Association of Use of the NEJM Knowledge+ Product and Performance on the ABIM IM-MOC Exam

Phenomenon: Internal medicine physicians in the United States must pass the American Board of Internal Medicine Internal Medicine Maintenance of Certification (ABIM IM-MOC) examination as part of their ABIM IM-MOC requirements. Many of these physicians use an examination product to help them prepare, such as e-Learning products, including the ACP's MKSAP, UpToDate, and NEJM Knowledge+, yet their effectiveness remains largely unstudied. Approach: We compared ABIM IM-MOC examination performance among 177 physicians who attempted an ABIM IM-MOC examination between 2014-2017 and completed at least 75% of the NEJM Knowledge+ product prior to the ABIM IM-MOC examination and 177 very similar matched control physicians who did not use NEJM Knowledge+. Our measures of ABIM IM-MOC exam performance for NEJM Knowledge+ users were based on the results of the first attempt immediately following the NEJM Knowledge+ use and for non-users were based on the applicable matched examination performance. The three dichotomous examination performance outcomes measured on the first attempt at the ABIM IM-MOC examination included pass rate, scoring in the upper quartile, and scoring in the lower quartile. Findings: Use of NEJM Knowledge+ was associated with a regression adjusted 10.6% (5.37% to 15.8%) greater likelihood of passing the MOC examination (p < .001), 10.7% (2.61% to 18.7%) greater likelihood of having an examination score in the top quartile (p = .009), and -10.8% (-16.8% to -4.86%) lower likelihood of being in the bottom quartile of the MOC examination (p < .001) as compared to similar physicians who did not use NEJM Knowledge+. Insight: Physicians who used NEJM Knowledge+ had better ABIM IM-MOC exam performance. Further research is needed to determine what aspects of e-Learning products best prepare physicians for MOC examinations.