Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing?

BACKGROUND: There is considerable variation among physicians in inappropriate antibiotic prescribing, which is hypothesized to be attributable to diagnostic uncertainty and ineffective communication. The objective of this study was to evaluate whether clinical and communication skills are associated with antibiotic prescribing for upper respiratory infections and sinusitis. METHODS: A cohort study of 2,526 international medical graduates and 48,394 U.S. Medicare patients diagnosed by study physicians with an upper respiratory infection or sinusitis between July 2014 and November 2015 was conducted. Clinical and communication skills were measured by scores achieved on the Clinical Skills Assessment examination administered by the Educational Commission for Foreign Medical Graduates (ECFMG) as a requirement for entry into U.S residency programs. Medicare Part D data were used to determine whether patients were dispensed an antibiotic following an outpatient evaluation and management visit with the study physician. Physician age, sex, specialty and practice region were retrieved from the ECFMG databased and American Medical Association (AMA) Masterfile. Multivariate GEE logistic regression was used to evaluate the association between clinical and communication skills and antibiotic prescribing, adjusting for other physician and patient characteristics. RESULTS: Physicians prescribed an antibiotic in 71.1% of encounters in which a patient was diagnosed with sinusitis, and 50.5% of encounters for upper respiratory infections. Better interpersonal skills scores were associated with a significant reduction in the odds of antibiotic prescribing (OR per score decile 0.93, 95% CI 0.87-0.99), while greater proficiency in clinical skills and English proficiency were not. Female physicians, those practicing internal medicine compared to family medicine, those with citizenship from the US compared to all other countries, and those practicing in southern of the US were also more likely to prescribe potentially unnecessary antibiotics. CONCLUSIONS: Based on this study, physicians with better interpersonal skills are less likely to prescribe antibiotics for acute sinusitis and upper respiratory infections. Future research should examine whether tailored interpersonal skills training to help physicians manage patient expectations for antibiotics could reduce unnecessary antibiotic prescribing.

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.

Investigating first instinct fallacy in cytology education and cytomorphology examination.

INTRODUCTION: The specific aims of the study are to assess whether answer changing on a high-stakes cytomorphology examination will lower the cytology examinees' scores and to examine whether there is a difference in the frequency of responses changed between high-, average-, and low-performing cytology learners. The paper also seeks to explore if there is a correlation between outcomes of answer changes (success rates) and cytology learner's levels of performance. MATERIALS AND METHODS: The eraser marks and pen cross-outs on the cytology final image examinations from 2019-2023 were reviewed and the number of changes made by the examinees and the frequency to which scores were raised or lowered as a result was recorded. Moreover, the response change patterns and outcomes across low-, medium-, and high-performing cytology learners were further analyzed for possible relationships. RESULTS: Among the total number of questions where answer(s) were changed (n = 98), close to half (n = 47, 48.0%) of the changes resulted in raising the score, compared with about one-third (n = 34, 34.7%) that lowered it. When the students were classified into academic abilities, there was a significant correlation between the success rates of answers changed across low-, medium-, and higher-performing learners χ2 (df = 24, n = 24) = 10.24, P < 0.05. Our data also showed the average student group to have the highest "scores raised" to "scores lowered" ratio. CONCLUSIONS: Based on these findings, those cytology examinees who are overly cautious about changing initial responses during a high-stake multiple-choice question BOC test may put themselves at a disadvantage.