Association of clinical competence, specialty and physician country of origin with opioid prescribing for chronic pain: a cohort study.

Background: Although little is known about why opioid prescribing practices differ between physicians, clinical competence, specialty training and country of origin may play a role. We hypothesised that physicians with stronger clinical competence and communication skills are less likely to prescribe opioids and prescribe lower doses, as do medical specialists and physicians from Asia.

Methods: Opioid prescribing practices were examined among international medical graduates (IMGs) licensed to practise in the USA who evaluated Medicare patients for chronic pain problems in 2014-2015.

Building a core competency assessment program for all stakeholders: the design and building of sailing ships can inform core competency frameworks.

When educators are developing an effective and workable assessment program in graduate medical education by employing action research and stakeholder mapping to identify core competency domains and directives, the multi-stage process can be guided and informed by utilizing the story of designing, building and sea-testing sailing ships as a metaphor. However, the current challenge of physician burnout demands additional attention when formulating medical training frameworks, assessment guidelines and mentoring programs in 2020. The possibility of job-crafting is raised for consideration by designers of core competency frameworks in the health professions.

A Further Examination of Previous and Future Policy Opportunities of the Educational Commission for Foreign Medical Graduates.

The Educational Commission for Foreign Medical Graduates (ECFMG) has a distinguished history of providing high-quality, innovative products and services to international medical graduates (IMGs) seeking to study and practice medicine in the United States. In 2010, the ECFMG board introduced a policy stating that, starting in 2023, all IMGs applying to the ECFMG for credentialing must have graduated from a medical school that has been accredited by an internationally recognized accrediting body akin to the Liaison Committee on Medical Education in the United States or the World Federation for Medical Education. In this issue of Academic Medicine, Tackett reviews the reasons for the policy and its adoption worldwide.

Specialty Board Certification Rate as an Outcome Metric for GME Training Institutions: A Relationship With Quality of Care.

Educational outcome measures, known to be associated with the quality of care, are needed to support improvements in graduate medical education (GME). This retrospective observational study sought to determine whether there was a relationship between the specialty board certification rates of GME training institutions and the quality of care delivered by their graduates. It is based on 7 years of hospitalizations in Pennsylvania ( = 354,767) with diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal hemorrhage, or pneumonia.

Considerations that will determine if competency-based assessment is a sustainable innovation.

Educational assessment for the health professions has seen a major attempt to introduce competency based frameworks. As high level policy developments, the changes were intended to improve outcomes by supporting learning and skills development. However, we argue that previous experiences with major innovations in assessment offer an important road map for developing and refining assessment innovations, including careful piloting and analyses of their measurement qualities and impacts.

Patients of doctors further from medical school graduation have poorer outcomes.

Context: There is an apparent contradiction between the findings of studies indicating that patient outcomes are better when physicians have a greater volume of practice and those that find outcomes to be worse with increased time since training, which implies greater volume.

Objectives: This study was designed to estimate the adjusted relationships between physicians' characteristics, including recent practice volume and time since medical school graduation, and patient outcomes.

Methods: This is a retrospective observational study based on all Pennsylvania hospitalisations over 7 years for acute myocardial infarction, congestive heart failure, gastrointestinal haemorrhage, hip fracture and pneumonia.

The role of theory-based outcome frameworks in program evaluation: Considering the case of contribution analysis.

In an era demanding greater accountability and the demonstration of positive outcomes and impacts, the field for the evaluation of interventions, program development and outreach projects is being challenged in many fields, including education, medical care, public health and social development. In consequence, the leaders in this field significantly changed their approaches to the evaluation of such interventions. Evaluators noted that simple linear models of evaluation do not address the wider community of interests and stakeholders involved in today's innovative and wide-reaching programs.

The relationship between licensing examination performance and the outcomes of care by international medical school graduates.

Purpose: The Step 2 Clinical Knowledge (CK) examination of the United States Medical Licensing Examination sequence is a requirement for the certification of international medical graduates (IMGs) by the Educational Commission for Foreign Medical Graduates. An association between scores on the test and the quality of care later provided by those who take it is central to its use in certification and licensure. The purpose of this study was to determine whether there is a relationship between scores on Step 2 CK and patient outcomes for IMGs.

Outcomes of cardiac surgery: associations with physician characteristics, institutional characteristics, and transfers of care.

Background: Although there are several studies of the human and system factors that influence the outcomes of cardiac surgery, it remains difficult to draw conclusions because many do not simultaneously adjust for the characteristics of patients, physicians, and institutions. The current study explores the associations between these factors and inhospital mortality, with a particular focus on whether patients had the same operating and attending physician.

Method And Results: This is a retrospective observational study of 114,751 hospitalizations from 2003 to 2009 in Pennsylvania that included a coronary artery bypass graft, valve surgery, or both.

Do physician communication skills influence screening mammography utilization?

Background: The quality of physician communication skills influences health-related decisions, including use of cancer screening tests. We assessed whether patient-physician communication examination scores in a national, standardized clinical skills examination predicted future use of screening mammography (SM).

Methods: Cohort study of 413 physicians taking the Medical Council of Canada clinical skills examination between 1993 and 1996, with follow up until 2006.

Educators must consider patient outcomes when assessing the impact of clinical training.

Context: The concept of outcomes has been used in health care for over 140 years. The use of outcomes in assessing quality of care regained prominence in the 1960s based on Donabedian's framework of structures, processes and outcomes. In the 1990s, the use of outcomes in medical education gained great favour, although the outcomes used were not carefully defined.

A framework for designing, implementing, and sustaining a national simulation network: building incentive-based network structures and iterative processes for long-term success: the case of the Medical Council of Canada's Qualifying Examination, Part II.

The use of networks for sharing and distributing information, for institutional collaboration, and action programs is commonplace. In 1989, the Medical Council of Canada began the implementation of a national clinical licensing examination to assess physicians for practice skills and decision making using standardized or simulated patients in an Objective Structured Clinical Examination format. Once fully implemented, the examination was administered through a network of medical schools at 16 locations across Canada in two languages twice yearly.

Are physicians with better clinical skills on licensing examinations less likely to prescribe antibiotics for viral respiratory infections in ambulatory care settings?

Background: Viral respiratory infections (VRIs) are a common reason for ambulatory visits, and 35% are treated with an antibiotic. Antibiotic use for VRIs is not recommended, and it promotes antibiotic resistance. Effective patient-physician communication is critical to address this problem.

Evidence-based practice: a review of theoretical assumptions and effectiveness of teaching and assessment interventions in health professions.

Health care professionals are expected to use a systematic approach based on evidence, professional reasoning and client preferences in order to improve client outcomes. In other words, they are expected to work within an evidence-based practice (EBP) context. This expectation has had an impact on occupational therapy academic programs' mandates to prepare entry-level clinicians who demonstrate competence in the knowledge, skills and behaviors for the practice of evidence-based occupational therapy.

Evaluating the quality of care provided by graduates of international medical schools.

One-quarter of practicing physicians in the United States are graduates of international medical schools. The quality of care provided by doctors educated abroad has been the subject of ongoing concern. Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.

Influence of physicians' management and communication ability on patients' persistence with antihypertensive medication.

Background: Less than 75% of people prescribed antihypertensive medication are still using treatment after 6 months. Physicians determine treatment, educate patients, manage side effects, and influence patient knowledge and motivation. Although physician communication ability likely influences persistence, little is known about the importance of medical management skills, even though these abilities can be enhanced through educational and practice interventions.

Commentary: one strategy for building public trust in changing times.

Major health care reforms are being debated in the United States. While these debates address issues of access and cost, the systems-based problems of patient safety, continuous quality improvement, and an integrated approach to continuing professional development (CPD) remain traditional opportunities for the profession to directly improve health care and maintain professional accountability. Such challenges can be addressed independently of proposed reforms and offer an opportunity for the profession to build greater public trust.

Doctor scores on national qualifying examinations predict quality of care in future practice.

Objectives: This study aimed to determine if national licensing examinations that measure medical knowledge (QE1) and clinical skills (QE2) predict the quality of care delivered by doctors in future practice.

Methods: Cohorts of doctors who took the Medical Council of Canada Qualifying Examinations Part I (QE1) and Part II (QE2) between 1993 and 1996 and subsequently entered practice in Ontario, Canada (n = 2420) were followed for their first 7-10 years in practice. The 208 of these doctors who were randomly selected for peer assessment of quality of care were studied.

Incorporating educational institutions into a unified model of health human resources.

This commentary discusses Tzountzouris and Gilbert's article on issues related to emerging health human resources (HHR) requirements and the role of educational institutions in anticipating and meeting them. It is apparent that educational institutions are influenced by and, in turn, influence a number of elements of HHR. They therefore have a unique role in responding to emerging HHR needs, from assessing the needs to evaluating responses.

Predictors of inappropriate antibiotic prescribing among primary care physicians.

Background: Inappropriate use of antibiotics promotes antibiotic resistance. Little is known about physician characteristics that may be associated with inappropriate antibiotic prescribing. Our objective was to assess whether physician knowledge, time in practice, place of training and practice volume explain the differences in antibiotic prescribing among physicians.