Associations of Internal Medicine Residency Milestone Ratings and Certification Examination Scores With Patient Outcomes.

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.

Adoption of Internal Medicine Milestone Ratings and Changes in Bias Against Black, Latino, and Asian Internal Medicine Residents.

Background: The 2014 adoption of the Milestone ratings system may have affected evaluation bias against minoritized groups.

Objective: To assess bias in internal medicine (IM) residency knowledge ratings against Black or Latino residents-who are underrepresented in medicine (URiM)-and Asian residents before versus after Milestone adoption in 2014.

Design: Cross-sectional and interrupted time-series comparisons.

Geriatricians, general internists, and potentially inappropriate medications for a national sample of older adults.

Background: Older adults are often prescribed medications that are potentially dangerous and geriatricians have specialized training in treating polypharmacy that may benefit these patients. To examine this, we compared potentially inappropriate medication (PIM) prescribing rates between geriatricians and similar general internists in the United States.

Methods: Using national cross-sectional data from 2013 to 2019, we compared annual PIM prescribing rates between 2815 outpatient geriatricians certified by the American Board of Internal Medicine in 1994-2018 and general internists matched 1:1 on IM certification exam score and year, residency exam pass rate, gender, and US birth and/or US medical school.

Which Outreach Modes Improve Response Rates to Physician Surveys? Lessons from an Experiment at the American Board of Internal Medicine.

Physicians are a notoriously difficult group to survey due to a low propensity to respond. We investigate the relative effectiveness of reminder phone calls, pre-notification postcards, mailed paper surveys, and $1 upfront incentives for boosting survey response rate by embedding a randomized experiment into a mixed-mode operational survey at the American Board of Internal Medicine in 2019. Expected response rates and average marginal effects for each follow-up method were computed from a logistic regression model.

Evolving Practice Choices by Newly Certified and More Senior General Internists : A Cross-Sectional and Panel Comparison.

Background: Hospital medicine has grown as a field. However, no study has examined trends in career choices by internists over the past decade.

Objective: To measure changes in practice setting for general internists.

Relationship Between Participation in ASCO's Quality Oncology Practice Initiative Program and American Board of Internal Medicine's Maintenance of Certification Program.

Purpose: Medical oncologists have a variety of options for demonstrating proficiency in providing high-quality patient care. Perhaps, the best-known opportunity for demonstrating individual expertise and lifelong learning is the American Board of Internal Medicine (ABIM) maintenance of certification (MOC) program. At the practice level, ASCO has offered the Quality Oncology Practice Initiative (QOPI) as a means of optimizing cancer care delivery.

The association between physician knowledge and inappropriate medications for older populations.

Background: Older patients are often prescribed potentially inappropriate medications (PIMs) given their age. We measured the association between a physician's general knowledge and their PIM prescribing.

Methods: Using a 2013-2017 cross-sectional design, we related a general internist's knowledge (n = 8196) to their prescribing of PIMs to fee-for-service Medicare beneficiaries, age ≥ 66 years with part D coverage, which they saw in the outpatient setting the year after their exam (n = 875,132).

Clinical Knowledge and Trends in Physicians' Prescribing of Opioids for New Onset Back Pain, 2009-2017.

Importance: Opioid musculoskeletal pain overprescribing was widespread in the mid-2000s. The degree to which prescribing changed as awareness of the danger grew among physicians with different levels of clinical knowledge remains unstudied.

Objective: To compare the association of clinical knowledge with opioid prescribing from 2009 to 2011 when prescribing peaked nationally with 2015 to 2017 when guidelines shifted away from opioid prescribing.

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.

Objective: Diagnostic error is a key healthcare concern and can result in substantial morbidity and mortality. Yet no study has investigated the relationship between adverse outcomes resulting from diagnostic errors and one potentially large contributor to these errors: deficiencies in diagnostic knowledge. Our objective was to measure that associations between diagnostic knowledge and adverse outcomes after visits to primary care physicians that were at risk for diagnostic errors.

Changes in Stress and Workplace Shortages Reported by U.S. Critical Care Physicians Treating Coronavirus Disease 2019 Patients.

Objectives: Eleven months into the coronavirus disease 2019 pandemic, the country faces accelerating rates of infections, hospitalizations, and deaths. Little is known about the experiences of critical care physicians caring for the sickest coronavirus disease 2019 patients. Our goal is to understand how high stress levels and shortages faced by these physicians during Spring 2020 have evolved.

Opportunities for Maintenance of Certification to Better Reflect Scope of Practice Among Medical Oncologists.

Purpose: Critics argue that the American Board of Internal Medicine's medical oncology Maintenance of Certification examination requires medical oncologists with a narrow scope of practice to spend time studying material that is no longer relevant to their practice. However, no data are available describing the scope of practice for medical oncologists.

Methods: Using Medicare claims, we examined the scope of practice for 9,985 medical oncologists who saw 8.

Physician clinical knowledge, practice infrastructure, and quality of care.

Objectives: To understand if and how one dimension of physician skill, clinical knowledge, moderates the relationship between practice infrastructure and care quality.

Study Design: We included 1301 physicians who certified in internal medicine between 1991 and 1993 or 2001 and 2003 and took the American Board of Internal Medicine (ABIM)'s Maintenance of Certification (MOC) exam and completed ABIM's diabetes or hypertension registry during their 10-year recertification period between 2011 and 2014. Composite quality scores (overall, process, and intermediate outcome) were based on chart abstractions.

Association between the American Board of Internal Medicine's General Internist's Maintenance of Certification Requirement and Mammography Screening for Medicare Beneficiaries.

Background: Breast cancer is a leading cause of death in the United States. Continuing medical education programs such as the American Board of Internal Medicine's Maintenance of Certification (MOC) program can increase early detection of cancers by educating physicians about the benefits of screening. Did the imposition of American Board of Internal Medicine's MOC requirement affect guideline-compliant mammography screening?

Method: To address this question, we took advantage of a natural experiment that occurred when one group of general internists was required to complete MOC by 2001 because they initially certified in 1991 (MOC required) and another group was grandfathered out of this requirement because they initially certified in 1989 (MOC grandfathers).

Do State Continuing Medical Education Requirements for Physicians Improve Clinical Knowledge?

Objective: To evaluate the effect of state continuing medical education (CME) requirements on physician clinical knowledge.

Data Sources: Secondary data for 19,563 general internists who took the Internal Medicine Maintenance of Certification (MOC) examination between 2006 and 2013.

Study Design: We took advantage of a natural experiment resulting from variations in CME requirements across states over time and applied a difference-in-differences methodology to measure associations between changes in CME requirements and physician clinical knowledge.

The role of internal medicine subspecialists in patient care management.

Objectives: To understand the clinical roles in which internal medicine (IM) subspecialists engage, especially those involving ongoing patient management.

Study Design: Measures of physician clinical roles were based on survey responses collected from 8020 mid-career IM subspecialists who registered for the American Board of Internal Medicine maintenance of certification program (86% registration/response rate) between 2009 and 2013.

Methods: Each subspecialist reported their percentage of clinical time in 5 clinical roles: primary, principal, longitudinal consultative, medical consultative, and procedural care.

Association between imposition of a Maintenance of Certification requirement and ambulatory care-sensitive hospitalizations and health care costs.

Importance: In 1990, the American Board of Internal Medicine (ABIM) ended lifelong certification by initiating a 10-year Maintenance of Certification (MOC) program that first took effect in 2000. Despite the importance of this change, there has been limited research examining associations between the MOC requirement and patient outcomes.

Objective: To measure associations between the original ABIM MOC requirement and outcomes of care.

Time to adjuvant chemotherapy for breast cancer in National Comprehensive Cancer Network institutions.

Background: High-quality care must be not only appropriate but also timely. We assessed time to initiation of adjuvant chemotherapy for breast cancer as well as factors associated with delay to help identify targets for future efforts to reduce unnecessary delays.

Methods: Using data from the National Comprehensive Cancer Network (NCCN) Outcomes Database, we assessed the time from pathological diagnosis to initiation of chemotherapy (TTC) among 6622 women with stage I to stage III breast cancer diagnosed from 2003 through 2009 and treated with adjuvant chemotherapy in nine NCCN centers.

Influential factors for post-fellowship career decision-making: an NCCN survey.

Insight into factors important to fellows' decision-making about their career paths is critical to successfully developing program curricula, making capacity projections, and recruiting oncology physicians. This study was performed to determine the factors associated with post-fellowship career decision-making. Program evaluation surveys were administered to oncology fellows who attended the Fellows Recognition Program at the 2009 NCCN Annual Conference.

First-line systemic therapy practice patterns and concordance with NCCN guidelines for patients diagnosed with metastatic NSCLC treated at NCCN institutions.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) allow many systemic therapy options for patients with metastatic non-small cell lung cancer (NSCLC). This analysis uses the NCCN NSCLC Outcomes Database to report on first-line therapy practice patterns and concordance with NCCN Guidelines. The analysis was limited to patients diagnosed with metastatic NSCLC between September 2006 and November 2009 at 1 of 8 participating NCCN Member Institutions.

Adoption of gene expression profile testing and association with use of chemotherapy among women with breast cancer.

Purpose: Gene expression profile (GEP) testing is a relatively new technology that offers the potential of personalized medicine to patients, yet little is known about its adoption into routine practice. One of the first commercially available GEP tests, a 21-gene profile, was developed to estimate the benefit of adjuvant chemotherapy for hormone receptor-positive breast cancer (HR-positive BC).

Patients And Methods: By using a prospective registry data set outlining the routine care provided to women diagnosed from 2006 to 2008 with HR-positive BC at 17 comprehensive and community-based cancer centers, we assessed GEP test adoption and the association between testing and chemotherapy use.

Comparative outcome of initial therapy for younger patients with mantle cell lymphoma: an analysis from the NCCN NHL Database.

Few randomized trials have compared therapies in mantle cell lymphoma (MCL), and the role of aggressive induction is unclear. The National Comprehensive Cancer Network (NCCN) Non-Hodgkin Lymphoma (NHL) Database, a prospective cohort study collecting clinical, treatment, and outcome data at 7 NCCN centers, provides a unique opportunity to compare the effectiveness of initial therapies in MCL. Patients younger than 65 diagnosed between 2000 and 2008 were included if they received RHCVAD (rituximab fractionated cyclophosphamide, vincristine, adriamycin, and dexamethasone), RCHOP+HDT/ASCR (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone + high-dose therapy/autologous stem cell rescue), RHCVAD+HDT/ASCR, or RCHOP.

Physical and psychosocial ergonomic risk factors for low back pain in automobile manufacturing workers.

Objectives: To examine the association between ergonomic physical and psychosocial exposures and the risk of prevalent and incident low back pain (LBP) in a longitudinal cohort of automobile manufacturing workers.

Methods: Ergonomic exposure intensity and LBP presence were determined through questionnaires at baseline (n=1181) and to workers in the same job 1 year later (n=505). Models were constructed using log-binomial regression with special attention to interactions between ergonomic exposures.