Abstract
Purpose: It was hypothesized that physicians who pursue early career specialization in their first year of graduate medical education after medical school are likely to experience a decline in their scores on the medical licensing examination.
Method: A longitudinal prospective design was used in which 1,927 physicians who graduated from Jefferson Medical College between 1980 and 1991 were studied. Type of first-year graduate training program was the independent variable, and performance on a medical licensing examination (Part III examination of the National Board of Medical Examiners [NBME]) was the dependent variable. Scores on Parts I and II of the NBME taken in medical school, medical school class rank, and gender were the control variables.
Results: Findings showed significant differences on Part III scores among physicians in 12 different graduate programs despite statistical adjustments for baseline differences. Physicians in family medicine and emergency medicine programs obtained the highest adjusted Part III scores, followed by physicians in internal medicine and transitional programs. The next group consisted of physicians in pediatrics, obstetrics-gynecology, anesthesiology, and general surgery programs. The group with the lowest Part III scores included physicians in pathology, radiology, and psychiatry.
Implications: These findings suggest that students who meet only the minimal standards in medical school should be advised to pursue a broad training program in the first year of graduate medical education to strengthen their general clinical competence as a means to increase their chances of passing licensing examinations.
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References
American Medical Association (1995). Graduate Medical Education Directory. American Medical Association: Chicago, IL.
Beeler, M.F. (1982). Throwing Babies into the Water (Editorial). American Journal of Clinical Pathology 77: 65.
Blacklow, R.S., Goepp, C.E. & Hojat, M. (1993). Further Psychometric Evaluation of a Class Ranking Model as a Predictor of Graduate's Clinical Competence in the First Year of Residency. Academic Medicine 68: 295–297.
Bomalaski, J.S., Martin, G.J. & Webster, J.R. General Internal Medical Consultation: The Last Bridge (Editorial). Archives of Internal Medicine 143: 875–876.
Cohen, J. (1987). Statistical Power Analysis for the Behavioral Sciences (revised edition). Erlbaum: Hillsdale, NJ.
Cole, W.J. (Chair) (1980). Graduate Medical Education: Present and Prospective: A Call for Action. Report of the Macy Study Group. Josiah Macy, Jr. Foundation, New York.
Federation of State Medical Boards of the United States and the National Board of Medical Examiners (1995). Step 3: General Instructions, Content Description and Sample Items. NBME: Philadelphia.
Ferry, J.J., Richardson, D.K. & Burg F.D. (1982). The Impact of Early Specialization on the Clinical Competence of Residents (Letter to the editor). New England Journal of Medicine 307: 257.
Future Directions for Medical Education (1982). Report of the Council on Medical Education. American Medical Association, Chicago, IL.
Gonnella, J.S. (1982). Experiments in Medical Education: The Pitfalls (Editorial). Journal of Medical Education 57: 729–730.
Gonnella, J.S. & Veloski, J.J. (1982). The Impact of Early Specialization on the Clinical Competence of Residents. New England Journal of Medicine 306: 275–277.
Hojat, M., Gonnella, J.S., Erdmann, J.B., Veloski, J.J. & Xu, G. (1995). Primary Care and NonPrimary Care Physicians: A Longitudinal Study of Their Similarities, Differences and Correlates Before, During, and After Medical School. Academic Medicine 70(Suppl.): 17–28.
Leigh, H. (1982). Comment: The role of Psychiatry in Medicine. American Journal of Psychiatry 139: 1581–1587.
Lindenbaum, J. (1982). The Impact of Early Specialization on the Clinical Competence of Residents (Letter to the editor). New England Journal of Medicine 307: 257–258.
Mitchel, M.L. & Spitalnik, S.L. (1982). The Impact of Early Specialization on the Clinical Competence of Residents (Letter to the editor). New England Journal of Medicine 307: 257.
Physicians for the Twenty-First Century (1984). Report of the panel on the General Professional Education of the Physician and College Preparation for Medicine. Association of American Medical Colleges, Washington, DC.
Spellacy, W.N. (1982). Survival of Departments of Obstetrics and Gynecology: Then Points for Association of Professors of Gynecology and Obstetric Action in the 1980's. American Journal of Obstetrics and Gynecology 144: 626–629.
Veloski, J.J., Hojat, M. & Gonnella, J.S. (1990). A Validity Study of Part III of the National Board Examination. Evaluation & the Health Professions 13: 227–240.
Verhulst, S.J. & Distlehorst, L.H. (1993). Examination of Nonresponse Bias in a Major Residency Follow-up Study. In Gonnella, J.S., Hojat, M., Erdmann, J.B. & Veloski, J.J. (eds.) Assessment Measures in Medical School, Residency, and Practice: The Connections, 121–127. Springer: New York.
Xu, G. & Veloski, J.J. (1991). A Comparison of Jefferson Medical College Graduates Who Chose Emergency Medicine with Those Who Chose Other Specialties. Academic Medicine 66: 366–368.
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Dr. Gonnella is Dean, senior vice president, professor of medicine, and director of the Center for Research in Medical Education and Health Care. Dr. Hojat is director, Jefferson Longitudinal Study of Medical Students and Graduates at the Center, and is research associate professor, Department of Psychiatry and Human Behavior (DPHB); Dr. Erdmann is associate dean for administration and registrar, and professor, Department of Medicine; Mr. Veloski is director of the medical education division of the Center, and instructor, DPHB, all at Jefferson Medical College, Thomas Jefferson University. Correspondence and requests for reprints should be addressed to Dr. Gonnella, Office of the Dean, Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA 19107.
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Gonnella, J.S., Hojat, M., Erdmann, J.B. et al. The impact of early career specialization on licensing requirements and related educational implications. Adv Health Sci Educ 1, 125–139 (1996). https://doi.org/10.1007/BF00159277
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DOI: https://doi.org/10.1007/BF00159277