 1.10, 1.18, and 1.14 per 10,000 population in those years, respectively. The density of anesthesiologists among states ranged from 0.37 to 3.10 per 10,000 population. The age distribution differed across the years. For example, anesthesiologists aged 40-49 years predominated in 2005 (47%), but by 2015, only 31% of anesthesiologists were aged 40-49 years. The proportion of female anesthesiologists grew from 22% in 2005, to 24% in 2010, and to 28% in 2015, particularly among early-career anesthesiologists. For anesthesiologists with licenses in 2005, the number who still had active licenses in 2015 decreased by 9.6% for those aged 45-49 years, by 14.1% for those aged 50-54 years, and by 19.7% for those aged 55-59 years. CONCLUSIONS: The temporary decrease in anesthesiology residency graduates around the turn of the 21st century decreased the proportion of anesthesiologists who were midcareer as of 2015. This may affect the future availability of senior leaders as well as the future overall workforce in the specialty as older anesthesiologists retire. National efforts to plan for workforce needs should recognize the geographical variability in the distribution of anesthesiologists.

The growth of teledermatology: Expanding to reach the underserved.

The regulation of telemedicine in the United States is evolving, with new legislation expanding reimbursement and cross-state licensing capabilities. As telemedicine grows, communities with limited access to traditional dermatologic care may find a solution in teledermatology. A search of the medical literature and online health care law resources published within the past decade was performed to assess the current status of telemedicine availability, health record integration and security, reimbursement policy, and licensure requirements in the United States, with a focus on teledermatology. The majority of states have implemented policies requiring private insurance coverage. Medicaid reimburses some form of telemedicine in all states but restricts which modalities can be used and by which specialties. Medicare places the heaviest limitations on telemedicine coverage. Twenty-four states and Guam are members of the Interstate Medical Licensure Compact (IMLC), and 27 states offer alternative cross-state practice options. With the advent of publicly and privately funded programs, volunteer efforts, and mobile applications, teledermatology is more readily available to rural and underserved communities.

Investigation of answer changes on the USMLE® Step 2 Clinical Knowledge examination.

BACKGROUND: Examinees often believe that changing answers will lower their scores; however, empirical studies suggest that allowing examinees to change responses may improve their performance in classroom assessments. To date, no studies have been able to examine answer changes during large scale professional credentialing or licensing examinations. METHODS: In this study, we expand the research on answer changes by analyzing responses from 27,830 examinees who completed the Step 2 Clinical Knowledge (CK) examination between August of 2015 and August of 2016. RESULTS: The results showed that although 68% of examinees changed at least one item, the overall average number of changes was small. Among the examinees who changed answers, approximately 45% increased their scores and approximately 28% decreased their scores. On average, examinees spent shortest time on the item changes from wrong to right and they were more likely to change their scores from wrong to right than right to wrong. CONCLUSIONS: Consistent with previous studies, these findings support the beneficial effects of answer changes in high-stakes medical examinations and suggest that examinees who are overly cautious about changing answers may put themselves at a disadvantage.

International Medical Graduates in Nephrology: Roles, Rules, and Future Risks.

International medical graduates (IMGs) have become an increasingly essential part of many residency and fellowship programs in the United States. IMGs, who may be of either US or non-US citizenship, contribute significantly to the physician workforce across this country, particularly in underserved areas, as well as in their home countries on their return after training. Approximately 65% of nephrology fellows are IMGs, with most of these being non-US citizens. Non-US IMG applications for nephrology fellowship have been declining, exacerbating an ongoing shortage of nephrology trainees. IMGs face visa status restrictions and immigration policy concerns, limitations on federally funded research support, and difficulty finding desirable jobs in both private practices and academia after fellowship. We review training, examination, and licensure requirements, as well as visa status rules for IMGs. We also discuss the potential negative impact of recent immigration policies limiting the entry of non-US IMGs on the medical community in general and in nephrology in particular.

[Model study programs in medicine : Innovations in medical education in Hamburg and Berlin]. / Modellstudiengänge in der Medizin : Lehrinnovationen am Beispiel der Studiengänge in Hamburg und Berlin.

Medical science is constantly evolving. Teaching and training must keep pace with these innovations and react in a flexible fashion to new requirements. Model medical education programs, which are governed by the provisions of Sect. 41 of the Regulations for the Licensing of Medical Practitioners (ÄAppO), permit the piloting of innovative teaching programs, which support the continuous development of medical training through incorporation into the standard curricula. This paper reports on the model study programs at the University Medical Centre Hamburg-Eppendorf (iMED) and Charité - University Medicine Berlin (MSM). It describes the reform objectives, the curricula and selected projects accompanying both models and concludes by exploring the significance of various training concepts for the development of medical education.

[Competence-based assessment in the national licensing examination in Germany]. / Kompetenzorientiert prüfen im Staatsexamen Medizin.

In Germany, future physicians have to pass a national licensing examination at the end of their medical studies. Passing this examination is the requirement for the license to practice medicine. The Masterplan Medizinstudium 2020 with its 41 measures aims to shift the paradigm in medical education and medical licensing examinations.The main goals of the Masterplan include the development towards competency-based and practical medical education and examination as well as the strengthening of general medicine. The healthcare policy takes into account social developments, which are very important for the medical education and licensing examination.Seven measures of the Masterplan relate to the realignment of the licensing examinations. Their function to drive learning should better support students in achieving the study goal defined in the German Medical Licensure Act: to educate a medical doctor scientifically and practically who is qualified for autonomous and independent professional practice, postgraduate education and continuous training.

Does the National Resident Match Program Rank List Predict Success in Emergency Medicine Residency Programs?

BACKGROUND: Emergency medicine (EM) residency programs use nonstandardized criteria to create applicant rank lists. One implicit assumption is that predictive associations exist between an applicant's rank and their future performance as a resident. To date, these associations have not been sufficiently demonstrated. OBJECTIVES: We hypothesized that a strong positive correlation exists between the National Resident Match Program (NRMP) match-list applicant rank, the United States Medical Licensing Examination (USMLE) Step 1 and In-Training Examination (ITE) scores, and the graduating resident rank. METHODS: A total of 286 residents from five EM programs over a 5-year period were studied. The applicant rank (AR) was derived from the applicant's relative rank list position on each programs' submitted NRMP rank list. The graduation rank (GR) was determined by a faculty consensus committee. GR was then correlated to AR using a Spearman's partial rank correlation. Additional correlations were sought with a ranking of the USMLE Step Score (UR) and the ITE Score (IR). RESULTS: Combining data for all five programs, weak positive correlations existed between GR and AR, UR, and IR. The majority of correlations ranged between. When comparing GR and AR, there was a weak correlation of 0.13 (p = 0.03). CONCLUSION: Our study found only weak correlations between GR and AR, UR, and IR, suggesting that those variables may not be strong predictors of resident performance. This has important implications for EM programs considering the resources devoted to applicant evaluation and ranking.

Trends in national licensing examinations in medicine.

CONTEXT: As a contribution to this special issue commemorating the journal's 50th volume, this paper seeks to explore directions for national licensing examinations (NLEs) in medicine. Increases in the numbers of new medical schools and the mobility of doctors across national borders mean that NLEs are becoming even more important to ensuring physician competence. OBJECTIVES: The purpose of this paper is to explore the use of NLEs in the future in the context of global changes in medical education and health care delivery. METHODS: Because the literature related to NLEs is so large, we have not attempted a comprehensive review, but have focused instead on a small number of topics on which we think we have something useful to say. The paper is organised around five predicted trends for NLEs. DISCUSSION: The first section discusses reasons why we think the use of NLEs will increase in the coming years. The second section discusses the ongoing problem of content specificity and its implications for the design of NLEs. The third section examines the evolution of large-scale, standardised cognitive assessments in NLEs and suggests some future directions. Reflecting the fact that NLEs are, increasingly, attempting to assess more than just knowledge, the fourth section addresses the future of large-scale clinical skills assessments in NLEs, predicting both increases in their use and some shifts in the nature of the stations used. The fifth section discusses workplace-based assessments, predicting increases in their use for formative assessment and identifying some limitations in their direct application in NLEs. The concluding section discusses the cost of NLEs and indulges in some further speculations about their evolution.

The impact of large scale licensing examinations in highly developed countries: a systematic review.

BACKGROUND: To investigate the existing evidence base for the validity of large-scale licensing examinations including their impact. METHODS: Systematic review against a validity framework exploring: Embase (Ovid Medline); Medline (EBSCO); PubMed; Wiley Online; ScienceDirect; and PsychINFO from 2005 to April 2015. All papers were included when they discussed national or large regional (State level) examinations for clinical professionals, linked to examinations in early careers or near the point of graduation, and where success was required to subsequently be able to practice. Using a standardized data extraction form, two independent reviewers extracted study characteristics, with the rest of the team resolving any disagreement. A validity framework was used as developed by the American Educational Research Association, American Psychological Association, and National Council on Measurement in Education to evaluate each paper's evidence to support or refute the validity of national licensing examinations. RESULTS: 24 published articles provided evidence of validity across the five domains of the validity framework. Most papers (n = 22) provided evidence of national licensing examinations relationships to other variables and their consequential validity. Overall there was evidence that those who do well on earlier or on subsequent examinations also do well on national testing. There is a correlation between NLE performance and some patient outcomes and rates of complaints, but no causal evidence has been established. CONCLUSIONS: The debate around licensure examinations is strong on opinion but weak on validity evidence. This is especially true of the wider claims that licensure examinations improve patient safety and practitioner competence.

Assessment in the context of licensure and certification.

Over the past 25 years, three major forces have had a significant influence on licensure and certification: the shift in focus from educational process to educational outcomes, the increasing recognition of the need for learning and assessment throughout a physician's career, and the changes in technology and psychometrics that have opened new vistas for assessment. These forces have led to significant changes in assessment for licensure and certification. To respond to these forces, licensure and certification programs have improved the ways in which their examinations are constructed, scored, and delivered. In particular, we note the introduction of adaptive testing; automated item creation, scoring, and test assembly; assessment engineering; and data forensics. Licensure and certification programs have also expanded their repertoire of assessments with the rapid development and adoption of simulation and workplace-based assessment. Finally, they have invested in research intended to validate their programs in four ways: (a) the acceptability of the program to stakeholders, (b) the extent to which stakeholders are encouraged to learn and improve, (c) the extent to which there is a relationship between performance in the programs and external measures, and (d) the extent to which there is a relationship between performance as measured by the assessment and performance in practice. Over the past 25 years, changes in licensure and certification have been driven by the educational outcomes movement, the need for lifelong learning, and advances in technology and psychometrics. Over the next 25 years, we expect these forces to continue to exert pressure for change which will lead to additional improvement and expansion in examination processes, methods of assessment, and validation research.

Revalidation for relicensing - reflections on the proposed British model.

BACKGROUND: In the United Kingdom, the General Medical Council aims to introduce revalidation for all medical doctors from 2012, in response to public and government pressure. Doctors will submit evidence to support their fitness to practise medicine every 5 years in relation to the four domains and 12 attributes of good medical practice. OBJECTIVE: This article reviews the argument for revalidation, the proposed process and some of the findings of a pilot carried out with general practitioners. DISCUSSION: A revalidation process is being piloted in several parts of the United Kingdom with a view to implementation in 2012. However, there is a lack of evidence internationally that revalidation or relicensure identifies doctors who are performing poorly. The medical profession in Australia needs to reflect on whether this model is one it wishes to consider.

Certification and licensing of clinical medical physicists in AFOMP countries.

In many countries the education and training of medical physicists has changed over the last few decades from being rather ad hoc to becoming structured with residency programs becoming quite common. These are often followed by formal certification by independent bodies, and medical physics professional organizations (MPPOs) affirming the quality of certified physicists and recognizing their competence and ability to practice independently. Policies on the training and education of medical physicists have been developed by the International Organization for Medical Physics (IOMP) and by the Asia-Oceania Federation of Organizations for Medical Physics (AFOMP). Currently nine countries in Asia-Oceania operate systems for the certification of clinical medical physicists and four others are planning or implementing such systems. The existing systems, which are described in this paper, generally conform to the policies. Licensing of medical physicists, which is primarily the responsibility of government bodies, is almost unknown in that region.

Evolution of Clinical Skills Assessment in the USMLE: Looking to the Future After Step 2 CS Discontinuation.

The COVID-19 pandemic interrupted administration of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam in March 2020 due to public health concerns. As the scope and magnitude of the pandemic became clearer, the initial plans by the USMLE program's sponsoring organizations (NBME and Federation of State Medical Boards) to resume Step 2 CS in the short-term shifted to long-range plans to relaunch an exam that could harness technology and reduce infection risk. Insights about ongoing changes in undergraduate and graduate medical education and practice environments, coupled with challenges in delivering a transformed examination during a pandemic, led to the January 2021 decision to permanently discontinue Step 2 CS. Despite this, the USMLE program considers assessment of clinical skills to be critically important. The authors believe this decision will facilitate important advances in assessing clinical skills. Factors contributing to the decision included concerns about achieving desired goals within desired time frames; a review of enhancements to clinical skills training and assessment that have occurred since the launch of Step 2 CS in 2004; an opportunity to address safety and health concerns, including those related to examinee stress and wellness during a pandemic; a review of advances in the education, training, practice, and delivery of medicine; and a commitment to pursuing innovative assessments of clinical skills. USMLE program staff continue to seek input from varied stakeholders to shape and prioritize technological and methodological enhancements to guide development of clinical skills assessment. The USMLE program's continued exploration of constructs and methods by which communication skills, clinical reasoning, and physical examination may be better assessed within the remaining components of the exam provides opportunities for examinees, educators, regulators, the public, and other stakeholders to provide input.