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Breadcrumb trail:

Medical Knowledge and Patient Outcomes

A Whirlwind Tour of the Evidence

In this video Furman S. McDonald, MD, MPH, FACP, Senior Vice President for Academic and Medical Affairs at ABIM, provides an overview of evidence related to medical knowledge and patient-relevant outcomes.


Arnhart KL, Cuddy MM, Johnson D, Barone MA, Young A. Multiple United States Medical Licensing Examination Attempts and the Estimated Risk of Disciplinary Actions Among Graduates of U.S. and Canadian Medical Schools. Academic Medicine. 2021 Sep 1; 96(9): 1319–1323. doi: 10.1097/ACM.0000000000004210. PMID: 34133346.

Bastian H, Glasziou P, Chalmers I. Seventy-five trials and eleven systematic reviews a day: How will we ever keep up? PLOS Medicine. 2010; 7(9): 1–6.

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

Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: The relationship between clinical experience and quality of health care. Annals of Internal Medicine. 2005; 142(4): 260-W-23.

Cuddy MM, LiuCuddy MM, Liu C, Ouyang W, Barone MA, Young A, Johnson DA. An Examination of the Associations Among USMLE Step 3 Scores and the Likelihood of Disciplinary Action in Practice. Academic Medicine. 2022 Oct 1; 97(10): 1504–1510. doi: 10.1097/ACM.0000000000004775. Epub 2022 Sep 23. PMID: 35675131.

Cuddy MM, Young A, Gelman A, Swanson DB, Johnson DA, Dillon GF, Clauser BE. Exploring the Relationships Between USMLE Performance and Disciplinary Action in Practice: A Validity Study of Score Inferences From a Licensure Examination. Academic Medicine. 2017 Dec; 92(12): 1780–1785. doi: 10.1097/ACM.0000000000001747. PMID: 28562454.

Davis DA, Mazmanian PE, Fordis M, Harrison RV, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence. The Journal of the American Medical Association. 2006; 296(9): 1094–110.

Durning SJ, Artino AR, Holmboe E, Beckman TJ, van der Vleuten C, Schuwirth L. Aging and cognitive performance: challenges and implications for physicians practicing in the 21st century. The Journal of Continuing Education in the Health Professions. 2010; 30(3): 153–160.

Fiorilli PN, Minges K, Herrin J, Messenger J, Ting H, Nallamothu B, Lipner RS, Hess BJ, Holmboe ES, Brennan J, Curtis J. Association of physician certification in Interventional Cardiology with in-hospital outcomes of percutaneous coronary intervention. Circulation. 2015; 132(19): 1816–1824.

Freed GL, Dunham KM, Gebremariam A. Changes in hospitals' credentialing requirements for board certification from 2005 to 2010. The Journal of Hospital Medicine. 2013; 8(6): 298–303.

Gabrick K, Makhoul AT, Riccelli V, Perdikis G, Janis JE, Drolet BC. Board Certification in Cosmetic Surgery: An Analysis of Punitive Actions. Plastic and Reconstructive Surgery. 2022 Sep 1; 150(3): 713–717. doi: 10.1097/PRS.0000000000009443. Epub 2022 Jul 13. PMID: 35819983.

Glynn RW, Chin JZ, Kerin MJ, Sweeney KJ. Representation of cancer in the medical literature—A bibliometric analysis. PLOS One. 2010; 5(11): e13902.

Gray BM, Vandergrift JL, Johnston MM, Reschovsky JD, Lynn LA, Holmboe ES, McCullough JS, Lipner RS. Association between imposition of a Maintenance of Certification requirement and ambulatory care-sensitive hospitalizations and health care costs. The Journal of the American Medical Association. 2014; 312(22): 2348.

Gray B, Vandergrift J, Landon B, Reschovsky J, Lipner R. Associations Between American Board of Internal Medicine Maintenance of Certification Status and Performance on a Set of Healthcare Effectiveness Data and Information Set (HEDIS) Process Measures. Ann Intern Med. 2018 Jul 17;169(2):97-105. doi: 10.7326/M16-2643. Epub 2018 Jun 12. PMID: 29893788

Gray BM, Vandergrift JL, Lipner RS. Association between the American Board of Internal Medicine's General Internist's Maintenance of Certification Requirement and Mammography Screening for Medicare Beneficiaries. Women’s Health Issues. 2018 Jan–Feb; 28(1): 35–41.

Gray BM, Vandergrift JL, McCoy RG, Lipner RS, Landon BE. Association between primary care physician diagnostic knowledge and death, hospitalisation and emergency department visits following an outpatient visit at risk for diagnostic error: a retrospective cohort study using Medicare claims. BMJ Open. 2021 Apr 1; 11(4): e041817. doi: 10.1136/bmjopen-2020-041817. PMID: 33795293.

Gray BM, Vandergrift JL, Weng W, Lipner RS, Barnett ML. Clinical Knowledge and Trends in Physicians' Prescribing of Opioids for New Onset Back Pain, 2009–2017. JAMA Network Open. 2021 Jul 1; 4(7): e2115328. doi: 10.1001/jamanetworkopen.2021.15328. PMID: 34196714.

Holmboe ES, Wang Y, Meehan TP, Tate JP, Ho SY, Starkey KS, Lipner RS. Association between maintenance of certification examination scores and quality of care for Medicare beneficiaries. Archives of Internal Medicine. 2008; 168(13): 1396–1403.

Jones AT, Kopp JP, Malangoni MA. Recertification Exam Performance in General Surgery is Associated With Subsequent Loss of License Actions. The Annals of Surgery. 2020 Dec; 272(6): 1020–1024. doi: 10.1097/SLA.0000000000003330. PMID: 31021828.

Kinney CL, Raddatz MM, Sliwa JA, Clark GS, Robinson LR. Does Performance on the American Board of Physical Medicine and Rehabilitation Initial Certification Examinations Predict Future Physician Disciplinary Actions? The American Journal of Physical Medicine & Rehabilitation. 2019 Dec; 98(12): 1079–1083. doi: 10.1097/PHM.0000000000001250. PMID: 31232708.

Kinney CL, Raddatz MM, Sliwa JA, Driscoll SW, Robinson LR. Association of Participation in the American Board of Physical Medicine and Rehabilitation Maintenance of Certification Program and Physician Disciplinary Actions. The American Journal of Physical Medicine & Rehabilitation. 2020 Apr; 99(4): 325–329. doi: 10.1097/PHM.0000000000001331. PMID: 31738280.

Kocher MS, Dichtel L, Kasser JR, Gebhardt MC, Katz JN. Orthopedic board certification and physician performance: an analysis of medical malpractice, hospital disciplinary action, and state medical board disciplinary action rates. The American Journal of Orthopedics. 2008 Feb; 37(2): 73–5. PMID: 18401481.

Kopp JP, Ibáñez B, Jones AT, Pei X, Young A, Arnhart K, Rizzo AG, Buyske J. Association Between American Board of Surgery Initial Certification and Risk of Receiving Severe Disciplinary Actions Against Medical Licenses. JAMA Surgery. 2020 May 1; 155(5): e200093. doi: 10.1001/jamasurg.2020.0093. Epub 2020 May 20. PMID: 32186688.

Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. The Journal of Personality and Social Psychology. 1999; 77: 1121–1134.

Lipner RS, Hess BJ, Phillips RL. Specialty Board Certification in the United States: Issues and Evidence. The Journal of Continuing Education in the Health Professions. 2013; (S1): 20.

Lipner RS, Young A, Chaudhry HJ, Duhigg LM, Papadakis MA. Specialty Certification Status, Performance Ratings, and Disciplinary Actions of Internal Medicine Residents. Academic Medicine. 2016; 91(3): 376.

McDonald FS, Duhigg LM, Arnold GK, Hafer RM, Lipner RS. The American Board of Internal Medicine Maintenance of Certification Examination and State Medical Board Disciplinary Actions: a Population Cohort Study. The Journal of General Internal Medicine. 2018 Mar 7. doi: 10.1007/s11606-018-4376-z. [Epub ahead of print] PMID: 29516388.

Morrison J, Wickersham P. Physicians disciplined by a state medical board. The Journal of the American Medical Association. 1998; 279(23): 1889.

Nelson LS, Duhigg LM, Arnold GK, Lipner RS, Harvey AL, Reisdorff EJ. The Association Between Maintaining American Board of Emergency Medicine Certification and State Medical Board Disciplinary Actions. The Journal of Emergency Medicine. 2019 Dec; 57(6): 772–779. doi: 10.1016/j.jemermed.2019.08.028. Epub 2019 Oct 10. PMID: 31607523.

Norcini JJ, Boulet JR, Opalek A, Dauphinee WD. The relationship between licensing examination performance and the outcomes of care by international medical school graduates. Academic Medicine. 2014 Aug; 89(8): 1157–62. doi: 10.1097/ACM.0000000000000310.

Norcini J, Grabovsky I, Barone MA, Anderson MB, Pandian RS, Mechaber AJ. The Associations Between United States Medical Licensing Examination Performance and Outcomes of Patient Care. Academic Medicine. 2023 Oct 9. doi: 10.1097/ACM.0000000000005480. Online ahead of print. PMID: 37816217.

Norcini JJ, Kimball HR, Lipner RS. Certification and specialization: do they matter in the outcome of acute myocardial infarction? Academic Medicine. 2000; 75(12): 1193–1198.

Norcini JJ, Weng W, Boulet J, McDonald F, Lipner RS. 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. BMJ Open. 2022 Apr 24; 12(4): e055558. doi: 10.1136/bmjopen-2021-055558. PMID: 35470191.

Papadakis MA, Arnold GK, Blank LL, Holmboe ES, Lipner RS. Performance during Internal Medicine Residency Training and Subsequent Disciplinary Action by State Licensing Boards. Annals of Internal Medicine. 2008; 148(11): 869–876.

Papadakis MA, Teherani A, Banach MA, et al. Disciplinary Action by Medical Boards and Prior Behavior in Medical School. The New England Journal of Medicine. 2005; 353(25): 2673–8.

Peabody MR, Young A, Peterson LE, O'Neill TR, Pei X, Arnhart K, Chaudhry HJ, Puffer JC. The Relationship Between Board Certification and Disciplinary Actions Against Board-Eligible Family Physicians. Academic Medicine. 2019 Jun; 94(6): 847–852. doi: 10.1097/ACM.0000000000002650. PMID: 30768464.

Reich JH, Maldonado J. Empirical findings on legal difficulties among practicing psychiatrists. The Annals of Clinical Psychiatry. 2011 Nov; 23(4): 297–307. PMID: 22073387.

Reid RO, Friedberg MW, Adams JL, McGlynn EA, Mehrotra A. Associations Between Physician Characteristics and Quality of Care. Archives of Internal Medicine. 2010; 170(16): 1442–1449.

Robinson LR, Raddatz MM. Comparison of State Board Disciplinary Actions in Board-Certified Versus Non-Board-Certified Physical Medicine and Rehabilitation Physicians. The American Journal of Physical Medicine & Rehabilitation. 2022 Jul 1; 101(7 Suppl 1): S26–S29. doi: 10.1097/PHM.0000000000002009. PMID: 35706115.

Sheth BP, Schnabel SD, Comber BA, Martin B, McGowan M, Bartley GB. Relationship Between the American Board of Ophthalmology Maintenance of Certification Program and Actions Against the Medical License. American Journal of Ophthalmology. 2023 Mar; 247: 1–8. doi: 10.1016/j.ajo.2022.11.001. Epub 2022 Nov 9. PMID: 36370838.

Vandergrift JL and Gray BM. Physician Clinical Knowledge, Practice Infrastructure, and Quality of Care. The American Journal of Managed Care. 2019; 25(10): 497–503.

Vandergrift JL, Weng W, Gray BM. The association between physician knowledge and inappropriate medications for older populations. Journal of the American Geriatrics Society. 2021 Aug 30. doi: 10.1111/jgs.17413. Online ahead of print. PMID: 34459494.

Vandergrift JL, Weng W, Leff B, Gray BM. Geriatricians, general internists, and potentially inappropriate medications for a national sample of older adults. J Am Geriatr Soc. 2023 Jun 23. doi: 10.1111/jgs.18489. Online ahead of print. PMID: 37350649

Zhou Y, Sun H, Culley DJ, Young A, Harman AE, Warner DO. Effectiveness of Written and Oral Specialty Certification Examinations to Predict Actions against the Medical Licenses of Anesthesiologists. Anesthesiology. 2017 Jun; 126(6): 1171–1179. doi: 10.1097/ALN.0000000000001623. PMID: 28383325.

Zhou Y, Sun H, Macario A, Keegan MT, Patterson AJ, Minhaj MM, Wang T, Harman AE, Warner DO. Association Between Participation and Performance in MOCA Minute and Actions Against the Medical Licenses of Anesthesiologists. Anesthesia & Analgesia. 2019 Nov; 129(5): 1401–1407. doi: 10.1213/ANE.0000000000004268. PMID: 31274598.

Zhou Y, Sun H, Macario A, Keegan MT, Patterson AJ, Minhaj MM, Wang T, Harman AE, Warner DO. Association between Performance in a Maintenance of Certification Program and Disciplinary Actions against the Medical Licenses of Anesthesiologists. Anesthesiology. 2018