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Certifying examination performance and patient outcomes following acute myocardial infarction
Author(s) -
Norcini John J,
Lipner Rebecca S,
Kimball Harry R
Publication year - 2002
Publication title -
medical education
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.776
H-Index - 138
eISSN - 1365-2923
pISSN - 0308-0110
DOI - 10.1046/j.1365-2923.2002.01293.x
Subject(s) - medicine , certification , myocardial infarction , acute care , emergency medicine , physical examination , health care , test (biology) , family medicine , medical emergency , physical therapy , political science , law , economics , economic growth , paleontology , biology
Objective To establish whether successful certifying examination performances of doctors are associated with their patients’ mortality and length of stay following acute myocardial infarction. Design Risk adjusted mortality and survivors’ length of stay were compared for doctors who had satisfactorily completed training in internal medicine or cardiology and attempted the relevant examination. Specifically, the study investigated the joint effects of hospital location, availability of advanced cardiac care, doctors’ specializations, certifying examination performances, year certification was first attempted and patient volume. Setting and participants Data on all acute myocardial infarctions in Pennsylvania for the calendar year 1993 were collected by the Pennsylvania Health Care Cost Containment Council. These data were combined withphysician information from the database of the American Board of Internal Medicine. Results Holding all variables constant, successful examination performance (i.e. certification in internal medicine or cardiology) was associated with a 19% reduction in mortality. Decreased mortality was also correlated with treatment in hospitals located outwith either rural or urban settings and with management by a cardiologist. Shorter stays were not related to examination performance but were associated with treatment by high volume cardiologists who had recently finished training and who cared for their patients in hospitals located outwith rural or urban settings. Conclusions The results of the study add to the evidence supporting the validity of the certifying examination and lend support to the concept that fund of knowledge is related to quality of practice.