Comparison of Time Used by U.S. Medical Graduates and International Medical Graduates on Maintenance of Certification Exams Across Multiple Disciplines

• In Event: Roundtable Session 9
  In Roundtable Session: Factors Contributing to Performance Differences of Practicing Physicians in Internal Medicine

Abstract

The composition of the US physician workforce has gradually changed and international medical graduates (IMGs) account for about a quarter of all physicians (AAMC, 2014). Table 1 presents the sample percentages of United States Medical Graduates (USMGs) and IMGs who recently took medical certification secure exams. It is apparent that IMGs comprise a large portion of the medical workforce, as nearly half of physicians in general internal medicine and non-procedural exams are IMGs. It is pivotal that examinations assessing the competence of medical professionals be examined for USMGs and IMGs.
As an extension of Zhang and Cubbellotti (2015), who focused on differences in medical certification exam performance in terms of demographics, the intent of this paper is to analyze differences in medical certification exam performance based on exam characteristics. Three different medical certification exams (general internal medicine, procedural, and non-procedural disciplines) were analyzed to evaluate differences between disciplines related to focus of medicine. Several t-tests were conducted to examine any mean differences between USMG and IMG response times across multiple exams. Next, several item characteristics (item length, cognitive ability assessed [knowledge, judgment, or synthesis], content area, and number of options [4, 5, or 6]) were modeled through regression to predict the differences in response time between IMGs and USMGs across all items on a given exam. The difference was calculated as IMG average response time for an item minus the USMG average response time.
We found that the mean response time (t = -1,053, p = 0.293; t = -1.01, p = 0.315; t = -0.41, p = 0.68) and the ratio of time used over character count (t = -1,217, p = 0.225; t = -0.193, p = 0.847; t = -1,329, p = 0.185) did not differ significantly between USMGs and IMGs for General, Procedural, and Non-Procedural exams respectively. As this statistic is calculated by averaged data, the relationship is likely more complex than can be detected by a general statistic. This suggests a more complex relationship between the content of the items and response time by medical graduate status. Although the mean response time did not differ significantly between the two groups, further investigation revealed through the regression model that character count significantly contributed to the average difference between the time used by USMGs and IMGs for the items on the general medicine and procedural exams (See Table 2). Specifically, IMGs took significantly longer to respond to longer items compared to USMGs. This is in line with the previous research by Zhang and Cubbellotti (2015) and is likely due to English not being the first language for non U.S. born IMGs who accounted for more than 90% of the IMG population. However, we did not have data to explore this hypothesis. Full results, implications and limitations will be discussed.

Authors

• Stephen Cubbellotti, American Board of Internal Medicine

• Yanling Zhang, American Board of Internal Medicine

• Bozhidar M. Bashkov, American Board of Internal Medicine