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Key Points: Question: Internal medicine residents' competency is evaluated with milestone ratings and the American Board of Internal Medicine's certification examination. Is physicians' performance on either of these measures related to their hospitalized patients' outcomes? Findings: We analyzed 6898 newly trained hospitalists treating Medicare fee-for-service beneficiaries during 455 120 hospitalizations occurring in 2017 to 2019. We found no associations between overall milestone ratings or medical knowledge ratings and hospitalization outcomes, but certification examination score was associated with reduced 7-day mortality and readmissions. Meaning: Among newly trained hospitalists, certification examination score, but not residency milestone ratings, was associated with improved outcomes among hospitalized Medicare beneficiaries. Importance: Despite its importance to medical education and competency assessment for internal medicine trainees, evidence about the relationship between physicians' milestone residency ratings or the American Board of Internal Medicine's initial certification examination and their hospitalized patients' outcomes is sparse. Objective: To examine the association between physicians' milestone ratings and certification examination scores and hospital outcomes for their patients. Design, Setting, and Participants: Retrospective cohort analyses of 6898 hospitalists completing training in 2016 to 2018 and caring for Medicare fee-for-service beneficiaries during hospitalizations in 2017 to 2019 at US hospitals. Main Outcomes and Measures: Primary outcome measures included 7-day mortality and readmission rates. Thirty-day mortality and readmission rates, length of stay, and subspecialist consultation frequency were also assessed. Analyses accounted for hospital fixed effects and adjusted for patient characteristics, physician years of experience, and year. Exposures: Certification examination score quartile and milestone ratings, including an overall core competency rating measure equaling the mean of the end of residency milestone subcompetency ratings categorized as low, medium, or high, and a knowledge core competency measure categorized similarly. Results: Among 455 120 hospitalizations, median patient age was 79 years (IQR, 73-86 years), 56.5% of patients were female, 1.9% were Asian, 9.8% were Black, 4.6% were Hispanic, and 81.9% were White. The 7-day mortality and readmission rates were 3.5% (95% CI, 3.4%-3.6%) and 5.6% (95% CI, 5.5%-5.6%), respectively, and were 8.8% (95% CI, 8.7%-8.9%) and 16.6% (95% CI, 16.5%-16.7%) for mortality and readmission at 30 days. Mean length of stay and number of specialty consultations were 3.6 days (95% CI, 3.6-3.6 days) and 1.01 (95% CI, 1.00-1.03), respectively. A high vs low overall or knowledge milestone core competency rating was associated with none of the outcome measures assessed. For example, a high vs low overall core competency rating was associated with a nonsignificant 2.7% increase in 7-day mortality rates (95% CI, −5.2% to 10.6%; P =.51). In contrast, top vs bottom examination score quartile was associated with a significant 8.0% reduction in 7-day mortality rates (95% CI, −13.0% to −3.1%; P =.002) and a 9.3% reduction in 7-day readmission rates (95% CI, −13.0% to −5.7%; P <.001). For 30-day mortality, this association was −3.5% (95% CI, −6.7% to −0.4%; P =.03). Top vs bottom examination score quartile was associated with 2.4% more consultations (95% CI, 0.8%-3.9%; P <.003) but was not associated with length of stay or 30-day readmission rates. Conclusions and Relevance: Among newly trained hospitalists, certification examination score, but not residency milestone ratings, was associated with improved outcomes among hospitalized Medicare beneficiaries. This study examines the association between physicians' milestone ratings and certification examination scores and hospital outcomes for their patients. [ABSTRACT FROM AUTHOR]

ABIM Policies on Time Away From Training I Objective: i To conduct a national survey of internal medicine (IM) PDs to assess their understanding of ABIM leave policies and their application to common scenarios, including parental leave. For the resident requesting 8 weeks of maternity leave in scenario 1, only 6.5% of PDs correctly chose not to extend training; 82.7% of all respondents reported that they would extend training to follow ABIM policy. Specialty board leave policies for resident physicians requesting parental leave JAMA, 2018, 320, 2374-7, 30535211 3 Willett LL, Wellons MF, Hartig JR, et al, Do women residents delay childbearing due to perceived career threats?. [Extracted from the article]

Resident physicians routinely perform bedside procedures that pose substantial risk to patients. However, no standard programmatic approach to supervision and procedural competency assessment among residents currently exists. The authors performed a national survey of internal medicine (IM) program directors to examine procedural assessment and supervision practices of IM residency programs. Procedures chosen were those commonly performed by medicine residents at the bedside. Of the 368 IM programs, 226 (61%) completed the survey. Programs reported the predominant method of training as 171 (74%) apprenticeship and 106 (46%) as module based. The majority of programs used direct observation to attest to competence, with 55% to 62% relying on credentialed residents. Most programs also relied on a minimum number of procedures to determine competence (64%-88%), 72% of which reported 5 procedures (a lapsed historical standard). This national survey demonstrates that procedural assessment practices for IM residents are insufficiently robust and may put patients at undue risk. [ABSTRACT FROM AUTHOR]