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Association of physicians' self-assessment of medical knowledge and maintenance of certification examination performance.


Weng W, McAllister K, Vandergrift J, Lipner R. — American Board of Internal Medicine

Presented: AcademyHealth Annual Research Meeting, June 2015

Research Objective: Lifelong learning is important to keep physicians up-to-date with rapidly expanding medical knowledge. Besides passing the secure examination, the ABIM Maintenance of Certification (MOC) program also includes a medical knowledge self-assessment requirement. This requirement involves physicians' completing exercise that help them assess their strengths and weaknesses in important aspects of both evolving and established knowledge. The goals of this study were to examine: 1) whether physicians’ baseline medical knowledge and skills as measured by initial Internal Medicine (IM) certification examination score and resident program director rating of medial knowledge are associated with choosing to complete self-assessment of medical knowledge before taking the MOC examination, and 2) whether completing self-assessment activities before the exam is associated with better MOC exam results.

Study Design: A multivariate logistic regression model was used to examine the association of baseline medical knowledge and skills with physician’s choice of completing self-assessment before the MOC exam; and a linear regression model to examine the association between MOC exam score and self-assessment activities before MOC exam controlling for baseline knowledge and skills. Physician’s demographic information and practice characteristics were included as covariates in both models.

Population Studied: 17,380 general internists who received initial Internal Medicine certification between years 1997-2003 and completed the ABIM MOC program.

Principal Findings: Physicians with higher initial Internal Medicine score (OR = 1.04 per 10 points increase in exam score; P-value < 0.001) and resident program director rating of medical knowledge (OR = 1.06; P-value = 0.057 per one point rating increase out of 9 points scale) were more likely to conduct self-assessment before they took their MOC exam. These 15,572 physicians (90% of total) performed 15.5 (P-value < 0.001) points better in the MOC exam than those who did nothing after controlling for baseline differences in performance (i.e., initial Internal Medicine exam score, resident program director medical knowledge rating) as well as other physician and practice characteristics. Further, the subgroup of 9,689 physicians (56% of total) who conducted sufficient self-assessment activities to meet MOC program requirement performed 19.0 points (P-value < 0.001) better on the MOC exam than those who did nothing.

Conclusions: For general internists who enrolled in ABIM MOC program, their baseline medical knowledge and skills are associated with their choice of whether to conduct self-assessment prior to taking MOC exam and, conditional on baseline performance, this decision was associated with better MOC exam performance.

Implications for Policy or Practice: Practicing physicians rely on continuous medical education to update their medical knowledge. Given that conducting self-assessment is associated with better exam results and physicians with lower baseline medical knowledge are less likely to choose to work on self-assessment earlier, implementing more continuous self-assessment/CME policy would help ensuring all physicians keep their knowledge updated; and those with lower baseline medical knowledge are more likely to be benefitted from the implementation.

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