ImportanceDespite 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.ObjectiveTo examine the association between physicians’ milestone ratings and certification examination scores and hospital outcomes for their patients.Design, Setting, and ParticipantsRetrospective 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 MeasuresPrimary 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.ExposuresCertification 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.ResultsAmong 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 RelevanceAmong newly trained hospitalists, certification examination score, but not residency milestone ratings, was associated with improved outcomes among hospitalized Medicare beneficiaries.

中文翻译：

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内科住院医师里程碑评级和认证考试分数与患者结果的关联

重要性尽管它对内科实习生的医学教育和能力评估很重要，但有关医生的里程碑住院医师评级或美国内科医学委员会的初始认证考试与其住院患者的结果之间关系的证据很少。里程碑评级和认证考试分数以及患者的医院结果。设计、设置和参与者对 6898 名住院医师进行回顾性队列分析，这些住院医师于 2016 年至 2018 年完成培训，并在 2017 年至 2019 年住院期间照顾 Medicare 按服务收费受益人。主要结果和指标主要结果指标包括 7 天死亡率和再入院率。还评估了三十天死亡率和再入院率、住院时间和亚专科咨询频率。分析考虑了医院固定效应，并根据患者特征、医生经验年数和年份进行调整。暴露认证考试分数四分位数和里程碑评级，包括总体核心能力评级指标，等于住院医师里程碑子能力评级结束时的平均值，分类为低、中、或高，知识核心能力衡量标准分类类似。结果在 455 120 例住院治疗中，患者中位年龄为 79 岁（IQR，73-86 岁），56.5% 的患者为女性，1.9% 为亚裔，9.8% 为黑人，4.6% 是西班牙裔，81.9% 是白人。 7 天死亡率和再入院率分别为 3.5% (95% CI, 3.4%-3.6%) 和 5.6% (95% CI, 5.5%-5.6%)，分别为 8.8% (95% CI, 8.7%) 30 天死亡率和再入院率分别为 -8.9%）和 16.6%（95% CI，16.5%-16.7%）。平均住院时间和专科咨询次数分别为 3.6 天（95% CI，3.6-3.6 天）和 1.01（95% CI，1.00-1.03）。总体或知识里程碑核心能力评级的高与低与评估的任何结果指标均无关。例如，总体核心能力评级的高与低与 7 天死亡率 2.7% 的非显着增加相关（95% CI，-5.2% 至 10.6%；磷= .51）。相比之下，考试分数最高与最低四分位数与 7 天死亡率显着降低 8.0% 相关（95% CI，-13.0% 至 -3.1%；磷= .002），7 天再入院率降低 9.3%（95% CI，-13.0% 至 -5.7%；磷< .001）。对于 30 天死亡率，这种关联为 -3.5%（95% CI，-6.7% 至 -0.4%；磷= .03)。检查分数最高与最低四分位数与 2.4% 的就诊次数增加相关（95% CI，0.8%-3.9%；磷< .003），但与住院时间或 30 天再入院率无关。结论和相关性在新培训的住院医师中，认证考试分数（而非住院医师里程碑评级）与住院医疗保险受益人的结局改善相关。