American Board of Internal Medicine, Philadelphia, PA.
Health Serv Res. 2018 Jun;53(3):1682-1701. doi: 10.1111/1475-6773.12697. Epub 2017 Apr 16.
To evaluate the effect of state continuing medical education (CME) requirements on physician clinical knowledge.
Secondary data for 19,563 general internists who took the Internal Medicine Maintenance of Certification (MOC) examination between 2006 and 2013.
We took advantage of a natural experiment resulting from variations in CME requirements across states over time and applied a difference-in-differences methodology to measure associations between changes in CME requirements and physician clinical knowledge. We measured changes in clinical knowledge by comparing initial and MOC examination performance 10 years apart. We constructed difference-in-differences estimates by regressing examination performance changes against physician demographics, county and year fixed effects, trend-state indicators, and state CME change indicators.
Physician data were compiled by the American Board of Internal Medicine. State CME policies were compiled from American Medical Association reports.
More rigorous CME credit-hour requirements (mostly implementing a new requirement) were associated with an increase in examination performance equivalent to a shift in examination score from the 50th to 54th percentile.
Among physicians required to engage in a summative assessment of their clinical knowledge, CME requirements were associated with an improvement in physician clinical knowledge.
评估州继续教育（CME）要求对医师临床知识的影响。
2006 年至 2013 年间参加内科医师维持认证（MOC）考试的 19563 名普通内科医师的二级数据。
我们利用了一个自然实验，该实验源于各州在不同时间的 CME 要求的变化，并应用差异中的差异方法来衡量 CME 要求变化与医师临床知识之间的关联。我们通过将初始和 MOC 考试表现进行 10 年的比较，来衡量临床知识的变化。我们通过回归考试表现变化与医师人口统计学、县和年份固定效应、趋势州指标以及州 CME 变化指标来构建差异中的差异估计值。
医师数据由美国内科医师学会汇编。州 CME 政策由美国医学协会的报告汇编而成。
更严格的 CME 学分要求（主要是实施新要求）与考试成绩提高有关，相当于考试分数从第 50 百分位提高到第 54 百分位。
在要求对其临床知识进行总结性评估的医师中，CME 要求与医师临床知识的提高有关。
