The American Board of Internal Medicine Research Pathway (ABIM RP) is designed to train physician-scientists by shortening postgraduate clinical training and increasing research time. We surveyed ABIM RP graduates to understand career trajectories, research engagement, and barriers to physician-scientist retention in academic research careers. We performed an anonymous, structured, web-based survey of 700 ABIM RP current and former trainees (2011-2022). We received 105 survey responses (97 RP graduates). The survey queried about demographics, training background, career outcomes, research involvement, and perceived barriers to retention in physician-scientist careers. Responses were stratified by trainee status, gender, and Medical Scientist Training Program (MSTP) participation, and select results were compared to test for statistical associations. Most respondents (79%) remained in academia, with 61% engaged in research-dominant roles. More MSTP graduates held research-focused academic positions than non-MSTP graduates. The most commonly reported barriers to sustaining research careers were funding instability, financial concerns, and lack of protected research time. Although many of the trainees in the ABIM RP who completed the survey remained in academia, systemic barriers such as funding instability and gaps in institutional support persist. Strategies to enhance financial stability, protected research time, and mentorship appear to be necessary to enhance physician-scientist career retention.

In 1988, the American Board of Internal Medicine (ABIM) defined essential procedural skills in nephrology, and candidates for ABIM certification were required to present evidence of possessing the skills necessary for placement of temporary dialysis vascular access, hemodialysis, peritoneal dialysis, and percutaneous renal biopsy. In 1996, continuous renal replacement therapy was added to the list of nephrology requirements. These procedure requirements have not been modified since 1996 while the practice of nephrology has changed dramatically. In March 2021, the ABIM Nephrology Board embarked on a policy journey to revise the procedure requirements for nephrology certification. With the guidance of nephrology diplomates, training program directors, professional and patient organizations, and other stakeholders, the ABIM Nephrology Board revised the procedure requirements to reflect current practice and national priorities. The approved changes include the Opportunity to Train standard for placement of temporary dialysis catheters, percutaneous kidney biopsies, and home hemodialysis which better reflects the current state of training in most training programs, and the new requirements for home dialysis therapies training will align with the national priority to address the underuse of home dialysis therapies. This perspective details the ABIM process for considering changes to the certification procedure requirements and how ABIM collaborated with the larger nephrology community in considering revisions and additions to these requirements.

Background:Many physician trainees plan pregnancy during residency and fellowship. A study of internal medicine program directors (PDs) demonstrated frequent misinterpretation of American Board of Internal Medicine (ABIM) leave policies applied to parental leave. The primary aim was to investigate how infectious disease (ID) PDs interpret current ABIM leave policies.Methods:We surveyed 155 ID PDs in an online anonymous questionnaire about knowledge of ABIM leave policies and application toward trainee leaves.Results:Of 155 PDs, 56 (36%) responded to the survey. Nearly 70% incorrectly identified leave limits permitted. A majority mistakenly chose to extend training when a competent fellow was within the allowed duration of leave. PDs reported that the majority of ID trainee maternity/birth parent leaves (60%) were ≤7 weeks and only 7% were ≥12 weeks; 50% of paternity/nonbirth parent leaves were ≤3 weeks.Conclusions:Surveyed ID fellowship PDs often misinterpret ABIM leave policies and apply policies incorrectly when given sample scenarios..

Importance Despite its importance to medical education and competency assessment for internal medicine trainees, evidence about the relationship between physicians' milestone residency ratings or the American Board of Internal Medicine's initial certification examination and their hospitalized patients' outcomes is sparse. Objective To examine the association between physicians' milestone ratings and certification examination scores and hospital outcomes for their patients. Design, Setting, and Participants Retrospective cohort analyses of 6898 hospitalists completing training in 2016 to 2018 and caring for Medicare fee-for-service beneficiaries during hospitalizations in 2017 to 2019 at US hospitals. Main Outcomes and Measures Primary outcome measures included 7-day mortality and readmission rates. Thirty-day mortality and readmission rates, length of stay, and subspecialist consultation frequency were also assessed. Analyses accounted for hospital fixed effects and adjusted for patient characteristics, physician years of experience, and year. Exposures Certification examination score quartile and milestone ratings, including an overall core competency rating measure equaling the mean of the end of residency milestone subcompetency ratings categorized as low, medium, or high, and a knowledge core competency measure categorized similarly. Results Among 455 120 hospitalizations, median patient age was 79 years (IQR, 73-86 years), 56.5% of patients were female, 1.9% were Asian, 9.8% were Black, 4.6% were Hispanic, and 81.9% were White. The 7-day mortality and readmission rates were 3.5% (95% CI, 3.4%-3.6%) and 5.6% (95% CI, 5.5%-5.6%), respectively, and were 8.8% (95% CI, 8.7%-8.9%) and 16.6% (95% CI, 16.5%-16.7%) for mortality and readmission at 30 days. Mean length of stay and number of specialty consultations were 3.6 days (95% CI, 3.6-3.6 days) and 1.01 (95% CI, 1.00-1.03), respectively. A high vs low overall or knowledge milestone core competency rating was associated with none of the outcome measures assessed. For example, a high vs low overall core competency rating was associated with a nonsignificant 2.7% increase in 7-day mortality rates (95% CI, -5.2% to 10.6%; P = .51). In contrast, top vs bottom examination score quartile was associated with a significant 8.0% reduction in 7-day mortality rates (95% CI, -13.0% to -3.1%; P = .002) and a 9.3% reduction in 7-day readmission rates (95% CI, -13.0% to -5.7%; P < .001). For 30-day mortality, this association was -3.5% (95% CI, -6.7% to -0.4%; P = .03). Top vs bottom examination score quartile was associated with 2.4% more consultations (95% CI, 0.8%-3.9%; P < .003) but was not associated with length of stay or 30-day readmission rates. Conclusions and Relevance Among newly trained hospitalists, certification examination score, but not residency milestone ratings, was associated with improved outcomes among hospitalized Medicare beneficiaries.

Residency program and associate program directors (PDs and APDs) hold highly visible educational leadership roles with the power to influence residency training, hospital operations, and the future physician workforce.1,2 They are the leaders of the educational missions of medical schools and teaching hospitals.1 As health care strives to create a more diverse workforce, diversity in leadership positions is foundational to meeting this goal.3-5 Recent publications have described the lack of gender and racial diversity in academic medicine leadership roles.

Objective To 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). Design Retrospective cohort study of hospitalisations in Pennsylvania, USA, from 2012 to 2017. Setting All hospitals in Pennsylvania. Participants All 184 115 hospitalisations for primary diagnoses of AMI or CHF where the attending physician was a self-designated internist. Primary outcome measure In-hospital mortality. Results Of 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). Conclusions Initial 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.

Significance Statement In recent years, there has been a decline in the number of applicants for nephrology fellowships and changes in characteristics of those entering them. There has also been a decline in the pass rate on the American Board of Internal Medicine nephrology certifying exam. This pass rate decline puts fellowship programs at risk for falling below board pass rate benchmarks of the Accreditation Council for Graduate Medical Education. The primary factors driving the decline in nephrology certifying exam performance between 2010 and 2019 were lower IM certifying exam score, older age, and training in a smaller program. In 2019, only 57% of nephrology fellowship programs had 3-year cumulative nephrology exam pass rates ≥80% among their graduates. Background The pass rate on the American Board of Internal Medicine (ABIM) nephrology certifying exam has declined and is among the lowest of all internal medicine (IM) subspecialties. In recent years, there have also been fewer applicants for the nephrology fellowship match. Methods This retrospective observational study assessed how changes between 2010 and 2019 in characteristics of 4094 graduates of US ACGME-accredited nephrology fellowship programs taking the ABIM nephrology certifying exam for the first time, and how characteristics of their fellowship programs were associated with exam performance. The primary outcome measure was performance on the nephrology certifying exam. Fellowship program pass rates over the decade were also studied. Results Lower IM certifying exam score, older age, female sex, international medical graduate (IMG) status, and having trained at a smaller nephrology fellowship program were associated with poorer nephrology certifying exam performance. The mean IM certifying exam percentile score among those who subsequently took the nephrology certifying exam decreased from 56.7 (SD, 27.9) to 46.1 (SD, 28.7) from 2010 to 2019. When examining individuals with comparable IM certifying exam performance, IMGs performed less well than United States medical graduates (USMGs) on the nephrology certifying exam. In 2019, only 57% of nephrology fellowship programs had aggregate 3-year certifying exam pass rates ≥80% among their graduates. Conclusions Changes in IM certifying exam performance, certain trainee demographics, and poorer performance among those from smaller fellowship programs explain much of the decline in nephrology certifying exam performance. IM certifying exam performance was the dominant determinant.

Abstract Background Many trainees plan pregnancy during fellowship training. A study of internal medicine program directors (PDs) demonstrated frequent misinterpretation of American Board of Internal Medicine (ABIM) leave policies when applied to parental leave. The ABIM has since attempted to clarify its leave and deficits in training policies. The primary aim of this study was to investigate how infectious disease (ID) program directors interpret the current ABIM leave policies in crafting parental leave for trainees. Methods We surveyed 155 ID program directors in an online, anonymous questionnaire regarding their knowledge of ABIM leave policies and application toward trainees’ leaves of absence. Results 75/155 (48%) of program directors responded to the survey. Most respondents incorrectly identified the leave limits permitted by ABIM policies, and a majority mistakenly chose to extend training when a clinically competent fellow was within their allowed duration of leave.(Figure 1) Most respondents correctly identified that equal time is permitted for both birth and non-birth parent parental leave, however, reported leave durations did not reflect this equity. PDs reported the majority (60.4%) of ID trainee maternity/birth parent leaves at their programs were ≤7weeks and 4.6% were≤3 weeks, while only 7% were≥12 weeks. In contrast, 50% of paternity/non birth parent leaves were ≤3weeks and none were ≥12 weeks. (Figure 2) PDs utilize various strategies to prevent extending training for fellows taking parental leaves that exceed the limits allowed by ABIM policies, including creating “home electives,” though 34% counsel trainees to take “a shorter maternity leave.” Conclusion Fellowship program directors often misinterpret ABIM leave policies, and misapply them when given example scenarios. These findings have clear implications for trainees’ family planning and may lead to shortened parental leaves and inappropriate fellowship training extensions. Disclosures All Authors: No reported disclosures

HomeCirculation: Cardiovascular Quality and OutcomesVol. 14, No. 6Letter by Akinboboye and McDonald Regarding Article, "A Blueprint for Productive Maintenance of Certification, but Is the American Board of Internal Medicine up to the Challenge?" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessLetterPDF/EPUBLetter by Akinboboye and McDonald Regarding Article, "A Blueprint for Productive Maintenance of Certification, but Is the American Board of Internal Medicine up to the Challenge?" Olakunle Akinboboye, MD, MPH, MBA Furman S. McDonaldMD, MPH Olakunle AkinboboyeOlakunle Akinboboye Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY (O.A.). Laurelton Heart Specialist PC, Rosedale, New York (O.A.). American Board of Internal Medicine, Philadelphia, PA (O.A., F.S.M.). , Furman S. McDonaldFurman S. McDonald American Board of Internal Medicine, Philadelphia, PA (O.A., F.S.M.). Originally published3 Jun 2021https://doi.org/10.1161/CIRCOUTCOMES.121.007881Circulation: Cardiovascular Quality and Outcomes. 2021;14:e007881To the Editor:In "A Blueprint for Productive Maintenance of Certification, but Is the American Board of Internal Medicine Up to the Challenge?"1 the authors call for the American Board of Internal Medicine (ABIM) to make changes posited to enhance the value of board certification; however, they—and some of their sources—fail to recognize many have already been made.2First, they present inaccuracies with the costs associated with maintenance of certification (MOC). The authors relied on an article that calculated its figures by estimating how much time physicians spend studying to stay current in their field,3 multiplying it by their hourly rate and extrapolating it to the entire population of physicians stating "counting educational activities toward both Continuing Medical Education and MOC would substantially decrease time costs." This is precisely what ABIM did with its Continuing Medical Education for MOC collaboration with the Accreditation Council for Continuing Medical Education launched in 2013 through which >183 000 diplomates have earned >22 million MOC points. Actual fees charged by ABIM average about $250 per physician annually.Second, questions were raised about associations of MOC with disciplinary actions, all of which are answered in an article assessing ABIM diplomates which the authors failed to cite.4Despite these misunderstandings, there are many areas on which we agree:The authors propose several guiding principles, among them calls to redefine ABIM's mission to include education with its role in certification, better understand the needs of adult learners, and co-create with transparency.While we agree with complementary roles for education and evaluation, ABIM was originally created by medical societies as an assessment organization, which remains its primary mission today. However, ABIM has taken steps to integrate concepts of adult learning theory into its assessments for better alignment with education and has done so by co-creating with the community.One example is the Collaborative Maintenance Pathway, an alternative assessment developed with the American College of Cardiology. Participating cardiologists use Self-Assessment Programs created by their medical specialty society as part of their ongoing learning and test their knowledge along the way to demonstrate understanding.Another example is the longitudinal assessment ABIM will launch in 2022.5 Physicians will have the flexibility to answer questions at any time and place and receive immediate feedback about whether their answer is correct or not—along with rationales for why the correct answer is correct and the incorrect answers are not. This immediate feedback represents both in-the-moment education, as well as information identifying areas for future study. ABIM is working with specialty societies on how to potentially align their educational activities with the longitudinal assessment.Since ABIM established its community engagement initiative in 2015, thousands of physicians have shared their feedback with us. We are keenly aware that some hold on to misperceptions of ABIM and that our work is not done, but readers should be aware of the many changes ABIM has made. We appreciate the authors' suggestions and invite all board-certified physicians to continue to share their insights so that we can best meet the needs of today's practicing physician.Disclosures Dr Akinboboye reports receiving a stipend from the American Board of Internal Medicine. Dr McDonald is an employee of the American Board of Internal Medicine.References1. Alyesh D, Gambhir A, Waase M, Remo B, Singh A, Green J, Kittleson M, Estes NAM, Heist EK. A blueprint for productive maintenance of certification, but is the American Board of Internal Medicine up to the challenge?Circ Cardiovasc Qual Outcomes. 2020; 13:e006696. doi: 10.1161/CIRCOUTCOMES.120.006696LinkGoogle Scholar2. Akinboboye O, Tcheng JE. The Transformation of the American Board of Internal Medicine.ABIM; 2019. Accessed January 18, 2021. https://blog.abim.org/the-transformation-of-the-american-board-of-internal-medicine/Google Scholar3. Baron RJ. The Cost of Keeping Up.ABIM; 2015. Accessed January 13, 2021. https://blog.abim.org/the-cost-of-keeping-up/Google Scholar4. 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.J Gen Intern Med. 2018; 33:1292–1298. doi: 10.1007/s11606-018-4376-zCrossrefMedlineGoogle Scholar5. Abraham GM, Saravolatz LD. The American Board of Internal Medicine's new longitudinal assessment option and what it means for infectious disease specialists.Clin Infect Dis. 2021; 72:1854–1857. doi:10.1093/cid/ciaa1493CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited ByAlyesh D, Gambhir A, Waase M, Remo B, Singh A, Green J, Kittleson M, Estes N and Heist E (2021) Response by Alyesh et al to Letter Regarding Article, "A Blueprint for Productive Maintenance of Certification, but Is the American Board of Internal Medicine up to the Challenge?", Circulation: Cardiovascular Quality and Outcomes, 14:6, Online publication date: 1-Jun-2021. June 2021Vol 14, Issue 6Article InformationMetrics Download: 10 © 2021 American Heart Association, Inc.https://doi.org/10.1161/CIRCOUTCOMES.121.007881PMID: 34078098 Originally publishedJune 3, 2021 PDF download SubjectsQuality and Outcomes

Purpose To examine whether there are group differences in milestone ratings submitted by program directors working with clinical competency committees (CCCs) based on gender for internal medicine (IM) residents and whether women and men rated similarly on milestones perform comparably on subsequent in-training and certification examinations. Method This national retrospective study examined end-of-year medical knowledge (MK) and patient care (PC) milestone ratings and IM In-Training Examination (IM-ITE) and IM Certification Examination (IM-CE) scores for 2 cohorts (2014-2017, 2015-2018) of U.S. IM residents at ACGME-accredited programs. It included 20,098/21,440 (94%) residents, with 9,424 women (47%) and 10,674 men (53%). Descriptive statistics and differential prediction techniques using hierarchical linear models were performed. Results For MK milestone ratings in PGY-1, men and women showed no statistical difference at a significance level of .01 (P = .02). In PGY-2 and PGY-3, men received statistically higher average MK ratings than women (P = .002 and P < .001, respectively). In contrast, men and women received equivalent average PC ratings in each PGY (P = .47, P = .72, and P = .80, for PGY-1, PGY-2, and PGY-3, respectively). Men slightly outperformed women with similar MK or PC ratings in PGY-1 and PGY-2 on the IM-ITE by about 1.7 and 1.5 percentage points, respectively, after adjusting for covariates. For PGY-3 ratings, women and men with similar milestone ratings performed equivalently on the IM-CE. Conclusions Milestone ratings were largely similar for women and men. Generally, women and men with similar MK or PC milestone ratings performed similarly on future examinations. Although there were small differences favoring men on earlier examinations, these differences disappeared by the final training year. It is questionable whether these small differences are educationally or clinically meaningful. The findings suggest fair, unbiased milestone ratings generated by program directors and CCCs assessing residents.

To accelerate change in primary care training by undertaking a national effort to build interprofessional (IP) faculty teams. This quasi-experimental mixed method study, conducted between 2015 and 2018, included >100 faculty and staff from medicine, nursing, pharmacy, physician assistant, and behavioral health from 9 institutions. Participants completed surveys at baseline, one year after training, and at program's completion to measure perceived changes in skills, clinics and training programs. Qualitative methods involved analyses of training and site visit observations and telephone interviews with team members. Self-assessment of competency in IP care and education, patient centered care, and leadership improved significantly for 15/15 (100%) skills assessed before and after program completion (p < 0.005). Medical home features improved significantly in all clinics (Leadership and Staff Engagement: 59.3% to 70.5%; Patient Self Management Support: 49.1% to 60.4%; and Team-Based Care: 44.2% to 56.9%, p < 0.05 for all comparisons). Joint educational activities across medical residencies and professions increased significantly (43.4% to 53.6% and 47.3% to 57.6% moderately or fully developed, respectively; p < 0.05 for all comparisons). At program completion, 75% of participants reported the program moderately or fully helped the team accomplish more than they would have working independently. Qualitative analysis identified that providing structure to bring together faculty from different professions, meeting regularly as a team, sharing best practices, and building trusting relationships made the greatest impact on transformation efforts. Creating and supporting IP primary care teams of faculty and staff within institutions appears to accelerate clinical learning environment transformation. Further study should determine if this model can sustain IP collaborative practice and education in other settings.

Purpose To assess the correlations between United States Medical Licensing Examination (USMLE) performance, American College of Physicians Internal Medicine In-Training Examination (IM-ITE) performance, American Board of Internal Medicine Internal Medicine Certification Exam (IM-CE) performance, and other medical knowledge and demographic variables. Method The study included 9,676 postgraduate year (PGY)-1, 11,424 PGY-2, and 10,239 PGY-3 internal medicine (IM) residents from any Accreditation Council for Graduate Medical Education-accredited IM residency program who took the IM-ITE (2014 or 2015) and the IM-CE (2015-2018). USMLE scores, IM-ITE percent correct scores, and IM-CE scores were analyzed using multiple linear regression, and IM-CE pass/fail status was analyzed using multiple logistic regression, controlling for USMLE Step 1, Step 2 Clinical Knowledge, and Step 3 scores; averaged medical knowledge milestones; age at IM-ITE; gender; and medical school location (United States or Canada vs international). Results All variables were significant predictors of passing the IM-CE with IM-ITE scores having the strongest association and USMLE Step scores being the next strongest predictors. Prediction curves for the probability of passing the IM-CE based solely on IM-ITE score for each PGY show that residents must score higher on the IM-ITE with each subsequent administration to maintain the same estimated probability of passing the IM-CE. Conclusions The findings from this study should support residents and program directors in their efforts to more precisely identify and evaluate knowledge gaps for both personal learning and program improvement. While no individual USMLE Step score was as strongly predictive of IM-CE score as IM-ITE score, the combined relative contribution of all 3 USMLE Step scores was of a magnitude similar to that of IM-ITE score.

Letters21 April 2020Misinterpretation of the American Board of Internal Medicine Leave Policies for Resident Physicians Around Parental LeaveKathleen M. Finn, MD, MPhil, Aimee K. Zaas, MD, MHS, Furman S. McDonald, MD, MPH, Michael Melfe, BS, Michael Kisielewski, MA, and Lisa L. Willett, MD, MACMKathleen M. Finn, MD, MPhilHarvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (K.M.F.), Aimee K. Zaas, MD, MHSDuke University, Durham, North Carolina (A.K.Z.), Furman S. McDonald, MD, MPHAmerican Board of Internal Medicine, Philadelphia, Pennsylvania (F.S.M., M.M.), Michael Melfe, BSAmerican Board of Internal Medicine, Philadelphia, Pennsylvania (F.S.M., M.M.), Michael Kisielewski, MAAlliance for Academic Internal Medicine, Alexandria, Virginia (M.K.), and Lisa L. Willett, MD, MACMUniversity of Alabama at Birmingham, Birmingham, Alabama (L.L.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2490 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Recent publications have noted inconsistent and variable parental leave policies in graduate medical education (1, 2). Graduate medical education leave policies are time-based and require extension of training if trainees are absent beyond the allowed leave. The American Board of Internal Medicine (ABIM) has 2 policies for time away from training: the Leave of Absence and Vacation policy, which allows residents up to 1 month of leave per year with accumulation of unused time, and the Deficits in Required Training Time policy, which permits 1 additional month for leave if the trainee is assessed by their clinical competency committee ...References1. Magudia K, Bick A, Cohen J, et al. Childbearing and family leave policies for resident physicians at top training institutions. JAMA. 2018;320:2372-4. [PMID: 30535210] doi:10.1001/jama.2018.14414 CrossrefMedlineGoogle Scholar2. Varda BK, Glover M. Specialty board leave policies for resident physicians requesting parental leave. JAMA. 2018;320:2374-7. [PMID: 30535211] doi:10.1001/jama.2018.15889 CrossrefMedlineGoogle Scholar3. Willett LL, Wellons MF, Hartig JR, et al. Do women residents delay childbearing due to perceived career threats? Acad Med. 2010;85:640-6. [PMID: 20354380] doi:10.1097/ACM.0b013e3181d2cb5b CrossrefMedlineGoogle Scholar4. Vassallo P, Jeremiah J, Forman L, et al. Parental leave in graduate medical education: recommendations for reform. Am J Med. 2019;132:385-9. [PMID: 30503884] doi:10.1016/j.amjmed.2018.11.006 CrossrefMedlineGoogle Scholar5. O'Connor AB, Halvorsen AJ, Cmar JM, et al. Internal medicine residency program director burnout and program director turnover: results of a national survey. Am J Med. 2019;132:252-61. [PMID: 30385223] doi:10.1016/j.amjmed.2018.10.020 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (K.M.F.)Duke University, Durham, North Carolina (A.K.Z.)American Board of Internal Medicine, Philadelphia, Pennsylvania (F.S.M., M.M.)Alliance for Academic Internal Medicine, Alexandria, Virginia (M.K.)University of Alabama at Birmingham, Birmingham, Alabama (L.L.W.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2490.Reproducible Research Statement: Study protocol and data set: Available from Mr. Kisielewski (e-mail, [email protected]org or [email protected]org). Statistical code: Not applicable.This article was published at Annals.org on 24 December 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byParental leave during pediatric fellowship training: A national surveyParental Leave Policies in Residency: A National Survey of Internal Medicine Program DirectorsThe Medical Community’s Evolving Focus on Physician and Surgeon Pregnancy: Thematic Trends From a Scoping ReviewBaby Steps in the Right Direction: Toward a Parental Leave Policy for Gastroenterology FellowsWhere Do International Medical Graduates Matriculate for Internal Medicine Training? A National Longitudinal StudyPediatric Trainees as Parents: Perspectives on Parenthood From Pediatric Resident ParentsBaby Steps in the Right Direction: Toward a Parental Leave Policy for Gastroenterology FellowsInternal medicine resident perspectives on scoring USMLE as pass/fail 21 April 2020Volume 172, Issue 8Page: 570-572KeywordsConflicts of interestDisclosureGraduate medical educationInstitutional review boards ePublished: 24 December 2019 Issue Published: 21 April 2020 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Resident physicians routinely perform bedside procedures that pose substantial risk to patients. However, no standard programmatic approach to supervision and procedural competency assessment among residents currently exists. The authors performed a national survey of internal medicine (IM) program directors to examine procedural assessment and supervision practices of IM residency programs. Procedures chosen were those commonly performed by medicine residents at the bedside. Of the 368 IM programs, 226 (61%) completed the survey. Programs reported the predominant method of training as 171 (74%) apprenticeship and 106 (46%) as module based. The majority of programs used direct observation to attest to competence, with 55% to 62% relying on credentialed residents. Most programs also relied on a minimum number of procedures to determine competence (64%-88%), 72% of which reported 5 procedures (a lapsed historical standard). This national survey demonstrates that procedural assessment practices for IM residents are insufficiently robust and may put patients at undue risk.

To evaluate validity evidence for internal medicine milestone ratings across programs for three resident cohorts by quantifying "not assessable" ratings; reporting mean longitudinal milestone ratings for individual residents; and correlating medical knowledge ratings across training years with certification examination scores to determine predictive validity of milestone ratings for certification outcomes.This retrospective study examined milestone ratings for postgraduate year (PGY) 1-3 residents in U.S. internal medicine residency programs. Data sources included milestone ratings, program characteristics, and certification examination scores.Among 35,217 participants, there was a decreased percentage with "not assessable" ratings across years: 1,566 (22.5%) PGY1s in 2013-2014 versus 1,219 (16.6%) in 2015-2016 (P = .01), and 342 (5.1%) PGY3s in 2013-2014 versus 177 (2.6%) in 2015-2016 (P = .04). For individual residents with three years of ratings, mean milestone ratings increased from around 3 (behaviors of an early learner or advancing resident) in PGY1 (ranging from a mean of 2.73 to 3.19 across subcompetencies) to around 4 (ready for unsupervised practice) in PGY3 (mean of 4.00 to 4.22 across subcompetencies, P < .001 for all subcompetencies). For each increase of 0.5 units in two medical knowledge (MK1, MK2) subcompetency ratings, the difference in examination scores for PGY3s was 19.5 points for MK1 (P < .001) and 19.0 for MK2 (P < .001).These findings provide evidence of validity of the milestones by showing how training programs have applied them over time and how milestones predict other training outcomes.

Some have questioned whether successful performance in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program is meaningful. The association of the ABIM Internal Medicine (IM) MOC examination with state medical board disciplinary actions is unknown.To assess risk of disciplinary actions among general internists who did and did not pass the MOC examination within 10 years of initial certification.Historical population cohort study.The population of internists certified in internal medicine, but not a subspecialty, from 1990 through 2003 (n = 47,971).ABIM IM MOC examination.General internal medicine in the USA.The primary outcome measure was time to disciplinary action assessed in association with whether the physician passed the ABIM IM MOC examination within 10 years of initial certification, adjusted for training, certification, demographic, and regulatory variables including state medical board Continuing Medical Education (CME) requirements.The risk for discipline among physicians who did not pass the IM MOC examination within the 10 year requirement window was more than double than that of those who did pass the examination (adjusted HR 2.09; 95% CI, 1.83 to 2.39). Disciplinary actions did not vary by state CME requirements (adjusted HR 1.02; 95% CI, 0.94 to 1.16), but declined with increasing MOC examination scores (Kendall's tau-b coefficient = - 0.98 for trend, p < 0.001). Among disciplined physicians, actions were less severe among those passing the IM MOC examination within the 10-year requirement window than among those who did not pass the examination.Passing a periodic assessment of medical knowledge is associated with decreased state medical board disciplinary actions, an important quality outcome of relevance to patients and the profession.

Purpose To evaluate validity evidence for internal medicine milestone ratings across programs for three resident cohorts by quantifying “not assessable” ratings; reporting mean longitudinal milestone ratings for individual residents; and correlating medical knowledge ratings across training years with certification examination scores to determine predictive validity of milestone ratings for certification outcomes. Method This retrospective study examined milestone ratings for postgraduate year (PGY) 1–3 residents in U.S. internal medicine residency programs. Data sources included milestone ratings, program characteristics, and certification examination scores. Results Among 35,217 participants, there was a decreased percentage with “not assessable” ratings across years: 1,566 (22.5%) PGY1s in 2013–2014 versus 1,219 (16.6%) in 2015–2016 (P = .01), and 342 (5.1%) PGY3s in 2013–2014 versus 177 (2.6%) in 2015–2016 (P = .04). For individual residents with three years of ratings, mean milestone ratings increased from around 3 (behaviors of an early learner or advancing resident) in PGY1 (ranging from a mean of 2.73 to 3.19 across subcompetencies) to around 4 (ready for unsupervised practice) in PGY3 (mean of 4.00 to 4.22 across subcompetencies, P < .001 for all subcompetencies). For each increase of 0.5 units in two medical knowledge (MK1, MK2) subcompetency ratings, the difference in examination scores for PGY3s was 19.5 points for MK1 (P < .001) and 19.0 for MK2 (P < .001). Conclusions These findings provide evidence of validity of the milestones by showing how training programs have applied them over time and how milestones predict other training outcomes.

PURPOSE:The Accreditation Council for Graduate Medical Education (ACGME) has surveyed residents since 2003, and faculty since 2012. Surveys are designed to assess program functioning and specify areas for improvement. The purpose of this study was to assess the association of the ACGME's resident and faculty surveys with residency-program-specific performance on the American Board of Internal Medicine (ABIM) certification exam. METHOD:Data were available from residents and faculty in 375 U.S. ACGME-accredited internal medicine programs from the 2012-2013, 2013-2014, and 2014-2015 academic years. Analysis of variance and correlations were used to examine the relationship between noncompliance with ACGME program requirements as assessed by the resident and faculty surveys, and ABIM program pass rates. RESULTS:Noncompliance reported on the resident and faculty surveys was highest for programs not meeting the ACGME program requirement of an 80% pass rate on the ABIM certification examination. This relationship was significant for overall noncompliance, both within the resident (P < .001) and faculty (P < .05) surveys, for many areas within the two surveys (correlations ranged between -.07 and -.25, and P values ranged between .20 and < .001), and for the highest levels of noncompliance across areas of the resident (P < .001) and faculty (P < .04) surveys. CONCLUSIONS:ACGME resident and faculty surveys were significantly associated with ABIM program pass rates, supporting the importance of these surveys within the ACGME's Next Accreditation System.

Theory: Networking has positive effects on career development; however, personal characteristics of group members such as gender or diversity may foster or hinder member connectedness. Social network analysis explores interrelationships between people in groups by measuring the strength of connection between all possible pairs in a given network. Social network analysis has rarely been used to examine network connections among members in an academic medical society. This study seeks to ascertain the strength of connection between program directors in the Association of Program Directors in Internal Medicine (APDIM) and its Education Innovations Project subgroup and to examine possible associations between connectedness and characteristics of program directors and programs. Hypotheses: We hypothesize that connectedness will be measurable within a large academic medical society and will vary significantly for program directors with certain measurable characteristics (e.g., age, gender, rank, location, burnout levels, desire to resign). Method: APDIM program directors described levels of connectedness to one another on the 2012 APDIM survey. Using social network analysis, we ascertained program director connectedness by measuring out-degree centrality, in-degree centrality, and eigenvector centrality, all common measures of connectedness. Results: Higher centrality was associated with completion of the APDIM survey, being in a university-based program, Educational Innovations Project participation, and higher academic rank. Centrality did not vary by gender; international medical graduate status; previous chief resident status; program region; or levels of reported program director burnout, callousness, or desire to resign. Conclusions: In this social network analysis of program directors within a large academic medical society, we found that connectedness was related to higher academic rank and certain program characteristics but not to other program director characteristics like gender or international medical graduate status. Further research is needed to optimize our understanding of connection in organizations such as these and to determine which strategies promote valuable connections.