Trends in medical knowledge as assessed by the certifying examination in internal medicine
Article Abstract:
After completing medical school and internship programs, most physicians enter residency programs, which provide additional training in a specialty field of medicine or surgery. After residency training these physicians take certifying examinations, which measure their knowledge and provide them with certification in the specialty area. The past ten years have witnessed a decrease in medical school applications from 2.8 to 1.7 applications for each available medical school position. There has also been a decrease in the number of medical school graduates applying for residencies in internal medicine, despite an increase in the number of internal medicine residencies available. Consequently, competition has decreased not only for medical school admission, but also for positions in training programs for internal medicine. There has been concern that diminished competition may result in a decrease in physicians' knowledge of internal medicine. The certifying examination administered by the American Board of Internal Medicine is taken by physicians upon completion of internal medicine residency training. In order to determine the degree of medical knowledge acquired by these physicians, the authors compared test scores and answers to a subset of questions that were common to some of the exams from 1983 to 1988. Overall the scores showed a small cumulative decrease during the six years studied; the 1983 scores were higher than the 1985 scores, which were higher than the 1988 scores. The test performances of candidates dropped regardless of the quality of their residency programs and regardless of their clinical competence as residents. A survey of the directors of the residency programs revealed that the number of physicians who received a rating of superior in overall clinical ability had increased over the period from 1983 to 1988. Some reasons for the trend in lower scores, relative to medical education, are discussed. The American Board of Internal Medicine has now adopted a pass-fail system of scoring the certifying exam. This new system will allow each candidate to be judged against an absolute standard and not, as in the past, against the relative quality of physicians taking the test.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1989
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Ability of primary care physicians to recognize physical findings associated with HIV infection
Article Abstract:
Many primary care physicians may miss important signs of early HIV infection. Researchers asked 134 internists and family physicians to see patients who had been trained to give specific histories and symptoms. The patients had three classic signs of early HIV infection: Kaposi's sarcoma (KS), oral hairy leukoplakia (OHL) or lymphadenopathy. Even though many of the patients had noticeable KS lesions, only 47% of the physicians who examined a patient with KS took note of the lesions. Half of these physicians did not correctly diagnose KS. A little over half of the physicians who examined a patient with OHL considered the lesion in their diagnosis, but 59% incorrectly diagnosed the condition. Physicians with experience treating HIV-infected patients were more likely to identify and correctly diagnose OHL.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1995
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