We thank Alexandra Junn, AB, and Alexandra Jacob, MS, for data support (compensated in the normal course of their employment); Elizabeth Linos, PhD (uncompensated), and Amy J. Markowitz, JD (compensated), for critical editing; and the members of Physician Moms Group (uncompensated) for their participation.

The large ceiling effects limit the ability to use several of the KOOS subscales with the younger, more active ACL population. However, by creating an aggregate score from the KOOS, JR and 4 KOOS Quality of Life subscale questions, the 11-item KOOS offers a responsive PRO tool after ACL reconstruction that converges with the information captured with the IKDC. Also, by offering the ability to calculate multiple scores from a single questionnaire, the KOOS may provide the orthopaedic community a single PRO platform to be used across knee-related subspecialties. Registration: NCT00478894 ( ClinicalTrials.gov identifier).

The quality of the instrument used in the measurement process of survey data is fundamental to successful outcomes. Issues regarding content and structure are often addressed during instrument development, but the rating scale is just as important, and too often overlooked. Specifically for Likert-type questionnaires, the words used to describe rating categories and the placement of a neutral or not sure category is at the core of this measurement issue. This study utilizes the Rasch model to assess the quality of an instrument and structure of the rating scale for a typical data set collected at an institution of higher education. The importance of category placement and an evaluation of the use of a middle category for Likert-type survey data are highlighted.

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Purpose Lack of specialty board certification has been reported as a significant physician-level predictor of receiving a disciplinary action from a state medical board. This study investigated the association between family physicians receiving a disciplinary action from a state medical board and certification by the American Board of Family Medicine (ABFM). Method Three datasets were merged and a series of logistic regressions were conducted examining the relationship between certification status and disciplinary actions when adjusting for covariates. Data were available from 1976 to 2017. Predictor variables were gender, age, medical training degree type, medical school location, and the severity of the action. Results Of the family physicians in this sample, 95% (114,454/120,443) had never received any disciplinary action. Having ever been certified was associated with a reduced likelihood of ever receiving an action (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.30, 0.40; P < .001), and having held a prior but not current certification at the time of the action was associated with an increase in receiving the most severe type of action (OR = 3.71; 95% CI = 2.24, 6.13; P < .001). Conclusions Disciplinary actions are uncommon events. Family physicians who had ever been ABFM certified were less likely to receive an action. The most severe actions were associated with decreased odds of being board certified at the time of the action. Receiving the most severe action type increased the likelihood of physicians holding a prior but not current certification.

Our findings suggest that FM Milestones seem to largely function as intended. Lack of spread in item difficulty and lack of variation in category probabilities show that FM Milestones do not measure the amount of a latent trait possessed by a resident, but rather describe where a resident falls along the training sequence. High reliability indicates residents are being rated in a stable manner as they progress through residency, and individual residents deviating from this rating structure warrant consideration by program leaders.

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Some of the increase in the examinees' overall ability estimate may attributed to a general increase in the latent trait; however, there was a small but detectable increase that could be attributed to prior exposure to the questions. On average, about 15% of the repeated questions were changed from wrong to right, but about 11% of questions were changed from right to wrong, suggesting that examinees may occasionally be using prior exposure to their benefit but general guessing accounts for more of the changes. The impact of the mean difference between the common and unique item scores (0.029 logits) is trivial at the individual level; however, such a bias among the population of repeat testers could be problematic if a small subset of examinees were using a "remember-research-retest" strategy to obtain nontrivial score increases.