RESUMEN
BACKGROUND: The pass rate on the American Board of Internal Medicine (ABIM) nephrology certifying exam has declined and is among the lowest of all internal medicine (IM) subspecialties. In recent years, there have also been fewer applicants for the nephrology fellowship match. METHODS: This retrospective observational study assessed how changes between 2010 and 2019 in characteristics of 4094 graduates of US ACGME-accredited nephrology fellowship programs taking the ABIM nephrology certifying exam for the first time, and how characteristics of their fellowship programs were associated with exam performance. The primary outcome measure was performance on the nephrology certifying exam. Fellowship program pass rates over the decade were also studied. RESULTS: Lower IM certifying exam score, older age, female sex, international medical graduate (IMG) status, and having trained at a smaller nephrology fellowship program were associated with poorer nephrology certifying exam performance. The mean IM certifying exam percentile score among those who subsequently took the nephrology certifying exam decreased from 56.7 (SD, 27.9) to 46.1 (SD, 28.7) from 2010 to 2019. When examining individuals with comparable IM certifying exam performance, IMGs performed less well than United States medical graduates (USMGs) on the nephrology certifying exam. In 2019, only 57% of nephrology fellowship programs had aggregate 3-year certifying exam pass rates ≥80% among their graduates. CONCLUSIONS: Changes in IM certifying exam performance, certain trainee demographics, and poorer performance among those from smaller fellowship programs explain much of the decline in nephrology certifying exam performance. IM certifying exam performance was the dominant determinant.
Asunto(s)
Certificación/tendencias , Evaluación Educacional/estadística & datos numéricos , Becas/tendencias , Medicina Interna/educación , Nefrología/educación , Adulto , Factores de Edad , Certificación/estadística & datos numéricos , Educación de Postgrado en Medicina/estadística & datos numéricos , Educación de Postgrado en Medicina/tendencias , Becas/estadística & datos numéricos , Femenino , Médicos Graduados Extranjeros/estadística & datos numéricos , Humanos , Medicina Interna/estadística & datos numéricos , Medicina Interna/tendencias , Masculino , Nefrología/estadística & datos numéricos , Nefrología/tendencias , Médicos Osteopáticos/estadística & datos numéricos , Factores Sexuales , Estados UnidosRESUMEN
BACKGROUND: Electronic resources are increasingly used in medical practice. Their use during high-stakes certification examinations has been advocated by many experts, but whether doing so would affect the capacity to differentiate between high and low abilities is unknown. OBJECTIVE: To determine the effect of electronic resources on examination performance characteristics. DESIGN: Randomized controlled trial. SETTING: Medical certification program. PARTICIPANTS: 825 physicians initially certified by the American Board of Internal Medicine (ABIM) who passed the Internal Medicine Certification examination or sat for the Internal Medicine Maintenance of Certification (IM-MOC) examination in 2012 to 2015. INTERVENTION: Participants were randomly assigned to 1 of 4 conditions: closed book using typical or additional time, or open book (that is, UpToDate [Wolters Kluwer]) using typical or additional time. All participants took the same modified version of the IM-MOC examination. MEASUREMENTS: Primary outcomes included item difficulty (how easy or difficult the question was), item discrimination (how well the question differentiated between high and low abilities), and average question response time. Secondary outcomes included examination dimensionality (that is, the number of factors measured) and test-taking strategy. Item response theory was used to calculate question characteristics. Analysis of variance compared differences among conditions. RESULTS: Closed-book conditions took significantly less time than open-book conditions (mean, 79.2 seconds [95% CI, 78.5 to 79.9 seconds] vs. 110.3 seconds [CI, 109.2 to 111.4 seconds] per question). Mean discrimination was statistically significantly higher for open-book conditions (0.34 [CI, 0.32 to 0.35] vs. 0.39 [CI, 0.37 to 0.41] per question). A strong single dimension showed that the examination measured the same factor with or without the resource. LIMITATION: Only 1 electronic resource was evaluated. CONCLUSION: Inclusion of an electronic resource with time constraints did not adversely affect test performance and did not change the specific skill or factor targeted by the examination. Further study on the effect of resource inclusion on other examinations is warranted. PRIMARY FUNDING SOURCE: ABIM Foundation.
Asunto(s)
Certificación/métodos , Sistemas de Apoyo a Decisiones Clínicas , Evaluación Educacional/métodos , Medicina Interna/educación , Adulto , Competencia Clínica , Femenino , Retroalimentación Formativa , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Estados UnidosRESUMEN
BACKGROUND: Previous research has shown fluid replacement beverages ingested after exercise can affect hydration biomarkers. No specific hydration marker is universally accepted as an ideal rehydration parameter following strenuous exercise. Currently, changes in body mass are used as a parameter during post-exercise hydration. Additional parameters are needed to fully appreciate and better understand rehydration following strenuous exercise. This randomized, double-blind, parallel-arm trial assessed the effect of high-pH water on four biomarkers after exercise-induced dehydration. METHODS: One hundred healthy adults (50 M/50 F, 31 ± 6 years of age) were enrolled at a single clinical research center in Camden, NJ and completed this study with no adverse events. All individuals exercised in a warm environment (30 °C, 70% relative humidity) until their weight was reduced by a normally accepted level of 2.0 ± 0.2% due to perspiration, reflecting the effects of exercise in producing mild dehydration. Participants were randomized to rehydrate with an electrolyzed, high-pH (alkaline) water or standard water of equal volume (2% body weight) and assessed for an additional 2-h recovery period following exercise in order to assess any potential variations in measured parameters. The following biomarkers were assessed at baseline and during their recovery period: blood viscosity at high and low shear rates, plasma osmolality, bioimpedance, and body mass, as well as monitoring vital signs. Furthermore, a mixed model analysis was performed for additional validation. RESULTS: After exercise-induced dehydration, consumption of the electrolyzed, high-pH water reduced high-shear viscosity by an average of 6.30% compared to 3.36% with standard purified water (p = 0.03). Other measured biomarkers (plasma osmolality, bioimpedance, and body mass change) revealed no significant difference between the two types of water for rehydration. However, a mixed model analysis validated the effect of high-pH water on high-shear viscosity when compared to standard purified water (p = 0.0213) after controlling for covariates such as age and baseline values. CONCLUSIONS: A significant difference in whole blood viscosity was detected in this study when assessing a high-pH, electrolyte water versus an acceptable standard purified water during the recovery phase following strenuous exercise-induced dehydration.
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Viscosidad Sanguínea/efectos de los fármacos , Deshidratación/dietoterapia , Agua Potable/química , Electrólitos/farmacología , Fluidoterapia/métodos , Adulto , Peso Corporal/efectos de los fármacos , Deshidratación/fisiopatología , Método Doble Ciego , Electrólitos/química , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Concentración Osmolar , Equilibrio Hidroelectrolítico/efectos de los fármacosRESUMEN
PURPOSE: One way to ensure quality of health care in the United States is through maintenance of certification (MOC). In this study, the authors explored whether participation in the internal medicine MOC program varies by physician-level characteristics, professional activities, and the size and location of the practice. They also sought to determine which component of MOC was incomplete for physicians who participated but did not complete the program. METHOD: The authors used a theoretical realist approach to understand whether participation in the American Board of Internal Medicine MOC program varies according to physician and practice characteristics. The data came from a study sample that consisted of all physicians whose original certification was granted in internal medicine from 1990 through 1999; the study was conducted in 2013. Chi-square tests of independence and a multinomial logistic regression were conducted to determine which physician-level characteristics, professional activities, and practice characteristics were significantly associated with MOC participation. RESULTS: Results showed that physicians who completed MOC tended to have higher certification exam scores; were younger; were U.S. medical graduates; practiced as subspecialists and in the Midwest; spent more time in patient care, teaching, or administration; worked in nonsolo practices; or were employed in counties with less than 20% of persons in poverty. CONCLUSIONS: As certifying boards evaluate their programs, they need to continuously improve their features to assure the public that physicians maintaining certification are providing high-quality patient care.
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Certificación , Medicina Interna/normas , Adulto , Factores de Edad , Anciano , Femenino , Práctica de Grupo , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Áreas de Pobreza , Administración de la Práctica Médica , Especialización , Estados UnidosRESUMEN
OBJECTIVE: A work function measure specific for persons with prodromal Huntington disease (HD) was created to assist with workplace accommodations. METHODS: A self-report HD Work Function (HDWF) measure was developed from focus group and expert validation. RESULTS: Pilot studies with 238 people with prodromal HD, and 185 companions; and 89 people without prodromal HD, and 70 companions indicate that HDWF has acceptable internal consistency (Cronbach α = 0.77), acceptable interrater reliability (r = 0.58), and acceptable convergent validity with selected items from the Endicott Work Productivity Scale (r = -0.56), Social Adjustment Scale-Self Report (r = -0.29), and Everyday Cognition (r = -0.70). The HDWF can distinguish between people with prodromal HD and people with an HD family history who do not have prodromal HD (P < 0.0001). CONCLUSIONS: The HDWF is a brief self-assessment that may be used to monitor work function.
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Enfermedad de Huntington/fisiopatología , Encuestas y Cuestionarios , Evaluación de Capacidad de Trabajo , Adulto , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Síntomas Prodrómicos , Reproducibilidad de los Resultados , Autoevaluación (Psicología) , Adulto JovenRESUMEN
AIMS: A family history of Huntington disease (HD) or receiving results of HD predictive genetic testing can influence individual well-being, family relationships, and social interactions in positive and negative ways. The aim of this study was to examine benefits reported by people with an HD family history or those who have undergone predictive HD testing, as well as the personal variables associated with perceived benefits. METHODS: Seventy-four of 433 people completing the International Response of a Sample Population to HD risk (I-RESPOND-HD) survey reported benefits. Knowledge and understanding was perceived as the most common benefit from participants in both groups. The next most frequent perceived benefits from a family history were connecting with others and achieving life meaning and insights. The next most common perceived benefits from genetic testing were life planning and social support. The least common perceived benefit for both groups was renewed hope and optimism. Older age and spirituality were significantly associated with benefits in both groups. CONCLUSIONS: Perceptions of benefit may not be as likely until later years in people with prodromal HD. A developed sense of spirituality is identified as a personal resource associated with the perception of benefit from genetic testing for HD. Associations among spirituality, perceived benefits, and other indicators of personal and family well-being may be useful in genetic counseling and health care of people with prodromal HD.