Certification in internal medicine: 1989-1992

Effects of gender in resident evaluations and certifying examination pass rates

BACKGROUND

Though the proportion of female Internal Medicine (IM) residents and faculty has increased, there is minimal large scale modern data comparing resident performance by gender. This study sought to examine the effects of resident and faculty gender on resident evaluations.

METHODS

Retrospective observational study over 5 years in a single IM program. IM certifying examination pass rates were obtained from the American Board of IM.

RESULTS

Four hundred eighty-eight residents (195 women, 293 men), evaluated by 430 attending physicians (163 women, 270 men) were included. Twelve thousand six hundred eighty-one evaluations between 2007 and 2012 were analyzed. Female residents scored higher in two domains (Medical Interviewing, and Interpersonal and Communication Skills) (p < 0.01 for each), with no significant difference between genders for the other domains (Medical Knowledge, Overall Patient Care, Physical Examination, Procedural Skills, Professionalism, Practice Based Learning and Improvement, System Based Practices and Overall score). There were no differences in scoring between female and male attending physicians. There were no differences in certifying examination scores between women and men among graduating residents. National pass rates for women were not statistically different to pass rates for men from 1987 to 2015.

CONCLUSIONS

Data from one large academic medical center demonstrate higher ratings for female residents on performance domains reflecting bedside care and interpersonal skills, with similar scores for medical knowledge and remaining domains. No significant difference was seen locally in certifying examination scores, nor in recent national pass rates, an objective measure of medical knowledge. Despite imbalanced female representation in areas of medicine, our data suggest that gender-based disparities in Internal Medicine resident medical knowledge and physician competency are no longer present.

Trends in the history of certification and recertification of the American Board of Internal Medicine

This commentary reviews the trends of pass rates for certification and recertification in internal medicine. This is true for certification since the 1930s and recertification since 2000. Predictors of performance, such as program director ratings and the in-training examination, are discussed in addition to positive clinical outcomes in relation to recertification. Differences in examinations pass rates due to gender, geographic location and number of attempts are reviewed. Recent trends in internal medicine demonstrate a decline, which may be multifactorial in reasoning. This is not unique to internal medicine as declines in certification rates have been noted in general surgery as well. Methods of preparing for the examination are discussed to maximize performance on the examination.

The reporting of statistics in medical educational studies: an observational study

BACKGROUND

There is confusion in the medical literature as to whether statistics should be reported in survey studies that query an entire population, as is often done in educational studies. Our objective was to determine how often statistical tests have been reported in such articles in two prominent journals that publish these types of studies.

METHODS

For this observational study, we used electronic searching to identify all survey studies published in Academic Medicine and the Journal of General Internal Medicine in which an entire population was studied. We tallied whether inferential statistics were used and whether p-values were reported.

RESULTS

Eighty-four articles were found: 62 in Academic Medicine and 22 in the Journal of General Internal Medicine. Overall, 38 (45%) of the articles reported or stated that they calculated statistics: 35% in Academic Medicine and 73% in the Journal of General Internal Medicine.

CONCLUSION

Educational enumeration surveys frequently report statistical tests. Until a better case can be made for doing so, a simple rule can be proffered to researchers. When studying an entire population (e.g., all program directors, all deans, and all medical schools) for factual information, do not perform statistical tests. Reporting percentages is sufficient and proper.