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01-08-2012 | Original Research

Relationship of Electronic Medical Knowledge Resource Use and Practice Characteristics with Internal Medicine Maintenance of Certification Examination Scores

Authors: Darcy A. Reed, MD, MPH, Colin P. West, MD, PhD, Eric S. Holmboe, MD, Andrew J. Halvorsen, MS, Rebecca S. Lipner, PhD, Carola Jacobs, BA, Furman S. McDonald, MD, MPH

Published in: Journal of General Internal Medicine | Issue 8/2012

ABSTRACT

BACKGROUND

Maintenance of certification examination performance is associated with quality of care. We aimed to examine relationships between electronic medical knowledge resource use, practice characteristics and examination scores among physicians recertifying in internal medicine.

METHODS

We conducted a cross-sectional study of 3,958 United States physicians who took the Internal Medicine Maintenance of Certification Examination (IM–MOCE) between January 1, 2006 and December 31, 2008, and who held individual licenses to one or both of two large electronic knowledge resource programs. We examined associations between physicians’ IM–MOCE scores and their days of electronic resource use, practice type (private practice, residency teaching clinic, inpatient, nursing home), practice model (single or multi-specialty), sex, age, and medical school location.

RESULTS

In the 365 days prior to the IM–MOCE, physicians used electronic resources on a mean (SD, range) of 20.3 (36.5, 0–265) days. In multivariate analyses, the number of days of resource use was independently associated with increased IM–MOCE scores (0.07-point increase per day of use, p = 0.02). Increased age was associated with decreased IM–MOCE scores (1.8-point decrease per year of age, p < 0.001). Relative to physicians working in private practice settings, physicians working in residency teaching clinics and hospital inpatient practices had higher IM–MOCE scores by 29.1 and 20.0 points, respectively (both p < 0.001).

CONCLUSIONS

Frequent use of electronic resources was associated with modestly enhanced IM–MOCE performance. Physicians involved in residency education clinics and hospital inpatient practices had higher IM–MOCE scores than physicians working in private practice settings.

American Board of Medical Specialties. Maintenance of Certification. http://www.abms.org/Maintenance_of_Certification/ABMS_MOC.aspx. Accessed January 7, 2012.

Drazen JM, Weinstein DF. Considering recertification. N Engl J Med. 2010;362:946–947.PubMedCrossRef

Lipner RS, Bylsma WH, Arnold GK, Fortna GS, Tooker J, Cassel CK. Who is maintaining certification in internal medicine–and why? A national survey 10 years after initial certification. Ann Intern Med. 2006;144(1):29–36.PubMed

Cassel CK, Holmboe ES. Credentialing and public accountability: a central role for board certification. JAMA. 2006;295(8):939–940.PubMedCrossRef

Brennan TA, Horwitz RI, Duffy FD, Cassel CK, Goode LD, Lipner RS. The role of physician specialty board certification status in the quality movement. JAMA. 2004;292(9):1038–1043.PubMedCrossRef

Sharp LK, Wang R, Lipsky MS. Perception of Competency to Perform Procedures and Future Practice Intent: A National Survey of Family Practice Residents. Acad Med. 2003;78(9):926–932.PubMedCrossRef

Holmboe ES, Lipner R, Greiner A. Assessing quality of care: knowledge matters. JAMA. 2008;299(3):338–340.PubMedCrossRef

American Board of Internal Medicine. Requirements for Maintenance of Certification. http://www.abim.org/moc/requirements-for-MOC.aspx. Accessed January 7, 2012.

Norcini JJ, Shea JA, Benson JA Jr. Changes in the medical knowledge of candidates for certification. Ann Intern Med. 1991;114(1):33–35.PubMed

10.

Norcini JJ, Grosso LJ, Shea JA, Webster GD. The relationship between features of residency training and ABIM certifying examination performance. J Gen Intern Med. 1987;2(5):330–336.PubMedCrossRef

11.

Norcini JJ, Webster GD, Grosso LJ, Blank LL, Benson JA Jr. Ratings of residents’ clinical competence and performance on certification examination. J Med Educ. 1987;62(6):457–462.PubMedCrossRef

12.

Norcini JJ, Lipner RS, Benson JA Jr, Webster GD. An analysis of the knowledge base of practicing internists as measured by the 1980 recertification examination. Ann Intern Med. 1985;102(3):385–389.PubMed

13.

Norcini JJ, Lipner RS, Kimball HR. Certifying examination performance and patient outcomes following acute myocardial infarction. Med Educ. 2002;36(9):853–859.PubMedCrossRef

14.

Norcini JJ, Boulet JR, Dauphinee WD, Opalek A, Krantz ID, Anderson ST. Evaluating the quality of care provided by graduates of international medical schools. Health Affairs. 2010;29(8):1461–1468.PubMedCrossRef

15.

Chen J, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Physician board certification and the care and outcomes of elderly patients with acute myocardial infarction. J Gen Intern Med. 2006;21(3):238–244.PubMedCrossRef

16.

Prystowsky JB, Bordage G, Feinglass JM. Patient outcomes for segmental colon resection according to surgeon’s training, certification, and experience. Surgery. 2002;132(4):663–670.PubMedCrossRef

17.

Holmboe ES, Wang Y, Meehan TP, et al. Association between maintenance of certification examination scores and quality of care for Medicare beneficiaries. Arch Intern Med. 2008;168(13):1396–1403.PubMedCrossRef

18.

Pham HH, Schrag D, Hargraves JL, Bach PB. Delivery of preventive services to older adults by primary care physicians. JAMA. 2005;294(4):473–481.PubMedCrossRef

19.

Davidoff F. Continuing Medical Education Resources. J Gen Intern Med. 1997;12(S2):S15–S19.PubMedCrossRef

20.

Duffy FD, Holmboe ES. Self-assessment in lifelong learning and improving performance in practice: physician know thyself. JAMA. 2006;296(9):1137–1139.PubMedCrossRef

21.

Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142(4):260–273.PubMed

22.

Norcini JJ, Maihoff NA, Day SC, Benson JA Jr. Trends in medical knowledge as assessed by the certifying examination in internal medicine. JAMA. 1989;262(17):2402–2404.PubMedCrossRef

23.

Marinopoulos SS, Dorman T, Ratanawongsa N, et al. Effectiveness of continuing medical education. Evid Rep Tech Assess (Full Rep). 2007;149:1–69.

24.

Bloom BS. Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews. Int J Technol Assess Health Care. 2005;21(3):380–385.PubMedCrossRef

25.

Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995;274(9):700–705.PubMedCrossRef

26.

Leach DC, Fletcher SW. Perspectives on continuing education in the health professions: improving health care through lifelong learning. Chest. 2008;134(6):1299–1303.PubMedCrossRef

27.

Goldman L, Goroll AH, Kessler B. Clinical Decisions. American Board of Internal Medicine Maintenance of Certification Program, Recommendation 2: Do not enroll in the current MOC program. N Engl J Med. 2010;362:950–952.

28.

Gruppen LD, Frohna AZ. Clinical reasoning. In: Norman GR, van der Vleuten CP, Newble DI, eds. International Handbook of Research in Medical Education. Dordrecht: Kluwer Academic; 2002:205–230.

29.

Bowen JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2006;355:2217–2225.PubMedCrossRef

30.

McDonald FS, Zeger SL, Kolars JC. Factors associated with medical knowledge acquisition during internal medicine residency. J Gen Intern Med. 2007;22(7):962–968.PubMedCrossRef

31.

American College of Physicians. PIER, Physicians’ information and Education Resource. Available at: http://pier.acponline.org/overview.html. Accessed January 7, 2012.

32.

UpToDate. About the company. Available at: http://www.uptodate.com/home/about/about.html. Accessed January 7, 2012.

33.

Brennan RL, Ed. Educational Measurement. Fourth ed. Westport, CT: Praeger Publishers; 2006.

34.

Callahan CA, Hojat M, Veloski J, Erdmann JB, Gonnella JS. The Predictive Validity of Three Versions of the MCAT in Relation to Performance in Medical School, Residency, and Licensing Examinations: A Longitudinal Study of 36 Classes of Jefferson Medical College. Acad Med. 2010;85(6):980–7.

35.

McDonald FS, Zeger SL, Kolars JC. Associations between United States Medical Licensing Examination (USMLE) and Internal Medicine In-Training Examination (IM-ITE) scores. J Gen Intern Med. 2008;23(7):1016–1019.PubMedCrossRef

36.

Grossman RS, Fincher RM, Layne RD, Seelig CB, Berkowitz LR, Levine MA. Validity of the in-training examination for predicting American Board of Internal Medicine certifying examination scores. J Gen Intern Med. 1992;7(1):63–67.PubMedCrossRef

37.

Babbott SF, Beasley BW, Hinchey KT, Blotzer JW, Holmboe ES. The predictive validity of the internal medicine in-training examination. Am J Med. 2007;120(8):735–740.PubMedCrossRef

38.

Carney PA, Poor DA, Schifferdecker KE, Gephart DS, Brooks WB, Nierenberg DW. Computer use among community-based primary care physician preceptors. Acad Med. 2004;79(6):580–590.PubMedCrossRef

39.

McGee SR, Irby DM. Teaching in the Outpatient Clinic: Practical Tips. J Gen Intern Med. 1997;12(S2):S34–S40.PubMedCrossRef

40.

Lipner R, Song H, Biester T, Rhodes R. Factors that influence general internists’ and surgeons’ performance on maintenance of certification exams. Acad Med. 2010;86(1):53–58.CrossRef

41.

Lavis JN, Lomas J, Hamid M, Sewankambo NK. Bull World Health Organ. 2006;84:620–628.PubMedCrossRef

Title: Relationship of Electronic Medical Knowledge Resource Use and Practice Characteristics with Internal Medicine Maintenance of Certification Examination Scores
Authors: Darcy A. Reed, MD, MPH
Colin P. West, MD, PhD
Eric S. Holmboe, MD
Andrew J. Halvorsen, MS
Rebecca S. Lipner, PhD
Carola Jacobs, BA
Furman S. McDonald, MD, MPH
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 8/2012
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-012-2017-5

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BACKGROUND

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