Factors that influence general internists' and surgeons' performance on maintenance of certification exams

Acad Med. 2011 Jan;86(1):53-8. doi: 10.1097/ACM.0b013e3181ff8283.


Purpose: Good clinical judgment is important to providing high-quality patient care. Keeping current in one's field is challenged by rapid advances in health care and demanding practices. Understanding the collective factors that influence a practicing physician's clinical judgment could help medical educators design improvement programs that target specific audiences.

Method: Data from two medical specialty boards, the American Board of Internal Medicine and American Board of Surgery, were used. Multiple regression analyses were conducted relating first-attempt performance on the maintenance of certification (MOC) exam with physician age, amount of continuing medical education (CME) undertaken, number of physicians in the practice, medical school type, and prior exam performance. Data were based on demographics and exam scores of 18,447 general internists and 4,961 general surgeons who took the MOC exam for the first time between 2003 and 2007.

Results: Similar findings were obtained for general internists and surgeons. Younger physicians, those with higher scores on initial certification, physicians in group not solo practice, and U.S. medical graduates were significantly more likely to pass the MOC exam (P<.001). Effect sizes were small except for performance on the initial certification exam. General internists with higher internal medicine program directors' ratings and more CME activities were also significantly more likely to pass (P<.001).

Conclusions: Medical educators may target improvement programs for those who practice in isolation, are older, are international medical graduates, and performed poorly on their initial certification exam. Practicing without sustaining requisite clinical judgment has serious implications for patient care.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Certification*
  • Clinical Competence*
  • Education, Medical, Continuing / methods*
  • Female
  • General Surgery / education
  • Humans
  • Internal Medicine / education*
  • Male
  • Practice Patterns, Physicians' / trends*
  • Primary Health Care / trends
  • Specialty Boards*
  • Surveys and Questionnaires
  • United States