Leigh T M, Young P R, Haley J V
American Board of Family Practice, Lexington, KY 40505.
Acad Med. 1993 Dec;68(12):912-9. doi: 10.1097/00001888-199312000-00012.
In 1969 the American Board of Family Practice (ABFP) became the 19th medical specialty board and the first since the inception of medical specialty certification to mandate recertification. As of July 1993, 16 other boards have adopted time-limited certification, but only two have reached the first recertification of their diplomates. As recertification approaches for the 14 boards, each will be faced with decisions concerning process, examination content and scope, and standards for passing. The physicians who will be facing mandatory recertification must be adequately prepared or accept the consequences of losing their certification.
This study examined the performances of six cohorts of family physicians--three cohorts of 711 practice-qualified physicians certified in 1971, 1972, and 1973, and three cohorts of 1,233 residency-trained physicians certified in 1977, 1978, and 1979--who were successfully recertified on successive six-year cycles from 1977 through 1991. Analyses of variance, multiple regression analysis, and Pearson correlation coefficients were used to investigate the relationships among the composite scores on the various certification and recertification examinations and among examination composite scores and demographic variables.
There were significant (p < .01) declines in performance on each recertification examination. The residency-trained physicians had higher examination scores than did the practice-qualified physicians. Multiple regression analysis showed the last recertification score to be the strongest predictor of the next recertification score. The combination of previous scores and demographic variables resulted in the ability to predict between 63% and 74% of the variance in the most current recertification composite score.
The results raise questions for further investigation, and such investigation may affect specialty boards' design of and/or examinees' test-taking strategies on future recertification examinations. For example, the decline in examination performance from certification through successive recertifications may result from factors related to the practice of medicine. It is possible that as the practice life of a family physician evolves, the focus of the practice becomes narrower, and this narrowed focus results in a decline in performance on an examination, half of which covers the breadth of the specialty. Thus, the medical specialties addressing mandatory recertification may wish to give thorough consideration to the focus of the examination--scope of specialty or scope of the practice, or some combination of both--as well as the implications of the standard-setting process used for recertification.
1969年，美国家庭医学委员会（ABFP）成为第19个医学专科委员会，也是自医学专科认证开始以来首个强制要求重新认证的委员会。截至1993年7月，其他16个委员会也采用了限时认证，但只有两个委员会对其持证人进行了首次重新认证。随着14个委员会的重新认证临近，每个委员会都将面临有关认证流程、考试内容和范围以及及格标准的决策。即将面临强制重新认证的医生必须做好充分准备，否则就要承担失去认证的后果。
本研究考察了六组家庭医生的表现，其中三组是1971年、1972年和1973年获得执业资格认证的711名医生，另外三组是1977年、1978年和1979年完成住院医师培训后获得认证的1233名医生，他们在1977年至1991年期间连续六个周期成功通过重新认证。采用方差分析、多元回归分析和皮尔逊相关系数来研究各种认证和重新认证考试的综合分数之间以及考试综合分数与人口统计学变量之间的关系。
每次重新认证考试的成绩都有显著下降（p <.01）。完成住院医师培训的医生考试成绩高于获得执业资格的医生。多元回归分析显示，上次重新认证成绩是下次重新认证成绩的最强预测指标。综合先前成绩和人口统计学变量能够预测当前重新认证综合分数中63%至74%的方差。
这些结果引发了有待进一步研究的问题，此类研究可能会影响专科委员会对未来重新认证考试的设计和/或考生的应试策略。例如，从首次认证到连续重新认证考试成绩下降，可能是与医疗实践相关的因素导致的。随着家庭医生职业生涯的发展，其业务重点可能会变窄，而这种变窄的重点会导致在涵盖该专科广度的考试中成绩下降。因此，涉及强制重新认证的医学专科可能希望充分考虑考试重点——专科范围还是业务范围，或两者的某种结合——以及重新认证所采用的标准设定过程的影响。
