Physician Age and Performance on the American Board of Emergency Medicine ConCert Examination

Marco, Catherine A.; Wahl, Robert P.; House, Hans; Goyal, Deepi G.; Keim, Samuel M.; John, Oommen; Joldersma, Kevin B.; Johnston, Mary M.; Harvey, Anne L.

doi:10.1111/acem.13420

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…We found that increased physician age was associated with increased patient mortality. Lending credence to our model is that our finding is concordant with many studies that have demonstrated negative associations of age with educational and patient-relevant outcomes 3 35 36. Based on our proposed mechanism, it is plausible that increased age, and in particular time from completion of medical training, may make staying current in knowledge and practice more challenging 37 38.…”

Section: Discussionsupporting

confidence: 85%

Associations between initial American Board of Internal Medicine certification and maintenance of certification status of attending physicians and in-hospital mortality of patients with acute myocardial infarction or congestive heart failure: a retrospective cohort study of hospitalisations in Pennsylvania, USA

et al. 2022

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ObjectiveTo determine whether internists’ initial specialty certification and the maintenance of that certification (MOC) is associated with lower in-hospital mortality for their patients with acute myocardial infarction (AMI) or congestive heart failure (CHF).DesignRetrospective cohort study of hospitalisations in Pennsylvania, USA, from 2012 to 2017.SettingAll hospitals in Pennsylvania.ParticipantsAll 184 115 hospitalisations for primary diagnoses of AMI or CHF where the attending physician was a self-designated internist.Primary outcome measureIn-hospital mortality.ResultsOf the 2575 physicians, 2238 had initial certification and 820 were eligible for MOC. After controlling for patient demographics and clinical characteristics, hospital-level factors and physicians’ demographic and medical school characteristics, both initial certification and MOC were associated with lower mortality. The adjusted OR for initial certification was 0.835 (95% CI 0.756 to 0.922; p<0.001). Patients cared for by physicians with initial certification had a 15.87% decrease in mortality compared with those cared for by non-certified physicians (mortality rate difference of 5.09 per 1000 patients; 95% CI 2.12 to 8.05; p<0.001). The adjusted OR for MOC was 0.804 (95% CI 0.697 to 0.926; p=0.003). Patients cared for by physicians who completed MOC had an 18.91% decrease in mortality compared with those cared for by MOC lapsed physicians (mortality rate difference of 6.22 per 1000 patients; 95% CI 2.0 to 10.4; p=0.004).ConclusionsInitial certification was associated with lower mortality for AMI or CHF. Moreover, for patients whose physicians had initial certification, an additional advantage was associated with its maintenance.

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Section: Discussionsupporting

confidence: 85%

Associations between initial American Board of Internal Medicine certification and maintenance of certification status of attending physicians and in-hospital mortality of patients with acute myocardial infarction or congestive heart failure: a retrospective cohort study of hospitalisations in Pennsylvania, USA

et al. 2022

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“…Personal Characteristics, such as high educational attainment and age-related maturity, were also highlighted by patients. Age-related expectations, which link age, experience and skill levels, are deeply rooted in the Chinese culture, even though age and performance are not necessarily positively correlated [ 62 , 63 ]. According to Chinese physician recruitment rules, doctors with lower education and experience are more likely to work in primary care institutions than hospitals.…”

Section: Discussionmentioning

confidence: 99%

Patient views of the good doctor in primary care: a qualitative study in six provinces in China

Wang

Zhang

Lü

et al. 2023

glob health res policy

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Background China has been striving to train primary care doctors capable of delivering high-quality service through general practitioner training programs and family doctor team reforms, but these initiatives have not adequately met patient needs and expectations. In order to guide further reform efforts to better meet patient expectations, this study generates a profile of the good doctor in primary care from the patient perspective. Methods Semi-structured interviews were conducted in six provinces (Shandong, Zhejiang, Henan, Shaanxi, Shanxi, Heilongjiang) in China. A total of 58 interviewees completed the recorded interviews. Tape-based analysis was used to produce narrative summaries. Trained research assistants listened to the recordings of the interviews and summarized them by 30-s segments. Thematic analysis was performed on narrative summaries to identify thematic families. Results Five domains and 18 attributes were generated from the analysis of the interview data. The domains of the good doctor in primary care from the patient perspective were: strong Clinical Competency (mentioned by 97% of participants) and Professionalism & Humanism (mentioned by 93% of participants) during service delivery, followed by Service Provision and Information Communication (mentioned by 74% and 62% of participants, respectively). Moreover, Chinese patients expect that primary care doctors have high educational attainment and a good personality (mentioned by 41% of participants). Conclusions This five-domain profile of the good doctor in primary care constitutes a foundation for further primary care workforce capacity building. Further primary care reform efforts should reflect the patient views and expectations, especially in the family physician competency framework and primary care performance assessment system development. Meanwhile, frontline primary care organizations also need to create supportive environments to assist competent doctors practice in primary care, especially through facilitating the learning of primary care doctors and improving their well-being.

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“…Since skills naturally tend to decay over time without actions to prevent decline, 1 determinations about professional competency made years earlier (e.g., in residency training or by initial specialty certification) have diminishing predictive association with evolving expectations for professional competency over time. 22 Certification exists to set the current standard for specialty competencies, and continuing certification must determine whether each certified physician is adequately maintaining those skills and abilities through a rigorous assessment program. 23 Doing so allows the specialty boards to reassure the public, including patients and family members, about their physicians’ abilities to provide safe and effective care.…”

Section: What Is the Role And Value Of Continuing Certification Over ...mentioning

confidence: 99%

The Role of Specialty Certification in Career-Long Competence

Lyness

McMahon

2023

Academic Medicine

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Across the medical profession there is broad acceptance of the critical role of continuing medical education (CME) in enabling physicians to adapt to both new information and evolving expectations within the profession. In the presence of widespread participation in CME, some have attempted to question, discredit, or marginalize the role of ongoing lifelong assessment of physician knowledge and skills through specialty continuing certification, advocating instead for a participatory standard based only on engagement with CME. This essay outlines the limitations of physician self-evaluation and clarifies the need for external assessments. Certification boards’ role is to set specialty-specific standards for competence, assess to those standards, and assure the public that certified physicians are adequately maintaining their skills and abilities; doing so credibly necessarily requires, in part, independent assessments of physician competence. In these contexts, the specialty boards are taking approaches to identify performance gaps and leverage intrinsic motivation to facilitate physician engagement in targeted learning. Specialty board continuing certification plays a unique role, distinct from and complementary to the CME enterprise. Calls to eliminate continuing certification requirements beyond self-directed CME are contradictory to the evidence and fail the profession and the public.

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Physician Age and Performance on the American Board of Emergency Medicine ConCert Examination

Cited by 9 publications

References 24 publications

Patient views of the good doctor in primary care: a qualitative study in six provinces in China

The Role of Specialty Certification in Career-Long Competence

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