MILITARY MEDICINE, 180,4:18,2015
Are Commonly Used Premedical School or Medical School Measures Associated With Board Certification Steven J. Durning, MD, PhD*; Ting Dong, PhD*; Col Paul A. Hemmer, USAF MC (Ret.)*; COL William R. Gilliland, MC USA (Ret.)f; David F. Cruess, PhDp John R. Boulet, PhD§; COL Louis N. Pangaro, MC USA (Ret.)*
ABSTRACT Purpose: To determine if there is an association between several commonly obtained premedical school and medical school measures and board certification performance. We specifically included measures from our institu tion for which we have predictive validity evidence into the internship year. We hypothesized that board certification would be most likely to be associated with clinical measures of performance during medical school, and with scores on standardized tests, whether before or during medical school. Methods: Achieving board certification in an American Board of Medical Specialties specialty was used as our outcome measure for a 7-year cohort of graduates (1995-2002). Age at matriculation. Medical College Admissions Test (MCAT) score, undergraduate college grade point average (GPA), undergraduate college science GPA, Uniformed Services University (USU) cumulative GPA, USU preclerkship GPA, USU clerkship year GPA, departmental competency committee evaluation, Internal Medicine (IM) clerkship clinical performance rating (points), IM total clerkship points, history of Student Promotion Committee review, and United States Medical Licensing Examination (USMLE) Step I score and USMLE Step 2 clinical knowledge score were associated with this outcome. Results: Ninety-three of 1,155 graduates were not certified, resulting in an average rate of board certification of 91.9% for the study cohort. Significant small correlations were found between board certification and IM clerkship points (r = 0.117), IM clerkship grade (r = 0.108), clerkship year GPA (r = 0.078), undergraduate college science GPA (r = 0.072), preclerkship GPA and medical school GPA (r = 0.068 for both), USMLE Step 1 (r = 0.066), undergraduate college total GPA (r = 0.062), and age at matriculation (r = -0.061). In comparing the two groups (board certified and not board certified cohorts), significant differences were seen for all included variables with the exception of MCAT and USMLE Step 2 clinical knowledge scores. All the variables put together could explain 4.1% of the variance of board certification by logistic regression. Conclusions: This investigation provides some additional validity evidence that measures collected for purposes of student evaluation before and during medical school are warranted.
INTRODUCTION The most widely used measure to judge the quality of an individual physician is achieving specialty board certification. There are several findings in support of this rationale. Prior studies have demonstrated an association between board cer tification and clinical practice outcomes1'2 and between main tenance of certification examination scores and quality of care for Medicare beneficiaries.3 Board certification is also the final culminating certification in a typical physician’s career, reflecting many years of education: medical school (4 years), residency and for some fellowship (3-9 years), and, in other cases, 2 years of clinical practice. As such, individuals who sit for the examination have successfully completed these several stages that include components of both written exam *Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. fF. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. ^Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. §Foundation for Advancement of International Medical Education and Research (FAIMER), 3634 Market Street, Philadelphia, PA 19104. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense or the U.S. Government. doi: 10.7205/MILMED-D-14-00569
18
inations and clinical performance measures. Finally, the general quality and rigor of the clinical vignette items is believed to be associated with practice.4 There is also a significant cost with not becoming board certified. Many acknowledge a physician shortage, at least in our current system of health care delivery, and not being successful with this final step can be at great cost to the individual with having spent years in medical school and subsequent training. Although an individual who is licensed but not board certified may practice medicine, these individ uals currently are not required to participate in a maintenance of licensure process (beyond that required by their individual state medical board) similar to the maintenance of certification from the certifying boards; however, there is a recent effort to implement maintenance of licensure.3 From the societal view, it would be optimal to identify individuals who will not become board certified as early as possible in their education. If these individuals could be successfully identified, resources might be then spent to provide remediation and improvement in subsequent performance to include passing this examina tion, at least for some of these individuals. Our study’s premise is that board certification is an appro priate long-term outcome for the system of selecting and training medical students. Beyond the use of in-training examination scores in residency, little is known regarding what predicts eventual board certification.6-8 Few studies have
MILITARY MEDICINE, Vol. 180, April Supplement 2015
Are Commonly Used Measures Associated With Board Certification
addressed this question beyond performance on national exam inations during medical school. This is likely because of sev eral reasons. First, large cohorts are needed for analysis given that fortunately, only a small percentage of individuals who take the examination do not become certified. Second, there are challenges with following individual trainees longitudi nally, and therefore single point in time large national exami nations tend to be used for the purpose of board certification prediction. Third, many question the association, particularly between medical school measures and performance on the board certification examination given the amount of time and accrued knowledge and experience between medical school and board certification; in other words, from this view, board certification depends far more on residency training than pre medical school or medical school measures. We explored the association between several commonly obtained premedical school and medical school measures and board certification performance. We specifically included measures from our institution or from other studies that have predictive validity evidence at least into the internship year. We hypothesized that clinical measures of performance would be most likely to be associated with board certification in addition to scores on national standardized tests as several investigations have shown that national standardized exami nations predict future examinations.9'10
METHODS The study cohort was Uniformed Service University (USU) F. Edward Hebert School of Medicine students graduating between 1995 and 2002. The measures under investigation were board certification (certified or not), age at matriculation, Medical College Admissions Test (MCAT) score, undergrad uate college grade point average (GPA), undergraduate col lege science GPA, USU cumulative GPA, USU preclerkship GPA, USU clerkship year GPA, departmental competency committee evaluation (Department of Medicine Education Committee [DOMECj, yes or no for review), Internal Medi cine (IM) clerkship clinical points, IM total clerkship points, Student Promotion Committee (SPC) review (yes or no for review), and United States Medical Licensing Examination (USMLE) Step 1 score and USMLE Step 2 clinical knowl edge (CK) score. Measures Board Certification
Performance was divided dichotomously into having achieved certification or not, based on American Medical Association Masterfile (accessed September 2013 for USU graduates between years 1995 and 2002). Age at Matriculation
The age of the students when they were accepted by USU was included, as questions regarding age at matricu lation and medical school performance have been inves
MILITARY MEDICINE, Vol. 180, April Supplement 2015
tigated in the past and age is a marker used by several admissions committees. Medical College Admissions Test
The MCAT measure only included Classes of 1996 to 2002 because Class of 1995 was on a different version of MCAT. Undergraduate College GPA and Undergraduate College Science GPA
We obtained the GPA measures from the admissions office. We included the cumulative GPA and the science/math GPA when they applied for USU. Medical School Cumulative GPA, Preclerkship GPA, and Clerkship Year GPA
The GPA is a weighted average created by multiplying each course grade by the number of contact hours for the given course, summing the weighted grades across courses, and then dividing the sum by the total number of contact hours. Preclerkship GPA was calculated using course grades from the first 2 years of medical school. Clerkship year GPA con tains no course grades. It is a composite of students’ clerkship grades, which include clinical points, objective structured clinical examination scores, and National Board Medical Examiner (NBME) subject examination in IM. At the time of the study, clerkship year GPA referred to the third year of medical school where students completed their core clinical clerkship rotations, working in various ward and clinic set tings. The medical school cumulative GPA was the average GPA of all 4 years. DOMEC Review
If a student received one or more evaluative recommenda tions of less than passing from any teacher, or if a student failed the NBME shelf examination in medicine, the student was referred to the Department of Medicine Education Com mittee (DOMEC), an IM competency committee for grade adjudication. Thus DOMEC referral is a potential marker for a struggling student during the IM clerkship. IM Clerkship Clinical Points and Total Points
During the student’s 12-week IM clerkship (6 weeks inpa tient and 6 weeks of ambulatory medicine), teachers recom mend a final judgment of student performance based on the Reporter-Interpreter-Manager-Educator (RIME) framework,11 and include such recommendations on end of clerkship eval uation forms and comment at face-to-face evaluation sessions during the clerkship.12 These recommendations are converted to points for the purpose of grade calculations; in general, more points are allocated to teachers who work with the students for a longer period of time, and the second 6 weeks of the clerkship was weighted more heavily than the first 6 weeks (1.5 times more points available). Clinical points represent the summation of all points from the teachers dur ing the 12-week clerkship.
19
Are Commonly Used Measures Associated With Board Certification
Clerkship “total points” represent the summation of clinical points and examination points, the latter points coming from the NBME subject examination in medicine, an in-house examination of analytic ability, and an in-house examination of interpreting laboratory values.13 We included these vari ables as the IM clerkship has also been found in prior studies to predict poor performance during internship.1415 SPC Review
Appearance before our SPC for any reason. Individuals are presented to this committee for concerns regarding academic performance. This variable has also been associated with poor performance in internship from a prior investigation at our institution.16
The USMLE is a single-assessment program consisting of four separate examinations designed to assess an examinee’s understanding of and ability to apply concepts and principles that are important in health, disease, and effective patient
Frequency of Board Certification by Graduating Year (1995-2002) Not Board Certified
Graduating Year
(%)
1995 1996 1997 1998 1999 2000 2001 2002 1995-2002
1 (4.8) 4 (2.9) 15 (10.4) 16(11.3) 17 (11.4) 6(4.1) 13 (9.4) 15 (9.7) 93 (8.1)
TABLE II.
Age at Matriculation MCAT College GPA College Science GPA Cumulative Medical School GPA Preclinical (First 2 Years) GPA Initial Clerkship Year (3rd Year) GPA IM Clerkship Clinical Points IM Clerkship Total Grade Step 1 Step 2 CK
DOMEC SPC Appearance
S ta tis tic a l A n a ly s is
We first reported the descriptive statistics of the measures in the board-certified and the not board-certified groups. Then, we examined the bivariate Pearson correlations between the mea sures. Last, we compared the differences between the two groups on the variables of interest using Student’s t and%2 tests. This study was approved by USU Institutional Review Board. RESULTS
USMLE Step 1 Score and Step 2 CK Score
TABLE I.
care. Students in this sample completed Step 1, which focuses on understanding of basic sciences, after their first 2 years of medical school. Students completed Step 2 CK during their fourth year of medical school. Step 2 CK is more clinically oriented compared with Step 1.
Board Certified (%)
Total
138 (95.2) 135 (97.1) 129 (89.6) 125 (88.7) 132 (88.6) 139 (95.9) 125 (90.6) 139 (90.3) 1,062 (91.9)
145 139 144 141 149 145 138 154 1,155
American Board of Medical Specialties certification data was available for 92% (1,155/1,255) of graduates during the study period. Table I shows the number and percentage of board certification vs. not board certification by graduating year. In all, 93 of 1,155 graduates were not certified, resulting in an average rate of board certification of 91.9% for the study cohort. Table II displays the results of the bivariate statistical comparisons between the two groups, and shows that the board-certified group was generally younger and showed better performance on the majority of our included measures (significant differences were seen for all included variables with the exception of MCAT and USMLE and Step 2 CK scores). Table III presents the bivariate Pearson correlation coefficients between the measures. This table reveals that board certification had weak to absent correlations with all our premedical school and medical school measures. Weak significant correlations were found between board certifica tion and IM clerkship clinical points (r = 0.117), IM clerkship total points (r = 0.108), clerkship year GPA (r = 0.078),
Group (Board Certified vs. Not Board Certified) Comparison Not Board Certified Mean (SD)
Board Certified Mean (SD)
26.29 (3.75) 29.87 (3.31) 3.39 (0.32) 3.36 (0.36) 3.12(0.37) 2.93 (0.50) 3.16(0.48) 32.95 (18.82) 45.64 (22.69) 205.26 (17.34) 204.04 (20.61)
25.52 (3.36) 29.91 (3.22) 3.46 (0.29) 3.44 (0.32) 3.21 (0.35) 3.05 (0.48) 3.28 (0.41) 40.46(17.12) 54.03 (20.81) 209.35 (16.83) 206.82 (18.84)
Not Board Certified Number (Percentage)
Board Certified Number (Percentage)
Chi-Square Test
9 out of 46 (19.6) 18 out of 92 (19.6)
70 out of 485 (14.4) 145 out of 1060(13.7)
X2 (1) = 2.41
,-test
t (1,149) = 2.09* t (986) = —0.11 t (1,139) = -2.08* t (1,139) = -2.45* t (1,099) = -2.27* r (1,141) = -2.31* t (1,140) = -2.64** t (949) = -3.64** , (947) = -3.35** ,(1134) = -2.23* ,(1135) = -1.34
/ ( 1 ) = 0.87
*p < 0.05; **p < 0.01.
20
MILITARY MEDICINE, Vol. 180, April Supplement 2015
MILITARY MEDICINE, Vol. 180, April Supplement 2015 Matrix of Pearson Correlations Between Board Certification and Assessment Measurements
*p< 0.05; **p
Are Commonly Used Premedical School or Medical School Measures Associated With Board Certification Steven J. Durning, MD, PhD*; Ting Dong, PhD*; Col Paul A. Hemmer, USAF MC (Ret.)*; COL William R. Gilliland, MC USA (Ret.)f; David F. Cruess, PhDp John R. Boulet, PhD§; COL Louis N. Pangaro, MC USA (Ret.)*
ABSTRACT Purpose: To determine if there is an association between several commonly obtained premedical school and medical school measures and board certification performance. We specifically included measures from our institu tion for which we have predictive validity evidence into the internship year. We hypothesized that board certification would be most likely to be associated with clinical measures of performance during medical school, and with scores on standardized tests, whether before or during medical school. Methods: Achieving board certification in an American Board of Medical Specialties specialty was used as our outcome measure for a 7-year cohort of graduates (1995-2002). Age at matriculation. Medical College Admissions Test (MCAT) score, undergraduate college grade point average (GPA), undergraduate college science GPA, Uniformed Services University (USU) cumulative GPA, USU preclerkship GPA, USU clerkship year GPA, departmental competency committee evaluation, Internal Medicine (IM) clerkship clinical performance rating (points), IM total clerkship points, history of Student Promotion Committee review, and United States Medical Licensing Examination (USMLE) Step I score and USMLE Step 2 clinical knowledge score were associated with this outcome. Results: Ninety-three of 1,155 graduates were not certified, resulting in an average rate of board certification of 91.9% for the study cohort. Significant small correlations were found between board certification and IM clerkship points (r = 0.117), IM clerkship grade (r = 0.108), clerkship year GPA (r = 0.078), undergraduate college science GPA (r = 0.072), preclerkship GPA and medical school GPA (r = 0.068 for both), USMLE Step 1 (r = 0.066), undergraduate college total GPA (r = 0.062), and age at matriculation (r = -0.061). In comparing the two groups (board certified and not board certified cohorts), significant differences were seen for all included variables with the exception of MCAT and USMLE Step 2 clinical knowledge scores. All the variables put together could explain 4.1% of the variance of board certification by logistic regression. Conclusions: This investigation provides some additional validity evidence that measures collected for purposes of student evaluation before and during medical school are warranted.
INTRODUCTION The most widely used measure to judge the quality of an individual physician is achieving specialty board certification. There are several findings in support of this rationale. Prior studies have demonstrated an association between board cer tification and clinical practice outcomes1'2 and between main tenance of certification examination scores and quality of care for Medicare beneficiaries.3 Board certification is also the final culminating certification in a typical physician’s career, reflecting many years of education: medical school (4 years), residency and for some fellowship (3-9 years), and, in other cases, 2 years of clinical practice. As such, individuals who sit for the examination have successfully completed these several stages that include components of both written exam *Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. fF. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. ^Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. §Foundation for Advancement of International Medical Education and Research (FAIMER), 3634 Market Street, Philadelphia, PA 19104. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense or the U.S. Government. doi: 10.7205/MILMED-D-14-00569
18
inations and clinical performance measures. Finally, the general quality and rigor of the clinical vignette items is believed to be associated with practice.4 There is also a significant cost with not becoming board certified. Many acknowledge a physician shortage, at least in our current system of health care delivery, and not being successful with this final step can be at great cost to the individual with having spent years in medical school and subsequent training. Although an individual who is licensed but not board certified may practice medicine, these individ uals currently are not required to participate in a maintenance of licensure process (beyond that required by their individual state medical board) similar to the maintenance of certification from the certifying boards; however, there is a recent effort to implement maintenance of licensure.3 From the societal view, it would be optimal to identify individuals who will not become board certified as early as possible in their education. If these individuals could be successfully identified, resources might be then spent to provide remediation and improvement in subsequent performance to include passing this examina tion, at least for some of these individuals. Our study’s premise is that board certification is an appro priate long-term outcome for the system of selecting and training medical students. Beyond the use of in-training examination scores in residency, little is known regarding what predicts eventual board certification.6-8 Few studies have
MILITARY MEDICINE, Vol. 180, April Supplement 2015
Are Commonly Used Measures Associated With Board Certification
addressed this question beyond performance on national exam inations during medical school. This is likely because of sev eral reasons. First, large cohorts are needed for analysis given that fortunately, only a small percentage of individuals who take the examination do not become certified. Second, there are challenges with following individual trainees longitudi nally, and therefore single point in time large national exami nations tend to be used for the purpose of board certification prediction. Third, many question the association, particularly between medical school measures and performance on the board certification examination given the amount of time and accrued knowledge and experience between medical school and board certification; in other words, from this view, board certification depends far more on residency training than pre medical school or medical school measures. We explored the association between several commonly obtained premedical school and medical school measures and board certification performance. We specifically included measures from our institution or from other studies that have predictive validity evidence at least into the internship year. We hypothesized that clinical measures of performance would be most likely to be associated with board certification in addition to scores on national standardized tests as several investigations have shown that national standardized exami nations predict future examinations.9'10
METHODS The study cohort was Uniformed Service University (USU) F. Edward Hebert School of Medicine students graduating between 1995 and 2002. The measures under investigation were board certification (certified or not), age at matriculation, Medical College Admissions Test (MCAT) score, undergrad uate college grade point average (GPA), undergraduate col lege science GPA, USU cumulative GPA, USU preclerkship GPA, USU clerkship year GPA, departmental competency committee evaluation (Department of Medicine Education Committee [DOMECj, yes or no for review), Internal Medi cine (IM) clerkship clinical points, IM total clerkship points, Student Promotion Committee (SPC) review (yes or no for review), and United States Medical Licensing Examination (USMLE) Step 1 score and USMLE Step 2 clinical knowl edge (CK) score. Measures Board Certification
Performance was divided dichotomously into having achieved certification or not, based on American Medical Association Masterfile (accessed September 2013 for USU graduates between years 1995 and 2002). Age at Matriculation
The age of the students when they were accepted by USU was included, as questions regarding age at matricu lation and medical school performance have been inves
MILITARY MEDICINE, Vol. 180, April Supplement 2015
tigated in the past and age is a marker used by several admissions committees. Medical College Admissions Test
The MCAT measure only included Classes of 1996 to 2002 because Class of 1995 was on a different version of MCAT. Undergraduate College GPA and Undergraduate College Science GPA
We obtained the GPA measures from the admissions office. We included the cumulative GPA and the science/math GPA when they applied for USU. Medical School Cumulative GPA, Preclerkship GPA, and Clerkship Year GPA
The GPA is a weighted average created by multiplying each course grade by the number of contact hours for the given course, summing the weighted grades across courses, and then dividing the sum by the total number of contact hours. Preclerkship GPA was calculated using course grades from the first 2 years of medical school. Clerkship year GPA con tains no course grades. It is a composite of students’ clerkship grades, which include clinical points, objective structured clinical examination scores, and National Board Medical Examiner (NBME) subject examination in IM. At the time of the study, clerkship year GPA referred to the third year of medical school where students completed their core clinical clerkship rotations, working in various ward and clinic set tings. The medical school cumulative GPA was the average GPA of all 4 years. DOMEC Review
If a student received one or more evaluative recommenda tions of less than passing from any teacher, or if a student failed the NBME shelf examination in medicine, the student was referred to the Department of Medicine Education Com mittee (DOMEC), an IM competency committee for grade adjudication. Thus DOMEC referral is a potential marker for a struggling student during the IM clerkship. IM Clerkship Clinical Points and Total Points
During the student’s 12-week IM clerkship (6 weeks inpa tient and 6 weeks of ambulatory medicine), teachers recom mend a final judgment of student performance based on the Reporter-Interpreter-Manager-Educator (RIME) framework,11 and include such recommendations on end of clerkship eval uation forms and comment at face-to-face evaluation sessions during the clerkship.12 These recommendations are converted to points for the purpose of grade calculations; in general, more points are allocated to teachers who work with the students for a longer period of time, and the second 6 weeks of the clerkship was weighted more heavily than the first 6 weeks (1.5 times more points available). Clinical points represent the summation of all points from the teachers dur ing the 12-week clerkship.
19
Are Commonly Used Measures Associated With Board Certification
Clerkship “total points” represent the summation of clinical points and examination points, the latter points coming from the NBME subject examination in medicine, an in-house examination of analytic ability, and an in-house examination of interpreting laboratory values.13 We included these vari ables as the IM clerkship has also been found in prior studies to predict poor performance during internship.1415 SPC Review
Appearance before our SPC for any reason. Individuals are presented to this committee for concerns regarding academic performance. This variable has also been associated with poor performance in internship from a prior investigation at our institution.16
The USMLE is a single-assessment program consisting of four separate examinations designed to assess an examinee’s understanding of and ability to apply concepts and principles that are important in health, disease, and effective patient
Frequency of Board Certification by Graduating Year (1995-2002) Not Board Certified
Graduating Year
(%)
1995 1996 1997 1998 1999 2000 2001 2002 1995-2002
1 (4.8) 4 (2.9) 15 (10.4) 16(11.3) 17 (11.4) 6(4.1) 13 (9.4) 15 (9.7) 93 (8.1)
TABLE II.
Age at Matriculation MCAT College GPA College Science GPA Cumulative Medical School GPA Preclinical (First 2 Years) GPA Initial Clerkship Year (3rd Year) GPA IM Clerkship Clinical Points IM Clerkship Total Grade Step 1 Step 2 CK
DOMEC SPC Appearance
S ta tis tic a l A n a ly s is
We first reported the descriptive statistics of the measures in the board-certified and the not board-certified groups. Then, we examined the bivariate Pearson correlations between the mea sures. Last, we compared the differences between the two groups on the variables of interest using Student’s t and%2 tests. This study was approved by USU Institutional Review Board. RESULTS
USMLE Step 1 Score and Step 2 CK Score
TABLE I.
care. Students in this sample completed Step 1, which focuses on understanding of basic sciences, after their first 2 years of medical school. Students completed Step 2 CK during their fourth year of medical school. Step 2 CK is more clinically oriented compared with Step 1.
Board Certified (%)
Total
138 (95.2) 135 (97.1) 129 (89.6) 125 (88.7) 132 (88.6) 139 (95.9) 125 (90.6) 139 (90.3) 1,062 (91.9)
145 139 144 141 149 145 138 154 1,155
American Board of Medical Specialties certification data was available for 92% (1,155/1,255) of graduates during the study period. Table I shows the number and percentage of board certification vs. not board certification by graduating year. In all, 93 of 1,155 graduates were not certified, resulting in an average rate of board certification of 91.9% for the study cohort. Table II displays the results of the bivariate statistical comparisons between the two groups, and shows that the board-certified group was generally younger and showed better performance on the majority of our included measures (significant differences were seen for all included variables with the exception of MCAT and USMLE and Step 2 CK scores). Table III presents the bivariate Pearson correlation coefficients between the measures. This table reveals that board certification had weak to absent correlations with all our premedical school and medical school measures. Weak significant correlations were found between board certifica tion and IM clerkship clinical points (r = 0.117), IM clerkship total points (r = 0.108), clerkship year GPA (r = 0.078),
Group (Board Certified vs. Not Board Certified) Comparison Not Board Certified Mean (SD)
Board Certified Mean (SD)
26.29 (3.75) 29.87 (3.31) 3.39 (0.32) 3.36 (0.36) 3.12(0.37) 2.93 (0.50) 3.16(0.48) 32.95 (18.82) 45.64 (22.69) 205.26 (17.34) 204.04 (20.61)
25.52 (3.36) 29.91 (3.22) 3.46 (0.29) 3.44 (0.32) 3.21 (0.35) 3.05 (0.48) 3.28 (0.41) 40.46(17.12) 54.03 (20.81) 209.35 (16.83) 206.82 (18.84)
Not Board Certified Number (Percentage)
Board Certified Number (Percentage)
Chi-Square Test
9 out of 46 (19.6) 18 out of 92 (19.6)
70 out of 485 (14.4) 145 out of 1060(13.7)
X2 (1) = 2.41
,-test
t (1,149) = 2.09* t (986) = —0.11 t (1,139) = -2.08* t (1,139) = -2.45* t (1,099) = -2.27* r (1,141) = -2.31* t (1,140) = -2.64** t (949) = -3.64** , (947) = -3.35** ,(1134) = -2.23* ,(1135) = -1.34
/ ( 1 ) = 0.87
*p < 0.05; **p < 0.01.
20
MILITARY MEDICINE, Vol. 180, April Supplement 2015
MILITARY MEDICINE, Vol. 180, April Supplement 2015 Matrix of Pearson Correlations Between Board Certification and Assessment Measurements
*p< 0.05; **p
