Maintenance of Certification and the Challenge of Professionalism

Author(s): D Nichols

Date: 05/2017

Publisher: Pediatrics

Volume/Edition: 139 (5)

Publication Type: Journal

Article:

This review article provides an overview of research literature focusing on Board Certification and Maintenance of Certification (MOC). Overall, this review shows a growing amount of research indicating that participation in MOC is associated with improved processes of care.

Teaching and Assessing Professionalism in Radiology Resident Education

Author(s): A Kelly, L Gruppen, P Mullan

Date: 03/2017

Publisher: Academic Radiology

Volume/Edition: Mar 2017

Publication Type: Journal

Article:

This review article discusses challenges in training for and teaching towards professionalism, how professionalism is part of Maintenance of Certification (MOC) and the American Board of Radiology (ABR) competency assessment, and how greater understanding of professionalism as part of competency assessment is needed.

Maintenance of Certification Part 4: From Trial to Tribute

Author(s): K Shaw, L Tanzer, R Keren, A Taylor, P DeRusso, J St. Geme

Date: 03/2017

Publisher: Journal of Pediatrics

Volume/Edition: Mar 2017

Publication Type: Journal

Article:

This article provides an overview of the Children’s Hospital of Philadelphia’s Maintenance of Certification (MOC) program initiatives and processes.

Practical Quality Improvement for the Allergist/Immunologist

Author(s): D Price, D Lang

Date: 01/2017

Publisher: Journal of Allergy and Clinical Immunology: In Practice

Volume/Edition: Jan 2017

Publication Type: Journal

Article:

This article describes the origins of the field of quality improvement (QI), quality measures used in allergy and immunology, and meaningful participation.

Demonstrating Construct Validity of the American Board of Physical Medicine and Rehabilitation Part I Examination: An Analysis of Dimensionality

Author(s): M Raddatz, L Robinson

Date: 02/2017

Publisher: PM&R

Volume/Edition: Feb 2017

Publication Type: Journal

Article:

This retrospective observational study evaluates the core knowledge requirements of the American Board of Physical Medicine and Rehabilitation part I certifcation examination (ABPMR-CE-1).

Outcomes from Pediatric Gastroenterology Maintenance of Certification Using Web-based Modules.

Author(s): J Sheu, S Chun, E O'Day, S Cheung, R Cruz, J Lightdale, J Huang

Date: 01/2017

Publisher: Journal of Pediatric Gastroenterology and Nutrition

Volume/Edition:

Publication Type: Journal

Article:

This cross-sectional study analyzed data taken from web-based Maintenance of Certification (MOC) quality improvement (QI) modules. This analysis showed significant practice variation across several processes and how the web-based MOC activities improved them.

Maintenance of Certification—A Prescription for Improved Child Health

Author(s): L First, D Gremse, J St Geme III

Date: 02/2017

Publisher: JAMA Pediatrics

Volume/Edition: Feb 2017

Publication Type: Journal

Article:

This viewpoint article updates the pediatric community on changes the American Board of Pediatrics (ABP) is making which allow continuing medical education (CME) activities to also provide credit for Maintenance of Certification (MOC) part II.

Implementation of a Professional Society Core Curriculum and Integrated Maintenance of Certification Program

Author(s): W Carlos, J Poston, G Michaud, C Dela Cruz, A Luks, D Boyer, C Thompson

Date: 01/2017

Publisher: Annals of the American Thoracic Society

Volume/Edition: Jan 2017

Publication Type: Journal

Article:

This article discusses the American Thoracic Society (ATS) maintenance of certification (MOC) program and the model for its development.

Provision of Palliative Care Services by Family Physicians Is Common

Author(s): C Ankuda, A Jetty, A Bazemore, S Petterson

Date: 03/2017

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 30 (2)

Publication Type: Journal

Article:

This cross sectional study analyzed data from the 2013 American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) Demographic Survey regarding family physicians’ perceptions of palliative care.

Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department

Author(s): R Jennings, J Burtner, J Pellicer, D Nair, M Bradford, M Shaffer, J Tieder

Date: 04/2017

Publisher: Pediatrics

Volume/Edition: 139 (4)

Publication Type: Journal

Article:

This evaluation of a quality improvement (QI) effort for Maintenance of Certification (MOC) found that coaching and mentoring from a regional hospital (i.e., Seattle Children’s Hospital) participating in the MOC Portfolio Program had a significant effect on a successful QI effort at a community hospital assisted by resources from the regional hospital. In this case the QI effort achieved reducing the number of head CT scans beyond its stated goals.

Training Matters: A Retrospective Study of Physician Disciplinary Actions by the Louisiana State Board of Medical Examiners, 1990–2010

Author(s): S Allen, R Marier, C Moulton, A Shankar

Date: 01/2016

Publisher: Journal of Medical Regulation

Volume/Edition: 102 (4)

Publication Type: Journal

Article:

This retrospective study looked at characteristics of physicians with disciplinary actions and found that those with board certification were less likely to have disciplinary actions.

The History, Role, and Value of Public Directors on Certifying Boards: The American Board of Ophthalmology Experience

Author(s): S Anderson, L Nora, C McEntee, M Fitzgerald, S Nugent

Date: 09/2016

Publisher: Ophthalmology

Volume/Edition: 123 (9 Supp)

Publication Type: Journal

Article:

This article discusses the evolution of governance structures of regulating and certifying bodies to include public directors and how the American Board of Ophthalmology (ABO) values their contributions.

Subspecialty Training and Certification in Geriatric Psychiatry: A 25-Year Overview

Author(s): D Juul, C Colenda, J Lyness, L Dunn, R Hargrave, L Faulkner

Date: 01/2017

Publisher: American Journal of Geriatric Psychiatry

Volume/Edition: 16

Publication Type: Journal

Article:

This article discusses the development of the geriatric psychiatry subspecialty certification, needed improvements in training, and recruitment needs.

Continuing Medical Education and Maintenance of Certification

Author(s): K Loughlin, T Granatir, G Jordan

Date: 11/2016

Publisher: Urology Practice

Volume/Edition: 3 (6)

Publication Type: Journal

Article:

This literature review examines whether Continuing Medical Education (CME) alone is sufficient to ensure lifelong learning.

A Practice Quality Improvement Project: Reducing Dose of Routine Chest CT Imaging in a Busy Clinical Practice

Author(s): E Takahashi, M Kohli, S Teague

Date: 03/2016

Publisher: Journal of Digital Imaging

Volume/Edition: 29 (5)

Publication Type: Journal

Article:

This retrospective medical record review reinforces previous research showing the value of participating in MOC part IV projects. The part IV project in this case is part of the American Board of Radiology MOC process. It allowed the reduction of the radiation dose used in CT imaging of the chest. This project not only benefitted patients but also provided for additional CMS reimbursement.

Performance of Certification and Recertification Examinees on Multiple Choice Test Items: Does Physician Age Have an Impact?

Author(s): L Shen, D Juul, L Faulkner

Date: 04/2016

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 36 (2)

Publication Type: Journal

Article:

This study contributes to research that skills decline over time and the ongoing process of Maintenance of Certification (MOC) contributes to maintaining clinical knowledge.

How Do Publicly Reported Medicare Quality Metrics for Radiologists Compare with Those of Other Specialty Groups?

Author(s): A Rosenkrantz, D Hughes, R Duszak

Date: 03/2016

Publisher: Journal of the American College of Radiology

Volume/Edition: 13 (3)

Publication Type: Journal

Article:

This retrospective study showed that participation in the Maintenance of Certification (MOC) program is an additional incentive because of PQRS. Radiologists performed highly in the MOC program specialty-specific metrics.

Transforming Physician Certification to Support Physician Self-motivation and Capacity to Improve Quality and Safety

Author(s): R Phillips, J Kennedy, C Jaen, K Stelter, J Puffer

Date: 12/2016

Publisher: Journal of Enterprise Transformation

Volume/Edition: 6 (3-4)

Publication Type: Journal

Article:

This article discusses the efforts ABFM is making to improve their programs including creating registries and assessment tools.

Physician Satisfaction With and Practice Changes Resulting From American Board of Family Medicine Maintenance of Certification Performance in Practice Modules

Author(s): L Peterson, A Eden, A Cochrane, M Hagen

Date: 01/2016

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 36 (1)

Publication Type: Journal

Article:

This study contributes to research on the value of MOC part IV activities.

Relationship Between Physicians Active Participation in Maintenance of Certification and Patients Perspective of Care Surveys

Author(s): J Morrell, E Stratman

Date: 06/2016

Publisher: Journal of Patient Experience

Volume/Edition: 3 (2)

Publication Type: Journal

Article:

This study contributes to research indicating that the public values their physician’s participation in MOC. Although overall statistical significance was not great, the most relevant finding of this study was that physicians participating in MOC had higher patient experience scores than those who were not participating. Active enrollment in MOC versus passive enrollment in MOC is also an important consideration.

Laparoscopic Colectomy and the General Surgeon

Author(s): J Moore, A Pellet, N Hyman

Date: 03/2016

Publisher: Journal of Gastrointestinal Surgery

Volume/Edition: 20 (3)

Publication Type: Journal

Article:

This retrospective study looked at surgeons in rural settings seeking recertification and contributed to research on the need for continuous learning to maintain skills and use of simulation.

Current Workforce of General Pediatricians in the United States

Author(s): G Freed, L Moran, K Van, L Leslie

Date: 04/2016

Publisher: Pediatrics

Volume/Edition: 137 (4)

Publication Type: Journal

Article:

This survey study reinforced previous research on the value of participation in MOC part IV projects. In this particular survey study, American Academy of Pediatrics modules and MOC requirements were identified as reasons for greater participation in QI efforts. MOC is also valuable as it may identify where gaps in resources exist that may hinder private practices’ ability to participate in QI efforts.

Improving HPV Vaccination Rates Using Maintenance-of-Certification Requirements

Author(s): A Fiks, X Luan, S Mayne

Date: 03/2016

Publisher: Pediatrics

Volume/Edition: 137 (3)

Publication Type: Journal

Article:

This study underscored the results of a previous randomized study showing that HPV vaccination rates, and missed opportunities to discuss HPV vaccination with patients and families, needed improvement. Through MOC part IV, physicians were able to participate in a quality improvement project to address this problem. This study notes that a benefit of MOC-required QI projects is that they can engage physicians in projects that may not otherwise draw participation in the projects. MOC allows for meaningful participation in QI projects, which provides a way for a physician to be involved in the inception of a project through to the completion.

Maintenance of Certification and the Aging Neurosurgeon

Author(s): M Babu, L Liau, R Spinner, F Meyer

Date: 08/2016

Publisher: Neurosurgery

Volume/Edition: 63 (1)

Publication Type: Journal

Article:

This survey study (oral presentation) showed that most neurosurgeons , including those currently participating in MOC, grandfathered, and retired, felt that neurosurgeons aged 65 and older should undergo additional cognitive assessment, although most also felt that there should not be any mandatory cut-off age for practice. 42 percent believed that MOC should be tailored to gaining neurosurgeons. This survey work contributes to the practice considerations and needs of aging physicians and how MOC could be used to support those needs, while keeping patient safety paramount.

Understanding the Operative Experience of the Practicing Pediatric Surgeon

Author(s): F Abdullah, J Salazar, C Gause, S Gadepalli, T Biester, K Azarow, R Hirschl

Date: 08/2016

Publisher: JAMA Surgery

Volume/Edition: 151 (8)

Publication Type: Journal

Article:

This retrospective review reinforces previous research regarding maintaining current knowledge and competency, recognizing the relevance of simulation programs.

Effects of a Web-based Educational Module on Pediatric Emergency Medicine Physicians’ Knowledge, Attitudes, and Behaviors Regarding Youth Violence

Author(s): T Madsen, A Riese, E Choo, M Ranney

Date: 08/2014

Publisher: Western Journal of Emergency Medicine

Volume/Edition: 15 (5)

Publication Type: Journal

Article:

A web-based educational module was developed focusing on the needs of victims of youth violence. This study evaluated the intervention of the educational module and showed that the module affected physicians’ knowledge of, and response to, cases involving youth violence.

Dreyfus and Dreyfus and Indicators of Behavioral Performance: A Study of Measurement Convergence

Author(s): B Williams, P Byrne, N Williams, M Williams

Date: 01/2017

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: Jan 2017

Publication Type: Journal

Article:

Data in this study was collected using three hundred sixty-degree (360˚) feedback from physicians. This study evaluates competency-based medical education and continuing professional development using the Dreyfus and Dreyfus five-stage model of skill acquisition.

Quality Metrics Currently Used in Academic Radiology Departments: Results of the QUALMET Survey

Author(s): E Walker, J Petscavage-Thomas, j Fotos, M Bruno

Date: 01/2017

Publisher: British Journal of Radiology

Volume/Edition: Jan 2017

Publication Type: Journal

Article:

This survey study presented the results of a survey of 112 radiology departments across the United States regarding quality indicators, including Maintenance of Certification (MOC) participation. MOC participation was found to be varied and a requirement of employment for nearly half of the respondents. The discussion notes that MOC is currently the best measure of a radiologist staying current with recommended practices.

Professional Self-regulation in a Changing World Old Problems Need New Approaches

Author(s): R Baron

Date: 05/2015

Publisher: Journal of the American Medical Association

Volume/Edition: 313 (18)

Publication Type: Journal

Article:

This commentary article discusses origins of the specialty boards, the role of the American Medical Association, and self-regulation, with a focus on the American Board of Internal Medicine (ABIM).

Of the Profession, by the Profession, and for Patients, Families, and Communities ABMSBoard Certification and Medicine’s Professional Self-regulation

Author(s): L Nora, M Wynia, T Granatir

Date: 05/2015

Publisher: Journal of the American Medical Association

Volume/Edition: 313 (18)

Publication Type: Journal

Article:

This commentary article discusses the background and future challenges of the American Board of Medical Specialties (ABMS) and Board Certification.

Ensuring Physicians’ Competence — Is Maintenance of Certification the Answer?

Author(s): J Iglehart, R Baron

Date: 12/2012

Publisher: New England Journal of Medicine

Volume/Edition: 367 (26)

Publication Type: Journal

Article:

This article discusses the background of Maintenance of Certification (MOC) programs and how programs are being revised to better accommodate diplomate needs and concerns.

American Board of Radiology Maintenance of Certification Program: Evolution to Better Serve Stakeholders

Author(s): P Wallner, D Shrieve, L Kachnic, L Wilson, S Hahn, K Alektiar, M Guiberteau

Date: 01/2016

Publisher: International Journal of Radiation Oncology, Biology, Physics

Volume/Edition: 94 (1)

Publication Type: Journal

Article:

This commentary reflects on the self-management of medical education and how historically it was recognized that more oversight was needed. This article is also an update report on how the American Board of Radiology (ABR) is staying current and adapting to diplomate needs.

Impact of One Versus Two Content-Specific Modules on American Board of Family Medicine Certification Examination Scores

Author(s): T O'Neill, M Peabody

Date: 01/2017

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 30 (1)

Publication Type: Journal

Article:

This study contributed to the cumulative research determining if physicians are good at self-assessment/recognizing knowledge gaps and the bias that can result in examination scores because of allowing self-selection of content in portions of the examination.

MyPOD: an EMR-Based Tool that Facilitates Quality Improvement and Maintenance of Certification

Author(s): L Berman, B Duffy, B Brenn, C Vinocur

Date: 03/2017

Publisher: Journal of Medical Systems

Volume/Edition: 41 (3)

Publication Type: Journal

Article:

Participation in Maintenance of Certification (MOC) by the American Board of Surgery (ABS) requires quality assessment efforts. This article discusses a quality improvement effort to review an electronic medical records tool called My Personal Outcomes Data (MyPOD) that tracked surgical outcomes at the Nemours-AI duPont Hospital for Children. The effort compared MyPOD and the National Surgical Quality Improvement Program (NSQIP) databases and revealed many adverse events were not being reported by surgeons. This project showed problems that can occur with self-reporting and how it can be improved upon through using MOC requirements.

Quality of Care Provided by Board-Certified Versus Non-Board-Certified Psychiatrists and Neurologists

Author(s): A Wallace, B McFarland, N Selvam, G Sahota

Date: 01/2017

Publisher: Academic Medicine

Volume/Edition: 92 (1)

Publication Type: Journal

Article:

This article describes use of quality measures to compare quality of care between Board-certified and non-Board-certified psychiatrists and neurologists.

ABAI’s MOC Assessment of Knowledge Program Matures: Adding Value with Continuous Learning and Assessment

Author(s): D Bernstein, S Wasserman, W Thompson, T Freeman

Date: 01/2017

Publisher: Journal of Allergy and Clinical Immunology: In Practice

Volume/Edition: 5 (1)

Publication Type: Journal

Article:

This article describes the American Board of Allergy and Immunology’s (ABAI) efforts to improve part III of their Maintenance of Certification (MOC) program, the assessment of knowledge, judgment, and skills, while focusing on adult learning theory methods and reducing burden on diplomates.

Survey of Family History Taking and Genetic Testing in Pediatric Practice

Author(s): R Saul, T Trotter, K Sease, B Tarini

Date: 01/2017

Publisher: Journal of Community Genetics

Volume/Edition: Jan 2017

Publication Type: Journal

Article:

This article discusses a survey done to determine the importance of primary care physicians understanding how to put genomics into their practice, and how undergraduate medical education, graduate medical education, and Maintenance of Certification (MOC) can be expanded to include genomic education.

A New Era in Quality Measurement: The Development and Application of Quality Measures

Author(s): T Adirim, K Meade, K Ministry

Date: 01/2017

Publisher: Pediatrics

Volume/Edition: 139 (1)

Publication Type: Journal

Article:

This article discusses the development of quality measures. Quality measures are used in Maintenance of Certification (MOC) programs.

MO-G-204-02: Assessing Cognitive Expertise of Medical Physics Diplomates

Author(s): G Ibbott

Date: 01/2016

Publisher: Medical Physics

Volume/Edition: 43 (6)

Publication Type: Journal

Article:

This learning objectives article discusses American Board of Radiology (ABR) Maintenance of Certification (MOC) requirements.

MO-G-204-01: Current MOC Requirements with An Emphasis On Recent Changes

Author(s): M Herman

Date: 06/2016

Publisher: Medical Physics

Volume/Edition: 43 (6)

Publication Type: Journal

Article:

This learning objectives article discusses American Board of Radiology (ABR) Maintenance of Certification (MOC) requirements.

MO-G-204-00: The American Board of Radiology Maintenance of Certification Process

Author(s): G Frey

Date: 06/2016

Publisher: Medical Physics

Volume/Edition: 43 (6)

Publication Type: Journal

Article:

This learning objectives article discusses American Board of Radiology (ABR) Maintenance of Certification (MOC) requirements.

Pediatric Residency Education and the Behavioral and Mental Health Crisis: A Call to Action

Author(s): J McMillan, M Land, L Leslie

Date: 01/2017

Publisher: Pediatrics

Volume/Edition: 139 (1)

Publication Type: Journal

Article:

This article addresses the importance of focusing on behavioral and mental health in pediatric resident training and the efforts being made by the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Medical Specialties (ABMS), and the American Board of Pediatrics (ABP) to improve this area of need. This article also identifies how Maintenance of Certification (MOC) will be used to improve learning.

Reliable Pregnancy Testing Before Intravenous Cyclophosphamide: A Quality Improvement Study

Author(s): K Hayward, W Haaland, J Hrachovec, M Leu, H Cllifton, N Rascoff, C Crowell

Date: 12/2016

Publisher: Pediatrics

Volume/Edition: 138 (6)

Publication Type: Journal

Article:

This article discusses a quality improvement study to improve rates of pregnancy screening in adolescent females.

Do Maintenance of Certification Activities Promote Positive Changes in Clinical Practice?

Author(s): L Heitlinger

Date: 12/2016

Publisher: Journal of Pediatric Gastroenterology and Nutrition

Volume/Edition: Dec

Publication Type: Journal

Article:

This brief article discusses quality improvement activities and their relevance to diplomates participating in maintenance of certification (MOC) programs.

Knowing What We Don’t Know — Improving Maintenance of Certification

Author(s): R Baron, C Braddock

Date: 11/2016

Publisher: New England Journal of Medicine

Volume/Edition: Nov

Publication Type: Journal

Article:

This perspective article discusses certification in a historical context, and also discusses future changes the American Board of Internal Medicine (ABIM) is planning.

Ecological Momentary Assessment

Author(s): S Shiffman, A Stone, M Hufford

Date: 04/2008

Publisher: Annual Review of Clinical Psychology

Volume/Edition: 4 (1-32)

Publication Type: Journal

Article:

This review discusses ecological momentary assessment (EMA) history, methods, and uses.

Scoring and Classifying Examinees Using Measurement Decision Theory

Author(s): L Rudner

Date: 04/2009

Publisher: Practical Assessment, Research and Evaluation

Volume/Edition: 14 (8)

Publication Type: Journal

Article:

This article discusses the main concepts of measurement decision theory.

Impact on Clinical Behavior of Face-to-Face Continuing Medical Education Blended with Online Spaced Education: A Randomized Controlled Trial

Author(s): T Shaw, A Long, S Chopra, P Kerfoot

Date: 04/2011

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 31 (2)

Publication Type: Journal

Article:

This randomized controlled trial of a spaced education study showed that spaced education can cause an in-person course to have greater impact, meaning blended learning programs, rather than just one in-person program, can have greater effect.

The Critical Role of Retrieval Practice in Long Term Retention

Author(s): H Roediger, A Butler

Date: 01/2011

Publisher: Trends in Cognitive Sciences

Volume/Edition: 15 (1)

Publication Type: Journal

Article:

This review article discusses evidence that retrieval of information during testing produces greater learning than studying.

Test-Enhanced Learning: Taking Memory Tests Improves Long Term Retention

Author(s): H Roediger, J Karpicke

Date: 03/2006

Publisher: Psychological Science

Volume/Edition: 17 (3)

Publication Type: Journal

Article:

This article reviews a study on testing as it relates to improved learning.

Retrieval Practice Produces More Learning than Elaborative Studying with Concept Mapping

Author(s): J Karpicke, J Blunt

Date: 02/2011

Publisher: Science

Volume/Edition: 331 (6018)

Publication Type: Journal

Article:

This article reviews two studies focusing on retrieval practice and elaborative studying, and how retrieval practice was found to enhance learning.

Improving Students’ Learning With Effective Learning Techniques: Promising Directions from Cognitive and Educational Psychology

Author(s): J Dunlosky, K Rawson, E Marsh, M Nathan, D Willingham

Date: 01/2013

Publisher: Psychological Science in the Public Interest

Volume/Edition: 14 (1)

Publication Type: Journal

Article:

This review discusses learning techniques, including testing, and their utility.

The Role of Internal Medicine Subspecialists in Patient Care Management

Author(s): J Vandergrift, B Gray, J Reschovsky, E Holmboe, R Lipner

Date: 11/2016

Publisher: American Journal of Managed Care

Volume/Edition: 22 (11)

Publication Type: Journal

Article:

This survey collected responses from internal medicine subspecialists in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program regarding how they perceived the time they spent on certain clinical roles. A significant amount of subspecialists identified care management as a significant role.

Brain Science Provides New Approach to Patient Safety Training

Author(s): P Kerfoot

Date: 11/2013

Publisher: Patient Safety and Quality Healthcare

Volume/Edition: 10 (6)

Publication Type: Journal

Article:

This article discusses efficiency and improvement in learning using spaced education, specifically focusing on patient safety and infection control.

To Really Learn, Quit Studying and Take a Test

Author(s): P Belluck

Date: 01/2011

Publisher: New York Times

Volume/Edition: Jan 2011

Publication Type: Newspaper

Article:

This is a news item from the New York Times discussing how examinations help in the learning process.

The American Board of Radiology Radiation Oncology Maintenance of Certification Part 3 Modular Examination: Evaluation of the First Administration

Author(s): P Wallner, A Gerdeman, J Willis, A Zietman

Date: 11/2016

Publisher: Practical Radiation Oncology

Volume/Edition: 6 (6)

Publication Type: Journal

Article:

The American Board of Radiology administered a new modular examination in 2015. This is an evaluation and report of this administration.

keywords: examination, MOC part III, areas of clinical interest, examination development, survey

The Predictive Validity of the National Board of Osteopathic Medical Examiners’ COMLEX-USA Examinations With Regard to Outcomes on American Board of Family Medicine Examinations

Author(s): T O'Neill, M Peabody, H Song

Date: 11/2016

Publisher: Academic Medicine

Volume/Edition: 91 (11)

Publication Type: Journal

Article:

This longitudinal study relates to the value of MOC in its role within a physician’s career. This study contributed to research on the predictive validity of examinations. In this regard, how performance on the National Board of Osteopathic Medical Examiners’ Comprehensive Osteopathic Medical Licensing Examination of the United States of America, predicted performance on the MC-FP examination. Alignment within the licensing and certification process can have predictive value in determining probability of success as well as possible physician workforce concerns.

Using Maintenance of Certification as a Tool to Improve the Delivery of Confidential Care for Adolescent Patients

Author(s): M Riley, S Ahmed, J Lane, B Reed, A Locke

Date: 08/2016

Publisher: Journal of Pediatric & Adolescent Gynecology

Volume/Edition: Aug 2016

Publication Type: Journal

Article:

Physician Attitudes About Maintenance of Certification: A Cross-Specialty National Survey

Author(s): D Cook, M Blachman, C West, C Wittich

Date: 10/2016

Publisher: Mayo Clinic Proceedings

Volume/Edition: 91 (10)

Publication Type: Journal

Article:

Criteria for Good Assessment: Consensus Statement and Recommendations From the Ottawa 2010 Conference

Author(s): J Norcini, B Anderson, V Bollela, V Burch, M Joao Costa, R Duvivier, T Roberts

Date: 01/2011

Publisher: Medical Teacher

Volume/Edition: 33 (3)

Publication Type: Journal

Article:

Online Formative Tests Linked to Microlectures Improving Academic Achievement

Author(s): R Bouwmeester, R De Kleijn, A Freriksen, M Van Emst, R Veeneklaas, M Van Hoeij, H Van Rijen

Date: 01/2013

Publisher: Medical Teacher

Volume/Edition: 35 (12)

Publication Type: Journal

Article:

Teaching to Test or Testing to Teach?

Author(s): J Boulet

Date: 01/2008

Publisher: Medical Education

Volume/Edition: 42

Publication Type: Journal

Article:

Learning With Retrieval-Based Concept Mapping

Author(s): J Blunt, J Karpicke

Date: 01/2014

Publisher: Journal of Educational Psychology

Volume/Edition: 106 (3)

Publication Type: Journal

Article:

Developing the Theory of Formative Assessment

Author(s): P Black, D William

Date: 01/2009

Publisher: Educational Assessment, Evaluation and Accountability

Volume/Edition: 21 (1)

Publication Type: Journal

Article:

Why Interleaving Enhances Inductive Learning: The Roles of Discrimination and Retrieval

Author(s): M Birnbaum, N Kornell, E Bjork

Date: 01/2013

Publisher: Memory & Cognition

Volume/Edition: 41

Publication Type: Journal

Article:

Challenging Medical Students With an Interim Assessment: A Positive Effect on Formal Examination Score in a Randomized Controlled Study

Author(s): M Olde Bekkink, R Donders, G van Muijen, D Ruiter

Date: 01/2012

Publisher: Advances in Health Sciences Education

Volume/Edition: 17 (1)

Publication Type: Journal

Article:

Test-Enhanced Learning and Its Effect on Comprehension and Diagnostic Accuracy

Author(s): M Baghdady

Date: 01/2014

Publisher: Medical Education

Volume/Edition: 48 (2)

Publication Type: Journal

Article:

How to Learn Effectively in Medical School: Test Yourself, Learn Actively, and Repeat in Intervals

Author(s): M Augustin

Date: 01/2014

Publisher: The Yale Journal of Biology and Medicine

Volume/Edition: 87 (2)

Publication Type: Journal

Article:

Influences on Medical Students Self-Regulated Learning After Test Completion

Author(s): S Agrawal, G Norman, K Eva

Date: 10/2012

Publisher: Medical Education

Volume/Edition: 46

Publication Type: Journal

Article:

Test-Potentiated Learning: Distinguishing Between Direct and Indirect Effects of Tests

Author(s): K Arnold, K McDermott

Date: 01/2013

Publisher: Journal of Experimental Psychology: Learning, Memory, and Cognition

Volume/Edition: 39 (3)

Publication Type: Journal

Article:

Assessment of the American Board of Ophthalmology’s Maintenance of Certification Part 4 (Improvement in Medical Practice)

Author(s): R Wiggins, R Etz

Date: 09/2016

Publisher: JAMA Ophthalmology

Volume/Edition: 134 (9)

Publication Type: Journal

Article:

This retrospective analysis contributes further to the value of participating in MOC part IV projects. Although most participants felt the activity was valuable, it was recognized that improvements in technology and data collection methods could contribute significantly to meaningful QI efforts.

The Value of Maintenance of Certification

Author(s): H Beaver

Date: 09/2016

Publisher: JAMA Ophthalmology

Volume/Edition: 134 (9)

Publication Type: Journal

Article:

National Academies Press

Author(s):

Date:

Publisher: National Academies Press

Volume/Edition:

Publication Type: Website

Article:

More Than Reducing Complexity: Canadian Specialists’ Views of the Royal College’s Maintenance of Certification Framework and Program

Author(s): T Horsley, K Moreau, J Lockyer, J Zeiter, L Varpio, C Campbell

Date: 06/2016

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 36 (3)

Publication Type: Journal

Article:

Commentary on the Potential of the MOCA Minute Program

Author(s): R Bjork

Date: 08/2016

Publisher: Anesthesiology

Volume/Edition:

Publication Type: Journal

Article:

This commentary discusses the Maintenance of Certification in Anesthesiology (MOCA) Minute initiative, relevance, and related benefits.

Association Between Participation in an Intensive Longitudinal Assessment Program and Performance on a Cognitive Examination in the Maintenance of Certification in Anesthesiology Program®

Author(s): H Sun, Y Zhou, D Culley, A Harman, D Warner

Date: 08/2016

Publisher: Anesthesiology

Volume/Edition:

Publication Type: Journal

Article:

This observational study reinforces previous research on the relevance of the MOC examination in association with lifelong learning. In this case, participation in the MOCA Minute program was evaluated. The MOCA Minute program has tremendous value in assessing improvements in physician learning and knowledge retention.

The ABMS MOC Part III Examination: Value, Concerns, and Alternative Formats

Author(s): R Hawkins, M Irons, C Welcher, M Pouwels, E Holmboe, E Reisdorff, J Gold

Date: 06/2016

Publisher: Academic Emergency Medicine

Volume/Edition:

Publication Type: Journal

Article:

The American Board of Emergency Medicine ConCert™ Examination: Emergency Physicians’ Perceptions of Learning and Career Benefits

Author(s): C Marco, R Wahl, F Counselman, B Heller, A Harvey, K Joldersma, E Reisdorff

Date: 03/2016

Publisher: Academic Emergency Medicine

Volume/Edition:

Publication Type: Journal

Article:

Physician Preparation for the American Board of Emergency Medicine ConCert Examination

Author(s): C Marco, R Wahl, F Counselman, B Heller, T Kowalenko, A Harvey, E Reisdorff

Date:

Publisher: Journal of General Internal Medicine

Volume/Edition:

Publication Type: Book

Article:

This survey study reinforced previous studies associating examinations with maintaining knowledge. This study showed that physicians go through significant preparation for examinations, and that while Board certification may be a condition of employment and a significant motivating factor, the MOC examination preparation also contributes to maintenance of knowledge over time.

Comparison of Certification and Recertification Examinee Performance on Multiple-Choice Items in Forensic Psychiatry

Author(s): D Juul, J Vollmer, L Shen, L Faulkner

Date: 03/2016

Publisher: Journal of the American Academy of Psychiatry and the Law Online

Volume/Edition: 44 (1)

Publication Type: Journal

Article:

Predictors of Performance on the Maintenance of Certification in Anesthesiology Program® (MOCA®) Examination

Author(s): H Sun, D Culley, C Lien, D Kitchener, A Harman, D Warner

Date: 02/2015

Publisher: Journal of Clinical Anesthesia

Volume/Edition: 27 (1)

Publication Type: Journal

Article:

Informal Peer Interaction and Practice Type as Predictors of Physician Performance on Maintenance of Certification Examinations

Author(s): M Valentine, S Barsade, A Edmondson, A Gal, R Rhodes

Date: 06/2014

Publisher: JAMA Surgery

Volume/Edition: 149 (6)

Publication Type: Journal

Article:

Community Size and Organization of Practice Predict Family Physician Recertification Success

Author(s): B Schulte, D Mannino, K Royal, S Brown, L Peterson, J Puffer

Date: 05/2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 27 (3)

Publication Type: Journal

Article:

Do Family Physicians Choose Self-assessment Activities Based on What They Know or Don’t Know?

Author(s): L Peterson, B Blackburn, A Bazemore, T O'Neill, R Phillips

Date: 06/2014

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 34 (3)

Publication Type: Journal

Article:

Spaced Education Improves the Retention of Clinical Knowledge by Medical Students: A Randomized Controlled Trial

Author(s): P Kerfoot, W DeWolf, B Masser, P Church, D Federman

Date: 01/2007

Publisher: Medical Education

Volume/Edition: 41 (1)

Publication Type: Journal

Article:

ACR Value-Based PQI Project

Author(s): R Haines

Date: 05/2015

Publisher: American College of Radiology

Volume/Edition:

Publication Type: Poster

Article:

ACP Quality Connect: Diabetes Performance Improvement Initiative Successfully Links Clinical Registries and Quality Improvement to Pay-for-Performance Programs

Author(s): L Lee Hall

Date: 05/2015

Publisher: American College of Physicians

Volume/Edition:

Publication Type: Poster

Article:

ACP Genesis Registry™: Early Experience and Results from an Internal Medicine Qualified Clinical Data Registry

Author(s): L Lee Hall

Date: 05/2015

Publisher: American College of Physicians

Volume/Edition:

Publication Type: Poster

Article:

Improving Maintenance of Certification Self-Assessment Through Collaboration and Innovation

Author(s): M Irons

Date: 05/2015

Publisher: American Board of Medical Specialties

Volume/Edition:

Publication Type: Poster

Article:

Attending Physician Adherence to a 29-Component Central Venous Catheter Bundle Checklist During Simulated Procedures

Author(s): J Barsuk, E Cohen, D Nguyen, D Mitra, K O'Hara, Y Okuda, D Wayne

Date: 06/2016

Publisher: Critical Care Medicine

Volume/Edition:

Publication Type: Journal

Article:

Measuring What Matters: Top-Ranked Quality Indicators for Hospice and Palliative Care

Author(s): S Morss Dy

Date: 05/2015

Publisher: American Academy of Hospice and Palliative Medicine

Volume/Edition:

Publication Type: Poster

Article:

Practical Applications for Maintenance of Certification Products in Child and Adolescent Residency Training

Author(s):

Date:

Publisher: Journal of General Internal Medicine

Volume/Edition:

Publication Type: Book

Article:

Minimally Invasive Surgery Fellowship Graduates: Their Demographics, Practice Patterns, and Contributions

Author(s):

Date:

Publisher: Journal of General Internal Medicine

Volume/Edition:

Publication Type: Book

Article:

A Pilot Quality Improvement Program to Increase Pediatrician Injury Anticipatory Guidance

Author(s):

Date:

Publisher: Journal of General Internal Medicine

Volume/Edition:

Publication Type: Book

Article:

Quality Improvement Tools & Resources

Author(s):

Date: 01/2016

Publisher: HHS Health Resources and Services Administration

Volume/Edition:

Publication Type: Website

Article:

AHRQ Quality Measure Tools & Resources

Author(s):

Date: 03/2016

Publisher: Agency for Healthcare Research and Quality

Volume/Edition:

Publication Type: Website

Article:

Role for Assessment in Maintenance of Certification: Physician Perceptions of Assessment

Author(s): J Lockyer, T Horsley, J Zeiter, C Campbell

Date: 01/2015

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 35 (1)

Publication Type: Journal

Article:

Completing Self-assessment Modules During Residency Is Associated With Better Certification Exam Results

Author(s): L Peterson, B Blackburn, M King

Date: 09/2014

Publisher: Family Medicine

Volume/Edition: 46 (8)

Publication Type: Journal

Article:

A Significant Number of Charter Diplomates Participate in American Board of Family Medicine (ABFM) Maintenance of Certification

Author(s): J Puffer

Date: 07/2015

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 28 (4)

Publication Type: Journal

Article:

The American Board of Surgery Maintenance of Certification Program: The First 10 Years

Author(s): M Malangoni, C Shiffer

Date: 07/2015

Publisher: Bulletin of the American College of Surgeons

Volume/Edition:

Publication Type: Journal

Article:

Lifelong Learning for the Hand Surgeon

Author(s): J Adkinson, K Chung

Date: 09/2015

Publisher: Academic Emergency Medicine

Volume/Edition: 40

Publication Type: Journal

Article:

Family Physicians’ Scope of Practice and American Board of Family Medicine Recertification Examination Performance

Author(s): L Peterson, B Blackburn, M Peabody, T O'Neill

Date: 03/2015

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 28 (2)

Publication Type: Journal

Article:

Forecasting the Effect of the Change in Timing of the ABR Diagnostic Radiology Examinations: Results of the ACR Survey of Practice Leaders

Author(s): E Bluth, L Muroff, J Cernigliaro, A Moore, G Smith, J Flug, A Roberts

Date: 05/2015

Publisher: Journal of the American College of Radiology

Volume/Edition: 12 (5)

Publication Type: Journal

Article:

Maintenance of Certification and Pediatrics Milestones-Based Assessment: An Opportunity for Quality Improvement Through Lifelong Assessment

Author(s): V Moyer

Date: 03/2014

Publisher: Academic Pediatrics

Volume/Edition: 14 (2 Suppl)

Publication Type: Journal

Article:

Quality Improvement in the Age of Electronic Health Records: The North Carolina Improving Performance in Practice Program

Author(s): S Batish

Date: 04/2013

Publisher: North Carolina Medical Journal

Volume/Edition: 74 (2)

Publication Type: Journal

Article:

This commentary describes the challenges and successes of practices that have participated in the Improving Performance in Practice (IPIP) program of the South East Area Health Education Center (SEAHEC) with the aim of effectively using electronic health records (EHR) to improve outcomes for patients with chronic disease. Physicians participating in the IPIP program are eligible for ABMS Maintenance of Certification® (ABMS MOC®) Part IV credit.

Changing Physician Behavior: What Works?

Author(s): F Mostofian, C Ruban, N Simunovic, M Bhandari

Date: 01/2015

Publisher: American Journal of Managed Care

Volume/Edition: 21 (1)

Publication Type: Journal

Article:

Conducting a Successful Practice Quality Improvement Project for American Board of Radiology Certification

Author(s): C Lee, V Wadhwa, J Kruskal, D Larson

Date: 04/2015

Publisher: Radiographics

Volume/Edition: 35 (6)

Publication Type: Journal

Article:

Continuous Certification Within Residency: An Educational Model

Author(s): S Rachlin, A Schonberger, N Nocera, J Acharya, N Shah, J Henkel

Date: 10/2015

Publisher: Academic Radiology

Volume/Edition: 22 (10)

Publication Type: Journal

Article:

ABFM to Simplify MOC for Family Physicians and Make It More Meaningful: A Family Medicine Registry

Author(s): R Phillips

Date: 05/2015

Publisher: Annals of Family Medicine

Volume/Edition: 13 (3)

Publication Type: Journal

Article:

Characteristics of Internal Medicine Physicians and Their Practices that have Differential Impacts on Their Maintenance of Certification

Author(s): R Lipner, B Brossman

Date: 01/2015

Publisher: Academic Medicine

Volume/Edition: 90 (1)

Publication Type: Journal

Article:

Board Certification in Internal Medicine and Cardiology: Historical Success and Future Challenges

Author(s): R Baron, H Krumholz, M Jessup

Date: 05/2015

Publisher: Trends in Cardiovascular Medicine

Volume/Edition: 25 (4)

Publication Type: Journal

Article:

Follow-up on ABIM Maintenance of Certification

Author(s): P O'Gara, W Oetgen

Date: 01/2015

Publisher: Journal of the American College of Cardiology

Volume/Edition: 65 (2)

Publication Type: Journal

Article:

Aiming Higher to Enhance Professionalism: Beyond Accreditation and Certification

Author(s): M Chassin, D Baker

Date: 05/2015

Publisher: Journal of the American Medical Association

Volume/Edition: 313 (18)

Publication Type: Journal

Article:

Measuring Reflection on Participation in Quality Improvement Activities for Maintenance of Certification

Author(s): C Wittich, D Reed, H Ting, R Berger, M Blachman, J Mandrekar, T Beckman

Date: 10/2014

Publisher: Academic Medicine

Volume/Edition: 89 (10)

Publication Type: Journal

Article:

Point: Twin Dogmas of Maintenance of Certification

Author(s): S Jha

Date: 05/2015

Publisher: Journal of the American College of Radiology

Volume/Edition: 12 (5)

Publication Type: Journal

Article:

Practice Improvements Based on Participation in Simulation for the Maintenance of Certification in Anesthesiology Program

Author(s): R Steadman, A Burden, Y Huang, D Gaba, J Cooper

Date: 05/2015

Publisher: Anesthesiology

Volume/Edition: 122 (5)

Publication Type: Journal

Article:

ABFM’s Heart Failure Self-Assessment Module Simulation Actions Vis-A-Vis Guideline Recommendations

Author(s): M Hagen

Date: 07/2012

Publisher: Annals of Family Medicine

Volume/Edition: 10 (4)

Publication Type: Journal

Article:

This article provides an overview of the results from chronic heart failure (CHF) self-assessment modules (SAM) and simulations that were introduced in 2006. Results indicated that knowledge gaps were present regarding the use of American College of Cardiology Foundation and American Heart Association guidelines, but also that the knowledge assessment items themselves could better reflect the decision to use the guidelines. Overall, SAMs and use of simulation are valuable tools in the identification of knowledge gaps that may occur in patient management.

Criterion-Referenced Examinations: Implications for the Reporting and Interpretation of Examination Results

Author(s): K Royal, J Puffer

Date: 03/2013

Publisher: Annals of Family Medicine

Volume/Edition: 11 (2)

Publication Type: Journal

Article:

This update from American Board of Family Medicine (ABFM) explains the basis for the criterion-referenced examinations used for the ABFM certification/Maintenance of Certification (MOC) examination. The article discusses different methods of reporting examination results and further explains the psychometric model, Item Response Theory (IRT), used to develop and score the present examination.

Maintenance of Certification, Medicare Quality Reporting, and Quality of Diabetes Care

Author(s): R Phillips, B Blackburn, L Peterson, J Puffer

Date: 03/2015

Publisher: American Journal of Medical Quality

Volume/Edition:

Publication Type: Journal

Article:

This study analyzed whether the quality improvement and feedback aspects of Maintenance of Certification (MOC) can be associated with improved outcomes in the Physician Quality Reporting System (PQRS). PQRS is an initiative created by the Centers for Medicare and Medicaid Services (CMS) in which participating physicians are eligible for a bonus on Medicare payments. The study compared completion of either Performance in Practice Modules (PPM), Physician Quality Reporting System (PQRS), or PPM and PQRS combined. Results indicated that the combined PPM and PQRS group showed cross-program improvement and suggested improved outcomes when performance measures and quality measures are aligned.

Specialty Board Certification in the United States: Issues and Evidence

Author(s): R Lipner, B Hess, R Phillips

Date: 12/2013

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 33 (S1)

Publication Type: Journal

Article:

This literature review examined the effectiveness of certification and Maintenance of Certification (MOC) programs by evaluating peer-reviewed literature on certification and MOC for perceptions of physicians, patients, and hospitals, as well as examining approaches to learning, and impacts of certification on quality of care. This review showed that overall certification and MOC is valued, but that more research on programs, and more focus on appropriate study design, is needed.

Hospital and Emergency Department Factors Associated with Variations in Missed Diagnosis and Costs for Patients Age 65 Years and Older with Acute Myocardial Infarction Who Present to Emergency Departments

Author(s): M Wilson, J Welch, J Schuur, K O'Laughlin, D Cutler

Date: 10/2014

Publisher: Academic Emergency Medicine

Volume/Edition: 21 (10)

Publication Type: Journal

Article:

This observational study evaluated over 300,000 Medicare records to determine quality and cost predictors related to acute myocardial infarction (AMI) diagnosis, including certification by the American Board of Emergency Medicine (ABEM). Although the study data used had limited clinical information, ABEM certification was associated with better patient outcomes and lower rates of missed AMI diagnosis. Overall, this study is valuable in recognizing predictors of improved quality of care for older patients, and associated costs.

Engagement of Groups in Family Medicine Board Maintenance of Certification

Author(s): D Fisher, C Brenner, M Cheren, K Stange

Date: 03/2013

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 26 (2)

Publication Type: Journal

Article:

This article described the development of an initiative undertaken to assist physicians in completing part IV Maintenance of Certification (MOC) requirements, and the study results of the intiative’s participants. Results showed that practice coaching is a key element of successful intrapractice and interpractice group collaborations as quality improvement (QI) needs were supported, and physicians were able to appreciate meaningful learning opportunities through the part IV projects.

Maintenance of Certification: What Everyone Needs to Know

Author(s): G Callender, B Kaplan, R White, D Brenin, A Chagpar, K Dalal, V Klimberg

Date: 04/2015

Publisher: Annals of Surgical Oncology

Volume/Edition: 22 (4)

Publication Type: Journal

Article:

This editorial gives a brief description of the American Board of Surgery (ABS) Maintenance of Certification (MOC) program and outlines an overall perspective on the importance of MOC to the practice of medicine. The article primarily focuses on MOC, Part  2 (Lifelong learning and self-assessment), by outlining the requirements and giving a detailed account of how a surgeon can complete the 3 year requirements and devise a plan for ongoing participation in self-assessment activities in order to overcome the barrier of the last minute rush to complete the credit cycle.

Maintenance of Certification 2.0-Strong Start, Continued Evolution

Author(s): M Irons, L Nora

Date: 01/2015

Publisher: New England Journal of Medicine

Volume/Edition: 372 (2)

Publication Type: Journal

Article:

This perspective provides background and describes the evolution of the American Board of Medical Specialties Maintenance of Certification® (ABMS MOC®) program that was adopted in 2000 by ABMS members, medical specialty boards. The authors cite evidence to support MOC by referencing studies that show that MOC can improve physicians performance and patient outcomes.  The need for periodic reevaluation of the program is stressed in order to meet the ongoing needs of physicians and community. Perceived burdens of MOC from the physician perspective are discussed as well as  the recently approved 2015 ABMS standards developed as a result of a current review of the MOC program.

Integrating Maintenance of Board Certification and Health Systems’ Quality Improvement Programs

Author(s): H Ting, K Nowicki, S Starr, J Deming, C Wittich, A Hartl, R Berger

Date: 11/2013

Publisher: Harvard Business Review Blog Network

Volume/Edition:

Publication Type: Journal

Article:

This article is a blog post that describes MAYO clinic’s 2009 efforts to partner with the American Board of Family Medicine (ABFM), the American Board of Internal Medicine (ABIM), and the American Board of Pediatrics (ABP) to create a pilot program: the Multi-Specialty Portfolio Program (MSPP) for Part IV Maintenance of Certification (MOC). The pilot involved adapting the traditional MOC Part IV process (that usually focuses more on individual QI projects) and allowed Mayo to oversee and award Part IV MOC to its physicians engaged in frontline as well as institutional efforts to improve patient outcomes, safety, and service. The article highlights the success of Mayo Clinic’s efforts and discusses the expansion of the MSPP to include other specialty boards and health care organizations. The authors conclude with suggestions for the future model of MOC.

Impact of a Performance Improvement CME Activity on the Care and Treatment of Patients with Psoriasis

Author(s): D Gist, R Bhushan, E Hamarstrom, P Sluka, C Presta, J Thompson, R Kirsner

Date: 01/2015

Publisher: Journal of the American Academy of Dermatology

Volume/Edition: 72 (3)

Publication Type: Journal

Article:

This study aimed at investigating the impact of a Performance Improvement (PI) activity on dermatologists’ practice specific to psoriasis treatment. The activity was approved for American Board of Dermatology (ABD) Maintenance of Certification (MOC) Part IV credit. Almost 200 physician participants audited their patient charts, reflected on results, benchmarked against peers, engaged in an educational activity, developed an improvement plan and audited a different set of patient charts to assess changes to practice. Study results revealed significant improvement in patient counseling on cardiovascular disease and shared decision making relevant to the treatment plan. Similarly, study results revealed an overall improvement of history taking. It should be noted that participants self-selected patient charts, that chart data was self-reported and that there was no control group.

 

Counterpoint: Maintenance of Certification: Focus on Physician Concerns

Author(s): M Guiberteau, G Becker

Date: 02/2015

Publisher: Journal of the American College of Radiology

Volume/Edition:

Publication Type: Journal

Article:

The article reviews American Board of Radiology (ABR) Maintenance of Certification (MOC) program. Specifically, it discusses program evolution, program perception by radiologists, and opportunities for program improvement. The ABR MOC allows radiologists to personalize the program per their scope of practice. The ABR continuously strives to improve the program. Specifically, it is investigating innovative ways to assess cognitive expertise; it provides MOC credit for quality improvement (QI) activities in which radiologists are already participating; and it allows participation in group QI. The ABR is committed to seeking diplomate feedback to ensure an open dialogue and further improvements to the program.

Maintenance of Certification Part IV Quality-Improvement Project for Hypertension Control: A Preliminary Retrospective Analysis

Author(s): V Kolasinski, D Price

Date: 03/2015

Publisher: The Permanente Journal

Volume/Edition: 19 (2)

Publication Type: Journal

Article:

This study evaluates the impact of an American Board of Medical Specialties Maintenance of Certification® (ABMS MOC®) program, Part IV project, designed to improve outcomes regarding blood pressure control in hypertensive patients and also assesses whether or not physician participation in MOC Quality Improvement (QI) adds perceived burden to participating practices. Results showed physician participants improved the care of their patients without perceived increase of burden to their practice.

Emergency Department Quality Improvement Activity: An Inventory from the American Board of Emergency Medicine Maintenance of Certification Program

Author(s): T Kowalenko, M Carius, R Korte, M Miller, E Reisdorff

Date: 03/2015

Publisher: Academic Emergency Medicine

Volume/Edition: 22 (3)

Publication Type: Journal

Article:

This descriptive report focuses on the quality improvement (QI) activities that emergency physicians (EP) participate in to fulfill the requirements of the American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) program. A variety of QI activities are discussed and a summary of type, number and cumulative frequency of activities is reported with the intent of informing the emergency medicine community about the current trends in QI programming.

Performance on the Maintenance of Certification for Family Physicians (MC-FP) Examination: Comparison of Initial Certifiers with Experienced Physicians

Author(s): M Peabody, T O'Neill, J Puffer

Date: 03/2015

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 28 (2)

Publication Type: Journal

Article:

This report addresses the perceived bias that clinical knowledge declines as a physician moves further away from formal training. The authors specifically focus on the American Board of Family Medicine’s Maintenance of Certification for Family Physicians (MC-FP) examination, discuss various ways to analyze the exam scores, and offer a perspective that suggests that most veteran family physicians are able to maintain and expand their knowledge base over time.

Patient Care Outcomes of the SEAHEC Improving Performance in Practice (IPIP) Experience

Author(s): A Meyer, K Donahue, S Batish, T Gentry, A Adams, A Brown, M Baumann

Date: 01/2013

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 26 (1)

Publication Type: Journal

Article:

This pre-post study describes the effects of the collaboration between the South East Area Health Education Center (SEAHEC) and Improving Performance in Practice (IPIP) on the improvement in quality markers in chronic disease states in a single southeastern North Carolina family practice. Authors describe the process for making changes within the practice and highlight the effectiveness of the learning collaborative, a key component of the IPIP program. Physicians participating in the IPIP program are eligible for ABMS Maintenance of Certification® (ABMS MOC®) Part IV credit.

Engagement of Family Physicians in Maintenance of Certification Remains High

Author(s): J Puffer, A Bazemore, C Jaen, I Xierali, R Phillips, S Jones

Date: 11/2012

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 25 (6)

Publication Type: Journal

Article:

This article is an analysis of participation rates of American Board of Family Medicine (ABFM) diplomates who certified or recertified in 2004, one year after Maintenance of Certification (MOC) was introduced at ABFM. Within this second cohort, 86 percent successfully met all MOC requirements, compared to 75 to 80 percent of family physicians who would recertify before MOC was introduced in 2003. This data suggests that voluntary participation in MOC remains high and exceeds historical levels for family physicians. This may be partially due to the fact that family medicine has required periodic recertification since 1969 and it is part of the culture.

Emergency Physicians Maintain Performance on the American Board of Emergency Medicine Continuous Certification (ConCert) Examination

Author(s): C Marco, F Counselman, R Korte, C Russ, C Whitley, E Reisdorff

Date: 05/2014

Publisher: Academic Emergency Medicine

Volume/Edition: 21 (5)

Publication Type: Journal

Article:

This retrospective, longitudinal study examined the trends in emergency physician (EP) knowledge over a 24-year period using performance on the ConCert examination. This study analyzed examination score trends for those taking the examination for the first time during recertification cycles. Trends showed slight differences in examination scores between certification cycles, but remained generally consistent. A reason for this consistency is that ConCert examinations are structured in a standardized way for difficulty, but also this consistency reflects the nature of the EP’s constant exposure to a quickly changing and varied medical environment which includes a continuous exchange of knowledge. Some limitations to this study included:

  • self-selection bias
  • variations in equating earlier examination scores
  • exclusion of examinees who failed the examination
  • small differences between groups (such as geographic distribution)

Nevertheless, this study showed that overall EPs maintained knowledge over time as evidenced by examination performance.

Quality Improvement in Childhood Obesity Management through the Maintenance of Certification Process

Author(s): J Huang, S Chun, A Sandhu, L Terrones

Date: 11/2013

Publisher: Journal of Pediatrics

Volume/Edition: 163 (5)

Publication Type: Journal

Article:

The article provides an evaluation of the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a project that provides American Board of Pediatrics (ABP) Maintenance of Certification (MOC) part IV credit. The evaluation showed that participants improved their knowledge of childhood obesity as a result of the project. Limitations included selection bias and a lack of follow-up on patients to determine outcomes. However, this part IV project did result in improvements in physician performance related to following guidelines, increased knowledge, self-efficacy for screening, and greater pediatric obesity prevention and management.

Factors Associated With American Board of Medical Specialties Member Board Certification Among US Medical School Graduates

Author(s): D Jeffe, D Andriole

Date: 09/2011

Publisher: Journal of the American Medical Association

Volume/Edition: 306 (9)

Publication Type: Journal

Article:

This retrospective study analyzed characteristics and variables of those with Board Certification who graduated from medical schools within the United States. The majority of graduates were certified by American Board of Medical Specialties (ABMS) Member Boards. Differences were identified in certification examination pass rates between older and younger graduates, certification rates among minorities, and certification rates based on total debt across specialties. Gender did not play a huge role in determining certification in the majority of specialties. Limitations identified in this study included the inability to make causal inferences from results due to the observational study design, and lack of follow-up on graduates who had not yet been Board Certified. The study provides an overview of graduates who become Board Certified and graduates who may encounter a delay in Board Certification.

The American Board of Family Medicine Certification Examination: A Proxy for Quality

Author(s): J Puffer

Date: 06/2011

Publisher: Family Medicine

Volume/Edition: 43 (6)

Publication Type: Journal

Article:

This commentary provides a discussion on dual accreditation in family medicine by the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) and how this affects certification by the American Board of Family Medicine (ABFM). Studies discussed show that more osteopathic family medicine residents in ACGME-accredited programs have opted to be certified by the AOA and not the ABFM. The commentary maintains that if this trend continues it may inhibit the ability to accurately assess osteopathic programs, but that the 2011 changes in the ABFM certification examination will continue as a consistent assessment measure.

Engagement of Family Physicians Seven Years into Maintenance of Certification

Author(s): J Puffer, A Bazemore, W Newton, L Makaroff, I Xierali, L Green

Date: 09/2011

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 24 (5)

Publication Type: Journal

Article:

This policy brief provided a reflection on the American Board of Family Medicine (ABFM) Maintenance of Certification for Family Physicians (MC-FP) program after seven years. The ABFM started its MC-FP program in 2003. Seven years later, the majority of those physicians who began MC-FP were actively engaged in their programs, indicating a strong commitment to professionalism within the specialty. The author anticipates greater impact on cost and quality as a result of significant family physician participation in MC-FP.

Do Professional Development Programs for Maintenance of Certification (MOC) Affect Quality of Patient Care?

Author(s): J Galliher, B Manning, S Petterson, L Dickinson, E Brandt, R Phillips, W Pace

Date: 01/2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 27 (1)

Publication Type: Journal

Article:

This retrospective study examined the relationship between physicians’ completion of American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) modules and the quality of medical care delivered. The study focused on patients with an established diagnosis of type 2 diabetes mellitus and involved analyses of data obtained from electronic health records. Study results revealed somewhat improved diabetes care as a result of physician participation in the MOC process.

It Takes a Community: The North Carolina Division of Public Health and the North Carolina Area Health Education Center Program Partner to Reduce Strokes and Health Attacks

Author(s): S Cykert, R Petersen, A Lefebvre

Date: 12/2012

Publisher: North Carolina Medical Journal

Volume/Edition: 73 (6)

Publication Type: Journal

Article:

This commentary highlights the prevalence of cardiovascular disease in North Carolina and points to some of the barriers that prevent improvement. The authors describe a program designed to allow the North Carolina Division of Public Health to collaborate with state and local partners to improve the population’s health over a five-year period with better integration of resources. The paper also includes more detailed descriptions of the successes observed with The Heart Disease and Stroke Prevention Branch of the North Carolina Division of Public Health and the Improving Performance in Practice Program (IPIP) of North Carolina. Physicians participating in the IPIP program are eligible for MOC Part IV, Improvement in Medical Practice, credit.

The Evolution of Maintenance of Certification for Family Physicians (MC-FP) Part IV, Performance in Practice

Author(s): N Lainhart, M Hagen

Date: 07/2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 27 (4)

Publication Type: Journal

Article:

This article provides historical background on the evolution of performance in practice modules (PPM) required of the American Board of Family Medicine (ABFM) diplomates participating in Maintenance of Certification (MOC). It follows the progression of the ABFM professional development program from 1976 through 2014 with special emphasis on “performance in practice” and the resources and tools that were developed to improve quality of care.

More Than a List of Values and Desired Behaviors: A Foundational Understanding of Medical Professionalism

Author(s): M Wynia, M Papadakis, W Sullivan, F Hafferty

Date: 05/2014

Publisher: Academic Medicine

Volume/Edition: 89 (5)

Publication Type: Journal

Article:

This article is a detailed perspective on how the American Board of Medical Specialties (ABMS) Standing Committee on Ethics and Professionalism developed an operational definition of professionalism that relates to both initial certification and ABMS Maintenance of Certification® (ABMS MOC®). Authors explain that medical professionalism is best considered a normative belief system about how to best deliver health care rather than a set of behaviors. Authors discuss key implications for this new definition of professionalism.

Lifelong Learning and Self-Assessment is Relevant to Emergency Physicians

Author(s): J Jones, R Smith-Coggins, J Meredith, R Korte, E Reisdorff, C Russ

Date: 12/2013

Publisher: Journal of Emergency Medicine

Volume/Edition: 45 (6)

Publication Type: Journal

Article:

This study prospectively reviewed the 2011 survey results provided by American Board of Emergency Medicine (ABEM) certified emergency physicians who completed the 2011 Lifelong Learning and Self-assessment (LLSA) as a continuing medical education (CME) activity. This study is the first of its kind by ABEM to review the effectiveness of the Maintenance of Certification (MOC) program. Authors conclude the results of this survey demonstrate two key points: 1) that emergency physicians view these articles as relevant to the clinical practice of Emergency Medicine, and 2) participating in the LLSA is reported to have changed clinical practice.

One Rural Federally Qualified Health Center’s Journey with North Carolina’s Improving Performance in Practice (IPIP) Program

Author(s): K Schwartz

Date: 11/2012

Publisher: North Carolina Medical Journal

Volume/Edition: 73 (6)

Publication Type: Journal

Article:

A brief description of Roanoke Chowan Community Health Center’s link with the North Carolina Improving Performance in Practice (IPIP) Program and how their combined efforts helped kick-start an effective quality improvement (QI) program. The author describes the process used for standardizing an electronic medical record (EMR) template for patients with diabetes and discusses the center’s conversion to a new electronic health record (EHR) in 2011. Also, documented improvement in several diabetes and hypertension measures is highlighted. Physicians participating in IPIP were eligible for MOC Part IV credit.

More Extensive Implementation of the Chronic Care Model is Associated with Better Lipid Control in Diabetes

Author(s): J Halladay, D DeWalt, A Wise, B Qaqish, K Reiter, S Lee, K Donahue

Date: 01/2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 27 (1)

Publication Type: Journal

Article:

Using a sample of practices involved in the North Carolina Improving Performance in Practice (IPIP) Program (a statewide quality improvement (QI) project in North Carolina), this study examined whether the extent of implementation of four key drivers of practice change was associated with improved population-level outcomes for diabetes care. Findings showed statistically significant improvements in the proportion of patients who met the LDL threshold. The results for hemoglobin A1C and blood pressure values were not significant. Authors suggest that improved outcomes for patients with diabetes may be associated with a practice’s ability to implement key drivers of practice change. Physicians participating in IPIP were eligible for Maintenance of Certification (MOC) Part IV credit.

Dimensionality of the Maintenance of Certification for Family Physicians Examination: Evidence of Construct Validity

Author(s): K Royal, J Puffer

Date: 05/2013

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 26 (3)

Publication Type: Journal

Article:

This descriptive narrative focuses on the American Board of Family Medicine (ABFM) Maintenance of Certification for Family Physicians (MC-FP) examination and the efforts made to ensure the dimensionality of the examination. It highlights the analysis that was performed to confirm that the test was properly designed to measure one aspect at a time and also measures what it is designed to measure. The authors discuss the implications for construct validity and that the examination accurately measures the ability of family physicians to make appropriate clinical decisions.

Effectiveness of an Asthma Quality Improvement Program Designed for Maintenance of Certification

Author(s): L Vernacchio, M Francis, D Epstein, J Santangelo, E Trudell, M Reynolds, W Risko

Date: 06/2014

Publisher: Pediatrics

Volume/Edition: 134 (1)

Publication Type: Journal

Article:

This study is an evaluation of a program developed by Pediatric Physicians’ Organization at Children’s (PPOC), affiliated with Boston Children’s Hospital. The program derived data from three cohorts, involving physicians and patients, spanning three years. Practice-based registries of pediatric asthma patients were developed and used a learning collaborative model. Each meeting brought together multiple practice teams covering multiple topics in asthma care. The three cohorts each experienced improvements in the care of asthma including asthma action plans, Asthma Control Tests, medications, and visits. Patient outcomes were also affected as asthma exacerbations declined in all three cohorts. This study is subject to several limitations such as sample size, lack of comparison groups, and a need for a common definition of quality improvement in research. The learning collaborative model counted towards fulfilling Maintenance of Certification (MOC) requirements and resulted in learning and sharing among medical teams.

Family Physicians’ Quality Interventions and Performance Improvement Through the ABFM Diabetes Performance in Practice Module

Author(s): L Peterson, B Blackburn, J Puffer, R Phillips

Date: 01/2014

Publisher: Annals of Family Medicine

Volume/Edition: 12 (1)

Publication Type: Journal

Article:

This study is a validation of the Family Medicine Maintenance of Certification program, Part IV (MC-FP). The MC-FP Performance in Practice Module (PPM) uses National Quality Forum-endorsed measures, as part IV of the MC-FP requires measurement of the quality of care provided. Data was collected from PPMs of over 8,000 quality improvement projects over a seven-year period. This study showed that family physicians did substantially increase examination procedures pertaining to diabetes control and successfully applied quality improvement practices using quality measures. Limitations to this study included self-reported data, potential selection bias (of patients), and inability to link related American Board of Family Medicine (ABFM) data for comparison. Despite these limitations, patient outcomes showed significant improvements in hemoglobin control and blood pressure control, as well as an increase in retina and foot examinations.

Knowledge Assessment Responses in the ABFM Self-Assessment Modules (SAMs)

Author(s): M Hagen

Date: 11/2012

Publisher: Annals of Family Medicine

Volume/Edition: 10 (6)

Publication Type: Journal

Article:

This is a summary of diplomates’ knowledge assessment performance on American Board of Family Medicine (ABFM) self-assessment modules (SAMs). SAMs are organized by competencies and consist of closed and open ended questions as well as a clinical simulation. The focus on knowledge assessment allows the diplomates to receive feedback and critiques after their first pass attempt on the exam. ABFM can collect this information and use it to analyze where the most success occurs in each competency during first pass attempts. The performance feedback diplomates receive after first pass attempts allows them to be more successful on second attempts, as well as decreases the time needed for completion of the SAMs

Predictors of Physician Performance on Competence Assessment: Findings From CPEP, the Center for Personalized Education for Physicians

Author(s): E Grace, E Wenghofer, E Korinek

Date: 06/2014

Publisher: Academic Medicine

Volume/Edition: 89 (6)

Publication Type: Journal

Article:

In this study, researchers analyzed data of physicians who were referred to the Center for Personalized Education for Physicians between 2000 and 2010 to determine predictive factors of unsafe assessment outcome. They found that Board-certified individuals were less likely than uncertified individuals to have poor assessment outcomes. Similarly, compared to physicians who have not warranted Board action (suspension, revocation, limitation, or stipulation), physicians with Board action were more likely to be deemed unsafe. The analysis also found that older physicians were more likely to have unsafe assessment outcomes. Physicians in solo practice settings were more likely to be deemed unsafe, compared to physicians in other settings. Compared to physicians whose practice scope did not match their training, termed practice drift, those whose practiced in the area in which they received training were less likely to have unsafe assessment outcomes. This study shows what the impact of being Board-certified, having Board action, a physician’s age, practice setting, and staying in their area of training on assessment outcomes.

Medical Specialty Boards Can Help Measure Graduate Medical Education Outcomes

Author(s): L Peterson, P Carek, E Holmboe, J Puffer, E Warm, R Phillips

Date: 06/2014

Publisher: Academic Medicine

Volume/Edition: 89 (6)

Publication Type: Journal

Article:

This commentary highlights the need for graduate medical education programs to measure program outcomes and show accountability for their federal funding. Authors suggest that American Board of Medical Specialties (ABMS) Member Boards and the Accreditation Council for Graduate Medical Education (ACGME) should broaden their long standing relationship to further develop shared roles and data-sharing mechanisms to better inform residencies and the public about graduate medical education training outcomes. Specifically, since Part IV Maintenance of Certification (MOC) generally involves assessment of the quality of care delivered in practice, ABMS Member Boards could share data with the ACGME and residency programs to provide direct feedback on practice outcomes of graduates. This commentary offers a general summary of the MOC process and the data synthesis involved.

Transforming Quality of Care in North Carolina

Author(s): W Newton, D Bradley

Date: 04/2013

Publisher: North Carolina Medical Journal

Volume/Edition: 74 (2)

Publication Type: Journal

Article:

This issue brief describes the current state of health care in North Carolina and provides a general review of strategies for improving health care quality. The brief also addresses three fundamental questions:

1) can quality of health care be measured and improved?
2) what does the landscape in North Carolina look like now?
3) what should North Carolina’s priorities be for improving quality of acre moving forward?

The article mentions North Carolina Improving Performance in Practice program. Physicians participating in Improving Performance in Practice program were eligible for Part IV MOC credit.

Maintenance of Certification: Beauty Is in the Eyes of the Beholder

Author(s): R Centor, D Fleming, D Moyer

Date: 08/2014

Publisher: Annals of Internal Medicine

Volume/Edition:

Publication Type: Journal

Article:

This article is a commentary on Baron and Johnson’s history of and rationale for the creation of the American Board of Internal Medicine (ABIM) and recent changes to its Maintenance of Certification (MOC) program. Authors relate that many internists find the MOC process frustrating and highlight the ever-growing demands to already overburdened physicians. However, the authors also acknowledge program benefits, as well as the complexities and challenges associated with a comprehensive professional assessment program.

Getting Maintenance of Certification to Work: A Grounded Theory Study of Physicians’ Perceptions

Author(s): D Cook, E Holmboe, K Sorenson, R Berger, J Wilkinson

Date: 11/2014

Publisher: JAMA Internal Medicine

Volume/Edition: 175 (1)

Publication Type: Journal

Article:

This article describes a grounded theory focus group study that addressed Maintenance of Certification (MOC) barriers and ways to overcome them. Study participants included Board certified primary care, internal medicine, and family medicine physicians. Researchers found that physicians perceive MOC as a complex activity, often unrelated to practice. Researchers identified six areas in which MOC needs to change in order to become more meaningful. The study is limited due to the use of a single institution and its qualitative nature. Nevertheless, it indicates that the MOC program can be improved to better meet physicians’ needs.

Improving Quality of Care and Guideline Adherence for Asthma Through a Group Self-Assessment Module

Author(s): K Elward, B Blackburn, L Peterson, M Greenawald, M Hagen

Date: 05/2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 27 (3)

Publication Type: Journal

Article:

This study aimed to assess whether the American Board of Family Medicine (ABFM) group self-assessment modules may increase knowledge and adherence to asthma clinical guidelines. Researchers argued that while the adherence to the guidelines is low, improved compliance may raise the quality of care. Study results showed that both quality of asthma care and adherence to clinical guidelines improved as a result of participation in the group self-assessment activity. Quality measures, such as diagnosis by severity and use of action plans (except from prescribing of controlled medications), showed improvement six months after module completion. The knowledge and adherence to clinical guidelines increased immediately and was sustained at six months. While the study sample was limited to one state, and while not all control group subjects finished the study, this study indicates that group self-assessment modules may be effective in improving adherence to clinical guidelines and improving quality of care.

Improving Quality of Care for Diabetes Through a Maintenance of Certification Activity: Family Physicians’ Use of the Chronic Care Model

Author(s): L Peterson, B Blackburn, R Phillips, J Puffer

Date: 01/2015

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 34 (1)

Publication Type: Journal

Article:

The authors introduce their study with a brief description of the current state of diabetes and the call for improving the quality of care for this chronic condition. Their objective was to determine associations between family physician characteristics and actions taken during engagement with Maintenance of Certification, Part IV diabetes modules. Their findings showed that all physician and patient quality measures improved.

Association Between Imposition of a Maintenance of Certification Requirement and Ambulatory Care-Sensitive Hospitalizations and Health Care Costs

Author(s): B Gray, J Vandergrift, M Johnston, J Reschovsky, L Lynn, E Holmboe, R Lipner

Date: 12/2014

Publisher: Journal of the American Medical Association

Volume/Edition: 312 (22)

Publication Type: Journal

Article:

The goal of this quasi-experimental study was to evaluate the association between the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program and outcomes of care. Researchers compared two groups of physicians, those certified by ABIM and participating in MOC, and those certified and not participating in MOC. Preventable hospitalizations and health care costs of Medicare beneficiaries served as outcome measures. Study results revealed no significant association between physician participation in MOC and hospitalization rates; however, a small reduction of health care costs was detected. It should be noted that the study is limited to the Medicare population, and, in addition to other factors, there are limitations associated with preventable hospitalization rates as outcome measures.

Certifying the Good Physician: A Work in Progress

Author(s): T Lee

Date: 12/2014

Publisher: Journal of the American Medical Association

Volume/Edition: 312 (22)

Publication Type: Journal

Article:

In this article, the author reviews the evolution of physician assessment. With progress in medicine and changes in health care, a good physician is characterized as someone who continuously seeks professional development and improvement. Board Certification has been regarded as an acceptable professional credential for most of the century. However, it has been evolving and has endured its share of complexity. Some of the most frequent criticisms related to American Board of Medical Specialties (ABMS) Maintenance of Certification® (ABMS MOC®) program are time, cost, and relevance to physician practice. The balance between meeting physician needs and providing adequate accountability to the public remains difficult. Nevertheless, there is a need to continue to evaluate and evolve MOC.

The Reliability of American Board of Family Medicine Examinations: Implications for Test Takers

Author(s): K Royal, J Puffer

Date: 01/2012

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 25(1)

Publication Type: Journal

Article:

This article describes the theory behind examination validation. It addresses American Board of Family Medicine (ABFM) Maintenance of Certification (MOC) examination validity, mainly focusing on its reliability estimate measured at 0.94 in 2009. When important decisions are to be made based on group test scores, recommended reliability estimate is 0.90.

Family Physician Participation in Quality Improvement

Author(s): L Peterson, C Jaen, R Phillips

Date: 11/2013

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 26(6)

Publication Type: Journal

Article:

American Board of Family Medicine (ABFM) conducted a survey which revealed that over a third of family physicians are participating in quality improvement activities. Participation in quality improvement is central to fulfilling ABFM Maintenance of Certification (MOC) Part IV requirements. Quality improvement is crucial to patient outcomes and health care cost reduction. Similarly, new health care delivery models and payment methods are tied to health care quality improvement.

The American Board of Internal Medicine: Evolving Professional Self-Regulation

Author(s): R Baron, D Johnson

Date: 05/2014

Publisher: Annals of Internal Medicine

Volume/Edition:

Publication Type: Journal

Article:

The authors reviewed the history of the American Board of Internal Medicine (ABIM) and the evolution of the certification process for internists. Changes in the certification process are reflective of the changes and growing complexity in health care. The authors acknowledge physician frustration and assure that the ABIM continuously strives to increase the value of the program to physicians.

Natural History of Practice Transformation: Development and Initial Testing of an Outcomes-Based Model

Author(s): K Donahue, W Newton, A Lefebvre, M Plescia

Date: 05/2013

Publisher: Annals of Family Medicine

Volume/Edition: 11(3)

Publication Type: Journal

Article:

This article describes the development of a two-phased practice transformation model, where quality improvement consultants worked with practices in designing custom interventions that would help improve the quality of care. In this process, three practice types were identified: transformed, activated, and engaged practices. A little less than half of the practices demonstrated improvement in one year. Authors concluded that practice transformation is a long-term process, where engagement, rate of improvement, and sustainability are influenced by certain motivators and support structures. Participating practices were those from North Carolina Improving Performance in Practice program. Physicians participating in the program were eligible for Maintenance of Certification (MOC) Part IV credit. It should be noted that the study is limited to a small sample size, volunteer participants, data collection methodology and variability of the interventions among the practices.

The American Board of Pathology’s Maintenance of Certification Program Update

Author(s): R Johnson

Date: 04/2014

Publisher: Archives of Pathology and Laboratory Medicine

Volume/Edition: 138

Publication Type: Journal

Article:

This article is an update on current American Board of Pathology Maintenance of Certification (MOC) program requirements and policies. Currently, there are close to 5000 physicians participating in the program. The Board is working with other organizations to align reporting requirements and make the program more relevant to physician practice, and ultimately increasing the value of the program. Pathologists holding non-time-limited certificates are strongly encouraged to participate in MOC.

Infrastructure for Large-Scale Quality-Improvement Projects: Early Lessons From North Carolina Improving Performance in Practice

Author(s): W Newton, A Lefebvre, K Donahue, T Bacon, A Dobson

Date: 01/2010

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 30(2)

Publication Type: Journal

Article:

This paper describes the early phase of a quality improvement project, the North Carolina Improving Perofrmance in Practice (NC IPIP)program, and how it helped to develop a community–based regional strategy that succeeded in improving care in different regions in the state, drove its spread across the state, and established sustainable infrastructure. The paper discusses the recruitment and experience of two waves of practices that participated in the program and reveals some improvement results from asthma and diabetes data collected during the initial stage. Maintenance of Certification (MOC) credit was offered as an incentive for physicians to participate in the NC IPIP project. The paper discusses key lessons learned, limitations, and cautions against generalizing results as their study reflects a “custom fit” strategy rather than a standard intervention.

Designing a Large-Scale Multilevel Improvement Initiative: The Improving Performance in Practice Program

Author(s): P Margolis, D DeWalt, J Simon, S Horowitz, R Perelman, B Bagley, P Miles

Date: 01/2010

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 30(3)

Publication Type: Journal

Article:

This report describes the design, development and spread strategy of the Improving Performance in Practice (IPIP) program through 2010. IPIP is a large system intervention led by a collaboration of the primary care medical certifying boards and professional societies that seek to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels to accelerate quality improvement in the care of chronic illness and preventive services. The authors site the Maintenance of Certification (MOC) program and its call for documentation regarding physician’s actual performance in practice in addition to individual knowledge as the impetus for the design, development, and evaluation of IPIP.

Collaboration in Pennsylvania: Rapidly Spreading Improved Chronic Care for Patients to Practices

Author(s): P Bricker, R Baron, J Scheirer, D DeWalt, J Derrickson, S Yunghans, R Gabbay

Date: 01/2015

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 30(2)

Publication Type: Journal

Article:

This research outlines the components of Pennsylvania’s IPIP program and Pennsylvania Chronic Care initiative led by the PA Governor’s Office of Health Care Reform. It presents 6 months results from 155 PA practice sites that have undergone practice transformation through the IPIP project. Early performance data indicate substantial improvement in care processes and show steady improvement in performance measures for diabetes and asthma. It also discusses the intent of the PA Chronic Care Initiative to spread to more practices and focus on more aspects of primary care, including prevention. Physicians participating in IPIP project are eligible for MOC Part IV credit.

Improving Performance in Practice: Rx for Primary Care

Author(s): IPIP

Date: 03/2015

Publisher: The Commonwealth Fund

Volume/Edition:

Publication Type: Journal

Article:

This brief published in 2010 provides a detailed overview of the Improving Performance in Practice Program (IPIP), describes the structure of the quality improvement program, and provides examples of its results in several states where improvement was documented in outcome measures for asthma and diabetes. The brief concludes with a “Lessons Learned” section that emphasizes the benefits of participation in IPIP, one being its compliance with the ABMS Maintenance of Certification (MOC) program, while drawing several practical conclusions for the broader area of quality of improvement.

ABFM Examination Asthma Item Performance and Asthma Prevention Quality Indicators in Kentucky

Author(s): W Sumner, T O'Neill, P Owens, M Schootman, M Hagen

Date: 07/2012

Publisher: Journal of the Kentucky Medical Association

Volume/Edition: 110

Publication Type: Journal

Article:

Researchers in this study examined Kentucky family physicians’ performance on asthma related content included in the 2009 ABFM examination and its correlation with adult asthma hospitalization rates in the state. They found an inverse relationship between the two variables which highlights the importance of Maintenance of Certification (MOC) Part III.

The Relationship Between the Nature of Practice and Performance on a Cognitive Examination

Author(s): J Norcini, R Lipner

Date: 10/2000

Publisher: Academic Medicine

Volume/Edition: 75 (10)

Publication Type: Journal

Article:

This study further examines the relationship between the nature of practice and performance on the 1997 or 1999 critical care medicine recertification examination. The researchers specifically focused on questions pertaining to cardiovascular and pulmonary disease. Additionally, they asked participants to provide information about the amount of time and difficulty of care they provide to patients with these problems. They found that for cardiovascular disease there was a significant relationship between volume and complexity with test scores for both years. However, for pulmonary disease, only volume had a significant relationship with test scores in the 1997 group. Although, both factors were significant in 1999. While keeping the limitations in mind, these results suggest the examination performance is related to performance of the practice of care and not merely testing a physicians ability to recall facts.

Evaluating the Systematic Validity of a Medical Subspecialty Examination

Author(s): M Raddatz, M Royal, J Pennington

Date: 11/2012

Publisher: ERIC database

Volume/Edition: conference presentation

Publication Type: Journal

Article:

To evaluate the systematic validity of a medical subspecialty examination, researchers compared scores between two groups: physicians taking the exam for initial certification who had completed a fellowship program and those that had not. Additionally, they compared practice pathway board candidates scores to all other candidates, both who had and had not completed a fellowship. Researchers found systematic validity, because test functioned the same way across different groups.

American Board of Family Medicine (ABFM) Maintenance of Certification: Variations in Self-Assessment Modules Uptake Within the 2006 Cohort

Author(s): A Bazemore, I Xierali, S Petterson, R Phillips Jr, J Rinaldo, J Puffer, L Green

Date: 01/2010

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 23 (1)

Publication Type: Journal

Article:

In this study, researchers reviewed the demographics of individuals who completed 3 self-assessment modules in the first 3 years of certification. If 3 modules were completed, the individuals could successfully extend their recertification cycle from 7 years to 10. They found that 30% of eligible participants did not complete the requirements needed to expand their cycle. Those that did not complete the self-assessment modules were more likely to be from underserved, poorer areas and more likely to be older men. While researchers did not find a significant difference in terms of rural and urban providers, understanding the barriers relevant to module completion is very important in pursuit of quality improvement through Maintenance of Certification (MOC).

Policies and Practices Related to the Role of Board Certification and Recertification of Pediatricians in Hospital Privileging

Author(s): G Freed, R Uren, E Hudson, I Lakhani, J Wheeler, J Stockman

Date: 02/2006

Publisher: Journal of the American Medical Association

Volume/Edition: 295 (8)

Publication Type: Journal

Article:

This study surveyed 200 hospitals to find out if they required their pediatricians and pediatric subspecialists to be board certified at initial privileging or at some point during their tenure. Out of the 200 surveyed, 159 hospitals completed the telephone interview, with a response rate of 82%. One hundred and twenty-four hospitals did not require pediatricians to be board certified at the initial privileging but, 111 did require they be certified at some time throughout their tenure.

Use of Board Certification and Recertification of Pediatricians in Health Plan Credentialing Policies

Author(s): G Freed, D Singer, I Lakhani, J Wheeler, J Stockman

Date: 02/2006

Publisher: Journal of the American Medical Association

Volume/Edition: 295 (8)

Publication Type: Journal

Article:

This study researches the credentialing policies health plans use in regards to board certification and recertification. The study specifically focuses on general pediatricians and pediatric subspecialists. Out of the roughly 200 respondents, a vast majority did not require general pediatricians to be board certified at the point of initial credentialing. Furthermore, less than half require general pediatricians ever to be board certified. For subspecialists, only 15% required certification at initial contract and 26% required certification at some point. Additionally, a majority of respondents said they would allow subspecialists to bill as subspecialist even if their certification as since expired. The authors believe that these results raise issues surrounding whether or not health plans can effectively guarantee the competency of their physicians.

Teaching and Evaluating Point of Care Learning with an Internet-Based Clinical Question Portfolio

Author(s): M Green, S Reddy, E Holmboe

Date: 10/2009

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 29 (4)

Publication Type: Journal

Article:

In this article, researchers developed and tested an alternative approach to the Maintenance of Certification (MOC) open-book multiple choice exams. Their method, an internet-based point of care learning portfolio, tested positively among participants. The majority preferred the new method and believed it was more consistent to how they practice medicine. As a result, ABIM began offering this portfolio as an elective option in MOC.

Gaps in Quality of Diabetes Care in Internal Medicine Residency Clinics Suggest the Need for Better Ambulatory Care Training

Author(s): L Lynn, B Hess, W Weng, R Lipner, E Holmboe

Date: 01/2012

Publisher: Health Affairs

Volume/Edition: 31 (1)

Publication Type: Journal

Article:

In this study, researchers compared the quality of diabetes care being delivered by residency clinics versus practicing physicians. To make this comparison, researchers used the American Board of Internal Medicine’s Diabetes Practice Improvement Modules. These modules, which include medical chart reviews, patients surveys and practice system analysis, are used to help physicians identify areas that need improvement. After analyzing the data, researchers came to the conclusion that residency clinics are not providing high-quality diabetes care. This could likely be the result of the design of residency clinics. By nature, care-coordination is a struggle because residents and faculty only spend on average a few hours at the site a week. This article showcases how ABIM’s modules serve as an important tool in identifying quality gaps.

Variations in Growth of Infants With a Single Ventricle

Author(s): J Anderson, S Lyer, D Schindlow, R Williams, J Varadarajan, M Horsley, C Lannon

Date: 07/2012

Publisher: Journal of Pediatrics

Volume/Edition: 161 (1)

Publication Type: Journal

Article:

This article examines the interstage growth variation in infants with hypoplastic left heart syndrome. Researchers collected data from National Pediatric Cardiology Quality Improvement Collaborative participants on their practices related to nutrition. They found significant variation in nutritional care provided and the interstage growth among the different locations. They believe standardization of care may be needed in this area. It has previously been shown that both improvements in surgical technology and medical management has led to better clinical outcomes. This study supports Maintenance of Certification (MOC) framework by indicating the importance of practice performance assessment (MOC Part IV) to patient care.

Systematic Review: The Relationship Between Clinical Experience and Quality of Health Care

Author(s): N Choudry, R Fletcher, S Soumerai

Date: 02/2005

Publisher: Annals of Internal Medicine

Volume/Edition: 142

Publication Type: Journal

Article:

In this paper, researchers conducted a systematic review to evaluate the relationship between years of experience practicing and performance outcomes. Their review findings suggest that physicians who have been practicing longer have less factual knowledge, follow standard care practices less often, and may have worse patient outcomes. Overall, there appears to be a risk that more experience in the field may be associated with lower quality of care delivered. The researchers suggest one of the reasons for this discrepancy is that many physician “toolkits” are used during training and not regularly updated. The Maintenance of Certification (MOC) program could play a large role in filling this void and ensuring that longer practicing physicians are still being exposed to new practice innovations.

Family Physicians’ Completion of Scoring Criteria in Virtual Patient Encounters

Author(s): W Sumner II, T O'Neill, G Roussel, J Xu, D Ivins, M Hagen

Date: 10/2011

Publisher: Academic Emergency Medicine

Volume/Edition: 2011

Publication Type: Journal

Article:

In this study, researchers reviewed criterion completion rates for asthma related virtual patient cases included in the ABFM examination. They found improvements in the completion of important asthma management criteria which could be the result of change of physicians treatment protocol or physicians learning from past Maintenance of Certification (MOC) exercises such as the multiple-choice sections. The researchers believe the likely explanation is that the multiple-choice section served as a trigger for certain actions. This shows the potential for the MOC program to change physicians’ behaviors.

The Certification Status of Generalist Physicians and the Mortality of Their Patients After Acute Myocardial Infarction

Author(s): J Norcini, R Lipner, H Kimball

Date: 10/2001

Publisher: Academic Medicine

Volume/Edition: 76 (10)

Publication Type: Journal

Article:

In this study, researchers compare the patient outcomes for certified and non-certified physicians. To determine this, the research team collected data regarding hospitalizations in which the patient was directly admitted for acute myocardial infarctions. When holding all other factors constant, the researchers found significantly lower rates of mortality resulting from treatment administered by a certified physicians. This offers further support for the validity of the certification program.

Toward Better Care Coordination Through Improved Communication with Referring Physicians

Author(s): B Hess, L Lynn, E Holmboe, R Lipner

Date: 10/2009

Publisher: Academic Medicine

Volume/Edition: 84 (1 supplement)

Publication Type: Journal

Article:

In this study, researchers analyzed the results of the Communication with Referring Physicians practice improvement module (CRP-PIM) included in the American Board of Internal Medicine Maintenance of Certification (MOC) program. This module was created to improve communication between consulting and referring physicians. To complete the PIM, consulting physicians had to finish a practice system survey and then were evaluated by their referring physicians. Upon receiving the report, the consulting physicians choose areas for improvement. This article demonstrates the usefulness of the PIM’s included in MOC.

Improved Outcomes in a Quality Improvement Collaborative for Pediatric Inflammatory Bowel Disease

Author(s): W Crandall, P Margolis, M Kappelman, E King, J Pratt, B Boyle, R Colletti

Date: 04/2012

Publisher: Pediatrics

Volume/Edition: 129 (4)

Publication Type: Journal

Article:

This study centers on six ImproveCare Now Network sites implementing new strategies to improve care delivery and outcomes for children with inflammatory bowel disease. The network established standardized diagnosis and care recommendations and used additional tools such as previsit planning templates and a Model IBD Care Guideline. Researchers ultimately found that changes in the overall delivery of care likely resulted in improved outcome measures as opposed to one particular intervention. The collaborative improvement network efforts align with acceptable Maintenance of Certification (MOC) Part IV methodology and highlight the importance of both system based practice and practice based learning and improvement.

The Role of Physician Engagement on the Impact of the Hospital-Based Practice Improvement Module (PIM)

Author(s): K Caverzagie, E Bernabeo, S Reddy, E Holmboe

Date: 10/2009

Publisher: Journal of Hospital Medicine

Volume/Edition: 4 (8)

Publication Type: Journal

Article:

Researchers in this study analyzed the results of implementing a Hospital Practice Improvement Module (PIM) with physicians who are engaged in hospital-based quality improvement (QI) activities. They found a majority of participants concluded that the module was a valuable experience. However, the physicians level of engagement in the QI project largely impacts their engagement in the PIM. The researchers did note that initial engagement was not a predicting factor, but the factor was their level of engagement throughout the span of the QI activities. Overall, the researchers suggest that the Hospital PIM is a helpful part of Maintenance of Certification (MOC).

Clinical Inactivity Among Pediatricians: Prevalence and Perspectives

Author(s): G Freed, K Dunham, K Switalski

Date: 02/2009

Publisher: Pediatrics

Volume/Edition: 123 (2)

Publication Type: Journal

Article:

Researchers in this study investigated the prevalence of clinical inactivity among pediatricians. They discovered that among those surveyed, over 10% had been clinically inactive for at least 12 months. This translates to approximately 1 in 8 pediatricians suspending care for a year or more. The researchers raise questions about the impact this gap could have on care quality. Maintenance of Certification (MOC) could serve as an effective tool to ensure quality even after gaps in practicing.

Comparative Trial of a Web-Based Tool to Improve the Quality of Care Provided to Older Adults in Residency Clinics: Modest Success and a Tough Road Ahead

Author(s): E Holmboe, B Hess, L Conforti, L Lynn

Date: 05/2012

Publisher: Academic Medicine

Volume/Edition: 87 (5)

Publication Type: Journal

Article:

With an aging population and a shrinking geriatrics workforce, it is important to assess the quality of care that internal medicine and family medicine residents can provide to older Americans. Researchers in this study investigated the impact of utilizing the American Board of Internal Medicine Care of the Vulnerable Elderly Practice Improvement Module among internal medicine and family medicine residencies. The PIM consisted of a medical record audit, microsystem survey and patient survey. Upon receiving the results, the residents set goals to improve the quality of care they were delivering. Performance improved in clinics using the ABIM CoVE PIM for important performance measures. The overall quality level of care for older adults in residency clinics remained poor. It is worthwhile to mention that the intervention targeted especially poor performance areas and that QI is an itterative process, where a single intervention may not be enough to change patient outcomes. This study sheds light on the importance of Maintenance of Certification (MOC) as a continuous professional development model with repetative engagement in practice performance assessment, MOC Part IV.

Ohio Statewide Quality-Improvement Collaborative to Reduce Late-Onset Sepsis in Preterm Infants

Author(s): H Kaplan, C Lannon, M Walsh, E Donovan

Date: 03/2011

Publisher: Pediatrics

Volume/Edition: 127 (3)

Publication Type: Journal

Article:

This study aims to decrease late-onset bacterial infection in infants born at 22 to 29 weeks gestation. The 24 NICUs in the study used the Institute for Healthcare Improvement Breakthrough Series quality-improvement model to apply evidence-based centered care. Each NICU established a team consisting of at least one physician, one nurse, and a data manager. These teams participated in 3, day-long, learning sessions spaced throughout the intervention. Additionally, the teams participated in monthly web-based seminars, to discuss strategies and share results. This approach is consistent with the aims of Maintenance of Certification (MOC) to improve care through practice performance assessment.

A Three-Part Model for Measuring Diabetes Care in Physician Practice

Author(s): R Lipner, W Weng, G Arnold, F Duffy, L Lynn, E Holmboe

Date: 10/2007

Publisher: Academic Medicine

Volume/Edition: 82 (10 supplement)

Publication Type: Journal

Article:

This study examines the American Board of Internal Medicine’s Diabetes Practice Improvement Module (PIM). Specifically, it compares the composite measures validity and reliability to individual items. The three components include: patient surveys, audit of medical records, and a questionnaire pertaining to the office’s practice system. The findings suggest that composites were more reliable measures than individual measures. This supports the practice of aggregating items into composites in Maintenance of Certification (MOC) as opposed to single items.

Reducing PICU Central Line-Associated Bloodstream Infections: 3-Year Results

Author(s): M Miller, M Niedner, W Huskins, E Colantuoni, C Moss, R Brilli

Date: 11/2011

Publisher: Pediatrics

Volume/Edition: 128 (5)

Publication Type: Journal

Article:

This study evaluates the ability to reduce CLA-BSIs using pediatrics-specific insertion and catheter care maintenance bundle care practices. The researchers studied 29 PICU’s for a 3-year period and determined that significant continued decreases could be achieved using this intervention. However, the research team did not find statistically significant results from the additional two interventions studied, a chlorhexidine-impregnated spongers at insertion sites or chlorhexidine scrub at central line access points. Overall, the study highlights the benefits associated with participation in QI, a requirement supported by Maintenance of Certification (MOC) Part IV.

Performance on the American Board of Family Medicine (ABFM) Certification Examination: Are Superior Test-Taking Skills Alone Sufficient to Pass?

Author(s): T O'Neill, K Royal, J Puffer

Date: 03/2014

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 24 (2)

Publication Type: Journal

Article:

This study looked to examine claims that the certification program is testing one’s ability to take tests rather than a physician’s skill level of practicing medicine. To test this theory, four nonphysicians, all of which were experts in the area of certification testing, completed the 2009 ABFM board examination certification. Ultimately, none of the four individuals were able to score high enough to meet the minimum reportable score and only one participant outperformed any physicians. These results show that medical training is needed to be able to pass the examination and that test takers can not rest solely on cues.

NICU Practices and Outcomes Associated With 9 Years of Quality Improvement Collaboratives

Author(s): N Payne, M Finkelstein, M Liu, J Kaempf, P Sharek, S Olsen

Date: 03/2010

Publisher: Pediatrics

Volume/Edition: 125 (3)

Publication Type: Journal

Article:

In this study, researchers examined outcomes from 8 NICUs regarding quality improvement collaboratives sponsored by the Vermont Oxford Network. Quality improvement collaboratives are conducted through teams implementing evidence-based practices. In their 9 year study, researchers found reduced nosocomial infection rates, increased survival rates, and sustained implementation of respiratory PBPs in the participating NICUs. However, they did not see an improvement in the BPD or BPD-free survival rate. Overall, the study highlights the benefits that could come about from participating in QI, which resonates with Maintenance of Certification (MOC) Part IV requirement.

Family Physician Participation in Maintenance of Certification

Author(s): I Xierali, J Rinaldo, L Green, S Petterson, R Phillips, A Bazemore, J Puffer

Date: 05/2011

Publisher: The Annals of Family Medicine

Volume/Edition: 9 (3)

Publication Type: Journal

Article:

This study examines the characteristics of family physicians that are participating in the Maintenance of Certification (MOC) program. Researchers found that over 90% of physicians eligible to participate in MOC are in fact participating. However, those that work in poor, underserved areas, graduated from an international medical school, or who are solo practitioners are more likely to allow for a lapse in certification. Additionally, researchers found that women are more likely than men to not have a gap in certification. Overall, this research shows that physicians are participating in the program in substantial numbers.

Nosocomial Infection Reduction in VLBW Infants with a Statewide Quality-Improvement Model

Author(s): D Wirtschafter, R Powers, J Petit, H Lee, W Boscardin, M Subeh, J Gould

Date: 03/2011

Publisher: Pediatrics

Volume/Edition: 127 (3)

Publication Type: Journal

Article:

Researchers in this study were evaluating the effectiveness of the California Perinatal Quality Care Collaborative (CPQCC) quality-improvement model using a toolkit in decreasing rates of neonatal nosocomial infection. The researchers found that nosocomial infection rate decreased. Overall, the study found that the intervention approach, using a toolkit and attending a workshop or webcast, was effective in improving care outcomes. This mirrors the goal of Maintenance of Certification (MOC) Part IV, practice performance assessment.

Using the American Board of Internal Medicine Practice Improvement Modules to Teach Internal Medicine Residents Practice Improvement

Author(s): R Shrunk, M Dulay, K Julian, P Cornett, J Kohlwes, L Tarter, P O'Sullivan

Date: 03/2014

Publisher: Academic Emergency Medicine

Volume/Edition: 2

Publication Type: Journal

Article:

Researchers in this article, investigated the impact of incorporating the American Board of Internal Medicine’s Practice Improvement Modules (PIM) in residency programs. The first part of the program involved learning practice improvement (PI) concepts. In the second portion, students used the ABIM PIM Communication-Primary Care to identify PI areas needing improvement. Finally, building upon what they had learned and identified, the residents engaged in projects to use these skills. They determined that the PIM’s were successfully utilized by the residents in spite of being designed for practicing physicians. The program required effective collaboration between residents and faculty which can be a particularly helpful skill set when working to strengthen care coordination. There were an average attendance of 70% at the PIM sessions and all residents were involved in their team projects. This study shows the important role PIM’s can play in identifying areas of weakness for practicing physicians or in this case, residents.

Specialty Board Certification and Clinical Outcomes: The Missing Link

Author(s): L Sharp, P Bashook, M Lipsky, S Horowitz, S Miller

Date: 06/2002

Publisher: Academic Medicine

Volume/Edition: 77 (6)

Publication Type: Journal

Article:

In this study, researchers conducted a literature review examining the relationship between board certification and clinical outcomes. They collected 33 studies that meet their criteria, over which over half support a positive relationship between certification and positive clinical outcomes. However, they did note that very few published studies were appropriate for their analysis.

Statewide NICU Central-Line Associated Bloodstream Infection Rates Decline after Bundles and Checklists

Author(s): J Schulman, R Stricof, T Stevens, M Horgan, K Gase, L Saiman

Date: 03/2014

Publisher: Pediatrics

Volume/Edition: 127 (3)

Publication Type: Journal

Article:

In this study, 18 NICUs in New York state implemented evidence-based central-line insertion and maintenance bundles to standardize care. Providers participated in conference calls, workshops, and used checklist templates to establish standardized care. Researchers compared the effect from pre-intervention data and found a significant decline in NICU CLABSIs. However, the researchers found that site of care remains a concern for CLABSI risk. This study supports the goals of Maintenance of Certification (MOC) Part IV to improve quality of care.

Continuing Medical Education Activity and American Board of Surgery Examination Performance

Author(s): R Rhodes, T Biesten, W Ritchie, M Malangoni

Date: 04/2003

Publisher: Journal of the American College of Surgeons

Volume/Edition: 196 (4)

Publication Type: Journal

Article:

To examine the relationship between specialty board examination performance and continuing medical education activity, researchers compiled results from the 2000 Recertification Examination in Surgery. They specifically considered variables including: practice type, career activity, applicant age, gender, year of initial certification, number of attempts taking the test, medical school, ethnicity, and other certifications obtained. The researchers analyzed the pass and fail groups and their relationship to CME hours completed. Overall, their results display a strong relationship between performance on the recertification examination and CME activity. This suggests the importance of engaging in CME activities throughout a physician’s career.

Anesthesiologist Board Certification and Patient Outcomes

Author(s): J Silber, S Kennedy, O Even-Shoshan, W Chen, R Mosher, A Showan, D Longnecker

Date: 05/2002

Publisher: Anesthesiology

Volume/Edition: 96 (5)

Publication Type: Journal

Article:

In this article, researchers investigated mortality rates between procedures administered with the assistance of a board certified anesthesiologist and a non-certified anesthesiologists. After reviewing Medicare claims records, the research team ultimately observed greater rates of death with non-certified providers which suggests their is support for the validity of the certification program. The study aimed to assess the impact of anesthesiologist board certification status on patient outcomes. Pennsylvania Medicare claims data, specifically, records for patients that underwent general surgical or orthopedic procedures between 1991 and 1994 was used for that purpose. Patient severity and case mix, as well as hospital characteristics were taken into consideration. Two main outcomes were mortality within 30 days of admission, and the failure to rescue rate. Study findings revealed that midcareer anesthesiologists lacking certification, as well as the hospitals where they practiced were associated with worse patient outcomes. However, authors point out, that poor outcomes may be associated with the hospitals where anesthesiologists practice, and not necessarily their manner of practice.

An Analysis of the Knowledge Base of Practicing Internists As Measured by the 1980 Recertification Examination

Author(s): J Norcini, R Lipner, J Benson, G Webster

Date: 03/1985

Publisher: Annals of Internal Medicine

Volume/Edition: 102

Publication Type: Journal

Article:

In this study, researchers reviewed the performance of candidates for the American Board of Internal Medicine’s 1980 Recertification Examination compared to those taking the ABIM’s 1979 Certifying Examination. They used a common-item linear equating procedure to compare the medical knowledge of both groups. Overall, they found their knowledge base was roughly on the same level between the two groups. They did note that performance on the test did decline with an increase in age but difference in performance measures were not impacted until the age of 60. The second study in the article addresses concerns that the recertification is not tailored to meet the needs of internists who have become very specialized in practice. The research team analyzed the performance on the 1980 Recertification Examination according to subspecialty concentration for ten different content areas. Their analysis confirmed that subspecialists do better than general internists on items related to their specialty. Furthermore, those interested in the subspecialty but not certified, performed better than those with no expressed interest. The researchers include that certification should be designed to test both general internal medicine as well as relevant subspecialties.

Maintenance of Certification and Its Association with the Clinical Knowledge of Family Physicians

Author(s): T O'Neill, J Puffer

Date: 06/2013

Publisher: Academic Medicine

Volume/Edition: 88 (6)

Publication Type: Journal

Article:

Researchers in this study compared the performances of recent residency graduates on the initial certification examination to already-certified family physician diplomates participating in the Maintenance of Certification (MOC) program. Additionally, they compared diplomates with gaps in their certification to those that had not allowed for a lapse. They found a significant trend that physicians who maintained their certification performed better than both initial certifiers and diplomates who allowed a gap in their certification status. These results suggest that maintaining certification is important component to improving clinical knowledge.

Effectiveness of Notification and Group Education in Modifying Prescribing of Regulated Analgesics

Author(s): J Anderson, K McEwan, W Hrudey

Date: 01/1996

Publisher: Canadian Medical Association Journal

Volume/Edition: 154(1)

Publication Type: Journal

Article:

This study explored the effect of education and notification on prescribing of regulated analgesics in non-academic primary care practices. Participants in the study group received a written notification of excessive prescribing and participated in a day-long, multifaceted educational workshop. Another study group received the notification only while a third group (i.e. the control group) received no intervention at all. In order to evaluate the effect of the interventions, prescribing data was assessed six months before and six months after the study. Study results revealed that analgesic prescribing was reduced in the education and notification, as well as the notification only groups, with less prescribing in the former. While study results suggest that notification alone may be effective, the effect is improved with education and may decrease the cost to patients and drug-benefit plans. The sustainability of the study results is not clear, the physicians studied (excessive prescribers only) may differ from the regular physician population and the effects of dose reduction on patients are not known. Nevertheless, the findings suggest that notification of excessive regulated analgesic prescribing combined with education may impact prescribing behavior change.

Effect of an Outpatient Antimicrobial Stewardship Intervention on Broad-spectrum Antibiotic Prescribing by Primary Care Pediatricians

Author(s): J Gerber, P Prasad, A Fiks, A Localio, R Grundmeier, L Bell, T Zaoutis

Date: 06/2013

Publisher: Journal of the American Medical Association

Volume/Edition: 309(22)

Publication Type: Journal

Article:

This study explored the effectiveness of antimicrobial stewardship intervention on antibiotic prescribing for pediatric outpatients. The intervention involved an hour-long education session followed by a year of individual, quarterly audit and feedback sessions related to prescribing practices. In order to evaluate the effectiveness of the intervention, prescribing rates served as the main outcome measures. Study results revealed improved adherence to prescribing guidelines for acute bacterial infections. Prescribing for viral infections remained unaffected; baseline prescribing for viral infections was very low. The study was carried out in a hospital-affiliated network of primary care pediatric practices with shared electronic medical records. Additionally, the feedback provided to the pediatricians was automated. Other factors may have contributed to the study outcomes, aside from or in addition to the intervention. The intervention group may have been contaminated across the practice sites, which served as the study unit. This study did not evaluate the actual outcomes of the disease treatment.

Improving Recognition and Management of Depression: Is There a Role for Physician Education?

Author(s): M Gerrity, S Cole, A Dietrich, J Barrett

Date: 12/1999

Publisher: Journal of Family Practice

Volume/Edition: 48(12)

Publication Type: Journal

Article:

This study explored the effect of an educational program on depression management among primary care physicians. The intervention involved two workshops combining lectures, discussion, audiotape review and role-playing. Study outcomes were determined with the help of pre-intervention and post-intervention questionnaires and standardized patient evaluations. The findings revealed a significant improvement in physician behavior associated with exposure to the educational program.  However, it is not known whether these improvements were sustained. It should be noted that study participants were volunteers and that the effect was more noticeable with female patients. Nevertheless, the findings suggest that a multifaceted, interactive, sequential educational program may be effective in changing physician behavior.

Training Physicians in Counseling About Smoking Cessation. A Randomized Trial of the “Quit for Life” Program

Author(s): S Cummings, T Coates, R Richard, B Hanson, E Zahnd, R VanderMarting, M Stein

Date: 04/1989

Publisher: Annals of Internal Medicine

Volume/Edition: 110(8)

Publication Type: Journal

Article:

This study explored the effectiveness of a continuing education program on smoking cessation. The intervention involved three training seminars that took place over a period of three months. Seminars included lecture presentation; a videotaped presentation; role playing and participant discussion about their experiences with patients; and methods to reinforce the educational content. The intervention also involved patient education materials and chart reminders. The study outcome was assessed using physician and patient questionnaires, patient interviews and patient biochemical testing. Smoking was addressed only in about half of the patient visits in the study group and chart reminders were used by only 30% of the medical stations. Nevertheless, the study results revealed that the intervention changed physician practice related to patient counseling. Study group participants discussed smoking with patients more often and longer, helped six times more patients set smoking quit dates, and distributed self-help materials to three times more patients. The intervention resulted in slightly higher rates of long-term abstinence from smoking among the patients that indeed intended to quit.

The National DES Education Program: Effectiveness of the California Health Provider Intervention

Author(s): B Cohn, D Wingard, R Patterson, S McPhee, B Gerbert

Date: 04/2002

Publisher: Journal of Cancer Education

Volume/Edition: 17(1)

Publication Type: Journal

Article:

This research study explored the effectiveness of academic detailing on physician knowledge and practices related to preventative care for women exposed to synthetic estrogen (DES). Mothers that were prescribed DES are at higher risk for developing cancer compared to women who were not exposed to DES. This risk extends to the daughters of the mothers who were exposed to DES. Physician participants were visited by a trained physician and received educational materials, management guidelines, chart reminders, medical history forms, office posters and brochures. They were informed about the reasons of why it was important to take a DES history. A lecture was featured to introduce the goals of this educational program to the participants. Physicians took a pre-intervention and post-intervention test that evaluated the change in their knowledge. To help assess study outcomes, patients likewise engaged in pre-intervention and post intervention surveys. While the study relied on self-reported outcome measures, the results revealed that academic detailing may increase physician knowledge and history taking practice.

Physician Education and Report Cards: Do They Make the Grade? Results from a Randomized Controlled Trial

Author(s): C Kim, R Kristopaitis, E Stone, M Pelter, M Sandhu, S Weingarten

Date: 12/1999

Publisher: American Journal of Medicine

Volume/Edition: 107(6)

Publication Type: Journal

Article:

This randomized controlled trial explored the effect of education, academic detailing and peer-comparison feedback on quality of preventative care and patient satisfaction. Participants received either educational material on preventative care practice guidelines alone, or combined with peer-comparison feedback and academic detailing (comprehensive group). Medical record review and patient satisfaction surveys were employed to evaluate study outcomes. While there were some discrepancies between the medical records and patient surveys (likely due to poor documentation and recall bias), in both groups patient surveys revealed an increase in offering of some of the preventative services. Patients in the comprehensive group thought the quality of care improved, although there was no significant improvement in patient satisfaction altogether.

Effectiveness of Case-based On-line Learning of Evidence-based Practice Guidelines

Author(s): M Stewart, J Marshall, T Ostbye, J Feightner, J Brown, S Harris, J Galajda

Date: 02/2005

Publisher: Family Medicine

Volume/Edition: 37 (2)

Publication Type: Journal

Article:

This study explored the effectiveness of electronic case-based education on family physician knowledge, behavior and quality of practice. The intervention involved two evidence-based cases and an online discussion. Questionnaires, chart audits & standardized patient visits helped determine study outcomes. While the sample size was small, participant assignment into groups was not random and online discussions relied on a single moderator. The study results revealed significant improvement in the intervention group for one of the two cases (in two of the three outcomes that were evaluated for each case). The findings suggest that case-based online discussions may be effective in changing physician knowledge and quality of practice.

Effect of Periodic Letters on Evidence-based Drug Therapy on Prescribing Behaviour: A Randomized Trial

Author(s): C Dormuth, M Maclure, K Bassett, C Jauca, C Whiteside, J Wright

Date: 10/2004

Publisher: Canadian Medical Association Journal

Volume/Edition: 171(9)

Publication Type: Journal

Article:

This study explored the effect of a series of mailed, evidence-based therapy letters to physicians.  Drug claims data were analyzed in order to determine the study’s outcome. While the sustainability of the results is unknown beyond the first couple of months, the study findings revealed that the probability of prescribing recommended medication rose by 30% in the study group and this was sustained at least 3 months following the intervention. The findings suggest that a series of evidence-based letters mailed to physicians may have an effect on prescribing behavior.

Acceptability and Feasibility of Physician-based Activity Counseling. The PAL Project

Author(s): B Pinto, M Goldstein, J DePue, F Milan

Date: 08/1998

Publisher: American Journal of Preventive Medicine

Volume/Edition: 159(2)

Publication Type: Journal

Article:

This study explored the effect of exercise counseling on physical activity among older adults. Specifically, it addressed barriers to physician counseling. The study group participated in an hour-long, interactive training session and received supplemental materials for their offices, including patient education materials. Study outcomes were evaluated using a physician survey administered before and after the activity. Patient surveys were also utilized. Study results revealed that the intervention was effective in improving physician counseling ability and increasing patient physical activity. The study relied on volunteer participants and research staff assisted with the utilization of office materials, therefore the study results may not be generalizable. Nevertheless, the findings suggest that a brief, interactive physician training session combined with a systems-based approach may be effective in changing physician behavior and patient outcomes.

Comparison of the Instructional Efficacy of Internet-based CME with Live Interactive CME Workshops: A Randomized Controlled Trial

Author(s): M Fordis, J King, C Ballantyne, P Jones, K Schneider, H Spann, A Greisinger

Date: 09/2005

Publisher: Journal of the American Medical Association

Volume/Edition: 294(9)

Publication Type: Journal

Article:

This study explored the effect of Internet based CME on primary care physician knowledge and instructional strategies and the content was based on adult cholesterol treatment guidelines. The change in participant knowledge was assessed through a test administered before and immediately after the intervention, as well as at follow up 12 weeks later. Change in practice was determined by chart audit for cholesterol screening and therapeutic treatment five months before and five months after the intervention. Baseline participant knowledge related to cholesterol management was high and cross contamination between the groups could not be excluded.  Also, participants received honoraria for filling out the data collection instruments. The study results revealed behavioral change among the online CME participants. Changes in knowledge where similar in both online and live CME groups. Study findings suggest that live and online multifaceted CME activity may be effective in changing physician knowledge. Further, online multifaceted CME may be effective in changing physician performance.

A Randomized Study to Decrease the Use of Potentially Inappropriate Medications Among Community-dwelling Older Adults in a Southeastern Managed Care Organization

Author(s): D Fick, J Maclean, N Rodriguez, L Short, R Heuval

Date: 11/2004

Publisher: American Journal of Managed Care

Volume/Edition: 10(11 Pt 1)

Publication Type: Journal

Article:

This study explored the effect of mailed physician prescribing feedback and prescribing guidelines on the use of potentially inappropriate medications (PIMs) for older adults. Both the study and control groups consisted of primary care physicians. Each participant received an educational letter and a brochure addressing the challenges of prescribing to seniors and providing the list of problematic drugs 3 months prior to the study. In addition, the study group received educational materials on appropriate prescribing, the list of medication alternatives to PIMs, and personal prescribing feedback. The effectiveness of the intervention was measured by a faxable form, which acknowledged patient assessment or therapy modification by physicians, as well as any actions taken. The study results revealed a physician response rate of 71% and a significant change (15%) in prescribing practices. It should be noted that the faxable forms posed some challenges, that the study did not involve patient education, and that individual prescribing decisions were patient dependent. Nevertheless, the findings suggest that an educational intervention combined with performance feedback may be effective in changing physician behavior.

Educational Program for Physicians to Reduce Use of Nonsteroidal Anti-inflammatory Drugs Among Community-dwelling Elderly Persons: A Randomized Controlled Trials

Author(s): W Ray, C Stein, V Byrd, R Shorr, J Pichert, P Gideon, M Griffin

Date: 05/2001

Publisher: Medical Care

Volume/Edition: 39(5)

Publication Type: Journal

Article:

This study explored the effectiveness of academic detailing and chart reminders on the use of non-steroidal anti-inflammatory drugs (NSAIDs) among elderly patients with osteoarthritis. The educational program concentrated on osteoarthritis management, including the risks and benefits of NSAIDS, as well as possible medication substitution. Study outcomes were measured by analyzing prescribing patterns and patient phone interview data before and after the intervention. Study results revealed a modest reduction of NSAID prescribing in the intervention group. The study placed considerable time demands on participating physicians and the patient population was composed of long time users of NSAIDs, which may have influenced the results. Nevertheless, the findings suggesting that academic detailing together with supplemental office materials may be effective in changing physician performance.

Decreasing Antibiotic Use in Ambulatory Practice: Impact of a Multidimensional Intervention on the Treatment of Uncomplicated Acute Bronchitis in Adults

Author(s): R Gonzales, J Steiner, A Lum, P Barrett, Jr.

Date: 04/1999

Publisher: Journal of the American Medical Association

Volume/Edition: 281(16)

Publication Type: Journal

Article:

Antibiotic overuse in treating acute respiratory tract infections has led to the emergence of antibiotic-resistant strains of microorganisms. This nonrandomized controlled trial targeted antibiotic prescribing through a systems-based educational intervention that included physicians, patients and hospital staff. The intervention involved office and household based educational materials for patients, as well as education, practice-profiling and academic detailing for clinicians. Clinician education involved prescribing data review, evidence-based management of acute bronchitis, management of patient expectations, and antibiotic prescribing goals. In order to evaluate the success of the intervention, prescribing data was extracted from a pharmacy database. The study was conducted in a health-maintenance organization, where physicians may be more responsive to similar interventions due to routine practice profiling. Nevertheless, study results revealed a decrease in antibiotic treatment, suggesting that multidimensional education may be effective in changing prescribing practices. The data were extracted from the local pharmacy database and may have not captured prescriptions filled elsewhere.

Improvements in Antimicrobial Prescribing for Treatment of Upper Respiratory Tract Infections Through Provider Education

Author(s): N Juzych, M Banerjee, L Essenmacher, S Lerner

Date: 10/2005

Publisher: Journal of General Internal Medicine

Volume/Edition: 20(10)

Publication Type: Journal

Article:

Overprescribing of antibiotics for upper respiratory tract infections has led to emergence of antibiotic resistance. This study was conducted in order to explore the effectiveness of continuing medical education on physician behavior associated with antibiotic prescribing. An interactive, case-based educational intervention program targeted physicians and their staff. In order to evaluate educational effectiveness, prescribing data for adult and pediatric patients were extracted from a pharmacy database and risk adjusted. Study results revealed a decrease in antibiotic prescribing (almost 25%), suggesting that an interactive educational program may have an effect on changing physician prescribing practices. It is important to mention that study results are subject to database limitations; this study was a non-randomized controlled trial.

Clinician Knowledge and Beliefs After Statewide Program to Promote Appropriate Antimicrobial Drug Use

Author(s): K Kiang, B Kieke, K Como-Sabetti, R Besser, E Belongia

Date: 06/2005

Publisher: Emerging Infectious Diseases

Volume/Edition: 11(6)

Publication Type: Journal

Article:

The Wisconsin Antibiotic Resistance Network involved a multifaceted, statewide educational campaign for clinicians and the public. The interventions targeted knowledge, beliefs and decision making regarding antimicrobial use for upper respiratory infections. This campaign was undertaken in response to widespread antibiotic use and its associated antimicrobial resistance. Clinicians filled out pre-intervention and post-intervention questionnaires and the study results revealed significant improvement relevant to appropriate antimicrobial prescribing, suggesting the effectiveness of the multifaceted, systems-based educational campaign.

Impacting Population Cardiovascular Health Through a Community-based Practice Network: Update on an ASH-supported Collaborative

Author(s): B Egan, M Laken, C Shaun Wagner, S Mack, K Seymour-Edwards, J Dodson, D Lackland

Date: 08/2011

Publisher: Journal of Clinical Hypertension

Volume/Edition: 13(8)

Publication Type: Journal

Article:

This article describes a hypertension initiative to reduce heart disease and stroke through healthy lifestyles and access to effective care and medications. The initiative utilized continuing medical education to train providers, e.g., encourage them to become a certified hypertension specialist, inform them about community-based practice network and encourage them to join the hypertension network. Practice audit and feedback (medical record review and quarterly provider feedback reports) served as the key quality improvement mechanism. In addition to performance feedback reports, physicians received newsletters summarizing evidence-based advances in managing hypertension, hypercholesterolemia and diabetes. The initiative resulted in improved hypertension, hypercholesterolemia and diabetes control, as well as decreased deaths related to cardiovascular disease.

The Effect of an Education and Feedback Intervention on Group-model and Network Model Health Maintenance Organization Physician Prescribing Behavior

Author(s): J Schectman, N Kanwal, W Schroth, E Elinsky

Date: 02/1995

Publisher: Medical Care

Volume/Edition: 33(2)

Publication Type: Journal

Article:

This study explored the effectiveness of an educational memo and performance feedback on prescribing behavior of primary care physicians in various practice settings. The intervention purpose was to decrease prescription drug costs. The outcomes were assessed by analyzing prescribing data before and after the intervention. The study results revealed a modest improvement in prescribing practices, however no difference was found between the effect of the educational memo alone and with individual prescribing feedback. The results were similar in both academic and non-academic settings. It should be noted that the study sample was small and that network physicians showed little interest in participating.

Does a Mailed Continuing Education Program Improve Physician Performance? Results of a Randomized Trial in Antihypertensive Care

Author(s): C Evans, R Haynes, N Birkett, J Gilbert, D Taylor, D Sackett

Date: 01/1986

Publisher: Journal of the American Medical Association

Volume/Edition: 255(4)

Publication Type: Journal

Article:

This study assessed the effectiveness of a mailed educational program on hypertension among primary care physicians. Participants in the study group received 14 weekly installments of practice-oriented education on hypertension management as well as office materials (i.e., chart reminders and a follow-up appointment system). Patient blood pressure measured before and after the study, patient and physician questionnaires, and chart audit helped determine study outcomes. The study results revealed no significant change in physician performance or patient outcomes. Lack of a chance to incorporate new information in practice as well as a high baseline rate of performance may have affected study results. However, the findings suggest that mailed educational materials may not be effective in changing physician performance or patient outcomes.

CURATA: A Patient Health Management Program of the Treatment of Osteoarthritis in Quebec: An Integrated Approach to Improving the Appropriate Utilization of Anti-inflammatory/Analgesic Medication

Author(s): M Beaulieu, D Choquette, E Rahme, L Bassette, R Carrier

Date: 08/2004

Publisher: American Journal of Managed Care

Volume/Edition: 10(8)

Publication Type: Journal

Article:

This study explored a small, interactive, case-based workshop and treatment guideline effect on osteoarthritis management. The intervention was evaluated with a pre-intervention and post-intervention questionnaire and prescribing data analysis. Study results revealed improvement in both the workshop and workshop with guidelines (decision tree) study groups, suggesting that dissemination of treatment guidelines is not enough to affect physician knowledge and behavior. Sequential, interactive, case-based education may aid physician ability to diagnose and manage osteoarthritis, including the ability to make appropriate therapeutic choices.

Improving Adherence to Guidelines for Hypertension Drug Prescribing: Cluster Randomized Controlled Trial of General Versus Patient-specific Recommendations

Author(s): M Goldstein, P Lavori, R Coleman, A Advani, B Hoffman

Date: 11/2005

Publisher: American Journal of Managed Care

Volume/Edition: 11(11)

Publication Type: Journal

Article:

This study explored general and patient specific guideline implementation initiatives for the treatment of hypertension in a VA healthcare system. In the general guideline implementation group, participants received the hypertension treatment guidelines as well as data related to treatment of hypertension. They also participated in small-group workshops where they reviewed the guidelines. Participants in the individualized intervention group received the same resources as the general intervention group as well as information that was patient specific regarding guideline conformity. Guideline compliance in the clinician patient panel served as the main outcome measure. The study results revealed that conformity with the guidelines improved in both groups, with significantly higher improvement in the individualized guideline implementation group. While this study was conducted in a single healthcare system and while some important patient variables weren’t taken into consideration, the study findings suggest that a multifaceted, systems-based educational initiative is effective in improving guideline adherence.

Web-based Continuing Medical Education (II): Evaluation Study of Computer-mediated Continuing Medical Education

Author(s): V Curran, T Hoekman, W Gulliver, I Landells, L Hatcher

Date: 04/2000

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 20(2)

Publication Type: Journal

Article:

This study explored the effectiveness of a hybrid computer-mediated education system on dermatologic office procedures. Combining static and interactive learning strategies, the multimedia format of this educational system enabled self-directed and collaborative learning. Pre-intervention and post-intervention tests helped assess the effectiveness of the intervention. While the study largely relied on self-reported outcomes and while technology introduced some challenges, the findings revealed that the system was effective in increasing knowledge and competence in dermatologic procedures.

Comparison of Problem-based Learning and Lecture Format in Continuing Medical Education on Headache Diagnosis and Management

Author(s): M Doucet, R Purdy, D Kaufman, D Langille

Date: 11/1998

Publisher: Medical Education

Volume/Edition: 32(6)

Publication Type: Journal

Article:

This study explored the impact of problem-based learning (PBL) on headache diagnosis and management in primary care, compared with traditional CME. A pre-intervention and post-intervention questionnaire, as well as a “Key Features Problems” examination measured clinical knowledge and reasoning. Study results revealed that participants in the PBL group benefited more; likewise, they reported greater satisfaction with the educational experience. It is worthwhile noting that the PBL group participants were volunteers and mainly consisted of younger women.

The Effectiveness of an Internet-based Tutorial in Improving Primary Care Physicians Skin Cancer Triage Skills

Author(s): B Gerbert, A Bronstone, T Maurer, T Berger, S McPhee, N Caspers

Date: 04/2002

Publisher: Journal of Cancer Education

Volume/Edition: 17(1)

Publication Type: Journal

Article:

The study explored the effect of Internet-based education on skin cancer triage among dermatologists. Besides information on skin cancer, the online tutorial included a built in pretest, individualized feedback, post-test, reassessment test, and a survey. The module allowed for self-directed learning. Participant performance was evaluated with 14 outcome measures. The study results revealed significant improvements in the intervention group relevant to overall skin cancer diagnosis and evaluation. The improvements were sustained for some of the outcomes. Physicians in private practice may have been underrepresented. Similarly, physicians may have been discouraged to participate due to the time demands related to engagement in the course or due to internet connectivity issues. Nevertheless, the findings suggest that a multi-module internet tutorial may be effective in changing physician performance.

A Randomized Trial to Increase Smoking Intervention by Physicians. Doctors Helping Smokers, Round I

Author(s): T Kottke, M Brekke, L Solberg, J Hughes

Date: 04/1989

Publisher: Journal of the American Medical Association

Volume/Edition: 261(14)

Publication Type: Journal

Article:

This randomized controlled trial aimed to increase smoking cessation among patients through education and training of physicians. Physicians received educational materials and participated in a 6-hour interactive workshop, or received educational materials alone. In order to evaluate the effectiveness of the intervention, patients were subsequently interviewed. While long term abstinence was not achieved, study results revealed significant improvement in physician requests to quit smoking, in patient agreement to quit smoking, and in physician requests to select a quit date. A systems approach, physician efforts to prevent patient relapse, physician persistence on follow up, and a supportive social environment may have improved the results even farther. Multifaceted, sequential, interactive activities may be needed in order to maximize the effect of the education/training.

Impact of a General Practitioner Educational Intervention on Osteoarthritis Treatment in an Elderly Population

Author(s): E Rahme, D Choquette, M Beaulieu, L Bessette, L Joseph, Y Toubouti, J LeLorier

Date: 11/2005

Publisher: American Journal of Medicine

Volume/Edition: 118(11)

Publication Type: Journal

Article:

This study explored the effectiveness of a continuing medical education activity on proper selection of osteoarthritis medications among general practitioners. Participants were exposed to an educational workshop that concentrated on evidence-based management of osteoarthritis, a decision tree for therapeutic options, a combination of both, or neither. Study outcomes were assessed through an analysis of dispensed prescription data before and after the workshop. The study findings might be subject to database accuracy. Nevertheless, the study results suggest that an interactive educational program accompanied with guidelines may be effective in improving osteoarthritis management by general practitioners.

Predictors of Physician Prescribing Change in an Educational Experiment to Improve Medication Use

Author(s): S Soumerai, J Avorn

Date: 03/1987

Publisher: Medical Care

Volume/Edition: 25(3)

Publication Type: Journal

Article:

This study explored the effectiveness of an educational program on physician prescribing practices. Study participants received print materials on appropriate prescribing alone or in combination with educational visits by pharmacists. Additional follow-up visits were used for reinforcement. Study outcomes were determined based on changes in physician prescribing practices. Researchers also analyzed the influence of physician characteristics on the study results. The findings revealed that personalized education was effective in changing physician performance regardless of physician characteristics. While physicians volunteered for additional visits by the pharmacists, the number of visits correlated with the degree of change in prescribing practices.

Randomized Controlled Trial of Education and Feedback for Implementation of Guidelines for Acute Low Back Pain

Author(s): J Schectman, W Schroth, D Verme, J Voss

Date: 10/2003

Publisher: Journal of Occupational and Environmental Medicine

Volume/Edition: 18(10)

Publication Type: Journal

Article:

This study explored the effectiveness of physician education involving interactive vignettes, performance feedback, and patient education materials on low back pain management.  Patient chart and electronic record review, as well as post-intervention patient and clinician surveys helped assess study outcomes. The study results revealed a modest increase in guideline adoption relevant to physician education and practice audit/performance feedback. Patient education had no effect. Guideline adherence was rather high at baseline, leaving little room for improvement; also, there may have been a contamination of the control group. Most of the participating patients had strong preconceptions about the management of the condition, which may have affected the effectiveness of the educational materials offered. Nevertheless, the findings suggest that education with practice audit/performance feedback may be effective in changing physician performance.

Does Patient Partnership in Continuing Medical Education (CME) Improve the Outcome in Osteoporosis Management?

Author(s): M Pazirandeh

Date: 07/2002

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 22(3)

Publication Type: Journal

Article:

This study explored the effect of patient education on osteoporosis management. Patients were screened for osteoporosis and educated about bone mass densitometry (BMD) and they then returned to their physicians with the test results. One group of participating physicians participated in a traditional CME activity on osteoporosis management and screening. Study outcomes were assessed using a patient survey administered before the intervention and at six-month follow-up. Study results revealed increased BMD ordering when BMD discussion was initiated by patients. Lecture did not have an effect on physician behavior though. The findings suggest that a traditional CME activity alone may not be effective in changing physician behavior but that the addition of a patient education component may be important in improving outcomes.

Effect of Training on Adoption of Cancer Prevention Nutrition-related Activities by Primary Care Practices: Results of a Randomized, Controlled Study

Author(s): C Tziraki, B Graubard, M Manley, C Kosary, J Moler, B Edwards

Date: 03/2000

Publisher: Journal of General Internal Medicine

Volume/Edition: 15(3)

Publication Type: Journal

Article:

The study explored the effect of nutrition related education for cancer prevention among primary care physician practices. The interventions involved the training on how to implement the recommendations from a National Cancer Institute manual versus mailing of the manual alone. The recommendations included office reorganization to better suit patient dietary counseling. The effectiveness was assessed using an observation instrument as well as structured interviews. Study results revealed that participants in the manual training group adopted more recommendations than the group that received the manual in the mail. Only about half of participants attended this one time educational intervention and it was not evaluated for sustainability. Nevertheless, the findings indicate that training on the guidelines is more effective in adopting the recommendations than dissemination of the guidelines alone.

An Educational Approach to Improving Physician Breast Cancer Screening Practices and Counseling Skills

Author(s): D Lane, C Messina, R Grimson

Date: 06/2001

Publisher: Patient Education and Counseling

Volume/Edition: 43

Publication Type: Journal

Article:

This study explored the effectiveness of an educational program on breast cancer screening among community-based, primary care physicians. The educational intervention was multifaceted and involved in-office training by a nurse educator, as well as a visit by a standardized patient. A workbook was used in addition to the educational visit, or as a self-study intervention.  In order to assess study outcomes, a physician survey was conducted before and after the intervention. Similarly, chart audit was conducted for a portion of study participants. The study results revealed that the intervention group had greater improvement than the control. It should be noted that the study relied on volunteer participants, that physician participation in the survey before and after the activity was limited, and that the results were based mainly on self-reported outcome measures. Nevertheless, the findings suggest that academic detailing may be effective in changing physician performance in the community setting.

 

An Intervention to Increase Physicians’ Use of Adherence-enhancing Strategies in Managing Hypercholesterolemic Patients

Author(s): L Casebeer, J Klapow, R Centor, M Stafford, L Renki, A Mallinger, R Kristofco

Date: 12/1999

Publisher: Academic Medicine

Volume/Edition: 74(12)

Publication Type: Journal

Article:

This study explored sequential, case-based audio-conference and chart reminder effectiveness on physician skills relevant to hypercholesterolemic patient adherence to their therapeutic regimens. Patient chart reminders were developed as a result of the audio-conference and were used by physicians in the intervention group. The success of the intervention was assessed by standardized patients that completed a post visit checklist as well as by patient lipid profile, nutrition information and hypercholesterolemia knowledge. The latter were measured via patient questionnaire. While the evaluation data showed wide variation in physician practices, the study results revealed increased physicians’ use of patient adherence-enhancing behaviors, suggesting that the intervention was effective.

Adapting an Effective Primary Care Provider STD/HIV Prevention Training Programme

Author(s): D Rabin

Date: 04/1998

Publisher: AIDS Care

Volume/Edition: 10

Publication Type: Journal

Article:

This study explored the effectiveness of mailed educational materials and Simulated Patient Instructors (SPI) on STD/HIV prevention among primary care physicians. Participants received educational materials about STD/HIV risk assessment and counseling. In one group, this was the only intervention but in another group this intervention was augmented with  a visit by an SPI. A separate control group had neither intervention. Study outcomes were assessed using telephone interviews before and after the intervention, as well as through standardized patient evaluators. The study results revealed that educational materials with the SPIs improved STD/HIV risk assessment and counseling. The telephone interviews provided self-reported outcome measures and the program was costly. Nevertheless, the findings suggest that this combination CME activity may be effective in changing physician performance.

Impact of a Drug-use Review Program Intervention on Prescribing after Publication of a Randomized Clinical Trial

Author(s): D Bjornson, T Rector, C Daniels, A Wertheimer, D Snowdon, T Litman

Date: 07/1990

Publisher: American Journal of Hospital Pharmacy

Volume/Edition: 47(7)

Publication Type: Journal

Article:

This study explored the effect of an educational packet mailing on physician prescribing practices. The packet included a letter, a questionnaire, a journal article, and drug history of a CHF patient that would benefit from the prescribing information in the packet. The study results revealed that the intervention was not successful in modifying physician behavior. While the findings may have been influenced by the availability of newly approved drugs and the complexity of CHF treatment, the results suggest that a mailed educational packet on pharmacologic therapy for CHF may not be enough to change physician behavior.

Effectiveness of Physician-based Assessment and Counseling for Exercise in a Staff Model HMO

Author(s): S Norris, L Grothaus, D Buchner, M Pratt

Date: 06/2000

Publisher: Preventive Medicine

Volume/Edition: 30(6)

Publication Type: Journal

Article:

This study explored the effectiveness of the Physician-based Assessment and Counseling for Exercise (PACE) tool. Intervention groups received training on the tool and a reminder follow up call with or without additional reminders. Baseline and follow up patient surveys were used to evaluate intervention outcomes. The study results revealed that the intervention was not effective. Participating patient activity levels and physician counseling practices were high at baseline. Also, contamination of the physician control group may have occurred. Seasonal variation in activity level, variation in individual provider implementation of the tool, and measurement problems may have contributed to the negative results. The findings suggest that a single, one-hour training session on exercise counseling may not be effective in changing patient outcomes.

Effect of a Controlled Feedback Intervention on Laboratory Test Ordering by Community Physicians

Author(s): P Bunting, C Van Walraven

Date: 02/2004

Publisher: Clinical Chemistry

Volume/Edition: 50(2)

Publication Type: Journal

Article:

This study explored whether a multifaceted education and feedback program would help reduce common laboratory test ordering among physicians practicing in a community setting. The intervention consisted of 4 individual laboratory representative visits to physician offices spread out over the periods of 2 years, where the representatives reviewed physician test ordering data and provided comparisons with the physicians’ peers. The number of participants was relatively small, physician selection was pseudo-randomized and the study did not evaluate test appropriateness (i.e., the investigators only assessed the volume of test ordered). Nevertheless, the study results revealed that the intervention significantly reduced laboratory utilization, suggesting that a multifaceted education and feedback program may be effective in changing physician behavior. The effect was sustained after the intervention was discontinued.

Physician Management of Hypercholesterolemia. A Randomized Trial of Continuing Medical Education

Author(s): W Browner, R Baron, S Solkowitz, L Adler, D Gullion

Date: 12/1994

Publisher: Western Journal of Medicine

Volume/Edition: 161(6)

Publication Type: Journal

Article:

This study explored the continuing medical education effect on guideline implementation for hypercholesterolemia management among primary care physicians. The educational intervention involved a standard, three hour CME session, alone or combined with supplemental educational materials, office visits to explain project participation and material use, and two follow-up seminars. In order to evaluate the effectiveness of the intervention, patient charts were randomly selected and reviewed for adherence with guideline recommendations. Study results revealed a modest, although not significant, improvement in care in the subgroup of patients that require more management. Guideline complexity and medical record/documentation accuracy may have influenced study results. It should be noted that not all participants took advantage of all of the interventions offered.

Randomized Controlled Trial of a Combined Video-workbook Educational Program for CME

Author(s): J Premi, S Shannon

Date: 10/1993

Publisher: Academic Medicine

Volume/Edition: 68(10)

Publication Type: Journal

Article:

This study explored the effect of a CME program on chest pain management. Participants reviewed relevant articles and either participated in a CME program, which involved a video presentation and a workbook on chest pain management, or did not. Study outcomes were assessed with a test administered to all of the participants before and after the intervention. The sample size was relatively small and the participants were military physicians.  The study results revealed a significant improvement in the post-test results of the intervention group, suggesting that the CME activity was effective in increasing physician knowledge relevant to the diagnosis and management of chest pain.

A Standardized-patient Assessment of a Continuing Medical Education Program to Improve Physicians’ Cancer-control Skills

Author(s): P Carney, A Dietrich, D Freeman, L Mott

Date: 01/1995

Publisher: Academic Medicine

Volume/Edition: 70(1)

Publication Type: Journal

Article:

This study explored the effect of a highly interactive continuing medical education program on cancer prevention in a community practice setting. The intervention consisted of small-group sessions addressing cancer control target areas (smoking cessation counseling, breast cancer early detection, colorectal cancer early detection, cervical cancer early detection, and nutrition counseling) throughout the course of 8 hours. Physician pre-intervention and post-intervention questionnaires, as well standardized patient post-encounter questionnaires helped determine the outcomes of the intervention. Each practice received one standardized patient visit; pre-intervention data was not obtained. Study results revealed a significant increase in breast cancer risk factor determination and smoking cessation counseling, suggesting that the intervention was effective in changing physician behavior related to cancer prevention.

Comparative Trial of a Short Workshop Designed to Enhance Appropriate Use of Screening Tests by Family Physicians

Author(s): M Beaulieu, M Rivard, E Hudon, C Beaudoin, D Saucier, M Remondin

Date: 11/2002

Publisher: Canadian Medical Association Journal

Volume/Edition: 167(11)

Publication Type: Journal

Article:

This study explored the effect of a short, interactive, educational workshop on guideline implementation relevant to the use of appropriate screening tests by family physicians. The intervention involved unannounced standardized patient visits to physicians before and after an educational workshop. Standardized patients completed a post-visit questionnaire in order to help evaluate the intervention. The questionnaire helped track the ordering of recommended tests as well as exclusion of  tests that were not recommended. Efforts to maintain subject randomization failed. Nevertheless, study results revealed that the short, interactive, educational workshop had a significant effect on decreasing the ordering of unnecessary screening tests.

Impact of Education for Physicians on Patient Outcomes

Author(s): N Clark, M Gong, M Schork, D Evans, D Roloff, M Hurwitz, R Mellins

Date: 05/1998

Publisher: Pediatrics

Volume/Edition: 101(5)

Publication Type: Journal

Article:

This study explored the effect of an interactive educational seminar on asthma management. The intervention included brief lectures; video presentation; case-studies; a physician communication assessment protocol; and patient education material that addressed content relevant to clinical practice guidelines, communication with patients, and patient education. In order to assess the effectiveness of the intervention, physician clinical practice and patient/parent satisfaction were evaluated by interviews and questionnaires before and after the intervention. Study results revealed that after the intervention, physicians were more likely to use anti-inflammatory therapies and educate patients and their families. This helped parents feel better prepared to manage asthma at home. Parents rated physicians more favorably and the number of office visits decreased. While study results relied on self-reported outcomes, the findings suggest that the interactive seminar may be effective in changing physician performance and patient/parent satisfaction.

Alcohol Counseling: Physicians Will Do It

Author(s): A Adams, J Ockene, E Wheller, T Hurley

Date: 10/1998

Publisher: Journal of General Internal Medicine

Volume/Edition: 13(10)

Publication Type: Journal

Article:

This study explored the effect of education and office support on counseling related to alcohol dependence. Study group participants received 2.5 hours of education on brief alcohol counseling intervention as well as office support that screened patients, cued providers and supplied patient education materials; the control group engaged in usual care. The intervention was evaluated using patient exit interviews. Study results revealed a significant improvement in alcohol counseling in the study group. The results were sustained for 32 months. This study did not include a condition of provider training without the office support. Nevertheless, the experiment reveals the value of education combined with system support in changing physician behavior.

Training Physicians to Increase Patient Trust

Author(s): D Thom

Date: 08/2000

Publisher: Journal of Evaluation in Clinical Practice

Volume/Edition: 6(3)

Publication Type: Journal

Article:

This study explored the effectiveness of a training course on physician behavior in an attempt to increase patient-physician trust. The workshop involved a brief didactic presentation, small group discussion, viewing of a videotape and role playing. The study outcomes were assessed by a patient questionnaire (before and after the intervention, as well as at follow-up) and through medical record abstraction. Study results revealed no effect associated with participation in the training workshop. It should be noted that the study relied on volunteer participation, that the workshop could have targeted fewer skills for better efficiency, and that systems changes may be needed for the improvement to occur. The findings suggest that a training workshop alone may not be enough to alter physician behavior.

Can Evidence Change the Rate of Back Surgery? A Randomized Trial of Community-based Education

Author(s): H Goldberg, R Deyo, V Taylor, A Cheadle, D Conrad, J Loeser, P Diehr

Date: 05/2001

Publisher: Effective Clinical Practice

Volume/Edition: 4(3)

Publication Type: Journal

Article:

This randomized trial aimed to aid the implementation of evidence based practice guidelines related to surgical treatment of low-back pain. The goal was to decrease surgery rates in the population that exceeded the national average. A systems based, multifaceted educational intervention involving physicians, patients and administrative staff served as the intervention. Quarterly observations of surgical rates helped determine the study outcome.  There was a significant decline in back surgery rates in the intervention communities. Non-educational strategies, e.g., changes in health regulations or financial incentives, may have contributed to these results.

A Randomized Trial of Continuing Medical Education

Author(s): J Sibley, D Sackett, V Nuefeld, B Gerrard, K Rudnick, W Fraser

Date: 03/1982

Publisher: New England Journal of Medicine

Volume/Edition: 306(9)

Publication Type: Journal

Article:

The article describes a study that assessed the effectiveness of a continuing medical education activity on the quality of clinical care. The educational intervention involved mailed educational packets related to a variety of topics commonly encountered in general practice. The packet materials included clinical cases along with background readings, slides and tapes. Testing was built into the packets. Study outcomes were determined through medical record review and questionnaires administered before and after the intervention. The study results revealed an improvement in physician knowledge, however, no significant change in clinical outcomes was found.  It is important to note that the results are subject to the accuracy of medical record documentation and that actual behavior change could not be confirmed. Also, the study concentrated on process measures and these measures may have not been sensitive enough. Nevertheless, the findings suggest that mailed educational materials may be effective in improving physician knowledge.

Persistence of Improvement in Antibiotic Prescribing in Office Practice

Author(s): W Ray, W Schaffner, C Federspiel

Date: 03/1985

Publisher: Journal of the American Medical Association

Volume/Edition: 253(12)

Publication Type: Journal

Article:

This study evaluated the sustainability of improvement in antibiotic prescribing one year after an educational intervention. Two educational visits were evaluated: a visit by a pharmacist (drug educator), and a visit by a trained physician counselor. Intervention effectiveness was assessed by prescribing data analysis. The study results revealed a decline in the undesirable antibiotic prescribing. This improvement was sustained for two full years in the participant group exposed to a visit by a trained physician counselor. A modest improvement in prescribing also occurred in the group that was visited by a pharmacist. This effect was sustained for one year but did not persist into the second year that followed the intervention. The findings suggest that education by a physician-counselor may be effective in changing physician behavior, and that such a change is likely to be lasting.

Two Educational Interventions to Improve Pediatricians Knowledge and Skills in Performing Ankle and Knee Examinations

Author(s): A Hergenroeder, J Chorley, L Laufman, A Fetterhoff

Date: 03/2002

Publisher: Archives of Pediatric and Adolescent Medicine

Volume/Edition: 156(3)

Publication Type: Journal

Article:

This study examined the effect of two educational methods on physician skills related to knee and ankle examination. Participating pediatricians were randomized by practice to either a group that received an educational videotape on ankle and knee examination, or to one that received the videotape as well as a skills building session. Educational effect was determined by assessment of clinical skills examination. Study results revealed an improvement in knee and ankle examination in both groups with a greater improvement in the group that received the videotape combined with the skills building session. The findings suggest greater effectiveness of the interactive educational activity compared to the videotape alone. Researcher familiarity with participating pediatricians may have influenced active engagement and is noted among the main study limitations.

The Effects of Two Continuing Medical Education Programs on Communication Skills of Practicing Primary Care Physicians

Author(s): W Levinson, D Roter

Date: 06/1993

Publisher: Journal of General Internal Medicine

Volume/Edition: 8

Publication Type: Journal

Article:

This study assessed the effectiveness of two educational programs on primary care physician communication skills. One educational program was short and had a set curriculum on the fundamentals of communication. It included a didactic presentation, as well as case-based discussion. The other program was long and participants were able to identify their own learning needs. They worked in small groups with a facilitator, where they reviewed and analyzed their interviewing skills. Study outcomes were determined based on analyses of audio taped patient visits before and after the intervention.  The study results revealed significant changes in the performance of the physicians participating in the long program, but not the short one. It is important to note that the study sample was relatively small, that the long program lacked a control group, and that the participants knew their encounters with patients were being assessed.  Nevertheless, the findings suggest that the longer, self-directed, practice oriented, interactive educational program may be effective in changing physician performance.

Improving Physician Performance Through Peer Comparison Feedback

Author(s): R Winickoff, K Coltin, M Morgan, R Buxbaum, G Barnett

Date: 06/1994

Publisher: Medical Care

Volume/Edition: 22(6)

Publication Type: Journal

Article:

This study assessed the effectiveness of an educational intervention aimed at improving colorectal cancer screening among internists. The intervention included an educational meeting as well as group and peer comparisons for colorectal screening rates using fecal occult blood tests. Changes in physician performance were measured with a pre-test and a post-test, as well as through chart audit. The findings revealed no significant change associated with the addition of an educational activity to group compliance rate comparisons. While the sample size for this intervention was small, peer compliance comparison by itself was associated with significant improvement, suggesting that individual feedback review may be the most effective intervention in improving physician performance.

Increasing the Screening and Counseling of Adolescents for Risky Behaviors: A Primary Care Intervention

Author(s): E Ozer, S Adams, J Lustig, S Gee, A Garber, L Gardner, C Irwin

Date: 04/2005

Publisher: Pediatrics

Volume/Edition: 115(4)

Publication Type: Journal

Article:

This study explored the effect of a systems intervention, consisting of provider training and screening and charting tools, on preventative screening and counseling of adolescents for risky health behaviors. Participants in the intervention group engaged in an eight hour training workshop that included didactic presentations, discussions and role plays. Adolescent screening questionnaires and charting forms were implemented in intervention clinics. Study outcomes were assessed using surveys of the patients immediately after the well visits. While the study was conducted in an HMO organization, a healthcare delivery setting that may differ from other models, the results revealed an increase in physicians’ delivery of preventive services to adolescents, suggesting that multi-component, systems-based education may be effective in changing physician behavior.

Effectiveness of Clinician Training in Smoking Cessation Counseling

Author(s): I Sharif, T Oruwariye, R Cohen, P Ozuh

Date: 09/2002

Publisher: Archives of Pediatric and Adolescent Medicine

Volume/Edition: 156(9)

Publication Type: Journal

Article:

This study explored the effectiveness of smoking cessation counseling training on physician behavior. The workshop included didactic presentation and role play. Medical records for scheduled visits were reviewed before and after the intervention in order to assess study outcomes. Study results showed significant improvement in some of the outcome measures of workshop attendees. Study participation was voluntary and the outcomes were dependent on documentation accuracy. Nevertheless, the findings suggest that a training workshop involving didactic lecture and interactive role play may be effective in changing physician behavior.

Evaluating the Impact of Pain Management (PM) Education in Physician Practice Patterns-A Continuing Medical Education (CME) Outcomes Study

Author(s): L Leong, J Ninnis, N Slatkin, M Rhiner, L Schroeder, B Pritt, R Morgan

Date: 06/2010

Publisher: Journal of Cancer Education

Volume/Edition: 25(2)

Publication Type: Journal

Article:

The article describes a study that explored CME effectiveness in changing physician attitudes and practice patterns relevant to pain management and end of life care. The intervention involved a didactic two-day conference on pain management. Participants completed an anonymous questionnaire immediately after the conference and at follow-up four months later. The study results revealed that the majority of the participants intended to change practice, and even more, changed practice as a result of the educational intervention. It should be noted that not all attendees responded to the survey, that the study relied on self-reported outcomes, and that the education was compulsory. However, the findings suggest that a two day conference may be effective in changing physician attitudes and practice patterns.

Evaluation of a Web-based Education Program on Reducing Medication Dosing Error: A Multicenter, Randomized Controlled Trial

Author(s): K Frush, S Hohenhaus, X Luo, M Gerardi, R Wiebe

Date: 01/2006

Publisher: Pediatric Emergency Care

Volume/Edition: 22(1)

Publication Type: Journal

Article:

This study explored the effect of a web-based educational program on reducing medication dosing error among medical professionals who may need to resuscitate children. A videotaped simulated stabilization scenario was conducted with study participants before and after the intervention. The intervention involved an online course on pediatric resuscitation, as well as a complimentary copy of the resuscitation videotape. Deviation from the accepted medication dose and the time to calculate medication dose were used as measures to assess physician performance. While the study involved a simulated environment, the results revealed a significant reduction in dosing deviation as well as a reduction in the time that it took to determine the does in the intervention group. The study evaluated only one component of the resuscitation process. Nevertheless, the findings suggest that an online educational course, accompanied with a videotape on resuscitation may be effective in changing physician performance.

Does Physician Education on Depression Management Improve Treatment in Primary Care?

Author(s): E Lin, G Simon, D Katzelnick, S Pearson

Date: 09/2001

Publisher: Journal of General Internal Medicine

Volume/Edition: 16

Publication Type: Journal

Article:

This study explored the effectiveness of physician training on depression management among primary care physicians. The intervention involved education on diagnosis and optimal management of depression, specifically, small group, interactive discussions, demonstrations, role play, academic detailing for pharmacotherapy, criteria for specialist referral, and case reviews with psychiatric consultants. Patient visit and pharmacy data were analyzed before and after the intervention in order to determine study outcomes. The findings revealed that participants in the intervention group did not differ from those in the control group with regard to depression management and pharmacotherapy. It should be noted that the intensity of training was moderate, that the study did not have sufficient statistical power to detect small differences between the groups, and that the size of the patient sample used to determine study outcomes may have been insufficient.

Physician Asthma Education Program Improves Outcomes for Children of Low-income Families

Author(s): R Brown, S Bratton, M Cabana, N Kaciroti, N Clark

Date: 08/2004

Publisher: Chest

Volume/Edition: 126(2)

Publication Type: Journal

Article:

This study attempted to assess whether an interactive educational workshop would help improve patient/parent satisfaction and decrease emergency department visits for children with asthma in low-income families. The educational intervention addressed clinical practice guidelines as well as patient teaching and communication. It included lectures, video material, clinical cases, a physician communication assessment element, and messaging/materials for patients. A random sample of parents was surveyed and patient data were analyzed to help evaluate study effectiveness. The number of children that were not of white race was relatively small, and so was the number of low income children overall. The study included children that had more advanced disease. Nevertheless, study results revealed significantly less use of emergency and hospital care in the study group, suggesting that a multifaceted, interactive workshop may be effective in improving patient outcomes.

Multicomponent Internet Continuing Medical Education to Promote Chlamydia Screening

Author(s): J Allison, C Kiefe, T Wall, L Casebeer, M Ray, C Spettell, N Neisman

Date: 04/2005

Publisher: American Journal of Preventive Medicine

Volume/Edition: 28(3)

Publication Type: Journal

Article:

This study explored the effect of a multicomponent, online continuing medical education intervention on chlamydia screening rates in 20 states. The intervention involved four case-based learning modules, and office-level feedback of chlamydia screening rates. Pre-intervention and post-intervention chlamydia screening rates were used to determine the effect of the intervention.  Study results revealed that chlamydia screening rates in the intervention group was significantly better than the rates in the comparison group. While this study did not explore overall chlamydia detection rates, treatment rates or patient outcomes, the findings suggest that sequential, online continuing medical education may have an effect on physician performance. Note that only primary care physicians were studied and that the study is subject to database limitations.

Efficacy of an Educational Web Site for Educating Physicians About Bioterrorism

Author(s): S Chung, K Mandl, M Shannon, G Fleisher

Date: 02/2004

Publisher: Academic Emergency Medicine

Volume/Edition: 11(2)

Publication Type: Journal

Article:

This study explored whether a Website with educational material on bioterrorism would improve general and pediatric emergency physician knowledge and sources of information on bioterrorism. All participants completed a pre-intervention test and attended a lecture on bioterrorism. Study group participants were given access to the website with weekly exposure to case scenarios of diseases due to biological agents. Participants completed a post-intervention test at one and six months and a survey that assessed their knowledge, as well as shed light on their sources of information. Study results revealed that providing physicians access to an educational website did not reliably increase their knowledge. Note that the study was conducted in 2000-2001, when the news media was excessively reporting on bioterrorism; this may have affected participant engagement with the website. Participants reported that they relied primarily on the media as their source of information on bioterrorism. Study results suggest that access to an educational website alone may not be sufficient in affecting physician knowledge.

Evaluating Online Continuing Medical Education Seminars: Evidence for Improving Clinical Practices

Author(s): C Weston, C Sciamanna, D Nash

Date: 11/2008

Publisher: American Journal of Medical Quality

Volume/Edition: 23(6)

Publication Type: Journal

Article:

The article describes a study that intended to evaluate the effectiveness of a continuing medical education seminar in changing quality of care. Participants engaged in an online course which targeted diabetes or systolic heart failure. Physicians were presented with clinical vignettes in order to assess the impact of the educational activity. A set of quality measures associated with disease treatment guidelines were also utilized to determine the effectiveness of the intervention. Also, participants completed a post-activity evaluation. The study results revealed that online education may be effective in improving physician practice. However, it should be noted that the study used an instrument given immediately after the intervention. As such, persistence of the benefit was not assessed.

Impact of a Physician Intervention Program to Increase Breast Cancer Screening

Author(s): M Costanza, J Zapka, D Harris, D Hosmer, R Barth, V Gaw, A Stoddard

Date: 11/1992

Publisher: Cancer Epidemiology, Biomarkers, & Prevention

Volume/Edition: 1(7)

Publication Type: Journal

Article:

This study explored the effect of a multifaceted educational intervention (continuing medical education and reminder system) on breast cancer screening practices among primary care physicians. The intervention involved a series of lectures on screening mammography, barriers to compliance, and legal consequences of screening/not screening. In addition, physicians participated in an hour long interactive session that concentrated on role play. The practice outreach component involved educational materials for physicians, office staff and patients, as well as reminder system materials for physicians. Pre-intervention and post intervention surveys of physicians and patients were conducted in order to evaluate the effect of the intervention. While the study relied primarily on self-reported outcomes, the findings revealed significant improvement in breast cancer screening practices, suggesting that a sequential, multifaceted educational intervention may be effective in changing physician practice.

Effect of Continuing Medical Education and Cost Reduction on Physician Compliance with Mammography Screening Guidelines

Author(s): D Lane, A Polednak, M Burg

Date: 10/1991

Publisher: Journal of Family Practice

Volume/Edition: 33(4)

Publication Type: Journal

Article:

The article describes an effort to determine the effectiveness of a multimodal continuing medical education program on mammography screening. The intervention consisted of a formal conference, a physician newsletter, breast examination skills training, a breast cancer CME monograph, a “monthly question” discussion at hospital staff meetings, primary care office visits and patient education materials. The study outcomes were assessed using a survey administered before and after the educational activity. Study results revealed a significant increase in mammography screening rates among the participants participating in the intervention. The study relied on self-reported outcome measures. However, the findings suggest that a multifaceted educational activity may be effective in improving physician adherence with clinical guidelines.

A Randomized Trial of Practice-based Education to Improve Delivery Systems for Anticipatory Guidance

Author(s): M Rosethal, C Lannon, J Stuart, L Brown, W Miller, P Margolis

Date: 05/2005

Publisher: Archives of Pediatric and Adolescent Medicine

Volume/Edition: 159

Publication Type: Journal

Article:

This study explored the effect of a quality improvement program on pediatrician discussion with parents regarding preventative care. The intervention concentrated on implementation of office systems for improved delivery of services. All of the participating practices were audited. Parents completed surveys in order to determine the impact of the intervention. The study results revealed an improvement in parental reports of preventative care discussions with physicians. It should be noted that the study relied on parent reports; parents may have been prone to give more socially desirable reports. Nevertheless, the findings suggest that a quality improvement program concentrating on systems may be effective in changing physician behavior as well as parent knowledge and behavior.

Impact of an Educational Initiative on Applied Knowledge and Attitudes of Physicians Who Treat Sexual Dysfunction

Author(s): R Shabsigh, R Sandovsky, R Rosen, C Carson III, A Seftel, M Noursalehi

Date: 01/2009

Publisher: International Journal of Impotence Research

Volume/Edition: 21(1)

Publication Type: Journal

Article:

This article describes a research study that assessed the effectiveness of longitudinal continuing medical education on the knowledge and attitudes of physicians treating erectile dysfunction. The educational programming was provided by the Consortium for Improvement in Erectile Dysfunction. Study outcomes were evaluated with validated questionnaires, case studies, and standardized patients. Results for primary care physicians and urologists were compared.  The study results revealed improved physician knowledge and attitudes. Primary care physicians that took more of the consortium courses were almost as knowledgeable on the subject matter as the participating urologists. It should be noted that the study relied on a relatively small sample size. Pre-tests were not utilized in this study due to its longitudinal nature, affecting the ability to assess baseline knowledge of the participants. Nevertheless, the findings suggest that sequential education may be effective in changing physician knowledge and attitudes.

Cancer Risk Communication With Low Health Literacy Patients: A Continuing Medical Education Program

Author(s): E Price-Haywood, K Roth, K Shelby, L Cooper

Date: 05/2010

Publisher: Journal of General Internal Medicine

Volume/Edition: 25 (Suppl. 2)

Publication Type: Journal

Article:

This article describes a study involving academic detailing targeting physician cancer risk communication and screening for low health literacy patients. Researchers attempted to assess the need for such training. Physician performance was evaluated with the help of standardized patients at baseline as well as in 12 and 24 month increments. Following baseline standardized patient screening, a thirty-minute individualized training on patient counseling and cancer screening was provided. Physicians were given access to both standardized patient feedback and patient ratings of their communication. Also, physicians completed a self-rating of their own communication abilities. The study results revealed that standardized patients and actual patients rated physicians lower than the physicians did themselves, suggesting the lack of accuracy in physician self-assessment and the need for appropriate training.

Highly Interactive Multi-session Programs Impact Physician Behavior on Hypertension Management: Outcomes of a New CME Model

Author(s): C Drexel, K Merlo, J Basile, B Watkins, B Whitfield, J Katz, T Sullivan

Date: 02/2011

Publisher: Journal of Clinical Hypertension

Volume/Edition: 13(2)

Publication Type: Journal

Article:

This article describes a study that addressed patient-centered care and utilization of evidence-based practice in hypertension management. A series of mini-conferences included three one-hour teaching modules and two 20-minute lectures, followed by a case study discussion. The outcomes were assessed with a survey instrument that incorporated questions and case vignettes. The study results revealed that the intervention group participants’ knowledge and competence significantly increased. It should be noted that the results were based upon an assessment done immediately after the intervention, providing no insight on the sustainability of the effect and that the study relied on self-reported outcomes. Nevertheless, the findings suggest that a sequential, multifaceted educational intervention may be effective in changing physician knowledge and competence relevant to hypertension control.

A Randomized Trial to Improve Patient-centered Care and Hypertension Control in Underserved Primary Care Patients

Author(s): L Cooper, D Roter, K Carson, L Bone, S Larson, E Miller III, D Levine

Date: 11/2011

Publisher: Journal of General Internal Medicine

Volume/Edition: 26(11)

Publication Type: Journal

Article:

This article describes a study that aimed to evaluate the effectiveness of a patient centered intervention on hypertension control in an underserved patient population. The intervention involved physician communication training and patient coaching. The physician intervention involved videotaping of a visit with a simulated patient with accompanying feedback on communication skills based upon the video material. Intervention participants received treatment guidelines and a monthly newsletter summarizing the latest research related to hypertension. The patient intervention involved communications coaching in preparation for the doctor’s visit. Patients received follow-up calls reinforcing the importance of the preparation for the visit and a monthly health education newsletter for low literacy adults. Simulated patient visit videotapes and audiotapes were used to rate physician communication behavior. Additionally, patients rated physician performance relevant to participatory decision making, patient involvement in care, and their own adherence to treatment follow up. Blood pressure was measured before the baseline visit and at follow-up. The study results revealed that the greatest improvement occurred among patients that received coaching combined with the physicians that had received communication skill training. Researchers encountered some challenges with patient recruitment and outcomes data collection. Both physician and patient exposure to the intervention was limited to a single encounter. A portion of the outcomes relied on self-reported measures. Nevertheless, the findings suggest that the study was successful in reducing the number of patients with uncontrolled blood pressure in the intervention group.

A Community-based Trial of an Online Intimate Partner Violence CME Program

Author(s): J Short, Z Suprenant, J Harris

Date: 02/2006

Publisher: American Journal of Preventive Medicine

Volume/Edition: 30(2)

Publication Type: Journal

Article:

This article describes a study that assessed the effectiveness of an online intimate partner violence prevention program in a community practice setting. This asynchronous online, interactive, case-based, multi-media CME program targeted physician knowledge, attitudes and behaviors related to intimate partner violence. The online program provided access to related resources. The study outcomes were assessed with a survey before the intervention, as well as in follow up at 6 and 12 months. Study results revealed that the program was associated with significant improvement in outcomes sustained over a period of 12 months. It should be noted that the findings relied on self-reported outcomes. Also, some of the participants were lost as the study progressed. Nevertheless, the findings suggest that an online, interactive, case-based, multi-media CME program may be effective in changing physician knowledge, attitudes and behaviors.

Game-based Versus Traditional Case-based Learning: Comparing Effectiveness in Stroke Continuing Medical Education

Author(s): D Telner, M Bujas-Babanovic, D Chan, B Chester, B Marlow, J Meuser, B Harvey

Date: 09/2010

Publisher: Canadian Family Physician

Volume/Edition: 56(9)

Publication Type: Journal

Article:

This article describes a study that compared case-based CME to game-based learning, specifically, their effectiveness relevant to knowledge change. The content focused on stroke prevention and management. Study outcomes were assessed with a post-test given immediately as well as three months after the intervention. The experiment relied on a smaller number of participants than was originally intended. Further, only changes in physician knowledge were examined. Nevertheless, the results revealed comparable change in knowledge in both case-based and gaming groups. Participant satisfaction was higher in the game-based group.

Teaching Sigmoidoscopy to Primary Care Physicians: A Controlled Study of Continuing Medical Education

Author(s): D Perera, J LoGerfo, E Shulenberger, J Ylvisaker, H Kirz

Date: 04/1983

Publisher: Journal of Family Practice

Volume/Edition: 16(4)

Publication Type: Journal

Article:

This article describes a study that evaluated the effectiveness and impact of sigmoidoscopy training on procedure utilization rates.  Chart reviews were used in order to assess study outcomes. It should be noted that the outcomes of care were not examined. Nevertheless, the study results revealed that sigmoidoscopy rates significantly increased among physicians that participated in the training. Importantly, a decline was noted at seven to ten months following the training so the results may not be sustainable.

Effect of Education and Feedback on Thyroid Function Testing Strategies of Primary Care Clinicians

Author(s): J Schectman, E Elinsky, L Pawlson

Date: 11/1991

Publisher: Archives of Internal Medicine

Volume/Edition: 151(11)

Publication Type: Journal

Article:

This article describes a study that evaluated the effectiveness of an educational intervention on thyroid test utilization in primary care. The intervention included a memorandum on the guidelines for thyroid function testing as well as feedback related to test ordering. Testing rate measurements before, as well as at 6 and 12 months following the intervention served as the means to measure the study’s outcomes. Because of a relatively small sample size, the findings may not be generalizable. Nevertheless, the study results showed that didactic content associated with feedback may be effective in altering clinician testing patterns.

Improving Pediatricians’ Compliance-enhancing Practices

Author(s): L Maiman, M Becker, G Liptak, L Nazarian, K Rounds

Date: 07/1988

Publisher: American Journal of Diseases in Children

Volume/Edition: 142

Publication Type: Journal

Article:

This article describes a study that evaluated the effectiveness of CME in increasing physician knowledge and practices, as well as patient mothers’ adherence with antibiotic regimens for acute otitis media. Five hours of didactic education addressed the mothers’ non-adherence with therapeutic regimens and provided practical adherence-enhancing strategies. The study outcomes were assessed using a pediatrician questionnaire, structured interviews of the mothers, and home visits that allowed evaluation of medication utilization (e.g. medication remaining in the packaging and mothers’ self-reported medication use). The study results revealed that the intervention was effective in changing physician knowledge and behavior, as well as affecting the mothers’ adherence with the treatment regimen of their children. The study relied on self- reported outcome measures and did not assess the sustainability of the results. Similarly, it did not evaluate patient outcomes.

Improving Physicians’ Interviewing Skills and Reducing Patients Emotional Distress: A Randomized Clinical Trial

Author(s): D Roter, J Hall, D Kern, L Barker, K Cole, R Roca

Date: 09/1995

Publisher: Archives of Internal Medicine

Volume/Edition: 155(17)

Publication Type: Journal

Article:

This article describes a study that explored the effectiveness of communication skills training on the care of patients with emotional distress. The intervention involved a presentation, round-table discussion, interactive lecture, small group simulation training, taping of interview practice with subsequent discussion, role play, and supplemental educational materials.  The outcomes of the intervention were assessed with a patient questionnaire before, as well as two weeks, three months and six months after the intervention. Likewise, physicians completed questionnaires and simulated patients submitted evaluations of participants’ performance. It should be noted that study participants were volunteers. Regardless, the study results revealed improved management of distressed patients and the results were sustained for 6 months.

Efficacy of Continuing Medical Education to Reduce the Risk of Buprenorphine Diversion

Author(s): M Lofwall, M Munsch, P Nuzzo, S Walsh

Date: 10/2011

Publisher: Journal of Substance Abuse Treatment

Volume/Edition: 41(3)

Publication Type: Journal

Article:

This article describes a study that targeted buprenorphine use before and after a continuing medical education activity. The intervention involved a CME course on best practices in buprenorphine use and strategies to mitigate the risk of diversion and misuse. The course included both didactic and interactive components. Participants also received a copy of guidelines as well as other supplemental educational/resource materials. The intervention was evaluated utilizing surveys administered before and after the CME program, as well as at one and three months after the intervention. The study results revealed improved knowledge and practice behaviors associated with buprenorphine use and these were sustained over time. The experiment relied on self-reported outcomes and was restricted to geographic regions with indicators of buprenorphine and buprenorphine/naloxone diversion and misuse. Nevertheless, the findings suggest that an educational activity combined with supplemental educational materials and resources may be effective in changing physician knowledge and behavior.

Can Internet-based Education Improve Physician Confidence in Dealing with Domestic Violence?

Author(s): J Harris, R Kutob, Z Surprenant, R Mairuro, T Delate

Date: 04/2002

Publisher: Family Medicine

Volume/Edition: 34(4)

Publication Type: Journal

Article:

This article describes a study that was designed to test the effectiveness of an online educational activity on physician attitudes and beliefs related to the management of patients suffering from domestic violence. The intervention consisted of an online, case-based, interactive educational program. Study outcomes were assessed with a test that physician participants completed before and after the intervention. The study did not assess the effectiveness of the educational activity on physician behavior or health outcomes. However, the study results revealed that the online program was effective in changing physician attitudes and beliefs. It also was effective in increasing the confidence of the physician participants related to the management of patients suffering from domestic violence.

The Effects of Continuing Medical Education on Family Doctors Performance in Office Practice: A Randomized Control Study

Author(s): P Jennett, O Laxdal, R Hayton, D Klaasen, R Swanson, T Wilson, R Wickett

Date: 03/1988

Publisher: Medical Education

Volume/Edition: 22 (2)

Publication Type: Journal

Article:

This randomized controlled trial explored continuing medical education effectiveness on family physician practice patterns. The educational interventions concentrated either on cardiovascular disease or cancer and included small group discussions, educational newsletters and teleconference activities. Study outcomes were evaluated through chart review and participant surveys that were conducted before and after the intervention. The study results revealed improved physician performance. It should be noted that the study relied on volunteer participants and that survey results constituted self-reported outcomes. However, the findings suggest that a multifaceted educational intervention may be effective in changing practice.

Flexible Sigmoidoscopy: Primary Care Outcomes After Two Types of Continuing Medical Education

Author(s): W Rodney, G Albers

Date: 02/1986

Publisher: American Journal of Gastroenterology

Volume/Edition: 81(2)

Publication Type: Journal

Article:

This study assessed the effectiveness of a CME course on sigmoidoscopy utilization among newly trained primary care physicians. Participants were exposed to sequential training, which consisted of prolonged lecturing, group demonstration, and individual simulation training. Study outcomes were assessed with a knowledge pre-test, a standardized data collection form, and phone/mail inquiries on procedure utilization in practice. The study results revealed higher utilization rates of sigmoidoscopy among the physicians that participated in the CME course, however, these physicians were less likely to perform higher risk procedures (e.g., electrocautery, polypectomy, etc.). The complication rate among the participants was comparable to that reported in previous studies. It should be noted that the study relied on self-reported outcome measures. Nevertheless, the findings suggest that a sequential training activity may lead to changes in physician knowledge and procedure utilization.

Implementation of On-site Screening Sigmoidoscopy Positively Influences Utilization by Primary Care Providers

Author(s): P Schroy, T Heeren, C Bliss, J Pincus, S Wilson, M Prout

Date: 08/1999

Publisher: Gastroenterology

Volume/Edition: 117(2)

Publication Type: Journal

Article:

This study, which included a didactic session, procedural training, and techniques to implement sigmoidoscopy services, explored the effectiveness of a multifaceted educational program on sigmoidoscopy utilization by primary care physicians.  The study outcomes were assessed using a pre-intervention and post-intervention participant survey while procedure utilization was determined through appointment schedules. Study results revealed that the intervention was effective in promoting sigmoidoscopy utilization by primary care providers.  However, the study results may have been influenced by coding discrepancies. Nevertheless, the findings suggest that a multifaceted educational program may be effective in changing physician performance.

Information About Barriers to Planned Change: A Randomized Controlled Trial Involving Continuing Medical Education Lectures and Commitment to Change

Author(s): P Mazmanian, S Daffron, R Johnson, D Davis, M Kantrowitz

Date: 08/1998

Publisher: Academic Medicine

Volume/Edition: 73(8)

Publication Type: Journal

Article:

This study explored whether continuing medical education lectures would change physician behavior just as well as the same lectures accompanied with information on barriers to change. The intervention was based upon the commitment to change model. Physicians completed a questionnaire after the lecture.  Those that indicated their intention to change practice received a reminder follow-up letter and were asked whether they had implemented the intended changes. The study results revealed that there was no significant effect associated with the information on barriers to change; however, completing an intent to change form was associated with actual change in physician behavior. It should be noted that clearer definition and testing is needed to determine the optimal utilization of the commitment of change model.

Impact of Certified CME in Atrial Fibrillation on Administrative Claims

Author(s): S Stowell, A Gardner, J Alpert, G Naccarelli, T Harkins, A Louder, L Tamariz

Date: 05/2012

Publisher: American Journal of Managed Care

Volume/Edition: 18(5)

Publication Type: Journal

Article:

This study explored the use of administrative claims data to measure changes in physician behavior associated with a continuing medical education activity. Physician practice changes, healthcare utilization and costs were reviewed and compared 6 months before and after the educational activity. The intervention took the form of a web-cast and incorporated a case-based discussion with an expert panel. The study results revealed a significant reduction in healthcare cost and utilization as well as gains in physician knowledge of evidence-based care. It should be noted that study participants may have been exposed to other education on atrial fibrillation during the study period. Similarly, the study time frame of 12 months was relatively short and it is possible that changes in practice occur gradually and may manifest at a later date. Patient adherence is yet another challenge affecting the accuracy of the outcomes. Ultimately, the findings are subject to claims data accuracy. Nevertheless, the results suggest that a web-based continuing medical education activity may be effective in reducing healthcare costs and utilization, as well as improving physician knowledge.

Does Hands-on CME in Gynaecologic Procedures Alter Clinical Practice?

Author(s): S Phillips

Date: 01/2010

Publisher: Medical Teacher

Volume/Edition: 32(3)

Publication Type: Journal

Article:

This study explored the effectiveness of procedural skills training on physician practice. A best practices toolkit for diagnosing and treating benign uterine conditions was developed and a series of related practical workshops involving simulation training was implemented. The study outcomes were evaluated by analyzing billing data. Also, participants completed a survey before and after the activity. Study results revealed an increase in IUD insertions and endometrial sampling associated with the intervention. It should be noted that the study relied on volunteer participants. Nevertheless, the findings suggest that hands on training associated with informational material may be effective in changing physician practice.

Effectiveness of a Controlled Trial to Promote Colorectal Cancer Screening in Vietnamese Americans

Author(s): B Nguyen, S McPhee, S Stewart, H Doan

Date: 05/2010

Publisher: American Journal of Public Health

Volume/Edition: 100(5)

Publication Type: Journal

Article:

This study explored the effectiveness of patient and physician education on colorectal cancer screening in Vietnamese American patient population. The patient education intervention included a media campaign, educational materials and a hotline. The physician intervention involved CME seminars, newsletters, and DVDs. The study results were assessed utilizing a pre-intervention and post-intervention survey. The findings revealed an increase in sigmoidoscopy and colonoscopy screening rates. It should be noted that the study relied on self-reported outcome measures. However, the results suggest that a multifaceted educational intervention involving both physician and patient education may be effective in improving colorectal cancer screening rates.

Intervention to Improve Physician Documentation and Knowledge of Child Sexual Abuse: A Randomized, Controlled Trial

Author(s): R Socolar, B Raines, M Chen-Mok, D Runyan, C Green, S Paterno

Date: 05/1998

Publisher: Pediatrics

Volume/Edition: 101(5)

Publication Type: Journal

Article:

This study explored the effectiveness of individual chart audit and feedback on documentation and knowledge of child sexual abuse among pediatricians. Researchers conducted chart audits, provided individualized feedback and disseminated related articles over a period of three months. Chart review and knowledge tests conducted before and after the intervention helped determine study outcomes. The study results revealed that the intervention was associated with improvement in some aspects of performing an appropriate physical examination, but not the documentation or the knowledge of child sexual abuse. The findings suggest that individual chart audit and feedback may not be effective in changing physician knowledge and behavior. Several factors may have contributed to the findings: the power of the study may have missed modest improvements, the participation in  the intervention (physicians actually reviewing the charts and reading the articles) was minimal, and contamination of the study groups was likely.

Effect of Training on Physician Attitudes and Practices in Home and Community Care of the Elderly

Author(s): J Schwartzberg, R Guttman

Date: 11/1997

Publisher: Archives of Family Medicine

Volume/Edition: 6(5)

Publication Type: Journal

Article:

This study explored the effectiveness of educational seminars on physician attitudes and practice approaches to home healthcare of elderly adults. The intervention involved educational seminars in 10 states, taking place over the course of one year. The seminars included supplemental materials for participating physicians. The education concentrated on guidelines for geriatric home healthcare. Study outcomes were assessed by pre-intervention, post-intervention and follow-up surveys. While the study relied on self-reported outcomes, results revealed that the educational intervention changed physician attitudes relevant to the elderly home healthcare. The findings suggest that an educational program composed of a seminar and supplemental educational materials may be effective in changing physician knowledge and attitudes.

Measuring the Impact of a Live, Case-based, Multiformat, Interactive Continuing Medical Education Program on Improving Clinician Knowledge and Competency in Evidence-based COPD Care

Author(s): C Drexel, A Jacobson, N Hanania, B Whitfield, J Katz, T Sullivan

Date: 02/2011

Publisher: International Journal of Chronic Obstructive Pulmonary Disease

Volume/Edition: 6

Publication Type: Journal

Article:

This study explored the effectiveness of continuing medical education on physician competence and performance relevant to evidence-based COPD care. Exposure to an interactive, multi-format, live, half-day CME conference on COPD served as the intervention. The outcomes were assessed with a post-activity survey that included case vignettes. The study results revealed that the intervention group participants were more likely to follow evidence-based guidelines when making decisions on COPD care. The study relied on self-reported outcomes and there was no participant assessment prior to the engagement in the educational activity or at follow-up. Nevertheless, the findings suggest that a multi-format CME activity may be effective in changing physician competence and performance related to COPD management.

Changing the Psychiatric Knowledge of Primary Care Physicians. The Effects of a Brief Intervention on Clinical Diagnosis and Treatment

Author(s): S Anderson, B Harthorn

Date: 05/1990

Publisher: General Hospital Psychiatry

Volume/Edition: 12(3)

Publication Type: Journal

Article:

This study explored the effectiveness of an educational intervention on the management of certain psychiatric disorders by primary care physicians. The seminar focused on the diagnosis and treatment of depression and anxiety, as well as the indications to appropriately refer patients to specialists. The intervention involved lecture, video presentation, decision trees and discussion. A post-test with case study vignettes was administered to the participants in order to determine study outcomes. The study results revealed that the intervention was effective in increasing physician diagnostic knowledge and changing treatment recommendations. It should be noted that a number of unintended generalizations (“halo” effect) relevant to management of these psychiatric conditions occurred as a result of the intervention and that these generalization are not necessarily accurate. As such, great caution should be taken to guard against such an effect. Nevertheless, the findings suggest that this single intervention may have been effective in changing physician knowledge and behavior.

Can a Specialty Society Educate its Members to Think Differently About Clinical Decisions? Results of a Randomized Trial

Author(s): D Gifford, B Mittman, A Fink, A Lanto, M Lee, B Vickery

Date: 11/1996

Publisher: Journal of General Internal Medicine

Volume/Edition: 11(11)

Publication Type: Journal

Article:

This study explored the effectiveness of a mailed continuing medical education course on clinical decision making among neurologists. The course addressed movement disorders, specifically, practice recommendations relevant to disease detection, diagnostic test utilization, and treatment. Participant knowledge and clinical decision making was assessed with a survey instrument, which included clinical vignettes. Study results revealed that neurologists that read the course materials were more likely to follow the recommendations than those that did not. Although the clinical vignettes represented scenarios typical of a neurologist’s practice, the simulated cases may or may not have been reflective of actual performance in practice. Nevertheless, the findings suggest that an educational course involving exercises that provide an opportunity for knowledge application may be effective in changing physician knowledge and decision making.

A Continuing Medical Education Program in Chronic Obstructive Pulmonary Diseases: Design and Outcome

Author(s): P Terry, V Wang, B Flynn, J Cuthie, J Salim, R Windsor, J Williamson

Date: 01/1981

Publisher: American Review of Respiratory Diseases

Volume/Edition: 123

Publication Type: Journal

Article:

This study explored the effectiveness of a CME course on the care of patients with chronic bronchitis and emphysema (COPD). The intervention involved meetings to discuss educational needs, audiovisual programs with related questionnaires, and feedback on the questionnaire results.  Questionnaires and simulated patients helped assess study outcomes. Participants exposed to any aspect of the intervention retained significantly greater amount of information over 9 months following the study and applied more knowledge in simulated patient visits than participants in the control group. However, there was no significant difference detected among the experimental groups exposed to different components of the educational program. It should be noted that less than half of the participants that entered the study actually finished it. There were some limitations associated with the simulated patient visit compared to the real-life situations (because physicians were aware of when the simulated visits took place). The study did not assess patient outcomes. Nevertheless, the findings indicate that feedback may have been effective in changing physician knowledge and behavior.

A Web-based Diabetes Intervention for Physician: A Cluster-randomized Effectiveness Trial

Author(s): C Estrada, M Safford, A Salanitro, T Houston, W Curry, J Williams, J Allison

Date: 12/2011

Publisher: International Journal for Quality in Health Care

Volume/Edition: 23(6)

Publication Type: Journal

Article:

This study explored the effectiveness of a multifaceted educational intervention on diabetes management among primary care physicians. The intervention involved web-based CME, performance feedback and quality improvement tools. Study outcomes were assessed through medical record review (i.e., tracking of hemoglobin A1c, blood pressure and LDL control). The study results revealed that this wide reach, low intensity multi-component educational intervention had no significant effect on diabetes management. Low physician engagement with the web-based activity and high attrition may have affected the findings. A higher intensity intervention may have been more successful in tackling change in physician performance.

Men’s Sexual Health: Evaluating the Effectiveness of Print- and PDA-based CME

Author(s): G Broderick, M Abdolrasulnia

Date: 09/2009

Publisher: Journal of Sexual Medicine

Volume/Edition: 6(9)

Publication Type: Journal

Article:

This article describes a study that compared the effectiveness of two different educational formats on the clinical management of erectile dysfunction. The content was identical but one format was print-based while the other was delivered electronically through a personal digital assistant (PDA). One group of participants, who included both primary care physicians and urologists, received a mailed print supplement that included articles, patient handouts and a CME post-test. Another group received the same articles, except they were rewritten to accommodate the PDA format and were also available for downloading from the internet. A case vignette survey served as a means to assess study outcomes. The survey results of the print supplement and electronic activity users were compared with those of non-participants. It should be noted that participants in both groups were self-selected, and that the sample of survey respondents was relatively small. Nevertheless, the study results revealed that participants in both groups demonstrated improved diagnostic and therapeutic treatment choices, suggesting that either of the learning formats may be effective in improving clinical management for this condition.

Measuring the Impact of a Continuing Medical Education Program on Patient Blood Pressure

Author(s): B Allaire, J Trogdon, B Egan, D Lackland, D Masters

Date: 07/2011

Publisher: Journal of Clinical Hypertension

Volume/Edition: 13(7)

Publication Type: Journal

Article:

This study evaluated the effectiveness of a CME activity on reducing patients’ blood pressure. The content focused on evidence-based guidelines for hypertension prevention and control. It featured in-depth case study discussion that emphasized strategies to enhance patient adherence. Patient blood pressure readings before and after the study were used to evaluate study outcomes. Study results revealed that the program was effective in moderately reducing blood pressure for the patient population associated with physician participants. These study results are limited to a segment of a primary care population, therefore, they may not be generalizable. Also, the results may be subject to data limitations. Nevertheless, the findings suggest that interactive education may be somewhat effective in altering patient outcomes.

Improving Prevention Systems in Primary Care Practices: The Health Education and Research Trial (HEART)

Author(s): P McBride, G Underbakke, M Plane, K Massoth, R Brown, I Solberg, A Knox

Date: 02/2000

Publisher: Journal of Family Practice

Volume/Edition: 49(2)

Publication Type: Journal

Article:

This study explored the effect of an integrated educational effort on cardiovascular disease prevention services. Physicians and their staffs participated in an educational conference, a series of quality improvement consultations, and/or the incorporation of a prevention coordinator within the practice. The conference included office and patient education materials. The quality improvement effort consisted of 3 consultation meetings and 2 reinforcement visits by a physician expert. These sessions involved practice data review, setting of improvement goals and the development of an implementation plan. The prevention coordinator worked to facilitate preventive services through the development of a practice-specific prevention system that included patient education and counseling.  Study outcomes were assessed by physician, staff and patient questionnaires; physician and staff phone interviews; and review of medical records. The study results revealed that combining interventions achieved improvement in documentation and screening for cardiac risk factors.  Among the limitations should be noted volunteer participation, practice flexibility in choosing their own goals, and no real control group (i.e., the conference only group served as the control.) Nevertheless, the findings suggest that a multifaceted educational intervention, involving a systems-based approach and quality improvement efforts may be effective in improving patient care.

A Controlled Trial of the Effectiveness of Internet Continuing Medical Education

Author(s): L Casebeer, S Engler, N Bennett, M Irvine, D Sulkes, M DesLauriers, S Zhang

Date: 12/2008

Publisher: BMC Medicine

Volume/Edition: 6

Publication Type: Journal

Article:

This study evaluated the effectiveness of a number of internet CME activities on evidence-based clinical care. The education involved 24 interactive CME activities and 24 text-based clinical updates on a variety of topics. A sample of physicians that participated in the CME activities completed relevant case vignettes immediately after engaging in an educational activity. Their results were compared with those of doctors that had not participated in the activity but who had completed the vignettes (control group). The study results revealed that physicians exposed to the CME activities were more likely to utilize evidence-based clinical decisions compared to those that did not. Not all information learned in the CME activities could be evaluated, since the case vignettes were associated with only 5 questions for each activity. Similarly, the answers to these questions were limited to a multiple choice question format. Nevertheless, the findings suggest that internet CME may be effective in influencing physician practice.

A Randomized Trial of a Family Physician Intervention for Smoking Cessation

Author(s): D Wilson, D Taylor, J Gilbert, J Best, E Lindsay

Date: 09/1988

Publisher: Journal of the American Medical Association

Volume/Edition: 260(11)

Publication Type: Journal

Article:

This study evaluated the effectiveness of an intervention focused on smoking cessation counseling. Physicians received education on a protocol for smoking cessation counseling, which  included the provision of advice to patients, the setting of a quit date, use of a contract for quitting, and additional patient support with or without nicotine gum therapy. The outcomes were assessed with a patient questionnaire administered two months and one year after the intervention as well as biochemical saliva testing. The study results indicated higher cessation rates in the patients of physicians who were in the study group that received the education. It should be noted that patient adherence with follow-up visits may have contributed to the success of the intervention. The intervention did not include any strategies relevant to enhancing patient adherence. Likewise, no training was provided on counseling style. Nevertheless, the findings suggest that training related to smoking cessation advice may be an effective tactic in help patients quit smoking.

The Impact on Medical Practice of Commitments to Change Following CME Lectures: A Randomized Controlled Trial

Author(s): F Domino, S Chopra, M Seligman, K Sullivan, M Quirk

Date: 09/2011

Publisher: Medical Teacher

Volume/Edition: 33(9)

Publication Type: Journal

Article:

This study evaluated the effectiveness of the commitment to change model on actual changes in practice as a result of attending a CME conference. Immediately after the conference, participants in the intervention group picked three commitments to change from a predefined list. The control group did not get a chance to note any commitments they might have considered.  All participants were queried on intentions to change practice as well as whether actual changes had taken place in practice 1 week and 4 weeks after the educational intervention. The findings revealed that the proportion of participants making commitments to change was greater in the intervention group at one week post conference compared to 4 weeks post conference. Similarly, more intervention group participants reported contemplating or implementing changes in practice at 30 days. It should be noted, however, that once committed, there were no differences in changes to practice between the two groups. Study participants were predominantly females. There were some challenges related to participant recruitment and sampling. Nevertheless, the study suggests that commitment to change may be effective in enhancing learning outcomes.

Measuring Continuing Medical Education Outcomes: A Pilot Study of Effect Size of Three CME Interventions at an SGIM Annual Meeting

Author(s): S Weiner, J Jackson, S Garten

Date: 05/2009

Publisher: Journal of General Internal Medicine

Volume/Edition: 24(5)

Publication Type: Journal

Article:

This study evaluated the effectiveness of three sessions of a national CME meeting for knowledge acquisition, sustainment, and changes in comfort level. Participants completed a baseline survey before the activity, immediately after the activity, and again, nine months later. The study results revealed knowledge acquisition on all three counts. However the knowledge was sustained for only one of the sessions. One session was associated with an immediate increase in comfort level with the material. However, knowledge decay subsequently occurred. It should be noted that among the limitations was a lack of a rigorous process for measure validation, a relatively small sample size and possible response bias.

Long-term Effects of Asthma Education for Physicians on Patient Satisfaction and Use of Health Services

Author(s): N Clark, M Gong, M Schork, N Kaciroti, D Evans, D Roloff, R Mellins

Date: 07/2000

Publisher: European Respiratory Journal

Volume/Edition: 16(1)

Publication Type: Journal

Article:

This study evaluated the long term effectiveness of an interactive seminar on asthma management among pediatricians. The intervention included a highly interactive, multifaceted seminar, video presentations, case studies, a protocol for communication with patients, a long term treatment plan, and small group meetings. It focused on communication and patient education skills, as well as therapeutic regimens for children recommended by the authors of the national asthma guidelines. Physician surveys, patient parent phone interviews and medical record review before and after the intervention determined study outcomes. It should be noted that other factors than the intervention itself may have contributed to the findings (e.g. individual patient characteristics). The study results revealed significant long term improvements as a result of the educational intervention. Specifically, increased use of patient education protocols; better explanation of the use and modification of therapeutic regimens among the physicians in the intervention group; higher ratings of the physicians in the intervention group by patients’ parents; and fewer ED visits and hospitalizations of patients under the care of the intervention group physicians were noted. The findings suggest that a multifaceted educational intervention may affect physician behavior and patient health outcomes related to asthma.

Training Providers in Hypertension Guidelines: Cost-effectiveness Evaluation of a Continuing Medical Education Program in South Carolina

Author(s): J Trogdon, B Allaire, B Egan, D Lackland, D Masters

Date: 10/2011

Publisher: American Heart Journal

Volume/Edition: 162(4)

Publication Type: Journal

Article:

This study explored the cost effectiveness of hypertension management in a continuing medical education collaborative. The educational program targeted management guidelines for hypertension prevention and control. Researchers used data on program costs and effectiveness measures to determine outcomes. The study relied on volunteer participants and long term effects are not known. However, the findings suggest that the collaborative CME intervention contributed to cost effectiveness related to cardiovascular disease risks.

Training Physicians About Smoking Cessation: A Controlled Trial in Private Practices

Author(s): S Cummings, R Richard, C Duncan, B Hansen, R Vander Martin, B Gerbert, TJ Coates

Date: 11/1989

Publisher: Journal of General Internal Medicine

Volume/Edition: 4

Publication Type: Journal

Article:

This study explored the effectiveness  of continuing medical education on smoking cessation counseling among internists and family physicians in private practices and long-term smoking cessation among their patients. The intervention involved three educational seminars on smoking cessation counseling, pharmacotherapy and sharing of experiences in counseling patients; patient education materials; and chart reminders to cue physicians to counsel patient who smoke. Intervention outcomes were determined through physician and patient questionnaires, patient interviews and and biochemical patient testing. Study results revealed substantial change in physician counseling practices, however, no significant change in patient smoking cessation rates was detected. It should be noted that the number of patient was large and that the participation rate of the physicians was low. Nevertheless, the findings suggest that a multifaceted educational effort may be effective in changing physician performance.

Identification of Knowledge Gaps in Neurosurgery Using a Validated Self-assessment Examination: Differences Between General and Spinal Neurosurgeons

Author(s): J Sheehan, R Starke , N Pouratian , Z Litvack

Date: 09/2012

Publisher: World Neurosurgery

Volume/Edition: S1878-8750(12)

Publication Type: Journal

Article:

This study describes knowledge gap assessment for general and sub-specialty neurosurgeons. Data from the self-assessment in neurological surgery (SANS) general and spine examinations (used in ABNS Maintenance of Certification (MOC) program) was analyzed. Study results revealed different educational needs for general and spine neurosurgeons. The findings provide valuable insight relevant to CME design, as well as general and subspecialty CME curriculum in anticipation of improved patient care.

Decreasing PICU Catheter-associated Bloodstream Infections: NACHRI’s Quality Transformation Efforts

Author(s): M Miller, M Griswold, M Harris II, G Yenokyan, C Huskins, M Moss, R Brilli

Date: 01/2010

Publisher: Pediatrics

Volume/Edition: 125(2)

Publication Type: Journal

Article:

This is a multi-institutional, interdisciplinary quality improvement research study aimed to decrease pediatric catheter-associated bloodstream infections. The study addressed catheter insertion and maintenance with quality improvement teaching and methods for participating PICUs (workshops, conference calls, data collection and submission, change implementation). Infection rate and compliance with the catheter insertion and maintenance protocol served as the main outcome measures. Study results suggest that compliance with central line catheter insertion and maintenance can help decrease associated infections, however, central line maintenance is essential. The study did not address sustainability of the results over time and was conducted with a very sick pediatric population. Nevertheless, it suggests that performance improvement activities have impact on quality of care.

Pay for Performance Alone Cannot Drive Quality

Author(s): K Mandel, U Kotagal

Date: 07/2007

Publisher: Archives of Pediatric and Adolescent Medicine

Volume/Edition: 161(7)

Publication Type: Journal

Article:

This study describes a pay-for-performance initiative, coupled with asthma improvement collaborative. Three levels of incentives were available for 3 levels of performance. The program intended to reward measurable improvements at practice and network level. Similarly, it aimed to foster engagement in performance improvement and to gain a better understanding of such activity design. Study results reveal that the three-level approach was effective in improving asthma care. Paired with a solid quality improvement program, pay-for-performance may help sustain the change.

Diuretic of Choice in ABFM Hypertension Self-assessment Module Simulations

Author(s): M Hagen , W Summer, H Fu

Date: 06/2012

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 25(6)

Publication Type: Journal

Article:

This research study explored the preferred diuretic use for hypertension treatment by physicians/ diplomates of ABFM in simulated environment. It aimed to assess the dissemination of new clinical information into practice. The SAM provided only general prescribing guidelines. All prescribing actions were recorded in the simulation and subsequently evaluated. Study results revealed decreased use of hydrochlorothiazide, suggesting that diplomates considered the newest information surrounding the use of chlorthalidone vs. hydrochlorothiazide, and the potential benefits of the former over the latter.

Setting a Fair Performance Standard for Physicians’ Quality of Patient Care

Author(s): B Hess, W Weng , L Lynn, E Holmboe, R Lipner

Date: 10/2010

Publisher: Journal of General Internal Medicine

Volume/Edition: 26(5)

Publication Type: Journal

Article:

This article describes the process of developing a composite performance measure, intended to serve as an acceptable standard in diabetes care. This is a retrospective study involving a study sample of nearly 1000 physicians certified by the American Board of Internal Medicine (ABIM). Individual clinical and patient experience measures representing evidence based care were adopted from ABIM diabetes PIM and used to develop the composite measure. Physician expert panel spanning the spectrum of the internal medicine practice established acceptable threshold for each measure and evaluated the importance of each measure in contributing to the overall diabetes care. They computed the composite measure and assessed its reliability (reproducibility), as well as classification accuracy subsequently. The study suggests that performance assessment is strengthened, when using a composite (as opposed to individual) performance measures. This study shows the commitment of ABIM to standard setting for physician performance.

The Association Between Physicians’ Cognitive Skills and Quality of Diabetes Care

Author(s): B Hess, W Weng , E Holmboe, R Lipner

Date: 02/2012

Publisher: Academic Medicine

Volume/Edition: 87(2)

Publication Type: Journal

Article:

This study explored the relationship between general internist Maintenance of Certification (MOC) examination scores and their clinical performance on a diabetes composite measure, assessed through ABIM diabetes PIM. For the PIM, participating physicians were required to abstract between 10 and 25 patient charts and distribute the same amount of patient surveys. Study results revealed a strong link between the examination scores and diabetes composite measure, indicating the importance of the cognitive skills to patient care. Participants chose to complete the PIM and they selected the patients for their performance evaluation themselves. However, the link between a comprehensive composite measure of diabetes care and MOC examination scores provides insight to the value of the examination in ABIM MOC program and in patient care.

Effects of Clinician Communication Skills Training on Patient Satisfaction: A Randomized, Controlled Trial

Author(s): J Brown, M Boles, J Mullooly, W Levinson

Date: 12/1999

Publisher: Annals of Internal Medicine

Volume/Edition: 131

Publication Type: Journal

Article:

Literature suggests that physician communication skills may influence patient satisfaction. However to date, no solid research studies have been performed to prove that it is effective. This randomized controlled trial explored whether clinician exposure to communication skills training had any effect on patient satisfaction. The training intervention included an initial workshop (focusing on effective communication/relationship building skills), homework (audio taping interaction with patients and listening to the recording) and a follow up workshop (focusing  on negotiation skills). Both workshops included a brief didactic component, as well as an interactive aspect (role playing/discussion). Study results revealed that the scores on most items of the patient satisfaction survey improved after the intervention, with a slightly higher average improvement in the control group. Similarly, the mean score improved in the control group. Overall, study results suggested that physician communication training did not improve patient satisfaction, although, it should be noted that the training encouraged physicians to concentrate mainly on “problem patients”. Ultimately, more than a single CME intervention might be needed in order to actually change physician behavior.

Effect of a Dementia Care Management Intervention on Primary Care Provider Knowledge, Attitudes, and Perceptions of Quality of Care

Author(s): J Chodosh, E Berry, M Lee, K Connor, R DeMonte, B Vickery, T Ganiats

Date: 02/2006

Publisher: Journal of the American Geriatrics Society

Volume/Edition: 54(2)

Publication Type: Journal

Article:

This study attempted to evaluate the effect of a dementia quality improvement program on provider knowledge and attitudes, perceptions of quality of care, and change in adherence to guidelines in the areas of disease assessment, treatment, education/support and safety. The intervention involved both system change and primary care provider education. The intervention consisted of 5 educational modules totaling 100 minutes of presentation and discussion time in a small group format; educational materials were available to the healthcare professionals on the web post intervention. While study results indicated significant improvement in quality of care for dementia patients, provider knowledge and attitudes were minimally affected. Nevertheless, intervention providers had a stronger perception of dementia as a disease that is difficult to manage in the primary care setting. It is worthwhile noting that educational intervention attendance was low (40%) and that there were no immediate opportunities to practice specific assessment skills. Likewise, a 9 month duration also may have been too short a time to observe changes resulting from the intervention.

Improving Adherence to Dementia Guidelines Through Education and Opinion Leaders

Author(s): D Gifford , R Holloway, M Frankel, C Albright, R Meyerson, R Griggs, B Vickery

Date: 08/1999

Publisher: Annals of Internal Medicine

Volume/Edition: 131(4)

Publication Type: Journal

Article:

This study aimed to assess the impact of a multifaceted, evidence-based educational intervention on dementia management, specifically, the use of 6 specialty society endorsed practice recommendations. The intervention consisted of a mailed CME course, a resource manual, a seminar and reminder mailings. Participants completed surveys, which included scenario-based assessment. Study findings revealed that the intervention was effective in influencing the use of some, but not all of the recommendations. While the study is limited to a neurologist population in one state only, it highlights the value of opinion leaders and specialty societies in the spreading and use of practice guidelines.

A Controlled Evaluation of a National Continuing Medical Education Programme Designed to Improve Family Physicians’ Implementation of Diabetes-specific Clinical Practice Quidelines

Author(s): H Gerstein, S Reddy, K Dawson, J Yale, S Shannon, G Norman

Date: 11/1999

Publisher: Diabetic Medicine

Volume/Edition: 16

Publication Type: Journal

Article:

This study aimed to evaluate the impact of a case-based, interactive, small group workshop on  diabetes management. The workshop addressed diabetes diagnosis, non-pharmacological therapy of hyperglycemia, pharmacological therapy, and chronic complications. It targeted physician knowledge, attitude and behavior. To assess the impact of the intervention overtime, participants completed 3 surveys. While survey respondents were volunteers, and while the assessment involved self-reported measures, study findings revealed that the workshop changed physician knowledge, attitude and behavior and that the change was sustained for no less than a month.

Enhancing Mammography Referral in Primary Care

Author(s): K Grady, J Lemkau, N Lee, C Caddell

Date: 11/1997

Publisher: Preventive Medicine

Volume/Edition: 26

Publication Type: Journal

Article:

This randomized controlled trial aimed to assess the impact of an educational intervention on mammography referral rates in community based primary care setting. The intervention involved interactive education enhanced with cues, performance feedback (based on patient chart audit) and token rewards, depending on the study arm. Study findings revealed that education with cues (i.e., posters, chart reminders, etc.) had a larger effect than education alone, suggesting the importance of systems in changing the practice patterns. Performance feedback and reward did not show a similar effect, however, the assessment may have been timed too close to the intervention. Physician characteristics had a modest effect on the study outcome.

The Impact of Two Teaching Techniques on Physicians’ Knowledge and Performance

Author(s): L Greenberg, L Jewett

Date: 05/1985

Publisher: Journal of Medical Education

Volume/Edition: 60

Publication Type: Journal

Article:

This study aimed to evaluate traditional (i.e. lecture) and interactive (i.e., case-based, problem based) CME activity effectiveness. Activity content was based on pediatric headaches, enuresis, and behavior and sleep problems. Study results were determined based on physician performance with simulated patients, medical record review, and a test administered before and after the intervention. Although the study sample was relatively small, results revealed that interactive activity was more effective in terms of imparting knowledge. However, there was only a slight difference in the effect on knowledge retention. Besides being interactive, sequential and multifaceted education may be a more effective practice in sustaining knowledge over time.

Teleconferenced Educational Detailing: Diabetes Education for Primary Care Physicians

Author(s): S Harris, L Leiter, S Webster-Bogaert, D Van, C O'Neill

Date: 04/2005

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 25

Publication Type: Journal

Article:

This cluster-randomized control trial aimed to evaluate teleconferenced educational detailing effect on glycemic control and physician adherence to diabetes treatment guidelines. The effectiveness of the sequential, small-group, case-based educational intervention on type 2 diabetes mellitus management was assessed by reviewing medical records before and after the intervention. While limited to the medical record review (i.e. possibly not capturing other important, non-clinical measures, such as communication), study findings revealed that the intervention was effective in improving diabetes management.

Better Prescribing Project: A Randomized Controlled Trial of the Impact of Case-based Educational Modules and Personal Prescribing Feedback on Prescribing for Hypertension in Primary Care

Author(s): C Herbert, J Wright, M Maclure, J Wakefield, C Dormuth, P Brett-MacLean, J Premi

Date: 10/2004

Publisher: Family Practice

Volume/Edition: 21(5)

Publication Type: Journal

Article:

This randomized controlled trial aimed to evaluate the effect of individualized prescribing feedback and interactive education on evidence-based prescribing practices to manage hypertension. Pharmacy registry data was used to track outcomes. Although the study effect was relatively modest, the results suggest that individualized feedback with group comparison, as well as case-based education can influence physician prescribing practices.

Improving On-line Skills and Knowledge: A Randomized Trial of Teaching Rural Physicians to Use On-line Medical Information

Author(s): J Kronick, C Blake, E Munoz, L Heilbrunn, L Dunikowski, W Milne

Date: 03/2003

Publisher: Canadian Family Physician

Volume/Edition: 49

Publication Type: Journal

Article:

This randomized trial explored rural physician use of online medical resources. The following resources were made available to different study cohorts: individualized 3-hour training sessions on retrieval of evidence-based information, the training sessions combined with a  reference binder, 6 months of online access to  a medical database, borrowing privileges at the electronic university library, a university e-mail account, and a service delivering educational resources to the e-mail account. Pre-intervention and post-intervention questionnaires were utilized to assess the impact of these various interventions. Study results revealed that the training had a significant effect on physician use and comfort level with online resources; improvements were greater in the intervention group, likely due to the additional tools that were provided. Among the limitations, some technical difficulties were experienced during the study period.

Integrating Clinical Practice Guidelines Into Daily Practice: Impact of an Interactive Workshop on Drafting of a Written Action Plan for Asthma Patients

Author(s): M Labelle, M Beaulieu, P Renzi, E Rahme, R Thivierge

Date: 12/2004

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 24

Publication Type: Journal

Article:

Poor adherence to asthma clinical practice guidelines, high prevalence of the disease and suboptimal self-medication/self-management of the illness warrant physician education and highlight its impact on disease management. This study examined the impact of a CME workshop on the knowledge and use of written action plans (WAPs), a set of instructions that help patients monitor their symptom severity and adjust therapy. Objective structured clinical examination (OSCE) helped assess study outcomes. Study results indicated that long-term knowledge of WAPs and related management criteria improved significantly in general practitioners who participated in the 6-month OSCE. While the workshop alone was not sufficient, the OSCE seemed to have formative and evaluative value. There were no significant differences in self-reported drafting of WAPS in either of the groups. It is important to note that the study sample was small and that the method of participant assignment to study groups may have skewed study results, where participant motivation may have affected study findings. Similarly, the absence of a control group limited the analysis of workshop impact to the participants. Nevertheless, the study results suggested that interactive, sequential educational activities, providing opportunities to practice, were most likely to impact physician practice patterns.

Evaluating the Impact of an Educational Program on Practice Patterns of Canadian Family Physicians Interested in Depression Treatment

Author(s): S Kutcher, B Lauria-Horner, C MacLaren, M Bujas-Bobanovic

Date: 12/2002

Publisher: Primary Care Companion to the Journal of Clinical Psychiatry

Volume/Edition: 4(6)

Publication Type: Journal

Article:

Literature notes that despite the high incidence, depression goes unrecognized up to 70% of time. This study was designed to assess brief educational activity impact on physician knowledge, diagnosis and treatment of depression. Here, study participants received either a general educational program, or an enhanced one. Besides information on epidemiology, neurobiology, clinical presentation, diagnosis and treatment of the disease featured in the general education program, the enhanced program offered more specific strategies for improving recognition and treatment of depression, e.g., the use of a diagnostic or symptom assessment tool, recommended medication dosing, and relapse prevention. Upon completion of the program, participants were asked to enroll 8 to 10 depressed patients in a study, which they followed for the next 6 months to help assess the intervention outcomes; it included patient chart audits. Study results revealed improved physician knowledge following the educational programs. Physicians in the enhanced program were more likely to use the diagnostic and side effect measurement tools as well as prescribe the recommended dose of medication. Similarly, the enhanced group participants had decreased numbers of office visits and referred fewer physicians to psychotherapists. It is worthwhile noting that study participants were volunteers and that their baseline depression knowledge was rather high. Further, the study did not include specific anxiety measures and examined short term effects only.

Achieving Guidelines for the Treatment of Depression in Primary Care: Is Physician Education Enough?

Author(s): E Lin, W Katon, G Simon, M Von Korff, T Bush, C Rutter, E Walker

Date: 08/1997

Publisher: Medical Care

Volume/Edition: 35(8)

Publication Type: Journal

Article:

This research study explored the effect of physician education on depression treatment. Here, physician education was part of a multifaceted Collaborative Care Program (designed along Agency for Health Care Policy and Research (AHCPR) guidelines), which also included reorganization of services to optimize patient education and integration of consulting psychiatrists to co-manage depressed patients in the primary care setting. The education spanned a 12-month period and included both didactic and interactive activities. Study results revealed improved physician therapeutic practices, better adherence to antidepressant therapy and higher patient satisfaction in the intervention group. The effects did not endure past the discontinuation of the program. Restructuring of services, however, seemed profound. Among the study limitations, consider that the patient population in the experiment may have differed from the natural setting, and that the information relevant to control clinics may have been inadequate.

Dual-track CME: Accuracy and Outcome

Author(s): J Lockyer, H Fidler, D Hogan, L Pereles, C Lebeuf, B Wright

Date: 10/2002

Publisher: Academic Medicine

Volume/Edition: 77(10)

Publication Type: Journal

Article:

Literature has indicated that group learning could be tailored to better meet individual needs. This research study explored the effect of an intensive, 2-track educational program (introductory and advanced) on Alzheimer’s disease  and other dementias’ diagnosis and management. Researchers were interested whether they correctly assigned physicians to the 2 educational tracks. In the introductory track, participants improved moderately; data on involvement in patient management was encouraging. While significant, there was only a small improvement in the advanced track, which was predictable due to higher knowledge, comfort and involvement baseline of participating physicians. The course was meant to create an opportunity to discuss cases and build on participant expertise, as opposed to teaching basic disease management skills, which was the case in the introductory track. Placement allowed participants to take courses that were more appropriately matched to their levels of expertise, and therefore, facilitated learner-centered teaching.

Influences of Educational Interventions and Adverse News About Calcium-channel Blockers on First-line Prescribing of Antihypertensive Drugs to Elderly People in British Columbia

Author(s): M Maclure, C Dormuth, T Naumann, K McCormack, R Rangno, C Whiteside, J Wright

Date: 09/1998

Publisher: The Lancet

Volume/Edition: 352

Publication Type: Journal

Article:

This study explored the translation of evidence into practice relevant to antihypertensive drug prescribing practices, compared to practice guidelines. Recruited participants included physicians that previously participated in an educational teleconference, a small group workshop and/or received a community wide newsletter. Researchers aimed to assess the change in prescribing pattern and used claims data for that purpose. Media coverage relevant to medication adverse effects was taken into consideration. Study findings revealed that a third of physicians continued to prescribe second line agents as first-line therapy to patients, contrary to the guidelines. Authors concluded that for the evidence to effectively translate into practice, multiple messages delivered by multiple methods, including lay media, were necessary.

Teaching Practicing Surgeons Critical Appraisal Skills with an Internet-based Journal Club: A Randomized, Controlled Trial

Author(s): H MacRae, G Regehr, M McKenzie, H Hentleff, M Taylor, J Barkun, S McLeod

Date: 09/2004

Publisher: Surgery

Volume/Edition: 136(3)

Publication Type: Journal

Article:

This randomized, controlled study aimed to assess the effectiveness of an Internet-based journal club on general surgeon critical appraisal skills. Participants in the study group received a total of 8 packages (one package per month), each of which included a clinical and a methodological article. They received a reminder to read the articles at the beginning of each month and participated in a week long list-serve discussion mediated by an expert colleague. At the end of the discussion, the participants received reviews of both articles, written by content experts. Participants completed a validated examination that assessed their critical appraisal skills. Study results revealed that the intervention group participants performed better on the test of critical  appraisal than the control group did. Not all of the participants were able to complete work on all 8 educational packages (including evaluations), possibly due to study fatigue.  Nevertheless, the findings shed light on the evidence that multifaceted Internet-based intervention may result in improving critical appraisal skills of general surgeons.

Improved Diabetes Care by Primary Care Physicians: Results of a Group-randomized Evaluation of the Medicare Health Care Quality Improvement Program (HCQIP)

Author(s): W McClellan, L Millman, R Presley, J Couzins, W Flanders

Date: 12/2003

Publisher: Journal of Clinical Epidemiology

Volume/Edition: 56

Publication Type: Journal

Article:

This study aimed to assess whether the feedback on HbA1C measurement would result in more frequent monitoring of the measure in diabetic patients. The group-randomized evaluation of the intervention included performance feedback to physicians (shared over a period of 6 months), clinical practice guidelines, general information about patterns of diabetes care in the state, as well as educational tape and practice aids to implement guideline recommendations. No information was provided to comparison participant group. Study results revealed that rates of the measure monitoring increased in both groups, but increases were larger in the intervention group. Since feedback relied on claims data, study results may be subject to database limitations, as well as issues relevant to attribution. Nevertheless, study findings point to improved processes of care of diabetes mellitus, resulting from performance feedback and education.

Quality Improvement for Depression Enhances Long-term Treatment Knowledge for Primary Care Clinicians

Author(s): L Meredith, M Jackson-Triche, N Duan, L Rubenstein, P Camp, K Wells

Date: 12/2000

Publisher: Journal of General Internal Medicine

Volume/Edition: 15

Publication Type: Journal

Article:

This study examined a quality improvement (QI) program effect on depression treatment by primary care clinicians (PCCs). Clinicians representative of a diverse sample of managed care organizations, were matched with patients and randomized to the usual care or one of the two intervention groups (QI-meds and QI-therapy). Each intervention group had to participate in an educational component (sequential and/or multifaceted educational activities) and had unique resources associated with their group. Participants completed self-reported assessment surveys prior to the beginning of and after the intervention (18 months after). While the study sample was rather modest and the assessment, self reported, and while there was only partial blinding, study findings indicated improvement in knowledge about the treatment of depression, especially, psychotherapy.

Measuring the Effectiveness of a Pilot Continuing Medical Education Program

Author(s): J Moran, P Kirk, M Kopelow

Date: 02/1996

Publisher: Canadian Family Physician

Volume/Edition: 42

Publication Type: Journal

Article:

This nonrandomized controlled trial assessed the effect of learner-centered small group CME program on the performance of family physicians that have serious practice deficiencies. Physicians in the intervention group attended a 10-session, learner-centered, small group CME program and were compared against randomly selected control physicians. Clinical care, preventative care, charting and the use of drugs served as the main outcome measures. Although the study sample size was small and the variables were evaluated quantitatively only, study results showed significant improvement during the course of the CME program in study participant performance.

Electronic Delivery of Research Summaries for Academic Generalist Doctors: A Randomized Trial of an Educational Intervention

Author(s): K Mukohara, M Schwartz

Date: 04/2005

Publisher: Medical Education

Volume/Edition: 39

Publication Type: Journal

Article:

This randomized controlled trial evaluated the effectiveness of electronic weekly summaries of new articles, or a Weekly Browsing Journal Club (WBJC) on the use of evidence in practice. Over a hundred academic internists were randomly assigned to receive either the WBJC or a health news website for a period of 3 months. Participants completed an assessment questionnaire before and after the intervention regarding the use of evidence in practice, their attitudes about it, critical appraisal ability and reading habits. Study results indicate that the intervention did not have a significant effect on the use of evidence in practice or the attitudes; reading ability was somewhat improved in the intervention group. The primary outcome measure, the use of research evidence in practice, may have been too general and the duration of the study may have been too short. However, study findings may suggest that a single (while sequential) educational activity may not be enough to change physician behavior. Interactive, multifaceted educational activities may be needed for that purpose.

Practice-based Small-group CME

Author(s): J Premi, S Shannon, K Hartwick, S Lamb, J Wakefield, J Williams

Date: 10/1994

Publisher: Academic Medicine

Volume/Edition: 69(10)

Publication Type: Journal

Article:

The article presents the evaluation of a practice based small-group CME program in Canada. The authors intended to assess program impact on physician satisfaction and practice patterns. The program could be best characterized as a network of small groups participating in innovative practice and problem based learning activities, centered on cases provided by program staff or taken from the experiences of the participants. The program utilized educational strategies, deemed effective in the literature, i.e., peer discussion, self-directed learning, and practice-centered interventions. Program evaluation was carried out with the help of questionnaires designed to measure global satisfaction, change in practice patterns and change in knowledge. Physicians interested in the program, but unable to participate served as a control group. The evaluation results indicated high overall satisfaction, 127 practice changes, reported by the respondents in the intervention group, and a 12% increase in knowledge, also, in the intervention group.

Randomized Trial of Problem-based Versus Didactic Seminars for Disseminating Evidence-based Guidelines on Asthma Management to Primary Care Physicians

Author(s): M White, G Michaud, G Pachev, D Lineman, A Kolenc, J Fitzgerald

Date: 09/2004

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 24

Publication Type: Journal

Article:

This study explored the effectiveness of a small-group problem-based learning (PBL) activity and a traditional didactic lecture on asthma management guideline dissemination. Study outcomes were assessed with a case-based questionnaire.  The findings revealed no difference between the PBL and traditional lecture method in changing physician knowledge and attitudes. However, physicians were likely to view the interactive PBL activity as more valuable than the traditional lecture format. The study sample was small and approaches to PBL may differ throughout the educational community, therefore the results may not be generalizable. The findings suggest that a didactic lecture may be just as effective in changing physician knowledge and attitudes as a PBL activity.

Quality Monitoring of Physicians Linking Patients’ Experience of Care to Clinical Quality and Outcomes

Author(s): T Sequist, E Schneider, M Anastario, E Odigie, R Marshall, W Rogers, D Safran

Date: 11/2008

Publisher: Journal of General Internal Medicine

Volume/Edition: 23(11)

Publication Type: Journal

Article:

This study compares the association of clinical performance and patient experiences between statewide sample of physician practice sites, and a sample of physicians within a large physician group. Processes of care and outcomes, as well as quality of clinical interactions and organizational features of care are examined using Health Plan Employer Data and Information Set data, as well as Ambulatory Care Experiences Survey data. Study findings reveal that patient experience measures are modestly correlated with process measures in both groups. Even though improvements in clinical quality do not automatically cause improvements in patient experiences, it is important to note that there is a relationship between the two.

The Role of Physician Specialty Board Certification Status in Quality Movement

Author(s): T Brennan, R Horwitz, F Duffy, C Cassel, L Goode, R Lipner

Date: 09/2004

Publisher: Journal of the American Medical Association

Volume/Edition: 292(9)

Publication Type: Journal

Article:

The article provides an opinion on the role of board certification in the national quality movement, largely prompted by the IOM report “To Err is Human.” The report focused on medical errors/patient safety and encouraged quality improvement through systems of care, opportunities for reliably measuring individual physician quality being limited. Unfortunately, Board certification hasn’t been considered as having a role in individual physician quality improvement, even though published evidence on the value of certification/Maintenance of Certification (MOC) suggest the correlation between examination scores and other physician quality measures, correlation of certification status and practice outcomes, and the internal validity of the very testing process. By means of practice performance assessment and cognitive examination, certification and MOC evaluate physician habits of practice and medical knowledge, both key in preventing mistakes. Gallup survey findings suggest that general public highly values certification/maintenance of certification.

Perspectives and Preferences Among the General Public Regarding Physician Selection and Board Certification

Author(s): G Freed, K Dunham, S Clark, M Davis

Date: 05/2010

Publisher: Journal of Pediatrics

Volume/Edition: 156(5)

Publication Type: Audio

Article:

Literature has shown that consumers are interested in health care quality reports, but they don’t necessarily know where to look for such information, or how to use it. Board certification and Maintenance of Certification (MOC), a voluntary public process, is one of the mechanisms for physician assessment. However, there is a lack of information on the public view of such a process, as well as the rigor that it entails. Most of the past studies concern adults choosing their health providers. This study attempts to identify parental attitudes regarding board certification and other factors influencing the choice of physicians for their children. Several hundred parents and non parents are surveyed in this study on a number of health related topics, with a significant portion of items focused on physician Board certification. The findings complement those of previous research, where patients are more likely to choose Board certified physicians and that they want information on certification status. Further, public expects hospitals and health plans to use Board certification as an indicator of competence.

Ratings of Residents’ Clinical Competence and Performance on Certification Examination

Author(s): J Norcini, G Webster, L Grosso, L Blank, J Benson

Date: 06/1987

Publisher: Journal of Medical Education

Volume/Edition: 62(6)

Publication Type: Journal

Article:

The study described in this article provides evidence to support the validity of board certification examination scores. Once residents apply to take internal medicine certification exam, residency program directors submit evaluations of their competence and its various components to the ABIM. These ratings were compared with performance on the Board certification examination. Study findings indicate that program director ratings and examination scores rank residents similarly. While the ratings of the individual components of clinical competence and ratings of general competence moderately correlated with examination performance, individual components correlated very highly with each other. Components that were less dependent on medical knowledge showed weaker correlation with examination performance.

Relationships of Ratings of Clinical Competence and ABIM Scores to Certification Status

Author(s): J Shea, J Norcini, H Kimball

Date: 10/1983

Publisher: Academic Medicine

Volume/Edition: 68(10)

Publication Type: Journal

Article:

The aim of this study was to compare the performance of Board certified internists who attempted certification in a subspecialty, and those who did not. Study participants were followed for 5 years. Besides comparison between the groups, participant performance was compared within the subset of the subspecialties. Overall clinical competence ratings by residency program directors and certification examination scores served as performance measures. Study findings suggest that the candidates who passed the subspecialty examination were perceived as most clinically competent at the end of their residency training. Similarly, examinees who earned a subspecialty certification scored highest on their initial certifying examination. There was no significant variation among the program director ratings within the subset of the examinees who obtained certification in both internal medicine and a subspecialty. Similarly, differences in average performance on an initial internal medicine examination were minimal among the members of this subset. In this retrospective study, scores were combined across the cohorts and not equated. Similarly, ratings by residency directors assessed participant performance indirectly. Nevertheless, study results point to differences among the performance of certified internists and certified subspecialists.

Certification and Specialization: Do They Matter in the Outcome of Acute Myocardial Infarction

Author(s): J Norcini, H Kimball, R Lipner

Date: 12/2000

Publisher: Academic Medicine

Volume/Edition: 75(12)

Publication Type: Journal

Article:

This study examined the differences among certified and non-certified cardiologists, internists, and family practitioners in light of their AMI patient mortality. The Pennsylvania Health Care Cost Containment Council data for AMI admissions and AMA Masterfile for specialty Board certification status and year of graduation from medical school were analyzed for this purpose. The AMI patient outcome data was risk adjusted. Besides patient and physician characteristics, hospital characteristics and hospital location were taken into consideration.  Study findings suggest that lower mortality is associated with treatment by cardiologists that cared for larger numbers of patients, were closer to their year of graduation from medical school, and were Board certified. Certification was associated with 15% reduction in AMI patient mortality. Limitations associated with physician attribution, risk adjustment procedures and lack of information on physician-patient relationships apply.

A Statewide, Population-based, Time Series Analysis of the Outcome of Ruptured Abdominal Aortic Aneurysm

Author(s): R Rutledge, D Oller, A Meyer, J Johnson

Date: 05/1996

Publisher: Annals of Surgery

Volume/Edition: 223

Publication Type: Journal

Article:

There were several aims addressed in this study: to perform the first, statewide, population based time-series analysis of the frequency of ruptured abdominal aortic aneurysm (RAAA); to determine the outcomes of RAAA; and to assess the association of patient, physician and hospital factors with survival after RAAA. For the purposes of the study, data was obtained from four different data sources; therefore, study results are subject to database limitations. Nevertheless, one of the main hypotheses of the study, increased physician expertise and experience would positively affect the outcome of RAAA patients, was generally confirmed. Results show that physicians lacking board certification have lower survival of patients with RAAA, although the effect was relatively modest. Similarly, association between physician experience with RAAAs and patient survival is found to be statistically significant.

Who Claims to be a Pediatrician?

Author(s): G Freed, R Uren, R Hudson, I Lakhani, American Board of Pediatrics Research Advisory Committee

Date: 06/2007

Publisher: Journal of Pediatrics

Volume/Edition: 150(6)

Publication Type: Journal

Article:

Since physicians have an opportunity to list themselves as specialists without proof of training or certification, there is a chance for misrepresentation. It becomes especially important, considering recent attention to patient safety and public’s preference for Board certification. The purpose of this study was to identify the proportion of physicians that aren’t Board certified, but declare being pediatricians. For the purpose of this study, state licensure roster was compared to a listing of ABP for physicians, designated as pediatricians in eight states. Physicians that appeared as non-certified pediatricians received a mail survey, which attempted to determine their training and practice characteristics. Survey results revealed that a portion of respondents claimed to be pediatricians without completing pediatric residency.  A study like this informs patients, when seeking out doctors for their children.

Annotated Bibliography for Clinician Patient Communications to Enhance Health Outcomes

Author(s): M White, K Bonvicini, C Iwema

Date: 2011

Publisher: Institute for Healthcare Communication

Volume/Edition:

Publication Type: Book

Article:

White, Bonvicini and Iwema provide a very useful annotated bibliography on the importance and impact of effective communication in health care. Based on multiple studies reviewed, effective communication has been shown to positively impact health, functional and emotional status; improve diagnosis; help improve patient adherence; increase in trust in a provider; improve patient satisfaction; improve clinician satisfaction; and decrease medical malpractice risk.  The bibliography also provides data and impact of communication training as part of continuing professional development.

Accuracy of Physician Self-assessment Compared with Observed Measures of Competence: A Systematic Review

Author(s): D Davis, P Mazmanian, M Fordis, R Harrison, K Thorpe, L. Perrier

Date: 09/2006

Publisher: Journal of the American Medical Association

Volume/Edition: 269 (9)

Publication Type: Journal

Article:

This seminal systematic review examined the accuracy of self-assessment compared to an “external” assessment. Self-assessment and self-directed lifelong learning are integral to continuing physician professional development. However, past literature review raised concerns over physician ability to appropriately self-assess without external performance data or feedback. The literature search included databases from Medline, Embase, Cinahl, Psycinfo, the Research and Development Resource Base in CME databases and proprietary search engines for relevant studies dating from late 60s through 2006. Included studies had to include a comparison between physicians’ self-assessment, as determined by self-ratings and 1 or more external measure of related competencies. Also, studies had to use quantifiable and replicable measures, have a study population of at least 50% practicing physicians, residents, or similar health professionals, and be conducted in UK, Canada, US, Australia or New Zealand.  Seventeen studies met the inclusion criteria. Overall, of the 20 comparisons between self-assessment and an external assessment standard, 13 comparisons demonstrated little, no, or an inverse association and only 7 demonstrated positive associations. The worst accuracy in self-assessment among physicians was found predominantly in the least skilled and those who were the most confident.  This study highlights the critical importance of not relying on self-assessments done in isolation, consistent with research in other professions.

Confirming the Validity of the General Pediatrics Certification Examinations: A Practice Analysis

Author(s): L Althouse, Y Du, H Ham

Date: 08/2009

Publisher: Journal of Pediatrics

Volume/Edition: 155(2)

Publication Type: Journal

Article:

Practice analysis was used in this study to validate the ABPeds initial certification and Maintenance of Certification (MOC) examinations. During phase one of the study, thirteen board-certified, actively practicing subject matter experts rated the importance and frequency in practice of 35 competency knowledge domains. During phase two, a random sample of 1000 actively certified GPs selected from the ABP database were asked to rate the importance (on a 5-point Likert scale) of detailed content outline for each competency domain reviewed by the experts in phase 1, and to also provide information about their practice. Survey response rate was approximately 51%. The phase 2 study participants recommended using essentially the same blueprint for both initial and MOC examinations. However, study findings prompted minor changes to examination content, suggesting a close match between current pediatric practice and examination content specifications. While the practice analysis reflects self reported rather than actual practice patterns, study results confirm that examination blueprint aligns with the knowledge necessary for competent general pediatric practice.

Improving Asthma Care Through Recertification: A Cluster Randomized Trial

Author(s): J Simpkins, G Divine, M Wang, E Holmboe, M Pladevall, L Williams

Date: 11/2007

Publisher: Annals of Internal Medicine

Volume/Edition: 167

Publication Type: Journal

Article:

This article describes a cluster randomized trial, aiming to assess whether completion of asthma specific PIM has impact on patient outcomes. In completing a PIM, physicians evaluate their management of a specific disease condition, develop and implement a plan to improve the care for that condition, and measure the impact of the implemented plan on subsequent care. Patient level data concerning sociodemographics, processes of care, medication dispensing, asthma control and symptoms and perception of general health are assessed using patient surveys and electronic claims data. Study results show that there is no improvement in the primary outcome, dispensing of the inhaled corticosteroids (ICSs). However, there is an improvement in patient self reported asthma severity in patients treated by intervention group physicians, when compared with the control group. Study findings, therefore, suggest that recent recertification requirements implemented by the ABIM may improve the disease outcomes. Some limitations apply, e.g., participant ability to choose the process measure to improve, generally low patient response rates on surveys, etc.

Association Between Licensure Examination Scores and Practice in Primary Care

Author(s): R Tamblyn, M Abrahamowicz, W Dauphinee, J Hanley, J Norcini, N Girad, C Brailovsky

Date: 12/2002

Publisher: Journal of the American Medical Association

Volume/Edition: 288(23)

Publication Type: Journal

Article:

The goal of this study was to find out whether there was a lasting relationship between certification examination scores and practice performance, and whether licensing examinations taken at the end of the medical school were predictive of future practice. Nearly a thousand family physicians that passed certification examination between 1990 and 1993 and entered practice in Quebec, Canada, participated in the study. Data on physician practice performance for 3.4 million patients was accessed through the linked databases in the universal health care system of Quebec; patients seen in the first 4 to 7 years of physicians’ practice were followed. Study findings (although subject to database limitations) showed that relationships between certification examination scores were indeed maintained through the first 4 to 7 years of practice, and that examinations taken in the final year of medical school were significant predictors of practice performance.

Effects of a Signature on Rates of Change: A Randomized Controlled Trial Involving Continuing Education and the Commitment-to-change Model

Author(s): P Mazmanian, R Johnson, A Zhang, J Boothby, E Yeatts

Date: 06/2001

Publisher: Academic Medicine

Volume/Edition: 76(6)

Publication Type: Audio

Article:

As part of a CME activity, learner commitment to change has been gaining popularity, however, the effect of signing such commitment remains unclear. The purpose of this randomized controlled trial is to find out whether participant signature has any effect on the rates of their practice change. One hundred and ten physicians were randomly assigned to a control or an experimental group. The participants had to specify the changes that they intended to make and to indicate the level of their commitment on a scale of 1 to 5 (1 being the lowest, and 5, the highest level of commitment). The participants in the control group were asked to sign the commitment form, while those in the experimental group, were not. Two follow up surveys were conducted to determine participant practice rates of change. Study results revealed that signatures did not matter, when considering compliance with the commitment. No significant difference was found between the control and experimental groups, when considering the rates of change. Study findings suggest that the participants that name the change and note commitment to implement it are more likely to change, regardless of the signature.

Impact of a Physician-oriented Intervention on Follow-up in Colorectal Cancer Screening

Author(s): R Myers, B Turner, D Weinberg, T Hyslop, W Hauck, T Brigham, N Schlackman

Date: 04/2004

Publisher: Preventive Medicine

Volume/Edition: 38

Publication Type: Journal

Article:

This randomized controlled trial aimed to determine whether reminder-feedback coupled with an educational intervention, had any effect on physician performance relevant to the recommendation for a complete diagnostic evaluation (CDE) for patients with abnormal fecal occult blood test (FOBT) results. Over 400 primary care physicians were randomly assigned to either a control or an experimental group and the CDE recommendation and performance rates served as outcome measures (assessed both before and after the study). Trial results suggest that reminder-feedback and educational outreach intervention increase CDE recommendation and performance. It is important to consider, however, that the study was restricted to a single geographic location and affiliated with a large Managed Care Organization (MCO), which may be indicative of a practice pattern specific to that region/organization. Study results may have also been affected by participant knowledge and attitudes and the effect is restricted to a combination of the intervention components. Lastly, the trial was not designed to verify the sustainability of the impact over time. Prisoner pulation is complex, with greater severity of illness, encouraging physicians to delay patient return to prison, and more likely to sue for malpractice.

Effectiveness of Women’s Telephone Counseling and Physician Education to Improve Mammography Screening Among Women Who Underuse Mammography

Author(s): C Messina, D Lane, R Grimson

Date: 09/2002

Publisher: Annals of Behavioral Medicine

Volume/Edition: 24(4)

Publication Type: Journal

Article:

The authors attempted to assess the effect of patient telephone counseling (barrier-specific telephone counseling technique) with or without a CME intervention on mammography utilization. A 4-arm quasi-experimental trial revealed that women previously screened for breast cancer and receiving phone counseling were more likely to become regular mammography users. The sample size for CME intervention was small, and therefore, precludes any generalizable conclusions; however, study results suggest that CME may help initiate mammography use among women who had never been screened. It is worthwhile noting that literature indicates that physician recommendation remains one of the critical factors, ensuring mammography use among older women.

An Application of Continuing Medical Education to Decrease Excessive Lengths of Stay

Author(s): S McMahon, P McKenna, J Hodgins

Date: 05/1988

Publisher: Journal of Medical Education

Volume/Edition: 63

Publication Type: Journal

Article:

In order to decrease lengths of stay in a tertiary care medical and surgical care unit for inpatients from penal institutions, researchers undertook a three-stage intervention: 16-month analysis to identify services with extensive lengths of stay, 2-month period that included 2 educational interventions to decrease excessive lengths of stay, and a 16-month follow up. Attending physicians of three services (internal medicine, hematology-oncology and nephrology) with prolonged lengths of stay were targeted with individual meetings, where length of stay data was discussed. Subsequently, a traditional CME meeting was held for all of the physicians of the hospital that admitted patient to the unit; length of stay data for all specialty services was discussed. The lengths of stay decreased significantly in the experimental groups, but not in the control. The improved length of stay was sustained for 16 months following the intervention. Study results suggest that focused educational interventions may be effective in significantly decreasing lengths of stay. It is worthwhile noting that the hospital was at an increased pressure to control costs of medical care due to then recent changes to reimbursement (hospital administrators may have devoted greater attention to medical practice at that point in time). On the other hand, a prisoner patient population is complex, with greater severity of illness, encouraging physicians to delay their return to prison, and more likely to sue for malpractice

Evaluation of the Impact of a Low Back Pain Educational Intervention on Physicians’ Practice Patterns and Patients’ Outcomes

Author(s): V Dereberry, G Giang, G Saracino, W Fogarty

Date: 10/2002

Publisher: Journal of Occupational and Environmental Medicine

Volume/Edition: 44(10)

Publication Type: Journal

Article:

Low back pain, the main reason of disability in individuals under 45 and the costliest of workers compensation claims, is largely a result of a lack of agreement among physicians on appropriate treatments and legitimate causes for work absence. The purpose of the study was to evaluate the effectiveness of an educational intervention in changing physician performance relevant to lower back pain management. In this study, physicians engaged in a 2 hour lecture (which included their performance review), received a low back pain manual promoting evidence-based treatment, engaged in a post-test and received periodic provider practice review reports; physicians were encouraged to discuss the studies with colleagues once monthly. Cases for the participating physicians were retrieved from a proprietary database for a year prior and a year after the intervention. Eight indicators of practice patterns and treatment outcomes were evaluated. Physicians not participating in the study, but meeting criteria for case selection were assigned to the control group; they only received the manual on evidence-based treatment for lower back pain. Study results revealed that all of the measured outcomes significantly improved in the study group (no significant changes in the control group) signaling effectiveness of the educational intervention in changing physician practices relevant to lower back pain management, and leading to better outcomes. It is important to note that assessment of the duration of pain or overall patient satisfaction was beyond the study scope. Similarly, study findings are based on the data collected from the proprietary data base; there were no chart reviews performed.

Effectiveness of Commitment Contracts in Continuing Medical Education

Author(s): L Pereles, J Lockyer, D Hogan, T Gondocz, J Parboosingh

Date: 04/1996

Publisher: Academic Medicine

Volume/Edition: 71(4)

Publication Type: Journal

Article:

The article describes a small study, involving 16 physician learners that attended an interactive geriatrics course at a university. Seven physicians were randomly assigned to an experimental group and were asked to make a written commitment to change their clinical practice. Follow-up with participants of both experimental and control groups was conducted at one and three months after the educational activity. Study results revealed that physicians in the experimental   group reported more changes on both follow-ups. Also, the changes reported at three months by the physicians in the experimental group affected more patients. While the study sample is small, the results suggest that an interactive CME course can change clinical practice, when physicians identify desired changes in writing; supposedly, follow-up reinforces the changes.

Commitment to Change Statements Can Predict Actual Change in Practice

Author(s): J Wakefield, C Herbert, M Maclure, C Dormuth, J Wright, J Legare, J Premi

Date: 04/2003

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 23

Publication Type: Journal

Article:

The study attempted to determine the effect of the commitment to change following an educational activity to actual changes in physician learner practice. Unlike similar research that relied on self-reported practice changes, this study engaged in data analysis of prescribing practices through a provincial pharmacy registry before and after the intervention. This randomized controlled trial took place in Canada and aimed to evaluate the effectiveness of an interactive CME activity (along with prescribing feedback) to promote evidence based prescribing. Study involved 207 physicians, who were randomly assigned to one of the four arms of the trial. The interventions focused on educational case-based, evidence-based modules on hypertension, type 2 diabetes, congestive heart failure and otitis media along with informational sections on evidence based condition management. One page prescribing portraits for individual and group performance 12 months prior to the study were developed for the purpose of the experiment. The experimental groups received the said educational modules with prescribing feedback portraits, while the control groups received unrelated educational modules of choice without the portraits. Following the educational intervention, participants completed a survey, relevant to the level of interest in the topic, assessment of the module quality, and the impact anticipated in practice. Study results revealed that those physicians that committed to change were more likely to actually change their prescribing practices than those that did not, which suggests that self-reported change may predict actual change in practice. However, the sample size of the experimental groups was relatively small and the overall variation of individual physician results was large. Similarly, only newly prescribed patients were targeted for data analysis, and a single data analysis 6 months post the intervention does not necessarily represent practice changes over time. Lastly, using self-report as the only assessment measure should be approached with caution due to possible overestimation.

Impact of Disseminating Quality Improvement Programs for Depression in Managed Primary Care: A Randomized Controlled Trial

Author(s): K Wells, C Sherbourne, M Schoenbaum, N Duan, L Meredith, J Unutzer, L Rubenstein

Date: 01/2000

Publisher: Journal of the American Medical Association

Volume/Edition: 283(2)

Publication Type: Journal

Article:

The article describes a randomized controlled trial, which attempted to assess the impact of QI programs on the care of patients with depression in a managed primary care setting. Over 40 primary care clinics (6 US managed care organizations) and over 13 thousand patients with depressive symptoms participated in this study. Participants were randomized to usual care or to one of 2 QI programs., the highlights of which involved institutional commitment, training of experts and staff to provide patient education, identification of potentially depressed patients and either a standard medication therapy, or access to trained psychotherapists. Study results suggest that quality of care, clinical outcomes, mental health related functioning and employment retention improved over a period of one year for patients participating in QI programs. It should be mentioned that the study relied on self-report for some of the measures, e.g. employment

Effectiveness of an Educational Strategy to Improve Family Physicians’ Detection and Managements of Depression: A Randomized Controlled Trial

Author(s): G Worrall, J Angel, P Chaulk, C Clarke, M Robbins

Date: 07/1999

Publisher: Canadian Medical Association Journal

Volume/Edition: 161(1)

Publication Type: Journal

Article:

The study aimed to assess whether participation in a CME activity would help improve detection and management of depression by family physicians. The study involved 42 family physicians that were randomly assigned either to an experimental or a control group. The participants of the experimental group attended a live activity, which introduced clinical practice guidelines for depression management; also, they received access to a psychiatrist for consultation. Physicians were encouraged to discuss their own cases and challenges they may have encountered with them. The participants of the control group received the clinical practice guidelines by mail, however, no further explanation was provided. Similarly, they did not receive access to a psychiatrist. All physicians recorded information on antidepressant use by patients, as well as patient referrals to a psychiatrist/other mental health specialist. Both physicians and patients had to complete a Centre for Epidemiologic Studies Depression scale before the treatment and 6 months after; the difference between the preceding and subsequent scores served as the primary outcome measure. Study results revealed that at six-month follow up, significantly more patients took antidepressants in the experimental group. Similarly, the referrals to psychiatrists/other mental health specialists were higher in this group. There was also a significant distinction in the difference of the scores between the experimental and control groups, as measured by the Centre for Epidemiologic Studies Depression scale before and after the intervention. While this randomized control trial in the primary care setting suggests a modest effect of this educational strategy on depression patient outcomes, it is important to note that the study has several limitations, i.e., short study duration, potential bias due to self rating, and a tendency to perform better, when observed.

Effect of Board Certification on Antihypertensive Treatment Intensification in Patients with Diabetes Mellitus

Author(s): A Turchin, M Shubina, A Chodos, J Einbinder, M Pendergrass

Date: 02/2008

Publisher: Circulation

Volume/Edition: 117

Publication Type: Journal

Article:

This is a retrospective study, which explores the association between the time of the last physician board certification and antihypertensive treatment intensification in diabetes mellitus patients. Study findings show that treatment intensification decreases, as the time from last physician certification increases. While past and present blood pressures, nature of physician-patient relationship, and the number of acute conditions addressed during the visit show a strong effect in the probability of treatment intensification, physician age does not. No direct comparison of medication doses is performed, and any medication change is considered treatment intensification. Study relies on medical record accuracy and the sensitivity of computerized technology (84%) used to analyze the data. However, it includes over 8000 hypertensive diabetes patients as participants, and it shows quantitative relationship between board certification and a process measure of quality of care.

Certifying Examination Performance and Patient Outcomes Following Acute Myocardial Infarction

Author(s): J Norcini, R Lipner, H Kimball

Date: 09/2002

Publisher: Medical Education

Volume/Edition: 36

Publication Type: Journal

Article:

The study explores whether successful completion of certifying examination is associated with patient mortality and length of stay following acute myocardial infarction. Results suggest that mortality is decreased for patients receiving care from board certified cardiologists. Doctor  characteristics, e.g. patient volume, year of attempted certification, are not related to mortality, according to study results. Further, findings demonstrate that patients treated by certified doctors do not spend significantly less time in hospital. Nevertheless, results suggest that examination performance is related to patient outcomes.

Who is Maintaining Certification in Internal Medicine – and Why? A National Survey 10 Years After Initial Certification

Author(s): R Lipner, W Bylsma, G Arnold, G Fortna, J Tooker, C Cassel

Date: 01/2006

Publisher: Annals of Internal Medicine

Volume/Edition: 144(1)

Publication Type: Journal

Article:

A mail survey consisting of 20 questions was distributed to physicians certified in internal medicine in 1990, 1991, and 1992, in order to determine the reasons for maintaining certification. The response rate was slightly over 50% and results revealed that for more than a half of respondents certification was required by at least one of their employers. However, only a third of the respondents that were engaged in/have completed the Maintenance of Certification (MOC) process indicated it as a reason for recertification; for this cohort, it was part of the professional development. The most common reasons diplomates provided for participating in MOC were to maintain or enhance their professional image, update their knowledge base, or maintain or improve patient care quality. Those that did not participate most frequently indicated that the process took too much time. Other reasons offered for not participating were the expense of MOC, unreasonable requirements, not relevant to practice (primarily for specialists not participating in general internal medicine MOC, and not required by their employer). Most respondents indicated that patients and peers value certification, and that physicians working in direct healthcare should be certified. The survey was completed by volunteers, therefore, those with less favorable attitude towards MOC might have responded at a higher rate. Further, since it involved self reporting, the results might lack accuracy. Lastly, misconceptions about program requirements might also have led to inaccurate responses.

Teaching Internal Medicine Residents Quality Improvement Techniques Using the ABIM’s Practice Improvement Modules

Author(s): J Oyler, L Vinci, V Arora, J Johnson

Date: 07/2008

Publisher: Journal of General Internal Medicine

Volume/Edition: 23

Publication Type: Journal

Article:

The article describes the use of ABIM Clinical Preventative Services Practice Improvement Module (CPS PIM) for teaching Internal Medicine residents quality assessment and improvement techniques, and the effect it has on resident confidence in QI skills. The quality assessment and improvement curriculum, based on ABIM CPS PIM is incorporated  in 2 required 1-month ambulatory rotations during the postgraduate year 2. Residents complete chart reviews in order to assess practice, and design group interventions that would help correct the deficiencies. To evaluate the effect of the curriculum, a self-assessment tool evaluating QI skills is administered. The ABIM’s CPS PIM provides a standardized, web based, evidence based, affordable and efficient tool to teach residents the QI basics. Group projects empower learners to reflect on the quality data, and to produce changes in their continuity clinic experience. The results of the intervention suggest that resident confidence in QI skills improves, as a result of this curriculum. Not only are residents able to make significant changes in practice, but also, disseminate the findings in scholarly work, e.g. an internal resident research day, or a hospital quality fair. Challenges to implementing the PIM include time, funding, and faculty with QI experience.

Continuing Medical Education and the Physician as Learner: Guide to the Evidence

Author(s): P Mazmanian, D Davis

Date: 09/2002

Publisher: Journal of the American Medical Association

Volume/Edition: 288

Publication Type: Journal

Article:

The study examines evidence of CME effect on physicians and planners per Cochrane search, accounting for 1992-2002. Search results reveal that CME definition has expanded beyond the traditional concept. Authors outline three key aspects that relate to effective CME: 1) educational interventions that are based on a needs assessment of physician knowledge, skills or patient outcomes, 2) interactive learning formats, including opportunities to practice, and 3) sequenced and multifaceted activities. Identifying gaps relevant to knowledge base, behavior or skills and employing tools to close those gaps are essential to change. Interactive educational activities are more effective in changing physician behaviors and patient outcomes. Similarly, educational activities that clearly address a specific aim, that come in series, or that target the same topic through multiple activities of different formats are more effective. In order to be effective, CME should truly be continuous and self directed; it should include learning needs assessment, assessment of practice, reflection on the progress, and active role in selecting future educational path by learners.

A Meta-analysis of Continuing Medical Education Effectiveness

Author(s): M Mansouri, J Lockyer

Date: 01/2007

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 27(1)

Publication Type: Journal

Article:

The article describes a meta-analysis of randomized controlled trials and experimental design studies of CME outcomes published between 1990 and 2004, identified through Medline and Eric databases. The authors examined a total of 31 studies, including 61 total interventions, to determine the effect of CME characteristics on physician knowledge, performance and patient outcomes. The meta-analysis combines data from different studies and considers only relevantly direct evidence on a given topic. It is also limited to major journals, which publish studies with significant results. Neither study participant demographic information, nor information relevant to measurement intervals is considered in the analysis. Yet, study findings suggest that CME is likely to have a moderate effect on physician knowledge, but a smaller effect on physician performance and patient outcomes. Study results show that CME is more effective when educational interventions are active or interactive (rather than passive), use multiple methods, are provided for longer periods of time (either continuously or episodically) and are designed for smaller groups of participants within a single discipline.

Predictive Validity of Certification by the American Board of Internal Medicine

Author(s): P Ramsey, J Carline, T Inui, E Larson, J LoGerfo, M Wenrich

Date: 05/1989

Publisher: Annals of Internal Medicine

Volume/Edition: 110

Publication Type: Journal

Article:

The article describes a study exploring predictive validity of American Board of Internal Medicine (ABIM) certification, where two groups of physicians: 1) internists certified by the ABIM, who successfully achieved certification 5 to 10 years prior; and 2) those that completed training 5 to 10 years prior, but did not successfully achieve or attain certification were compared relative to performance on peer and patient evaluations and medical record audit. The peer survey assessed clinical skills, clinical reasoning, communication skills and humanistic qualities. The patient questionnaire measured satisfaction with physician services and information relevant to risk assessment and counseling aspects of preventative care. Ratings of clinical skills by professional peers were significantly higher for certified internists. Multivariate analysis showed ABIM certification status was significantly associated with performance on these measures of clinical competence. Lastly, study findings show that certified physicians provide a more comprehensive preventative care.

Patient Outcomes for Segmental Colon Resection According to Surgeon’s Training, Certification, and Experience

Author(s): J Prystowsky, G Bordage, J Feinglass

Date: 10/2002

Publisher: Surgery

Volume/Edition: 132

Publication Type: Journal

Article:

This is a retrospective study, which examined whether colon resection outcomes were associated with: 1) general surgery certification, 2) colorectal subspecialty certification, 3) university/non-university residency training site, and 4) years of experience since general  certification. Over 15, 000 patients having undergone colorectal resection by more than 500 surgeons from 1994-1997 were examined. Outcome measures were: 1) mortality, 2) complications and 3) hospital length of stay. Study findings revealed that general surgery certification and years of experience were associated with lower morbidity and mortality, while subspecialty certification and residency training site were non-significant predictors of the outcomes. Limitations of the study include: 1) retrospective design; 2) quality of diagnostic coding with ICD-9 codes; 3) lack of adjustment for hospital-level factors; 4) only select outcomes were examined (but mortality was a key outcome); and 5)ABS recertification or National Practitioner Data Bank reporting were not included as variables.

Delivery of Preventive Services to Older Adults by Primary Care Physicians

Author(s): H Pham, D Schrag, J Hargraves, P Bach

Date: 07/2005

Publisher: Journal of the American Medical Association

Volume/Edition: 294

Publication Type: Journal

Article:

This study, using Medicare claims data, explored an association between physician and practice characteristics, and the  quality of preventive care received by Medicare patients. Over 3,000 physicians providing care to over 24, 000 Medicare patients (65 and older), who participated in an ongoing practice survey study, were included in the analyses. Physician variables included training, certification, qualifications, and gender, and practice variables included practice type, size, sources of revenue, and access to information technology. Study results were adjusted for patient demographics, comorbidity, and community characteristics. Large variations in the quality of care were found, based on physician characteristics. Patients treated in group practices were more likely to receive preventative services than those treated in solo/2 person practices or institution-based practices. Also, board certified physicians were more likely to deliver some, but not all, preventative services. Information technology, availability of clinical guidelines, or physician reminders showed only a limited improvement in delivery of preventative care services. It is important to note that physicians lacking board certification made up only 15% of participants; lastly, claims data may not necessarily capture all preventive care services rendered, and there was no certainty that physicians, analyzed in this study, were always the main sources of primary care for the beneficiaries.

Physicians Disciplined by a State Medical Board

Author(s): J Morrison, P Wickersham

Date: 06/1998

Publisher: Journal of the American Medical Association

Volume/Edition: 279

Publication Type: Journal

Article:

This study examined physician disciplinary action in California between October 1995 and April 1997. A total of 375 physicians were disciplined for 465 offenses by the California State Medical Board during the 18-month period. Findings revealed that one third of all cases were relevant to negligence or incompetence. Disciplined physicians were more likely to be male, in practice for over 20 years and not have board certification. This article cited previous studies that showed that board certified physicians were less likely to be disciplined by the state medical board.

The Importance of Surgeon Volume and Training in Outcomes for Vascular Surgical Procedures

Author(s): W Pearce, M Parker, J Feinglass, M Ujiki, M Manheim

Date: 05/1999

Publisher: Journal of Vascular Surgery

Volume/Edition: 29(5)

Publication Type: Journal

Article:

This study attempted to assess the impact of surgeon volume on outcome after carotid endarterectomy, lower extremity bypass grafting, and abdominal aortic aneurysm repair. The study was based on hospital discharge data for all non federal hospitals of Florida from 1992-1996. The data was obtained from Florida agency for Health Care Administration and contained attending physician and surgeon identifiers. Deaths were determined from discharge status coding and vascular surgeon certification status obtained from the American Board of Medical Specialties. In order to predict outcomes for each procedure, the year of discharge, length of stay, patient age, sex and emergency admission status were considered; similarly, hospital bed size, teaching status, and ownership characteristics. Study findings revealed that longer hospital stay was associated with worse outcomes, and complications determined longer hospital stays. In case of carotid endarterectomy, hospital size, the volume of the procedures performed in that hospital, surgeon caseload and certification in vascular surgery were all responsible for successful outcomes. Similar findings were revealed relevant to abdominal aortic aneurysm repairs. However, the records did not provide adequate basis to determine the quality of care relevant to lower extremity bypass grafting, except that surgeon volume was associated with the rates of MI, CVA, and death. It is important to note that study findings are subject to database limitation. There is a chance that associated clinical variables not evident from the records might have affected the outcomes. In summary, vascular surgery is most likely to generate good outcomes, if it is performed in a hospital that has high volumes, and by surgeons that operate frequently and have qualification in general vascular surgery.

Characteristics Associated with Physician Discipline: A Case-control Study

Author(s): N Kohatsu, D Gould, L Ross, P Fox

Date: 03/2004

Publisher: Archives of Internal Medicine

Volume/Edition: 164

Publication Type: Journal

Article:

The aim of this study was to see if there was an association between certain physician characteristics and the likelihood of medical board imposed discipline. The study was conducted in California and involved physicians disciplined by the state medical board between 1998 and 2001. Physicians in the specialties of obstetrics and gynecology, general practice, psychiatry, and family practice were more likely to be disciplined than those in internal medicine, while those practicing pediatrics and radiology were less likely to be disciplined than internists. Increasing age, male sex, and international medical education were associated with a higher risk of discipline. Since the study was restricted to one specific state, the results may have been biased due to the prevalent practice styles, patient populations and legal framework. Similarly, social and cultural factors relating to physician-patient interactions were not taken into consideration. Nevertheless, board certification was associated with a significantly lower risk of discipline (53% of disciplined physicians were board certified, compared to 73% of control group physicians).

Disciplinary Action Against Physicians: Who is Likely to Get Discipline?

Author(s): A Khaliq, H Dimassi, C-Y Huang, L Narine, R Smego

Date: 07/2005

Publisher: American Journal of Medicine

Volume/Edition: 118

Publication Type: Journal

Article:

Researchers attempted to identify the characteristics of physicians disciplined by State Medical Boards, and to assess the risk of disciplinary action over time. For that purpose, publicly available data for physicians licensed in Oklahoma was obtained and analyzed for disciplinary action in 2001. Study findings showed that the rate of disciplinary action increased over time, with each successive 10 year period since licensure. Increased risk of disciplinary action was associated with being a man, non-white, and non-board certified, and practicing family medicine, general practice, psychiatry, obstetrics gynecology, and emergency medicine. The hazard ratio for adverse licensure action for non-board certified compared to board certified physicians was 3.3 (p<0.001) by univariate analysis and 2.2 (p<0.001) by multivariate analysis. The most common disciplinary action involved quality of care issues, medication/prescription violations, incompetence, and negligence/malpractice. More than half of the complaints were brought forward by general public; significantly less came from the Federation of State Medical Boards, Medicare, insurance companies and law enforcement agencies; and least, from other physicians, office staff, national practitioner data bank, pharmacies and pharmacists, and hospital personnel. Study findings are subject to database accuracy.

Heart Disease and Hospital Deaths: An Empirical Study

Author(s): J Kelly, F Hellinger

Date: 08/1987

Publisher: Health Services Research

Volume/Edition: 22

Publication Type: Journal

Article:

The study examines mortality rates of heart patients that survive their first day in the hospital. Three groups of patients diagnosed with atherosclerosis are examined: 1) those that undergo a CABG operation, 2) those that undergo a cardiac catheterization, but not CABG, and 3) those that experience the AMI, but don’t receive any treatment. Treating physician characteristics are board certification status and the volume of similar patients. Hospital characteristics include the presence of coronary care unit, teaching status, size, and volume of similar patients. Other factors taken into consideration are severity of illness, patient age, sex, and comorbidities. The findings reveal that AMI patients are more likely to survive if their attending physicians treat high volumes of AMI patients, and when they are board certified in family or internal medicine. CABG/cardiac catheterization patients are more likely to survive in hospitals that handle high volumes of such procedures. Further, AMI patients in teaching facilities are less likely to die, just as in facilities that have a cardiac care unit. Finally, age and comorbidity variables performed as expected.

Physician and Hospital Factors Associated with Mortality of Surgical Patients

Author(s): J Kelly, F Hellinger

Date: 09/1986

Publisher: Medical Care

Volume/Edition: 24

Publication Type: Journal

Article:

The aim of this study was to examine the deviation of hospital mortality relevant to the volume of specific surgical procedures performed in a hospital, the volume of these procedures performed by patient’s primary surgeon, physician board certification, and other factors, such as severity of illness, patient age, hospital teaching status, size and location. Researchers obtained data from discharge abstract records, as well as American Hospital Association’s Annual Survey of Hospitals for 1977 and American Medical Association’s Masterfile of U.S. Physicians. Study findings revealed that surgical patient mortality was lower in hospitals with a larger volume of specific surgical procedures and in those with a medical school affiliation. Mortality was not associated with the volume of procedures performed by surgeons, but was lower for doctors who were board certified. For patients operated on for peptic ulcer disease, the mortality rate was 2% lower if their surgeon was board certified. Similar associations were seen for stomach cancer and abdominal aneurysm surgery, but the reported coefficients were not statistically significant.

Patients’ Perception of Hospital Care in the United States

Author(s): A Jha, E Orav, J Zheng, A Epstein

Date: 10/2008

Publisher: New England Journal of Medicine

Volume/Edition: 359

Publication Type: Journal

Article:

This article reviews patient perceptions of hospital care in the United States, based on HCAHPS data, provided by 60% of U.S. hospitals. The study examines whether key characteristics of hospitals thought to enhance patient experiences are indeed associated with better experiences for patients, and whether performance on HCAHPS is related to quality of care. The findings reveal that most patients are generally satisfied with the care they receive; however, there is room for improvement. Areas for improvement include those of nursing care, communication about medications, pain control and provision of clear discharge instructions. Hospitals with higher nurses to patient-days show better patient experiences. Similarly, hospitals performing better on HCAHPS are more likely to provide better quality of care across measures of clinical quality (for example management of acute myocardial infarction and pneumonia).

Audit and Feedback: Effects on Professional Practice and Health Care Outcomes

Author(s): G Jamtvedt, J Young, D Kristoffersen, M O'Brien, A Oxman

Date: 06/2008

Publisher: Cochrane Database of Systematic Reviews

Volume/Edition: 4

Publication Type: Journal

Article:

This study aimed to assess the effect of audit and feedback on physician practice and patient outcomes. A total of 118 randomized trials of audit and feedback reporting objectively measured practice or outcomes (Cochrane Effective Practice and Organization of Care Group’s register and pending file) were reviewed. Only 24 of those studies were judged as having high methodological quality. Analysis findings showed that providing physicians with data about their performance might help improve their practice; effects, however, are variable. Audit and feedback lead to more significant improvement when baseline performance is lower and when the intensity of audit and feedback are higher.

Association Between Maintenance of Certification Examination Scores and Quality of Care for Medicare Beneficiaries

Author(s): E Holmboe, Y Wang, T Meehan, J Tate, S Ho, K Starkey, R Lipner

Date: 07/2008

Publisher: Archives of Internal Medicine

Volume/Edition: 168(3)

Publication Type: Journal

Article:

The study examines the association between physician cognitive skills, measured by the ABIM Maintenance of Certification (MOC) examination, and physician practice performance, defined by a set of CMS quality measures for patients with diabetes, patients requiring mammography screening, and patients with cardiovascular disease. Study findings for 3602 general internists suggest that top scoring (top quartile on the MOC examination) physicians are more likely to perform processes of care for diabetes patients (HbA1C and lipid screening and retinal examinations) and patients requiring mammography screening. However, the results indicate no significant association between lipid screening and examination scores for patients with cardiovascular disease (potentially explained by concomitant care by a cardiologist). Physician cohort is restricted to those certified between 1990 and 1995.

Promoting Physicians’ Self-assessment and Quality Improvement: The ABIM Diabetes Practice Improvement Module

Author(s): E Holmboe, T Meehan, L Lynn, P Doyle, T Sherwin, F Duffy

Date: 04/2006

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 26(2)

Publication Type: Journal

Article:

This is a review of a beta test of the ABIM diabetes practice improvement module, used in recertification program of general internists and endocrinologists. Participant feedback reveals that physicians found self-assessment using the PIM to be a valuable experience. There was wide variability in the performance of some target clinical goals. They were able to identify areas for improvement through medical record audit and responded that the information was useful in implementing change in their practices. There was also wide variability in ratings on the patient surveys; specifically, the helped identify areas for improvement relevant to patient- education. It is important to note that the pilot sample size was small (16 completed PIM data entry/14 completed all PIM steps), and that physicians were self selected. There was no set sampling strategy for medical record audit, and participants chose different interventions for quality improvement in their respective practices.

Assessing Quality of Care: Knowledge Matters

Author(s): E Holmboe, R Lipner, A Greiner

Date: 01/2008

Publisher: Journal of the American Medical Association

Volume/Edition: 299(3)

Publication Type: Journal

Article:

This article discusses the relationship between medical knowledge and quality,specifically, how secure examination component of specialty board certification is an important complement to performance measures. Over the last couple decades there has been a significant development in understanding of how physicians integrate medical knowledge and clinical skills in the clinical judgment process. In order to properly manage a condition, conduct testing, or assign therapy, physicians have to adequately process information, and therefore, exercise sound clinical judgment. Researchers suggest that among other things, medical errors happen due to problems with clinical judgment. Knowledge ages over time, and when a new body of knowledge emerges, ideally, physicians should incorporate it into clinical reasoning. Rigorous testing, specifically via secure examination, provides an opportunity for assessing, whether physicians are successful in incorporating new information over time. Relying on quality measurement alone will not address many aspects of care and, in particular diagnostic reasoning, errors in which are associated with adverse outcomes. While examination raises anxiety, requires preparation and generates costs, knowledge is one of the foundational clinical practice competencies, and therefore requires proper attention.

Physician Credentials and Practices Associated with Childhood Immunization Rates: Private Practice Pediatricians Serving Poor Children in New York City

Author(s): K Hanson, G Butts, S Friedman, G Fairbrother

Date: 03/2001

Publisher: Journal of Urban Health

Volume/Edition: 78

Publication Type: Journal

Article:

The article describes a study that compares children’s immunization rates at 60 private physician practices in poor neighborhoods of New York. Half of the physicians participating in the study are board certified, and half are a part of the Medicaid Preferred Physicians and Children (PPAC) program. Study results demonstrate higher immunization rates among PPAC physicians and better rates among those that are board certified. Study limitations include a small study sample, self reporting of credentials, affiliations and practices, and a focus on a subset of foreign-trained physicians serving a large number of high-risk children, therefore study results may not be generalized to all pediatricians/primary care providers. Nevertheless, board certification, one of the conditions for enrolling in PPAC, is associated with immunization performance, according to the findings.

Maintenance of Certification of Family Physicians (MC-FP) Self-assessment Modules (SAMs): The First Year

Author(s): M Hagen, D Ivins, J Puffer, J Rinaldo, G Roussel, W Summer, J Xu

Date: 07/2008

Publisher: Journal of the American Board of Family Medicine

Volume/Edition: 19(4)

Publication Type: Journal

Article:

The article summarizes the feedback of a family physician cohort (over 7000 physicians) that went through the first year of activities (Part II self-assessment modules (SAMs)) for the ABFM Maintenance of Certification (MOC) program, newly implemented in 2004. Free text comments from activity evaluations were analyzed and revealed generally favorable responses relevant to diabetes and hypertension SAMs. The SAMs were rated highly with regard to the relevance and usefulness of information provided, the knowledge assessment and the overall module value. More than half of respondents shared that the experience would lead to changes in practice. It shoud be noted that the SAMs were modified over the course of the year; the participants engaged in the activity at different times throughout that year, which was not taken into consideration, when analyzing study results. Changes in practice are self-reported.

The Relationship Between Physicians’ Qualifications and Experience and the Adequacy of Prenatal Care and Low Birthweight

Author(s): J Haas, J Orav, L Goldman

Date: 08/1995

Publisher: American Journal of Public Health

Volume/Edition: 85(8.1)

Publication Type: Journal

Article:

This study explored the relationship between physicians’ qualifications and experience, and the recommended number of prenatal visits and low birthweight for women in Massachusetts in 1990. Prior research demonstrates a relationship between the process of prenatal care and neonatal mortality and low birth weight; low birth weight is associated with increased neonatal morbidity and mortality. Board certification was used as a measure of physicians’ qualification. Study findings, based on 80,537 deliveries show that non-board-certified physicians are significantly less likely to provide the recommended number of prenatal visits and are more likely to deliver low birthweight infants. The results also suggest a positive association between physicians’ time in practice and practice volume, and the quality of prenatal care and birth outcomes. Study limitations include the possibility that more motivated patients may select “better” physicians, which may have contributed to the outcome. Also, there were no specific data available on detailed clinical information about the actual prenatal services. In addition, physicians recorded on the birth certificates of infants might have not necessarily been the ones to provide the most of the prenatal care.

Patient-centered Processes of Care and Long-term Outcomes of Myocardial Infarction

Author(s): A Fremont, P Cleary, J Hargraves, R Rowe, N Jacobson, J Ayanian

Date: 12/2001

Publisher: Journal of General Internal Medicine

Volume/Edition: 16

Publication Type: Journal

Article:

The aim of this study was to determine whether patient experiences with nontechnical aspects of care, i.e., patient education and discharge planning, were associated with long term outcomes. Acute myocardial infarction patients hospitalized in 23 New Hampshire hospitals received a survey at 1, 3, and 12 months post discharge, which aimed to assess the experience of care; other clinical measures were obtained from discharge abstracts. There was no data available on non-respondents, or patients that died during 12 months after their hospitalization, and the study sample was concentrated in a few hospitals of a single state. Yet, study findings revealed that negative hospital experiences were associated with worse long term outcomes, specifically, worse health status and more symptoms. The authors conclude that patient experiences of care and patient reported measures provide important information about clinical quality of care, and serve as more than just an indicator of patient satisfaction.

Characteristics of General and Subspecialty Pediatricians Who Choose Not to Recertify

Author(s): G Freed, K Dunham, L Althouse

Date: 04/2008

Publisher: Pediatrics

Volume/Edition: 121(4)

Publication Type: Journal

Article:

This study attempted to discover why general and subspecialty pediatricians, whose certificates expired, did not plan to participate in maintenance of certification. A complete list of U. S. pediatricians with lapsed certification as specialists and/or subspecialists that did not recertify in 2004-2005 was obtained from the ABP database. Separate questionnaires were developed for generalists and subspecialists, and they focused on the reasons for participation/nonparticipation. Study findings demonstrated that more than half of the participating generalists and almost all subspecialists intended to recertify. More than half of the participants indicated that the main reason for future participation in Maintenance of Certification (MOC) was the chance to update the knowledge. A significant portion of participants indicated hospital privileging requirements as another reason. For those that did not intend on participating in MOC, the main reasons cited were the expense and the time associated with the process. Other reasons for generalists were perceived lack of relevance to their current practice, and for subspecialists, a change in career path that did not necessitate participation in MOC. About a third of participants that did not intend to recertify shared that they didn’t want to take a secure examination. In general, participants believed that specialists providing patient care should maintain certification, and that patients and peers felt that there was professional value in participation in MOC. It is important to note that in this study, there was a lack of physician representation in some subspecialties, and that international medical graduates were least likely to respond.

Self-assessment of Practice Performance: Development of the ABIM Practice Improvement Module (PIM)

Author(s): F Duffy, L Lynn, H Didura, B Hess, K Caverzagie, L Grosso, E Holmboe

Date: 01/2008

Publisher: Journal of Continuing Education in the Health Professions

Volume/Edition: 28

Publication Type: Journal

Article:

The article describes how the American Board of Internal Medicine (ABIM) develops Practice Improvement Modules (PIMs) and reviews the experiences of the first time users of the Preventative Cardiology PIM (PC-PIM). In this study, the PC-PIM serves as a self administered tool to assess the quality of practice using performance measures; also, to obtain feedback from patients. Study findings suggest opportunities to enhance PIM-like activities deployed in Maintenance of Certification (MOC) programs. Meaningful gaps in physician clinical performance were identified, including difficulty in the application of quality improvement methods to impact system change and improve performance. The authors suggest that future efforts should focus on identification of factors that could help physicians apply QI method in their practices and of educational interventions that might be beneficial. Patient surveys were useful in identifying improvement needs in practice communication and in physicians’ ability to self-assess their patients’ healthcare needs. Of note, the performance of physicians enrolled in ABIM’s MOC and participating in this study was better than that reported in recent research; several reasons are offered for the noted difference.

Impact of Formal Continuing Medical Education: Do Conferences, Workshops, Rounds, and Other Traditional Continuing Education Activities Change Physician Behavior or Health Care Outcomes

Author(s): D Davis, M Thomson, N Freemantle, F Wolf, P Mazmanian, A Taylor-Vaisey

Date: 12/1999

Publisher: Journal of the American Medical Association

Volume/Edition: 282(9)

Publication Type: Journal

Article:

This study reviews 14 randomized, controlled trials that include educational interventions, which: 1) employ educational activities meant to be persuasive, rather than coerce or incentivize physicians, 2) study physician performance and patient outcomes, and 3) involve more that 50% physician participants. The aim of the study is to assess the effect of formal CME. Study findings show that didactic education (focusing solely on knowledge acquisition) does not change physician performance, but interactive activities (i.e., case discussions, role-plays, hands on practice sessions) are more effective in changing performance/outcomes; sequenced or longitudinal sessions are similarly effective. It is important to note that the interactive educational techniques match adult learning principles, where education is learner centered, active, relevant to learner needs, engaging, and reinforcing. The study points to the need for collaboration between CME providers and the practice sector and their data sources, so that clinical changes can be sustained over time. This study is subject to publication, as well as reviewer bias, and it looks at a small sample of trials that involve predominantly primary practice physicians, disallowing for broad generalizability. Nevertheless, it offers valuable insight on the potential for CME to impact more than knowledge acquisition.

Professionalism in Medicine: Results of a National Survey of Physicians

Author(s): E Campbell, S Regan, R Gruen, T Ferris, S Rao, P Cleary, D Blumenthal

Date: 12/2007

Publisher: Annals of Internal Medicine

Volume/Edition: 147(11)

Publication Type: Journal

Article:

A national survey assessing physician professionalism queried physicians specializing in internal medicine, family practice, pediatrics, surgery, anesthesiology, and cardiology. Physician respondents generally agreed with published norms regarding professionalism principles and behaviors (although approximately a quarter disagreed with the need for recertification). However, self-reported behaviors were not consistent with their expressed beliefs, particularly in the areas related to professional self-regulation, conflict of interest, and resource use. As examples, reported behaviors were consistent with beliefs regarding honesty with patients and protecting patient confidentiality, but not necessarily with reporting of an incompetent/impaired colleagues to the authorities and management of financial conflict of interest. A number of respondents indicated they would accommodate a patient that badly wanted a test, even knowing it was unnecessary. Also, a gap was found between physician attitudes toward quality improvement and  participation in related activities. It is important to note that conformance to norms varied  across participating physician subgroups (specialties). While the authors did not identify a specific means or method for doing so, they suggested exploration of ways to improve  physician professionalism that should reflect physician specialty and practice context.

Comparison of Quality of Care in the Veterans Health Administration and Patients in a National Sample

Author(s): S Asch, E McGlynn, M Hogan, R Hayward, P Shekell, L Rubenstein, E Kerr

Date: 12/2004

Publisher: Annals of Internal Medicine

Volume/Edition: 141

Publication Type: Journal

Article:

Previous research demonstrated that a sample of patients from 12 communities in the United States received just over half (55%) of the recommended healthcare in preventive, acute and chronic care contexts (McGlynn, 2003). This study compared the quality of outpatient and inpatient care among a national sample of patients drawn from 12 communities, and VHA patients from 12 healthcare systems of southwestern and midwestern United States. Specifically, 348 quality indicators targeting 26 conditions were measured. While the study did not account for all medical care, and just for its specific aspects, it found that adherence to recommended processes of care in 2 VHA regions exceeded that in the national sample in several categories (overall quality, 67% vs. 51%; chronic disease care, 72% vs. 59%, and preventive care, 64% vs. 44%). Differences in performance were largest in areas that were targeted by VHA performance measurement (66% vs. 43%). Although other variables may have contributed to the outcome, study results suggest that the implementation of performance measurement and monitoring are strongly related to the quality of healthcare provided.

Physician Board Certification and the Care and Outcomes of Elderly Patients with Acute Myocardial Infarction

Author(s): J Chen, S Rathore, Y Wang, H Krumholtz, M Radford

Date: 03/2006

Publisher: Journal of General Internal Medicine

Volume/Edition: 21

Publication Type: Journal

Article:

The study examined the relationship between board certification, quality of care and outcomes in elderly patients hospitalized with acute myocardial infarction (AMI). Study findings revealed that physicians board certified in Internal Medicine, Family Medicine and Cardiology provided a slightly higher quality of care, as assessed by guideline recommended treatments for AMI. Despite higher uses of ASA and B-blockers in managing AMIs, there was no difference in mortality between board certified and non-certified physicians. Study limitations included the inability to determine that decisions regarding patient care were made solely by the attending physicians examined in this study, and the accuracy of board certification status as listed in the AMA Physician Masterfile. Although the study demonstrates a modest correlation between board certification and quality of the treatment of a life threatening disease the authors pointed out that even board-certified physicians had considerable room to improve the quality of care provided.