The Vascular Surgery in Training Examination Is Highly Predictive of Board Pass Rates
Vincent L. RoweThomas S. HuberGilbert UpchurchKellie R. BrownRabih A. ChaerMalachi SheahanAndrew JonesBeatriz IbáñezBernadette AulivolaRonald L. DalmanC. Keith OzakiAndres Schanzer
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Introduction In 2010 diagnostic radiology (DR) changed the board certification process for residents using the new Core exam. However, there is not a standardized way to evaluate DR residency graduates. With no specific target pass rate for the exam, the “appropriate” pass rate has remained a debated topic among the field. In this paper, the board certification exam passage rates of DR are compared to other medical specialties to assess the standardization method of the American Board of Radiology (ABR) and serve as basis for additional specialties considering changes to their board exam structure. Methods Performance on the United States Medical Licensing Examination (USMLE) was obtained from the National Resident Matching Program (NRMP) and San Francisco match. Boards passage rates were analyzed using data from the American Board of Medical Specialties. USMLE and board exam passage rates were averaged and ranked, and statistical analysis was conducted using Stata (College Station, TX). Results DR performance on USMLE Step 1 has increased at the lowest rate (0.563 points/year) since 2005 and anesthesiology performance has increased at the greatest rate (1.313 points/year). Residents matching from US allopathic medical schools during the 2010 and 2012 years had DR oral board exams with USMLE 1 averages of 232 and 235, respectively. First-time pass rate for the first Core exam was 87% and the overall pass rate since the first Core exam has been 88.54%. The Spearman rho coefficient for specialty ranks of board passage rate and USMLE 1 was 0.0679 (p = 0.8101). The Spearman rho coefficient for board passage rate and USMLE 2 CK was 0.1430 (p = 0.6257). The Spearman rho coefficient for USMLE 1 and USMLE 2 CK was 0.8317 (p = 0.0002). Conclusions Specialty board pass rates have not increased in concert with improved trainee performance on the USMLE. USMLE performance among those matching in diagnostic radiology has increased, ABR board exam passage rate has decreased. ABR determines passing thresholds to the relative performance of examinees rather than using a criterion referenced Angoff standard.
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To the Editor: As members of a residency recruitment committee (RRC), we disagree with Andolsek1 and Chen et al.2 Elimination of the United States Medical Licensing Examination (USMLE) Step 1 score would limit the ability of the RRC to evaluate candidates for postgraduate training, threaten board certification, and jeopardize the excellence of physicians. Selection of medical school applicants for residency is rigorous. Ideal applicant characteristics include motivation to achieve excellence, a greater goal than competence, and predicted successful board certification. We previously described a successful well-rounded approach to candidate selection.3 Assessment of medical knowledge (MK) is constant during medical school, postgraduate training, and maintenance of certification. Successful certification is paramount for individuals as well as residency training programs. In anesthesiology, for example, Step 1 and in-training examination scores predict academic and clinical success.4,5 Additionally, anesthesiology residents must pass part one of their specialty board certification exams during their second year of residency. Inability to pass this exam prohibits further continuation in residency. Data from our institution demonstrate that success on this exam strongly correlates to Step 1 performance. Furthermore, the lay public expects that physicians possess excellent MK. We suspect they would embrace excellence over competence. The paucity of useful information within the medical student performance evaluation (MSPE) increases the need to rely on Step 1 scores. The majority of MSPEs now use pass/fail grading, an arbitrary ranking system wherein “outstanding” has equal likelihood to mean either first or fourth quartile, and they lack National Board of Medical Examiners shelf exam scores during clerkships. Without useful information in the MSPE, numeric Step 1 scores are critical for evaluation of applicants for residency. Johanna Blair de Haan, MDAssistant professor, Department of Anesthesiology, McGovern Medical School at UTHealth, Houston, Texas; [email protected] Travis Markham, MDAssistant professor, Department of Anesthesiology, McGovern Medical School at UTHealth, Houston, Texas. Semhar Ghebremichael, MDAssistant professor, Department of Anesthesiology, McGovern Medical School at UTHealth, Houston, Texas.
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United States Medical Licensing Exam (USMLE) Step I score is cited as one of the most important factors when for applying to neurosurgery residencies. No studies have documented a correlation between USMLE Step I score and metrics of neurosurgical career trajectory beyond residency.To determine whether USMLE Step I exam scores are predictive of neurosurgical career beyond residency, as defined by American Board of Neurological Surgery (ABNS) certification status, practice type, academic rank, and research productivity.A database of neurosurgery residency applicants who matched into neurosurgery from 1997 to 2007 was utilized that included USMLE Step I score. Online databases were used to determine h-index, National Institutes of Health (NIH) grant funding, academic rank, practice type, and ABNS certification status of each applicant. Linear regression and nonparametric testing determined associations between USMLE Step I scores and these variables.USMLE Step I scores were higher for neurosurgeons in academic positions (237) when compared to community practice (234) and non-neurosurgeons (233, P < .01). USMLE Step I score was not different between neurosurgeons of different academic rank (P = .21) or ABNS certification status (P = .78). USMLE Step I score was not correlated with h-index for academic neurosurgeons (R2 = 0.002, P = .36).USMLE Step I score has little utility in predicting the future careers of neurosurgery resident applicants. A career in academic neurosurgery is associated with a slightly higher USMLE Step I score. However, USMLE Step I score does not predict academic rank or productivity (h-index or NIH funding) nor does USMLE Step I score predict ABNS certification status.
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Since 2014, the Registered Physician in Vascular Interpretation (RPVI) designation has been required for a vascular surgery board certification candidate to register for the vascular surgery certifying exam. Although the importance of the noninvasive vascular laboratory (NIVL) is recognized, vascular laboratory education within vascular surgery fellowship programs is heterogeneous and much less regulated compared with clinical education. Evidence suggests that many vascular surgery trainees may not have received ideal training to obtain RPVI certification or direct an NIVL. The NIVL curriculum at The Ohio State University Wexner Medical Center has been used since 2005 and combines didactics, supervised reading, videos, hands-on experience with vascular sonographers, and one on one time with the vascular laboratory medical director. This curriculum is outlined in this article and can be used as a guide for creating NIVL curricula for vascular surgery and other training programs.
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To determine if there is an association between several commonly obtained premedical school and medical school measures and board certification performance. We specifically included measures from our institution for which we have predictive validity evidence into the internship year. We hypothesized that board certification would be most likely to be associated with clinical measures of performance during medical school, and with scores on standardized tests, whether before or during medical school.Achieving board certification in an American Board of Medical Specialties specialty was used as our outcome measure for a 7-year cohort of graduates (1995-2002). Age at matriculation, Medical College Admissions Test (MCAT) score, undergraduate college grade point average (GPA), undergraduate college science GPA, Uniformed Services University (USU) cumulative GPA, USU preclerkship GPA, USU clerkship year GPA, departmental competency committee evaluation, Internal Medicine (IM) clerkship clinical performance rating (points), IM total clerkship points, history of Student Promotion Committee review, and United States Medical Licensing Examination (USMLE) Step 1 score and USMLE Step 2 clinical knowledge score were associated with this outcome.Ninety-three of 1,155 graduates were not certified, resulting in an average rate of board certification of 91.9% for the study cohort. Significant small correlations were found between board certification and IM clerkship points (r = 0.117), IM clerkship grade (r = 0.108), clerkship year GPA (r = 0.078), undergraduate college science GPA (r = 0.072), preclerkship GPA and medical school GPA (r = 0.068 for both), USMLE Step 1 (r = 0.066), undergraduate college total GPA (r = 0.062), and age at matriculation (r = -0.061). In comparing the two groups (board certified and not board certified cohorts), significant differences were seen for all included variables with the exception of MCAT and USMLE Step 2 clinical knowledge scores. All the variables put together could explain 4.1% of the variance of board certification by logistic regression.This investigation provides some additional validity evidence that measures collected for purposes of student evaluation before and during medical school are warranted.
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