Changes in the medical knowledge of candidates for certification

Article Abstract:

To determine whether changes have occurred in the level of medical knowledge possessed by physicians who attempted to become board-certified in internal medicine in the years between 1983 and 1988, a study was undertaken of candidates who took certification examinations in those years. Of interest were candidates' answers to test items that were the same in four pairs of years during the study period: 1983 and 1985; 1984 and 1986; 1985 and 1987; and 1986 and 1988. Candidates were classified into groups according to their medical schools (location, osteopathic, foreign) and citizenship. Results showed that the number of graduates of US medical schools who took the certification examination each year was between 3,435 and 3,659. The number of graduates of Canadian medical schools increased from 42 in 1983 to 113 in 1987 (the year with the greatest number of Canadian graduates), as did the number of graduates of foreign medical schools (from 206 in 1983 to 347 in 1988). Graduates of osteopathic medical schools increased from 53 (1984) to 102 (1988). For graduates of US schools, scores dropped in the second year of each pair by 14 to 25 points. Canadian and osteopathic graduates' scores improved in some year-pairs, and grew worse in others. This was also true for the foreign medical school graduates. On the whole, scores of graduates of Canadian medical schools were higher than scores of graduates of US schools. The number of non-US citizens who graduated from foreign medical schools increased (535 in 1983 to 715 in 1988), and their scores increased from 8 to 29 points for each year-pair. The results show that score decreases were seen consistently only for graduates of US medical schools, while non-citizen graduates of foreign medical schools improved considerably. These trends may have implications for patient care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Tests, problems and exercises, Evaluation, International aspects, Education

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The mini-CEX (clinical investigation exercise): a preliminary investigation

Article Abstract:

A shortened form of the traditional evaluation for residents called the mini-Clinical Evaluation Exercise (mini-CEX) seems to be practical, effective, and reproducible. The mini-CEX is designed for attending physicians to evaluate a resident's skills during routine physical examinations. Researchers presented data from 388 mini-CEX evaluations performed by 97 attending physicians on 88 residents. Mini-CEX evaluations took place in a broad range of settings including emergency rooms (14%), outpatient clinics (38%), and in-hospital locations (54%) covering a broad range of patient conditions. The mean evaluation time was 31.5 minutes. The overall mean rating given to the residents by mini-CEX evaluation was 6.6 on a scale from 1 to 9. The evaluations included a combined rating for skills on history-taking, physical examination, and ability to correctly identify a patient's condition (6.5), bedside manner (7.0), and overall ability (6.5). Both the residents and attending physicians reported moderate satisfaction with the mini-CEX format.

Social aspects, Aged, Elderly, Health risk assessment, Nursing home patients

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Future roles and training of internal medicine subspecialists

Article Abstract:

The recommendations of a task force on internal medicine subspecialty training may align this training with the needs of the public while also improving the quality of training. The recommendations may meet demands to reduce the number of subspecialist doctors and to increase the number of subspecialist investigators. Two pathways for training are proposed, one for doctors who see patients, the other for investigators. Certification standards may be raised and training time may lengthen, but both may produce better trained subspecialists. Internal medicine subspecialists may need enhanced training in the health care system of the future. The entire system of health care payers should share the cost of graduate medical education and research.

Training, Study and teaching, Medical specialties

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