Male physician talks to his patient about her medical test results
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A new study, published this week in JAMA, found that internal medicine patients of new doctors with top scores on their board certification exams had a lower risk of dying within seven days of being admitted to the hospital and a lower risk of readmission. Board Certification exams are typically given after graduating physicians complete their residency training. But little is known about whether these standardized tests can predict one of the most important measures of a doctor’s performance—patient survival.

“These results confirm that certification exams are measuring knowledge that directly translates into improved outcomes for patients,” said study senior author Bruce Landon, MD, professor of health care policy at Harvard Medical School (HMS) and an internal medicine doctor at Beth Israel Deaconess Medical Center.

The study was led by HMS researchers and the American Board Internal Medicine (ABIM), the organization that updates the exam that qualifies a doctor as an internal medicine specialist and Landon noted that this research is the first known attempt to assess the reliability of test scores in predicting patient outcomes.

Also included in the research was a comparison of patient outcomes compared with “medical milestone” ratings from the Accreditation Council for Graduate Medical Education (ACGME), which are based on a periodic review of the knowledge and skills of doctor in training throughout their medical residency. The current research showed no link between milestone ratings and patient outcomes.

For this study, the researchers analyzed the patient outcomes of roughly 70,000 hospitalist physicians—the job that most internal medicine specialists begin at the beginning of their careers. Treatment data from 455,000 hospitalizations of Medicare beneficiaries connected with these hospitalists were scrutinized and outcomes from doctors within the same hospital, but with differing test scores, were compared. This method allowed the investigators to minimize differences in patient populations, hospital resources, and other factors that could influence the odds of a patient dying or of them being re-admitted, independent of the doctor’s performance.

These data showed that there was an 8% reduction of the risk of death or readmission of patients who were treated by a doctor who scored in the top quartile of the exam, versus those who scored in the bottom quartile of all passing grades.

While the ACGME milestone measurements did not affect patient outcomes, the team noted that period assessment of doctors during their residency, can still be a valuable tool for those who run residency programs.

“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,” Landon concluded.

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