Factors Influencing Success on Maintenance of Certification of Internal Medicine International Medical Graduates

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

Abstract

International medical graduates (IMGs) have accounted for about a quarter of the US medical training and workforce (AAMC, 2014). A few studies evaluated the performance of IMGs on the in-training examination in internal medicine and found that after the 1990s, IMGs were outperforming US medical graduates (USMGs) (Norcini, Boulet, Whelan, and McKinley, 2005). Another study by Norcini, Boulet, Dauphinee, Opalek, Krantz, and Anderson (2010) concluded that IMGs provided better healthcare to patients than their US counterparts. Additional research focused on the predictors of certification success for IMGs on the Educational Commission for Foreign Medical Graduates exam and the Canadian college certification exam (Norcini, Shea, Webster, & Benson 1986; Schabort, Mercuri, & Grierson, 2014) found that educational background and demographic information (e.g., first language, birthplace, country of medical training, and previous professional experience) were important predictors of IMGs’ success.
Some studies have examined factors affecting the likelihood of passing maintenance of certification (MOC) secure exam assessing medical knowledge, and less proper healthcare of practicing physicians. These negative factors include age (Choudhry, Fletcher, & Soumeral, 2005), solo practice (Lipner, Song, Biester, & Rhodes, 2011), and fewer continuing medical education (CME) activities (Rhodes, Biester, Ritchie, & Malangoni, 2003).
Most of the previous research cited above focused on all examinees, not IMGs. The objective of the proposed study was to expand on the previous research and further evaluate how factors related to medical educational background and physician practice characteristics affect IMGs’ initial MOC exam success. Data came from administrative data including performance on an MOC exam, survey data about practice characteristics, and physician demographic information. The IMG general internists who took an MOC exam since 2014 were included in the analyses.
Two sets of logistic regression (LR) were conducted to predict the initial MOC exam success (dependent variable) of the IMGs using candidate background variables. The independent variables included in the first LR analysis were sex, age when first obtaining internal medicine (IM) certification, IM program director ratings, and the scaled score of their first attempt of IM certification exam. The findings for IMGs in the first set of analysis (Table 1) indicate that, other than sex, all variables were significantly associated with the probability of passing initial MOC exam. These findings are consistent with previous studies by Lipner et al (2011) on MOC candidates.
The second LR focused on practice characteristic variables and included solo practice, percent of time spent on primary patient care, number of physicians in practice, and hours working each week. As shown in Table 2, all independent variables were statistically significant. Doctors who were in a solo practice and working longer hours each week had a negative effect on the probability of passing the initial MOC exam. However, spending more time on primary care of and being in a larger practice were associated with a higher probability of passing the initial MOC exam.
Detailed descriptions on data analysis, interpretation of results, and implications of the study will be provided in the full paper.

Authors

• Yanling Zhang, American Board of Internal Medicine

• Stephen Cubbellotti, American Board of Internal Medicine

• Bozhidar M. Bashkov, American Board of Internal Medicine