TL/DR –
A study by Harvard Medical School and the American Board of Internal Medicine (ABIM) found that internal medicine patients of newly trained doctors with high board certification exam scores had a lower risk of death within seven days of hospital admission or of being readmitted to the hospital. The study suggests that board exams in internal medicine effectively predict future physician performance on critical indicators of patient care and outcomes. However, the research found no link between patient outcomes and physicians’ scores on periodic “medical milestone” ratings administered during residency training.
Understanding the Role of Board Certification Exams in New Physician’s Performance
How can we measure if newly graduated doctors are adequately prepared to prevent patient deaths? Board certification exams, taken upon completion of residency training, aim to assess this, but little is known about their effectiveness in predicting significant performance indicators, such as patient survival or avoidance of readmission to the hospital.
In a recent study published in JAMA, it was found that internal medicine patients treated by newly trained physicians who scored high on their board certification exams had lower risk of dying within seven days of hospital admission or being readmitted to the hospital. This study was led by researchers at Harvard Medical School and the American Board of Internal Medicine (ABIM).
The findings suggest that board exams in internal medicine effectively reflect future physician performance on key patient care and outcomes indicators. Bruce Landon, study senior author, states, “These results confirm that certification exams are measuring knowledge that directly translates into improved outcomes for patients.”
This research represents one of the first efforts to evaluate the reliability of these test scores in predicting patient outcomes. The researchers also compared patient outcomes against “medical milestone” ratings developed by the Accreditation Council for Graduate Medical Education (ACGME). These ratings were found to have no correlation with patient outcomes.
The Journey of Medical Training
After graduating from medical school, students undertake residency training in their chosen specialty before completing board certification exams and becoming fully qualified independent doctors. In internal medicine, resident competency is assessed with ACGME’s milestone ratings during residency and the ABIM’s certification exam, known as medical boards, upon completion of training.
Scientific Approach to Improving Medical Training
The study reviewed patient outcomes of nearly 70,000 newly trained hospitalist physicians treating Medicare patients during 455,000 hospitalizations from 2017 to 2019. Results showed a significant link between board exam performance and patient risk of death or hospital readmission.
Despite no apparent link between physicians’ milestone ratings and patient outcomes, researchers believe these ratings can still serve as a valuable tool for training program assessments.
Landon adds, “This type of evidence-based assessment of our own testing tools provides valuable insights on which types of tests work for what purpose, which informs how they should be deployed in educating our future practitioners and leaders of medicine.”
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