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J J Norcini

Publications and source records attributed to J J Norcini.

At least 37 records · Page 2Linked to original sources
PubMed1994

Methods of preparing for the Certifying Examination in internal medicine and their efficacy.

Candidates for the 1991 Certifying Examination were asked how they prepared for the examination. There were 2,780 respondents (32% of the eligible candidates). The responding candidates used a mean of 5.2 study methods and gave higher educational value ratings to methods used most frequently. Regression analyses showed no independent contribution of study method or effort to explaining the variance in score for first-time takers, and a 2% contribution for repeat takers. Program director ratings were the most important predictors of score for first-time takers and previous examination score for repeat takers. Intensive study is likely to produce at most a small improvement in performance.

Certification↗
PubMed1994

Certification in internal medicine: 1989-1992.

OBJECTIVE: To determine whether changes in the demographic/educational mix of those entering internal medicine from 1986 to 1989 were associated with differences among them at the time of certification. PARTICIPANTS: Included in the study were all candidates for the 1989 to 1992 American Board of Internal Medicine certifying examinations in internal medicine. MEASUREMENTS: Demographic information and medical school, residency training, and examination experience were available for each candidate. Data defining quality, size, and number of subspecialties were available for internal medicine training programs. RESULTS: From 1990 to 1992, the total number of men and women candidates increased as did the numbers of foreign-citizen non-U.S. medical school graduates and osteopathic medical school graduates; the number of U.S. medical school graduates remained nearly constant and the number of U.S.-citizen graduates of non-U.S. medical schools declined. The pass rates for all groups of first-time examination takers decreased, while the ratings of program directors remained relatively constant. Program quality, size, and number of subspecialty programs had modest positive relationships with examination performance. CONCLUSIONS: Changes in the characteristics of those entering internal medicine from 1986 to 1989 were associated with declines in performance at the time of certification. These declines occurred in all content areas of the test and were apparent regardless of program quality. These data identify some of the challenges internal medicine faces in the years ahead.

Certification↗
PubMed1994

Pilot study of the use of the ECFMG clinical competence assessment to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors. Educational Commission for Foreign Medical Graduates.

PURPOSE: To conduct the first of a series of pilot projects of the clinical competence assessment (CCA) of the Educational Commission for Foreign Medical Graduates (ECFMG) in order to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors in the United States and for governments and institutions in other countries. METHOD AND RESULTS: In September 1992 the first pilot project of the ECFMG CCA was conducted for a program director who wanted to evaluate ten first-year residents in a midwestern U.S. program. The CCA consists of integrated clinical encounters with ten standardized patients, 60 laser videodisc pictorials, and analysis of test items of previously completed ECFMG certification examinations. Profiles of the following clinical competencies were provided to the program director: data gathering (history and physical examination), interviewing and interpersonal skills, diagnosis and management skills, interpretation of diagnostic and laboratory procedures, written communication of information to the health care team, and spoken-English proficiency. The profiles were provided as individual scores compared with mean scores of a reference group of 525 first-year residents who took the CCA at four U.S. assessment centers, and as percentile scores with a range of one standard error of measurement. CONCLUSION: The individual performance data in this first pilot project were valuable to the program director, who used them to supplement scores on a written examination during the first residency year. The pilot project has shown the ECFMG CCA to be a useful tool for program directors to evaluate applicants and residents who are graduates of foreign medical schools.

Clinical Competence↗
PubMed1994

Recertification in the medical specialties.

To summarize, this paper presents three goals for an ideal rectification program. Based on these goals, two dimensions of an evaluation system for recertification are described. The first dimension focuses on what needs to be assessed and how it is measured, including assessments of practice, potential, and nontechnical aspects of practice. The second dimension is composed of three issues that cut across the assessment components: pathways to recertification, content of the assessments, and standards. It will take decades for the Boards work through these issues, but the result will be credibility in the eyes of the public and enhanced recognition in the eyes of the profession.

Certification↗
PubMed1994

Research on standards for professional licensure and certification examinations.

The purpose of this article is to outline an agenda for research on standards for professional licensure and certification examinations. To avoid confusion, scores are defined as content-based decisions about the correctness of responses, and standards refer to the educational/social decisions about how many questions need to be answered correctly to pass. Standards are the focus of this article. The two major types of standards, relative and absolute, are described and the major standard-setting methods for each are presented. Some of the published results in four different areas are reviewed: (a) basis of the judgements, (b) efficiency of the process, (c) group effects, and (d) content and expertise effects. Topics for future research in all four areas are identified.

Certification↗
PubMed1993

ECFMG assessment of clinical competence of graduates of foreign medical schools. Educational Commission for Foreign Medical Graduates.

OBJECTIVE: To develop an assessment of clinical competence of graduates of foreign medical schools and to determine the reliability and validity of the assessment and the feasibility of large-scale administration. DESIGN: The Educational Commission for Foreign Medical Graduates (ECFMG) clinical competence study included (1) clinical encounters with standardized patients to assess history taking, physical examination, and communication skills; (2) laser videodisk pictorials to assess identification and interpretation of diagnostic procedures; (3) written clinical vignettes to assess diagnosis and management skills; and (4) assessment of spoken English. A uniform method of operating the test centers and of training the standardized patients was developed. SETTING: Medical schools and their primary teaching hospitals and affiliated hospitals. PARTICIPANTS: Six hundred twenty-four first-year residents, of whom 525 are graduates of foreign medical schools. MAIN OUTCOME MEASURES: Scores, reliability coefficients, validity measures, feasibility of multisite administration, trends of scores over time, and acceptability by examinees. RESULTS: The ECFMG clinical competence assessment was conducted at four geographically separate test centers. Reliability coefficients were high (.85) for the integrated clinical encounter and were in a reasonable range (.71 to .82) for all test components. The assessment adds to the predictability of the residents' performance in the hospital over that of current ECFMG certification examinations. Test security was addressed by demonstrating no consistent pattern of change in scores over testing dates. Virtually all examinees thought the assessment was appropriate. Standardized patients were able to assess spoken English accurately. CONCLUSION: The feasibility of conducting a reliable and valid test of clinical competence for graduates of foreign medical schools was demonstrated for this test population.

Clinical Competence↗
PubMed1993

The relevance to clinical practice of the certifying examination in internal medicine.

OBJECTIVE: To determine the relevance of the initial certifying examination to the practice of internal medicine and the suitability of items used in initial certification for recertification. DESIGN: Using a matrix-sampling approach, items from the 1991 Certifying Examination were assigned to two sets of judges: directors of the American Board of Internal Medicine (ABIM) and practicing general internists. Each judge rated the relevance of items on a five-point scale. PARTICIPANTS: 54 current or former directors of the ABIM and 72 practicing general internists; practitioners were nominated by directors and their ratings were included if they spent > 80% of their time in direct patient care. RESULTS: The directors' mean rating of all 576 items was 3.98 (SD = 0.62); the practitioners' mean rating was 4.11 (SD = 0.82). The directors assigned to 27 items ratings of less than 3 and the practitioners assigned to 42 items ratings of less than 3; seven of these items received low ratings from both groups. There were differences in the two groups' ratings of the relevance of various medical content categories, but the mean rating of core items was higher than that of noncore items and the mean rating of items testing clinical judgment was higher than that of items testing knowledge or synthesis. CONCLUSIONS: These findings suggest that the initial certifying examination is relevant to clinical practice and that many of the examination items are suitable for use in recertification. Differences in perception appear to exist between practitioners and directors, and the use of practitioner ratings is likely to be a routine part of judging the suitability of items for Board examinations in the future.

Certification↗
PubMed1993

A core component of the certification examination in internal medicine.

OBJECTIVE: To develop and test the psychometric characteristics of an examination of core content in internal medicine. DESIGN: A cross-sectional pilot test comparing the core examination with the 1988 certifying examination and two pretest examinations. SETTING: The 1988 certifying examination of the American Board of Internal Medicine. PARTICIPANTS: A random sample of 2,975 candidates from 8,968 candidates who took the 1988 certifying examination were given the core examination; similarly drawn samples were each given one of two pretests of traditional questions. INTERVENTIONS: A framework for developing an examination of core internal medicine questions was designed and used to develop a 92-question core test with an absolute pass/fail standard. RESULTS: Candidates answered 74% of core internal medicine questions, compared with 64%, 52%, and 53% of traditional questions on the 1988 certifying examination and the two pretests. The discriminating ability of the core internal medicine examination was lower than that of the certifying examination (r-values were 0.28 and 0.34, respectively). The pass rate was 83% for the core internal medicine examination and 57% for the certifying examination; 27% passed the core examination and failed the certifying examination; 1% passed the certifying examination and failed the core examination. CONCLUSION: Core internal medicine questions were easier than but almost as discriminating as traditional questions of the certifying examination. A small percentage of candidates passed the certifying examination but failed the core examination.

Certification↗
PubMed1991

Changes over time in the knowledge base of practicing internists.

OBJECTIVE: To determine factors affecting the knowledge base of practicing internists. DESIGN: An 82-item multiple-choice examination with questions from the 1988 American Board of Internal Medicine (ABIM) certifying examination was used to assess the knowledge base of 289 internists. SETTING AND PARTICIPANTS: Participants were selected from among practicing internists in New York, New Jersey, and Pennsylvania who had received ABIM certification 5 to 15 years previously. RESULTS: significant inverse correlation (r = -.30) was found between examination scores and the number of years elapsed since certification. Knowledge declined sharply within 15 years of certification. In addition, procedure-oriented subspecialists (cardiologists and gastroenterologists) had lower scores than other internists in this examination of general medical knowledge. Multivariate analyses showed that independent variables that predicted test performance were initial ABIM certifying examination score, time elapsed since certification, subspecialty classification, medical school type, and residency type. CONCLUSIONS: These results support the recent decision for time-limited certification of internists and raise questions related to content and standard setting for recertification examinations.

Certification↗
PubMed1991

Changes in the medical knowledge of candidates for certification.

PURPOSE: To determine whether the medical knowledge of candidates from different types of medical schools changed between 1983 and 1988. SUBJECTS: Candidates for certification who took the 1983 to 1988 examinations in internal medicine were divided into five groups according to the type and location of the medical school they had attended and, in some instances, their citizenship: graduates of U.S. medical schools, of Canadian medical schools, and of osteopathic medical schools as well as U.S. citizens who graduated from foreign medical schools and non-U.S. citizens who graduated from foreign medical schools. DESIGN: Performance on items that were common to four pairs of the 1983 to 1988 certifying examinations (1983 and 1985, 1984 and 1986, 1985 and 1987, and 1986 and 1988) was analyzed. RESULTS: The scores of graduates of U.S. medical schools decreased, and the scores of non-U.S. citizens who graduated from foreign medical schools increased. Trends in the performance of graduates of Canadian and osteopathic medical schools and of U.S. citizens who graduated from foreign medical schools were not discernible. CONCLUSIONS: The cumulative decline in the performance of graduates from U.S. medical schools and the progressive improvement in the performance of non-U.S. citizens who graduated from foreign medical schools may ultimately manifest itself in patient care.

Canada↗
PubMed1990

Performances of U.S. osteopathic and Canadian medical school graduates on the American Board of Internal Medicine Certifying Examinations, 1984-1988.

The performances of Canadian medical school graduates and U.S. osteopathic medical school graduates who first took the American Board of Internal Medicine Certifying Examination between 1984 and 1988 were compared with the performances, during the same period, of U.S. and foreign medical school graduates. Approximately 100 Canadian graduates took the examination each year; by 1988 the number of osteopathic graduates taking it was 102, double the number participating in 1984. Nearly all the Canadian graduates attended university or university-affiliated residencies, whereas half of the osteopathic graduates attended non-university-affiliated programs. For their overall clinical competence and for the eight components of clinical competence, the Canadian graduates were rated highest, followed by the U.S., osteopathic, and foreign graduates. The Canadians' average examination scores were also highest. The authors discuss the relatively low level of performance of the osteopathic graduates, but conclude that these graduates appear to be an untapped source of talented physicians for internal medicine residencies. The limitations of studying self-selected groups of candidates are also discussed.

Canada↗