The association between physicians' cognitive skills and quality of diabetes care

Acad Med. 2012 Feb;87(2):157-63. doi: 10.1097/ACM.0b013e31823f3a57.


Purpose: To examine the association between physicians' cognitive skills and their performance on a composite measure of diabetes care that included process, outcome, and patient experience measures.

Method: The sample was 676 physicians from the United States with time-limited certification in general internal medicine between 2005 and 2009. Scores from the American Board of Internal Medicine (ABIM) internal medicine maintenance of certification (MOC) examination were used to measure practicing physicians' cognitive skills (scores reflect fund of medical knowledge, diagnostic acumen, and clinical judgment). Practice performance was assessed using a diabetes composite measure aggregated from clinical and patient experience measures obtained from the ABIM Diabetes Practice Improvement Module.

Results: Using multiple regression analyses and controlling for physician and patient characteristics, MOC examination scores were significantly associated with the diabetes composite scores (β = .22, P < .001). The association was particularly stronger with intermediate outcomes than with process and patient experience measures. Performance in the endocrine disease content domain of the examination was more strongly associated with the diabetes composite scores (β = .19, P < .001) than the performance in other medical content domains (β = .06-.14).

Conclusions: Physicians' cognitive skills significantly relate to their performance on a comprehensive composite measure for diabetes care. Although significant, the modest association suggests that there are unique aspects of physician competence captured by each assessment alone and that both must be considered when assessing a physician's ability to provide high-quality care.

MeSH terms

  • Adult
  • Aged
  • Clinical Competence*
  • Cognition*
  • Diabetes Mellitus / therapy*
  • Educational Measurement
  • Female
  • Humans
  • Internal Medicine
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Satisfaction
  • Physicians / psychology*
  • Physicians / statistics & numerical data*
  • Quality of Health Care
  • Regression Analysis
  • United States