Related Experiment Videos
Certifying examination performance and patient outcomes following acute myocardial infarction
John J Norcini1, Rebecca S Lipner, Harry R Kimball
1Foundation for Advancement of International Medical Education and Research, 3624 Market Street, 4th Floor, Philadelphia, PA 19104, USA.
Insights
Successful physician certification exams correlate with a 19% reduction in patient mortality after heart attacks. This suggests that a strong knowledge base, demonstrated by passing exams, improves the quality of medical practice and patient outcomes.
Area of Science:
- Medical Education
- Cardiology
- Health Services Research
Background:
- Physician certification examinations aim to ensure a baseline level of medical knowledge and competence.
- The relationship between physician performance on certifying examinations and actual patient outcomes remains an area of active investigation.
Purpose of the Study:
- To determine if successful performance on certifying examinations for internal medicine and cardiology is associated with patient mortality and length of stay following acute myocardial infarction.
- To explore factors influencing patient outcomes, including hospital characteristics and physician specialization.
Main Methods:
- Retrospective analysis of acute myocardial infarction cases in Pennsylvania (1993).
- Data linkage between patient records (Pennsylvania Health Care Cost Containment Council) and physician certification information (American Board of Internal Medicine).
- Risk-adjusted models were used to compare mortality and length of stay for physicians based on their examination performance and other variables.
Main Results:
- Successful completion of internal medicine or cardiology certifying examinations was associated with a 19% reduction in patient mortality, holding other factors constant.
- Factors associated with decreased mortality included treatment in non-rural/urban hospitals and care by a cardiologist.
- Shorter patient length of stay was not linked to examination performance but was associated with care by high-volume cardiologists in non-rural/urban hospitals.
Conclusions:
- The findings support the validity of physician certifying examinations as a measure of medical knowledge.
- The study suggests a correlation between a physician's fund of knowledge, as assessed by examinations, and the quality of patient care provided.
Objective:
To establish whether successful certifying examination performances of doctors are associated with their patients' mortality and length of stay following acute myocardial infarction.
Design:
Risk adjusted mortality and survivors' length of stay were compared for doctors who had satisfactorily completed training in internal medicine or cardiology and attempted the relevant examination. Specifically, the study investigated the joint effects of hospital location, availability of advanced cardiac care, doctors' specializations, certifying examination performances, year certification was first attempted and patient volume.
Setting And Participants:
Data on all acute myocardial infarctions in Pennsylvania for the calendar year 1993 were collected by the Pennsylvania Health Care Cost Containment Council. These data were combined with physician information from the database of the American Board of Internal Medicine.
Results:
Holding all variables constant, successful examination performance (i.e. certification in internal medicine or cardiology) was associated with a 19% reduction in mortality. Decreased mortality was also correlated with treatment in hospitals located outwith either rural or urban settings and with management by a cardiologist. Shorter stays were not related to examination performance but were associated with treatment by high volume cardiologists who had recently finished training and who cared for their patients in hospitals located outwith rural or urban settings.
Conclusions:
The results of the study add to the evidence supporting the validity of the certifying examination and lend support to the concept that fund of knowledge is related to quality of practice.