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Association between physician cognitive skills and performance in clinical practice.


Hess BJ, Lipner RS, Weng W. — American Board of Internal Medicine

Presented: American Educational Research Association Meeting, May 2010

Background: Physicians' cognitive skills, as measured by a secure multiple-choice examination, have been associated with clinical performance. However, research has not examined this relationship using a psychometrically robust composite measure of patient care.

Objective: To determine if physician cognitive skills are associated with performance on a comprehensive measure of diabetes care, and to examine this relationship in the context of a specific clinical domain (i.e., cognitive skills in endocrine disease and care of diabetic patients).

Design and Participants: 676 physicians from the United States certified in general internal medicine by the American Board of Internal Medicine (ABIM) took a secure Maintenance of Certification (MOC) examination and completed the ABIM Diabetes Practice Improvement Module (PIM) between 2005 and 2007 as requirements for maintaining their certification.

Measurements: Cognitive skill was assessed using scores from the ABIM Internal Medicine Maintenance of Certification Examination, a computer-based 180-item multiple choice examination. Practice performance was assessed using a composite measure of diabetes care aggregated from evidence-based clinical measures from the ABIM Diabetes PIM medical chart review.

Results: Controlling for physician and patient characteristics, scores from the ABIM Internal Medicine Maintenance of Certification Examination were significantly related to the diabetes composite measure scores (β = .22, p < .01), and performance in the endocrine disease medical content domain of the examination was more strongly associated with the diabetes composite measure scores than the performance in other individual medical content domains (β = .19 vs. βs = .06 to 14).

Conclusion: Incorporating an assessment of cognitive skills with an assessment of practice performance is important to comprehensively evaluate a physician’s competency in patient care.

For more information about this presentation, please contact Research@abim.org.