Publications by authors named "Brian Hess"

48 Publications

Using Kane's framework to build a validity argument supporting (or not) virtual OSCEs.

Med Teach 2021 Apr 9:1-6. Epub 2021 Apr 9.

Department of Certification and Assessment, The College of Family Physicians of Canada, Mississauga, Canada.

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http://dx.doi.org/10.1080/0142159X.2021.1910641DOI Listing
April 2021

Phase 1 trial of N-803, an IL-15 receptor agonist, with rituximab in patients with indolent non-Hodgkin lymphoma.

Clin Cancer Res 2021 Apr 8. Epub 2021 Apr 8.

Dept. of Medicine, Division of Oncology, Washington University in St. Louis School of Medicine

Purpose: N-803 is an IL-15 receptor superagonist complex, designed to optimize in vivo persistence and trans-presentation, thereby activating and expanding natural killer (NK) cells and CD8+ T cells. Monoclonal antibodies (mAb) direct FcR-bearing immune cells, including NK cells, to recognize and eliminate cancer targets. The ability of IL-15R agonists to enhance tumor-targeting mAbs in patients has not been previously reported.

Experimental Design: Relapsed/refractory indolent Non-Hodgkin's lymphoma patients were treated with rituximab and intravenous or subcutaneous N-803 on an open-label, dose-escalation phase 1 study using a 3+3 design (NCT02384954). Primary endpoint was maximum tolerated dose. Immune correlates were performed using multidimensional analysis via mass cytometry and cellular indexing of transcriptomes and epitopes by sequencing (CITE-seq) which simultaneously measures protein and single-cell RNA expression.

Results: This immunotherapy combination was safe and well-tolerated and resulted in durable clinical responses including in rituximab-refractory patients. Subcutaneous N-803 plus rituximab induced sustained proliferation, expansion, and activation of peripheral blood NK cells and CD8 T cells, with increased NK cell and T cells present 8 weeks following last N-803 treatment. CITE-seq revealed a therapy-altered NK cell molecular program, including enhancement of AP-1 transcription factor. Further, the monocyte transcriptional program was remodeled with enhanced MHC expression and antigen-presentation genes.

Conclusions: N-803 combines with mAbs to enhance tumor-targeting in patients, and warrants further investigation in combination with immunotherapies.
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http://dx.doi.org/10.1158/1078-0432.CCR-20-4575DOI Listing
April 2021

A Phase 1b Study to Evaluate the Safety and Efficacy of Durvalumab in Combination With Tremelimumab or Danvatirsen in Patients With Relapsed or Refractory Diffuse Large B-Cell Lymphoma.

Clin Lymphoma Myeloma Leuk 2020 Dec 17. Epub 2020 Dec 17.

Division of Hematology & Oncology, MUSC Health Hollings Cancer Center, Charleston, SC.

Background: Despite recent advances, outcomes in patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) remain poor. Immune checkpoint inhibitors have shown limited efficacy in this setting, but combinations with novel agents may enhance benefit. Combination therapy with durvalumab, an anti-programmed death ligand 1 (PD-L1) antibody, and danvatirsen (AZD9150; an antisense oligonucleotide inhibiting signal transducer and activator of transcription 3 [STAT3]) or tremelimumab (an anti-cytotoxic T-lymphocyte-associated antigen 4 [CTLA-4] antibody) may augment endogenous antitumor activity.

Patients And Methods: In this phase 1b dose escalation and dose expansion study, we evaluated durvalumab 20 mg/kg every 4 weeks plus either tremelimumab 1 mg/kg every 4 weeks or danvatirsen 2 or 3 mg/kg (administered on days 1, 3, 5, 8, 15, and 22, then every week). Treatment continued until disease progression. The primary endpoint was safety; secondary endpoints included efficacy, pharmacokinetics, and immunogenicity.

Results: As of April 4, 2019, 32 patients were enrolled and treated, receiving a median of 2 prior lines of systemic therapy. Treatment-related adverse events occurred in 21 patients (65.6%), most commonly alanine aminotransferase/aspartate aminotransferase increased (grade 1-3), anemia (grade 1-3), and fatigue (grade 1). The overall objective response rate was 6.3%, with 2 partial responses. Median time to response was 11.0 weeks (range, 7.7-14.3 weeks). Median progression-free survival was 7.4 weeks (range, 0.1-31.4 weeks), and median overall survival was 28.0 weeks (range, 1.9-115.4 weeks).

Conclusion: The primary endpoint was met, with durvalumab plus tremelimumab/danvatirsen generally well tolerated in patients with relapsed/refractory DLBCL; however, antitumor activity was limited.
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http://dx.doi.org/10.1016/j.clml.2020.12.012DOI Listing
December 2020

A call to understand the psychometric implications of virtual OSCE delivery.

Med Teach 2020 Nov 21:1-2. Epub 2020 Nov 21.

Director of Certification and Examinations, College of Family Physicians of Canada.

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http://dx.doi.org/10.1080/0142159X.2020.1849591DOI Listing
November 2020

Cranial flap fixation in sheep using a resorbable bone adhesive.

J Neurosurg 2020 Feb 7:1-9. Epub 2020 Feb 7.

5LaunchPad Medical, Lowell, Massachusetts.

Objective: The authors' goal in this study was to investigate the use of a novel, bioresorbable, osteoconductive, wet-field mineral-organic bone adhesive composed of tetracalcium phosphate and phosphoserine (TTCP-PS) for cranial bone flap fixation and compare it with conventional low-profile titanium plates and self-drilling screws.

Methods: An ovine craniotomy surgical model was used to evaluate the safety and efficacy of TTCP-PS over 2 years. Bilateral cranial defects were created in 41 sheep and were replaced in their original position. The gaps (kerfs) were completely filled with TTCP-PS (T1 group), half-filled with TTCP-PS (T2 group), or left empty and the flaps fixated by plates and screws as a control (C group). At 12 weeks, 1 year, and 2 years following surgery, the extent of bone healing, local tissue effects, and remodeling of the TTCP-PS were analyzed using macroscopic observations and histopathological and histomorphometric analyses. Flap fixation strength was evaluated by biomechanical testing at 12 weeks and 1 year postoperatively.

Results: No adverse local tissue effects were observed in any group. At 12 weeks, the bone flap fixation strengths in test group 1 (1689 ± 574 N) and test group 2 (1611 ± 501 N) were both statistically greater (p = 0.01) than that in the control group (663 ± 385 N). From 12 weeks to 1 year, the bone flap fixation strengths increased significantly (p < 0.05) for all groups. At 1 year, the flap fixation strength in test group 1 (3240 ± 423 N) and test group 2 (3212 ± 662 N) were both statistically greater (p = 0.04 and p = 0.02, respectively) than that in the control group (2418 ± 1463 N); however, there was no statistically significant difference in the strengths when comparing the test groups at both timepoints. Test group 1 had the best overall performance based on histomorphometric evaluation and biomechanical testing. At 2 years postoperatively, the kerfs filled with TTCP-PS had histological evidence of osteoconduction and replacement of TTCP-PS by bone with nearly complete osteointegration.

Conclusions: TTCP-PS was demonstrated to be safe and effective for cranial flap fixation in an ovine model. In this study, the bioresorbable, osteoconductive bone adhesive appeared to have multiple advantages over standard plate-and-screw bone flap fixation, including biomechanical superiority, more complete and faster bony healing across the flap kerfs without fibrosis, and the minimization of bone flap and/or hardware migration and loosening. These properties of TTCP-PS may improve human cranial bone flap fixation and cranioplasty.
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http://dx.doi.org/10.3171/2019.11.JNS192806DOI Listing
February 2020

Outcomes of patients with limited-stage aggressive large B-cell lymphoma with high-risk cytogenetics.

Blood Adv 2020 01;4(2):253-262

Roswell Park Comprehensive Cancer Center, Buffalo, NY.

There is a paucity of data regarding outcomes and response to standard therapy in patients with limited-stage (LS) agressive B-cell lymphoma (LS-ABCL) who harbor MYC rearrangement (MYC-R) with or without BCL2 and/or BCL6 rearrangements. We conducted a multicenter retrospective study of MYC-R LS-ABCL patients who received either rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), or more intensive immunochemotherapy (IIC) plus or minus consolidative involved-field radiation therapy (IFRT). One hundred four patients from 15 academic centers were included. Forty four patients (42%) received R-CHOP, of whom 52% had IFRT. Sixty patients (58%) received IIC, of whom 40% had IFRT. Overall response rate was 91% (84% complete response [CR]; 7% partial response). Patients with double-hit lymphoma (DHL; n = 40) had a lower CR rate compared with patients with MYC-R only (75% vs 98%; P = .003). CR rate was higher in the IFRT vs no-IFRT group (98% vs 72%; P < .001). Median follow-up was 3.2 years; 2-year progression-free survival (PFS) and overal survival (OS) were 78% and 86% for the entire cohort, and 74% and 81% for the DHL patients, respectively. PFS and OS were similar across treatment groups (IFRT vs no IFRT, R-CHOP vs IIC) in the entire cohort and in DHL patients. Our data provide a historical benchmark for MYC-R LS-ABCL and LS-DHL patients and show that outcomes for this population may be better than previously recognized. There was no benefit of using IIC over R-CHOP in patients with MYC-R LS-ABCL and LS-DHL.
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http://dx.doi.org/10.1182/bloodadvances.2019000875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988401PMC
January 2020

Outcomes in patients with aggressive B-cell non-Hodgkin lymphoma after intensive frontline treatment failure.

Cancer 2020 01 30;126(2):293-303. Epub 2019 Sep 30.

Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.

Background: Salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation is the standard-of-care second-line treatment for patients with relapsed/refractory diffuse large B-cell lymphoma after first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Outcomes after receipt of second-line immunochemotherapy in patients with aggressive B-cell lymphomas who relapse or are refractory to intensive first-line immunochemotherapy regimens (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab [R-EPOCH], rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine [R-HyperCVAD], rituximab, cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate alternating with ifosfamide, etoposide, and cytarabine [R-CODOX-M/IVAC]) remain unknown.

Methods: Outcomes of patients with non-Burkitt, aggressive B-cell lymphomas and relapsed/refractory disease after first-line treatment with intensive immunochemotherapy regimens who received platinum-based second-line immunochemotherapy were reviewed retrospectively. Analyses were performed to determine progression-free survival (PFS) and overall survival (OS) from the time of receipt of second-line immunochemotherapy.

Results: In total, 195 patients from 19 academic centers were included in the study. The overall response rate to second-line immunochemotherapy was 44%, with a median PFS of 3 months and a median OS of 8 months. Patients with early treatment failure (primary refractory or relapse <12 months from completion of first-line therapy) experienced inferior median PFS (2.8 vs 23 months; P < .001) and OS (6 months vs not reached; P < .001) compared with patients with late treatment failure. Although the 17% of patients with early failure who achieved a complete response to second-line immunochemotherapy experienced prolonged survival, this outcome could not be predicted by clinicopathologic features at the start of second-line immunochemotherapy.

Conclusions: Patients with early treatment failure after intensive first-line immunochemotherapy experience poor outcomes after receiving standard second-line immunochemotherapy. The use of standard-of-care or experimental therapies currently available in the third-line setting and beyond should be investigated in the second-line setting for these patients.
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http://dx.doi.org/10.1002/cncr.32526DOI Listing
January 2020

Snake Fungal Disease in Colubridae Snakes in Connecticut, USA in 2015 and 2017.

J Wildl Dis 2019 07 3;55(3):658-662. Epub 2019 Jan 3.

1 Department of Pathobiology and Veterinary Science, University of Connecticut, 61 N Eagleville Road, Storrs, Connecticut 06269, USA.

Snake fungal disease (SFD), caused by the fungus , is an emerging threat to wild snake populations in the US. Data regarding its distribution, prevalence, and population-level impacts are sparse, and more information is needed to better manage SFD in the wild. In this study, we captured 38 wild snakes of five species in Connecticut in the summers of 2015 and 2017. Skin lesions were biopsied and evaluated histologically for fungal dermatitis. At least one individual from each species was positive for SFD, and 48% of snakes sampled in 2015 and 39% of snakes sampled in 2017 were positive for SFD. A Dekay's brownsnake () with SFD lesions, captured in the summer of 2017, extended the host range of the disease. Thus, SFD was present in wild Connecticut snakes in 2015 and 2017, which demonstrated a wide-spread distribution throughout the state.
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http://dx.doi.org/10.7589/2018-04-100DOI Listing
July 2019

Heartland Virus and Hemophagocytic Lymphohistiocytosis in Immunocompromised Patient, Missouri, USA.

Emerg Infect Dis 2018 05;24(5):893-897

Heartland virus is a suspected tickborne pathogen in the United States. We describe a case of hemophagocytic lymphohistiocytosis, then death, in an immunosuppressed elderly man in Missouri, USA, who was infected with Heartland virus.
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http://dx.doi.org/10.3201/eid2405.171802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938783PMC
May 2018

Correlations Between Ratings on the Resident Annual Evaluation Summary and the Internal Medicine Milestones and Association With ABIM Certification Examination Scores Among US Internal Medicine Residents, 2013-2014.

JAMA 2016 Dec;316(21):2253-2262

American Board of Internal Medicine, Philadelphia, Pennsylvania.

Importance: US internal medicine residency programs are now required to rate residents using milestones. Evidence of validity of milestone ratings is needed.

Objective: To compare ratings of internal medicine residents using the pre-2015 resident annual evaluation summary (RAES), a nondevelopmental rating scale, with developmental milestone ratings.

Design, Setting, And Participants: Cross-sectional study of US internal medicine residency programs in the 2013-2014 academic year, including 21 284 internal medicine residents (7048 postgraduate-year 1 [PGY-1], 7233 PGY-2, and 7003 PGY-3).

Exposures: Program director ratings on the RAES and milestone ratings.

Main Outcomes And Measures: Correlations of RAES and milestone ratings by training year; correlations of medical knowledge ratings with American Board of Internal Medicine (ABIM) certification examination scores; rating of unprofessional behavior using the 2 systems.

Results: Corresponding RAES ratings and milestone ratings showed progressively higher correlations across training years, ranging among competencies from 0.31 (95% CI, 0.29 to 0.33) to 0.35 (95% CI, 0.33 to 0.37) for PGY-1 residents to 0.43 (95% CI, 0.41 to 0.45) to 0.52 (95% CI, 0.50 to 0.54) for PGY-3 residents (all P values <.05). Linear regression showed ratings differed more between PGY-1 and PGY-3 years using milestone ratings than the RAES (all P values <.001). Of the 6260 residents who attempted the certification examination, the 618 who failed had lower ratings using both systems for medical knowledge than did those who passed (RAES difference, -0.9; 95% CI, -1.0 to -0.8; P < .001; milestone medical knowledge 1 difference, -0.3; 95% CI, -0.3 to -0.3; P < .001; and medical knowledge 2 difference, -0.2; 95% CI, -0.3 to -0.2; P < .001). Of the 26 PGY-3 residents with milestone ratings indicating deficiencies on either of the 2 medical knowledge subcompetencies, 12 failed the certification examination. Correlation of RAES ratings for professionalism with residents' lowest professionalism milestone ratings was 0.44 (95% CI, 0.43 to 0.45; P < .001).

Conclusions And Relevance: Among US internal medicine residents in the 2013-2014 academic year, milestone-based ratings correlated with RAES ratings but with a greater difference across training years. Both rating systems for medical knowledge correlated with ABIM certification examination scores. Milestone ratings may better detect problems with professionalism. These preliminary findings may inform establishment of the validity of milestone-based assessment.
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http://dx.doi.org/10.1001/jama.2016.17357DOI Listing
December 2016

Medical Knowledge Assessment by Hematology and Medical Oncology In-Training Examinations Are Better Than Program Director Assessments at Predicting Subspecialty Certification Examination Performance.

J Cancer Educ 2017 Sep;32(3):647-654

Division of Hematology/Oncology, University of Michigan Health System and Veterans Affairs Ann Arbor Health System, C345 Med Inn Building/SPC 5848, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.

The Accreditation Council for Graduate Medical Education's Next Accreditation System requires training programs to demonstrate that fellows are achieving competence in medical knowledge (MK), as part of a global assessment of clinical competency. Passing American Board of Internal Medicine (ABIM) certification examinations is recognized as a metric of MK competency. This study examines several in-training MK assessment approaches and their ability to predict performance on the ABIM Hematology or Medical Oncology Certification Examinations. Results of a Hematology In-Service Examination (ISE) and an Oncology In-Training Examination (ITE), program director (PD) ratings, demographic variables, United States Medical Licensing Examination (USMLE), and ABIM Internal Medicine (IM) Certification Examination were compared. Stepwise multiple regression and logistic regression analyses evaluated these assessment approaches as predictors of performance on the Hematology or Medical Oncology Certification Examinations. Hematology ISE scores were the strongest predictor of Hematology Certification Examination scores (β = 0.41) (passing odds ratio [OR], 1.012; 95 % confidence interval [CI], 1.008-1.015), and the Oncology ITE scores were the strongest predictor of Medical Oncology Certification Examination scores (β = 0.45) (passing OR, 1.013; 95 % CI, 1.011-1.016). PD rating of MK was the weakest predictor of Medical Oncology Certification Examination scores (β = 0.07) and was not significantly predictive of Hematology Certification Examination scores. Hematology and Oncology ITEs are better predictors of certification examination performance than PD ratings of MK, reinforcing the effectiveness of ITEs for competency-based assessment of MK.
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http://dx.doi.org/10.1007/s13187-016-0993-6DOI Listing
September 2017

Pulmonary and Critical Care In-Service Training Examination Score as a Predictor of Board Certification Examination Performance.

Ann Am Thorac Soc 2016 Apr;13(4):481-8

7 American Board of Internal Medicine, Philadelphia, Pennsylvania.

Rationale: Most trainees in combined pulmonary and critical care medicine fellowship programs complete in-service training examinations (ITEs) that test knowledge in both disciplines. Whether ITE scores predict performance on the American Board of Internal Medicine Pulmonary Disease Certification Examination and Critical Care Medicine Certification Examination is unknown.

Objectives: To determine whether pulmonary and critical care medicine ITE scores predict performance on subspecialty board certification examinations independently of trainee demographics, program director competency ratings, fellowship program characteristics, and prior medical knowledge assessments.

Methods: First- and second-year fellows who were enrolled in the study between 2008 and 2012 completed a questionnaire encompassing demographics and fellowship training characteristics. These data and ITE scores were matched to fellows' subsequent scores on subspecialty certification examinations, program director ratings, and previous scores on their American Board of Internal Medicine Internal Medicine Certification Examination. Multiple linear regression and logistic regression were used to identify independent predictors of subspecialty certification examination scores and likelihood of passing the examinations, respectively.

Measurements And Main Results: Of eligible fellows, 82.4% enrolled in the study. The ITE score for second-year fellows was matched to their certification examination scores, which yielded 1,484 physicians for pulmonary disease and 1,331 for critical care medicine. Second-year fellows' ITE scores (β = 0.24, P < 0.001) and Internal Medicine Certification Examination scores (β = 0.49, P < 0.001) were the strongest predictors of Pulmonary Disease Certification Examination scores, and were the only significant predictors of passing the examination (ITE odds ratio, 1.12 [95% confidence interval, 1.07-1.16]; Internal Medicine Certification Examination odds ratio, 1.01 [95% confidence interval, 1.01-1.02]). Similar results were obtained for predicting Critical Care Medicine Certification Examination scores and for passing the examination. The predictive value of ITE scores among first-year fellows on the subspecialty certification examinations was comparable to second-year fellows' ITE scores.

Conclusions: The Pulmonary and Critical Care Medicine ITE score is an independent, and stronger, predictor of subspecialty certification examination performance than fellow demographics, program director competency ratings, and fellowship characteristics. These findings support the use of the ITE to identify the learning needs of fellows as they work toward subspecialty board certification.
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http://dx.doi.org/10.1513/AnnalsATS.201601-015OCDOI Listing
April 2016

How hospitalists work to pull healthcare teams together.

J Health Organ Manag 2015 ;29(7):933-47

Division of Assessment and Research, American Board of Internal Medicine, Philadelphia, Pennsylvania, USA.

Purpose: The purpose of this paper is to document everyday practices by which hospitalist physicians negotiate barriers to effective teamwork.

Design/methodology/approach: Ethnographic observation with a sample of hospitalists chosen to represent a range of hospital and practice types.

Findings: Hospitals rely on effective, interprofessional teamwork but typically do not support it. Hospitalist physicians must bridge the internal boundaries within their hospitals to coordinate their patients' care, but they face challenges - scattered patients, fragmented information, uncoordinated teams, and unreliable processes - that can impact the timeliness and safety of care. Hospitalists largely rely on personal presence and memory to deal with these challenges. Some invent low-tech supports for teamwork, but these are typically neither tested nor shared with others. Formal support for teamwork, primarily case management rounds, is applied unevenly and may not be respected by all team members.

Research Limitations/implications: The findings are drawn from observation over a limited period of time with a small, purposefully chosen sample of physicians and hospitals. Practical implications - Hospitals must recognize the issues hospitalists and other providers face, evaluate and disseminate supports for teamwork, and make interprofessional teamwork a core feature of hospital design and evaluation.

Originality/value: The authors show the nuances of how hospitalists struggle to practice teamwork in a challenging context, and how the approaches they take (relying on memory and personal presence) do not address, and may actually contribute to, the system-level problems they face.
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http://dx.doi.org/10.1108/JHOM-01-2015-0008DOI Listing
February 2017

The IL-15-Based ALT-803 Complex Enhances FcγRIIIa-Triggered NK Cell Responses and In Vivo Clearance of B Cell Lymphomas.

Clin Cancer Res 2016 Feb 30;22(3):596-608. Epub 2015 Sep 30.

Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.

Purpose: Anti-CD20 monoclonal antibodies (mAb) are an important immunotherapy for B-cell lymphoma, and provide evidence that the immune system may be harnessed as an effective lymphoma treatment approach. ALT-803 is a superagonist IL-15 mutant and IL-15Rα-Fc fusion complex that activates the IL-15 receptor constitutively expressed on natural killer (NK) cells. We hypothesized that ALT-803 would enhance anti-CD20 mAb-directed NK-cell responses and antibody-dependent cellular cytotoxicity (ADCC).

Experimental Design: We tested this hypothesis by adding ALT-803 immunostimulation to anti-CD20 mAb triggering of NK cells in vitro and in vivo. Cell lines and primary human lymphoma cells were utilized as targets for primary human NK cells. Two complementary in vivo mouse models were used, which included human NK-cell xenografts in NOD/SCID-γc (-/-) mice.

Results: We demonstrate that short-term ALT-803 stimulation significantly increased degranulation, IFNγ production, and ADCC by human NK cells against B-cell lymphoma cell lines or primary follicular lymphoma cells. ALT-803 augmented cytotoxicity and the expression of granzyme B and perforin, providing one potential mechanism for this enhanced functionality. Moreover, in two distinct in vivo B-cell lymphoma models, the addition of ALT-803 to anti-CD20 mAb therapy resulted in significantly reduced tumor cell burden and increased survival. Long-term ALT-803 stimulation of human NK cells induced proliferation and NK-cell subset changes with preserved ADCC.

Conclusions: ALT-803 represents a novel immunostimulatory drug that enhances NK-cell antilymphoma responses in vitro and in vivo, thereby supporting the clinical investigation of ALT-803 plus anti-CD20 mAbs in patients with indolent B-cell lymphoma.
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http://dx.doi.org/10.1158/1078-0432.CCR-15-1419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738096PMC
February 2016

Association of Physician Certification in Interventional Cardiology With In-Hospital Outcomes of Percutaneous Coronary Intervention.

Circulation 2015 Nov 18;132(19):1816-24. Epub 2015 Sep 18.

From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).

Background: The value of American Board of Internal Medicine certification has been questioned. We evaluated the Association of Interventional Cardiology certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010.

Methods And Results: We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined interventional cardiology (ICARD) certification status using American Board of Internal Medicine data. We compared in-hospital outcomes of patients treated by certified and noncertified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary end points were all-cause in-hospital mortality and bleeding complications. Secondary end points included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510,708 PCI procedures performed by 5175 physicians, case mix and unadjusted outcomes were similar among certified and noncertified physicians. The adjusted risks of in-hospital mortality (odds ratio, 1.10; 95% confidence interval, 1.02-1.19) and emergency coronary artery bypass grafting (odds ratio, 1.32; 95% confidence interval, 1.12-1.56) were higher in the non-ICARD-certified group, but the risks of bleeding and vascular complications and the composite end point were not statistically significantly different between groups.

Conclusions: We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency coronary artery bypass grafting in patients treated by non-ICARD-certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes and indicate a need to enhance the value of subspecialty certification.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.115.017523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4641797PMC
November 2015

Performance on the adult rheumatology in-training examination and relationship to outcomes on the rheumatology certification examination.

Arthritis Rheumatol 2015 Nov;67(11):3082-90

Massachusetts General Hospital, Boston.

Objective: The American College of Rheumatology (ACR) Adult Rheumatology In-Training Examination (ITE) is a feedback tool designed to identify strengths and weaknesses in the content knowledge of individual fellows-in-training and the training program curricula. We determined whether scores on the ACR ITE, as well as scores on other major standardized medical examinations and competency-based ratings, could be used to predict performance on the American Board of Internal Medicine (ABIM) Rheumatology Certification Examination.

Methods: Between 2008 and 2012, 629 second-year fellows took the ACR ITE. Bivariate correlation analyses of assessment scores and multiple linear regression analyses were used to determine whether ABIM Rheumatology Certification Examination scores could be predicted on the basis of ACR ITE scores, United States Medical Licensing Examination scores, ABIM Internal Medicine Certification Examination scores, fellowship directors' ratings of overall clinical competency, and demographic variables. Logistic regression was used to evaluate whether these assessments were predictive of a passing outcome on the Rheumatology Certification Examination.

Results: In the initial linear model, the strongest predictors of the Rheumatology Certification Examination score were the second-year fellows' ACR ITE scores (β = 0.438) and ABIM Internal Medicine Certification Examination scores (β = 0.273). Using a stepwise model, the strongest predictors of higher scores on the Rheumatology Certification Examination were second-year fellows' ACR ITE scores (β = 0.449) and ABIM Internal Medicine Certification Examination scores (β = 0.276). Based on the findings of logistic regression analysis, ACR ITE performance was predictive of a pass/fail outcome on the Rheumatology Certification Examination (odds ratio 1.016 [95% confidence interval 1.011-1.021]).

Conclusion: The predictive value of the ACR ITE score with regard to predicting performance on the Rheumatology Certification Examination supports use of the Adult Rheumatology ITE as a valid feedback tool during fellowship training.
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http://dx.doi.org/10.1002/art.39281DOI Listing
November 2015

Dyadic validity of the Decisional Conflict Scale: common patient/physician measures of patient uncertainty were identified.

J Clin Epidemiol 2015 Aug 21;68(8):920-7. Epub 2015 Mar 21.

Research Centre of the Centre Hospitalier Universitaire de Québec, Hôpital St-François d'Assise, 10 rue de l'Espinay, Quebec City, Quebec, G1L 3L5, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, 1050, avenue Ferdinand-Vandry, Quebec City, Quebec, G1V OA6, Canada. Electronic address:

Objectives: We aimed to assess the dyadic validity of the Decisional Conflict Scale (DCS) for assessing shared decision making in clinical consultations. We applied dyadic criteria, which consider the patient and physician as an interactive dyad instead of as independent individuals, to identify common patient/physician measures of patient uncertainty.

Study Design And Setting: Patients and their physicians, participating in a randomized clustered trial, completed separately an adapted version of the DCS with five subscales. We performed factor analysis on the full DCS and each subscale independently. We defined a measure as dyadic when measurement invariance across patients and physicians was supported.

Results: We analyzed 332 paired responses (physicians with adults or with parents and children) at study entry and 339 at exit. Factor analysis showed that the full DCS is not a valid dyadic measure. However, independent analysis of each subscale showed measurement invariance for values clarity, support, and effective decision (comparative fit index range, 0.93-1; root mean square error of approximation range, 0-0.07; and P-value > 0.05).

Conclusion: Application of our dyadic validation criterion indicated that the full DCS cannot be considered a dyadic measure. However, three of its subscales, values clarity, support and effective decision, are valid dyadic measures.
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http://dx.doi.org/10.1016/j.jclinepi.2015.03.005DOI Listing
August 2015

Assessing the Quality of Osteoporosis Care in Practice.

J Gen Intern Med 2015 Nov 9;30(11):1681-7. Epub 2015 May 9.

American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA, 19106, USA.

Background: Patients with osteoporosis can sustain fractures following falls or other minimal trauma. This risk of fracture can be reduced through appropriate diagnostic testing, pharmacologic therapy, and other readily measured standards of care.

Objectives: Our aim was to develop a credible clinical performance assessment to measure physicians' quality of osteoporosis care, and determine reasonable performance standards for both competent and excellent care.

Design: This was a retrospective cohort study.

Participants: Three hundred and eighty one general internists and subspecialists with time-limited board certification were included in the study.

Main Measures: Performance rates on eight evidence-based measures were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module® (PIM), a web-based tool that uses medical chart reviews to help physicians assess and improve care. We applied a patented methodology, using an adaptation of the Angoff standard-setting method and the Dunn-Rankin method, with an expert panel skilled in osteoporosis care to form a composite and establish standards for both competent and excellent care. Physician and practice characteristics, including a practice infrastructure score based on the Physician Practice Connections Readiness Survey (PPC-RS), were used to examine the validity of the inferences made from the composite scores.

Key Results: The mean composite score was 67.54 out of 100 maximum points with a reliability of 0.92. The standard for competent care was 46.87, and for excellent care it was 83.58. Both standards had high classification accuracies (0.95). Sixteen percent of physicians performed below the competent care standard, while 22 % met the excellent care standard. Specialists scored higher than generalists, and better practice infrastructure was associated with higher composite scores, providing some validity evidence.

Conclusions: We developed a rigorous methodology for assessing physicians' osteoporosis care. Clinical performance feedback relative to absolute standards of care provides physicians with a meaningful approach to self-evaluation to improve patient care.
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http://dx.doi.org/10.1007/s11606-015-3342-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617929PMC
November 2015

Assessing interprofessional teamwork: pilot test of a new assessment module for practicing physicians.

J Contin Educ Health Prof 2015 ;35(1):3-10

Introduction: Teamwork is a basic component of all health care, and substantial research links the quality of teamwork to safety and quality of care. The TEAM (Teamwork Effectiveness Assessment Module) is a new Web-based teamwork assessment module for practicing hospital physicians. The module combines self-assessment, multisource feedback from members of other professions and specialties with whom the physician exercises teamwork, and a structured review of those data with a peer to develop an improvement plan.

Methods: We conducted a pilot test of this module with hospitalist physicians to evaluate the feasibility and usefulness of the module in practice, focusing on these specific questions: Would physicians in hospitals of different types and sizes be able to use the module; would the providers identified as raters respond to the request for feedback; would the physicians be able to identify one or more "trusted peers" to help analyze the feedback; and how would physicians experience the module process overall?

Results: 20 of 25 physicians who initially volunteered for the pilot completed all steps of the TEAM, including identifying interprofessional teammates, soliciting feedback from their team, and identifying a peer to help review data. Module users described the feedback they received as helpful and actionable, and indicated this was information they would not have otherwise received.

Conclusions: The results suggest that a module combining self-assessment, multisource feedback, and a guided process for interpreting these data can provide help practicing hospital physicians to understand and potentially improve their interprofessional teamwork skills and behaviors.
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http://dx.doi.org/10.1002/chp.21267DOI Listing
December 2016

The relationship between performance on the Infectious Diseases In-Training and Certification Examinations.

Clin Infect Dis 2015 Mar 18;60(5):677-83. Epub 2014 Nov 18.

Department of Internal Medicine, University of Michigan, Ann Arbor.

Background: The Infectious Diseases Society of America In-Training Examination (IDSA ITE) is a feedback tool used to help fellows track their knowledge acquisition during fellowship training. We determined whether the scores on the IDSA ITE and from other major medical knowledge assessments predict performance on the American Board of Internal Medicine (ABIM) Infectious Disease Certification Examination.

Methods: The sample was 1021 second-year fellows who took the IDSA ITE and ABIM Infectious Disease Certification Examination from 2008 to 2012. Multiple regression analysis was used to determine if ABIM Infectious Disease Certification Examination scores were predicted by IDSA ITE scores, prior United States Medical Licensing Examination (USMLE) scores, ABIM Internal Medicine Certification Examination scores, fellowship director ratings of medical knowledge, and demographic variables. Logistic regression was used to evaluate if these same assessments predicted a passing outcome on the certification examination.

Results: IDSA ITE scores were the strongest predictor of ABIM Infectious Disease Certification Examination scores (β = .319), followed by prior ABIM Internal Medicine Certification Examination scores (β = .258), USMLE Step 1 scores (β = .202), USMLE Step 3 scores (β = .130), and fellowship directors' medical knowledge ratings (β = .063). IDSA ITE scores were also a significant predictor of passing the Infectious Disease Certification Examination (odds ratio, 1.017 [95% confidence interval, 1.013-1.021]).

Conclusions: The significant relationship between the IDSA ITE score and performance on the ABIM Infectious Disease Certification Examination supports the use of the ITE as a valid feedback tool in fellowship training.
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http://dx.doi.org/10.1093/cid/ciu906DOI Listing
March 2015

Blink or think: can further reflection improve initial diagnostic impressions?

Acad Med 2015 Jan;90(1):112-8

Dr. Hess is a consultant, Hess Consulting, St-Nicolas, Québec, Canada. Dr. Lipner is senior vice president of evaluation, research and development, American Board of Internal Medicine, Philadelphia, Pennsylvania. Dr. Thompson is professor of cognitive psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Holmboe is senior vice president of milestone development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. Dr. Graber is senior research fellow, RTI International, Research Triangle Park, North Carolina, and professor emeritus, at SUNY Stony Brook University School of Medicine, Stony Brook, New York.

Purpose: Experienced clinicians derive many diagnoses intuitively, because most new problems they see closely resemble problems they've seen before. The majority of these diagnoses, but not all, will be correct. This study determined whether further reflection regarding initial diagnoses improves diagnostic accuracy during a high-stakes board exam, a model for studying clinical decision making.

Method: Keystroke response data were used from 500 residents who took the 2010 American Board of Internal Medicine (ABIM) Internal Medicine Certification Examination. Data included time to initial response on each question, whether the answer was correct, and whether or not the resident changed her or his initial response. The focus was on 80 diagnosis questions that comprised realistic clinical vignettes with multiple-choice single-best answers. Cognitive skill (ability) was measured using overall exam scores. Case complexity was determined using item difficulty (proportion of examinees that correctly answered the question). A hierarchical generalized linear model was used to assess the relationship between time spent on initial responses and the probability of correctly answering the questions.

Results: On average, residents changed their responses on 12% of all diagnosis questions (or 9.6 questions out of 80). Changing an answer from incorrect to correct was almost twice as likely as changing an answer from correct to incorrect. The relationship between response time and accuracy was complex.

Conclusions: Further reflection appears to be beneficial to diagnostic accuracy, especially for more complex cases.
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http://dx.doi.org/10.1097/ACM.0000000000000550DOI Listing
January 2015

Specialty board certification in the United States: issues and evidence.

J Contin Educ Health Prof 2013 ;33 Suppl 1:S20-35

Senior Vice President, Evaluation, Research & Development, American Board of Internal Medicine.

Background: The American Board of Medical Specialties (ABMS) certification and maintenance of certification (MOC) programs strive to provide the public with guidance about a physician's competence. This study summarizes the literature on the effectiveness of these programs.

Method: A literature search was conducted for studies published between 1986 and April 2013 and limited to ABMS certification. A modified version of Kirkpatrick's 4 levels of program evaluation included the reaction of stakeholders to certification, the extent to which physicians are encouraged to improve, the relationship between performance in the programs and nonclinical external measures of physician competence, and the relationship of performance in the programs with clinical quality measures.

Results: Patients' and hospitals' value of board certification and physician participation in MOC are high. Physicians are conflicted as to whether the effort involved is worth its value. Self-reported evidence shows improvement in knowledge, practice infrastructure, communication with patients and peers, and clinical care. Certification performance is generally related to nonclinical external measures such as types of training, practice characteristics, demographics, and disciplinary actions. In general, physicians who are board certified provide better patient care, albeit the results have modest effect sizes and are not unequivocal.

Conclusions: Certification boards should continuously try to improve their programs in response to feedback from stakeholders, changes in the way physicians practice, as well as the growth in the fields of measurement and technology. Keeping pace with these changes in a responsible and evidence-based way is important.
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http://dx.doi.org/10.1002/chp.21203DOI Listing
April 2015

Development of an instrument to evaluate residents' confidence in quality improvement.

Jt Comm J Qual Patient Saf 2013 Nov;39(11):502-10

Hess Consulting, St-Nicolas, Québec, Canada.

Background: Practice-based learning and improvement is a core competency that all medical residents must demonstrate. Because confidence is important in translating competence into action, effective quality improvement (QI) curricula should evaluate trainees' knowledge and confidence to perform QI. Past efforts to assess educational outcomes in QI have not adequately evaluated trainees' confidence from a multidimensional perspective.

Methods: Participants--732 internal medicine and family medicine residents from 42 training programs in the United States--completed the 31-item Quality Improvement Confidence Instrument (QICI), which was developed to measure confidence in six QI skill domains based on the Institute for Healthcare Improvement model ofQI. Confirmatory factor analysis was performed to support construct validity. Multivariate analysis of covariance was used to examine associations between residents' QI experience and other characteristics with confidence scores.

Results: Confirmatory factor analysis supported the QICI's multidimensional structure. Individual items yielded adequate variability, and reliability estimates for all six domains were high (> 0.86). On average, residents rated their confidence lowest for skills pertaining to choosing a target for improvement (specifically, using methods to evaluate interventions and to identify sources of process errors) and for testing a change in practice using specific tools for data collection and analysis. After controlling for program year and other characteristics, residents with previous QI experience reported significantly greater QI confidence.

Conclusion: The QICI offers a psychometrically rigorous approach to evaluating residents' confidence levels. It can be used to gauge the appropriateness of a trainee's confidence against actual QI performance.
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http://dx.doi.org/10.1016/s1553-7250(13)39066-7DOI Listing
November 2013

Practice-based learning can improve osteoporosis care.

J Am Geriatr Soc 2013 Oct;61(10):1651-60

Hess Consulting, St-Nicolas, Québec, Canada.

Objectives: To examine physician engagement in practice-based learning using a self-evaluation module to assess and improve their care of individuals with or at risk of osteoporosis.

Design: Retrospective cohort study.

Setting: Internal medicine and subspecialty clinics.

Participants: Eight hundred fifty U.S. physicians with time-limited certification in general internal medicine or a subspecialty.

Measurements: Performance rates on 23 process measures and seven practice system domain scores were obtained from the American Board of Internal Medicine (ABIM) Osteoporosis Practice Improvement Module (PIM), an Internet-based self-assessment module that physicians use to improve performance on one targeted measure. Physicians remeasured performance on their targeted measures by conducting another medical chart review.

Results: Variability in performance on measures was found, with observed differences between general internists, geriatricians, and rheumatologists. Some practice system elements were modestly associated with measure performance; the largest association was between providing patient-centered self-care support and documentation of calcium intake and vitamin D estimation and counseling (correlation coefficients from 0.20 to 0.28, Ps < .002). For all practice types, the most commonly selected measure targeted for improvement was documentation of vitamin D level (38% of physicians). On average, physicians reported significant and large increases in performance on measures targeted for improvement.

Conclusion: Gaps exist in the quality of osteoporosis care, and physicians can apply practice-based learning using the ABIM PIM to take action to improve the quality of care.
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http://dx.doi.org/10.1111/jgs.12451DOI Listing
October 2013

Internists' views of maintenance of certification: a stages-of-change perspective.

J Contin Educ Health Prof 2013 ;33(2):99-108

American Board of Internal Medicine, Philadelphia, PA 19106, USA.

Introduction: Board certification has evolved from a "point-in-time" event to a process of periodic learning and reevaluation of medical competence through maintenance of certification (MOC). To better understand MOC participation, the transtheoretical model (TTM) was used to describe physicians' perceptions of MOC as a sequence of attitudinal changes.

Method: Data were from a survey of internal medicine (IM) physicians' attitudes toward periodic reevaluation through MOC. An overall importance or decisional balance score was computed for each physician by summing his or her ratings across the 10 quality measures. The decisional balance score was used to classify physicians according to their acceptance of MOC, aligned with the 3 early TTM stages-of-change groups-precontemplation (PC), contemplation (C), and preparation (P)-where PC was least accepting and P was most accepting. Effect sizes assessed whether differences in attitudes toward reevaluation via MOC were of sufficient magnitude to support the TTM principles.

Results: The difference in degree of acceptance of MOC between the P group and the PC and C groups was significant (p < 0.001), but the effect size was lower than predicted by the "strong" principle. Resistance to MOC for the PC and C groups was significantly greater than the P group (p < 0.001) and supported the "weak" principle. Physicians' beliefs about how often they should demonstrate performance on quality measures aligned well with the American Board of Internal Medicine's MOC requirements, with the P group believing in more frequent assessments than the PC and C groups (p < 0.001).

Conclusions: Results show that physicians in the Preparation stage had overcome resistance to MOC as predicted by the "weak" principle of the TTM, but their attitude scores about the benefits of MOC were below what was expected by theory. This suggests that the structure of MOC may have made it easier for physicians to overcome barriers to MOC participation but may have lacked adequate resources to promote the benefits of participating in the process. More effort is needed to understand the specific benefits of MOC for reevaluating competencies, how to engage physicians and other stakeholders in the design of MOC, and how to communicate the rationale and evidence to those who are less accepting of MOC.
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http://dx.doi.org/10.1002/chp.21172DOI Listing
September 2013

Examining changes in certification/licensure requirements and the international medical graduate examinee pool.

Adv Health Sci Educ Theory Pract 2014 Mar 20;19(1):19-28. Epub 2013 Apr 20.

Foundation for Advancement of International Medical Education and Research (FAIMER®), 3624 Market Street, 4th Floor, Philadelphia, PA, 19104, USA,

Changes in certification requirements and examinee characteristics are likely to influence the validity of the evidence associated with interpretations made based on test data. We examined whether changes in Educational Commission for Foreign Medical Graduates (ECFMG) certification requirements over time were associated with changes in internal medicine (IM) residency program director ratings and certification examination scores. Comparisons were made between physicians who were ECFMG-certified before and after the Clinical Skills Assessment (CSA) requirement. A multivariate analysis of covariance was conducted to examine the differences in program director ratings based on CSA cohort and whether the examinees emigrated for undergraduate medical education (national vs. international students). A univariate analysis of covariance was conducted to examine differences in scores from the American Board of Internal Medicine (ABIM) Internal Medicine Certification Examination. For both analyses, United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores were used as covariates. Results indicate that, of those certified by ECFMG between 1993 and 1997, 17 % (n = 1,775) left their country of citizenship for undergraduate medical education. In contrast, 38 % (n = 1,874) of those certified between 1999 and 2003 were international students. After adjustment by covariates, the main effect of cohort membership on the program director ratings was statistically significant (Wilks' λ = 0.99, F 5, 15391 = 19.9, P < 0.001). However, the strength of the relationship between cohort group and the ratings was weak (η = 0.01). The main effect of migration status was statistically significant and weak (Wilks' λ = 0.98, F 5,15391 = 45.3, P < 0.01; η = 0.02). Differences in ABIM Internal Medicine Certification Examination scores based on whether or not CSA were required was statistically significant, although the magnitude of the association between these variables was very small. The findings suggest that the implementation of an additional evaluation of skills (e.g., history-taking, physical examination) as a prerequisite to postgraduate medical education (residency) provides some additional, relevant data to those who select ECFMG-certified residents.
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http://dx.doi.org/10.1007/s10459-013-9456-6DOI Listing
March 2014

Variability in obtaining institutional review board approval for quality improvement activities in residency programs.

J Grad Med Educ 2012 Mar;4(1):106-8

Introduction: Quality improvement (QI) activities are an important part of residency training. National studies are needed to inform best practices in QI training and experience for residents. The impact of the Institutional Review Board (IRB) process on such studies is not well described.

Methods: This observational study looked at time, length, comfort level, and overall quality of experience for 42 residency training programs in obtaining approval or exemption for a nationally based educational QI study.

Results: For the 42 programs in the study, the time period to IRB approval/exemption was highly variable, ranging from less than 1 week to 56.5 weeks; mean and median time was approximately 18 weeks (SD, 10.8). Greater reported comfort with the IRB process was associated with less time to obtain approval (r  =  -.50; P < .01; 95% CI, -0.70 to -0.23). A more positive overall quality of experience with the IRB process was also associated with less time to obtain IRB approval (r  =  -.60; P < .01; 95% CI, -0.74 to -0.36).

Discussion: The IRB process for residency programs initiating QI studies shows considerable variance that is not explained by attributes of the projects. New strategies are needed to assist and expedite IRB processes for QI research in educational settings and reduce interinstitutional variability and increase comfort level among educators with the IRB process.
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http://dx.doi.org/10.4300/JGME-D-11-00176.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312516PMC
March 2012

Physician performance assessment: prevention of cardiovascular disease.

Adv Health Sci Educ Theory Pract 2013 Dec 16;18(5):1029-45. Epub 2013 Feb 16.

American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA, 19106, USA,

Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight evidence-based clinical measures from 811 physicians that completed the American Board of Internal Medicine's Preventive Cardiology Practice Improvement Module(SM) to form an overall composite score for preventive cardiology care. An expert panel of nine internists/cardiologists skilled in preventive care for cardiovascular disease used an adaptation of the Angoff standard-setting method and the Dunn-Rankin method to create the composite and establish a standard. Physician characteristics were used to examine the validity of the inferences made from the composite scores. The mean composite score was 73.88 % (SD = 11.88 %). Reliability of the composite was high at 0.87. Specialized cardiologists had significantly lower composite scores (P = 0.04), while physicians who reported spending more time in primary, longitudinal, and preventive consultative care had significantly higher scores (P = 0.01), providing some evidence of score validity. The panel established a standard of 47.38 % on the composite measure with high classification accuracy (0.98). Only 2.7 % of the physicians performed below the standard for minimally acceptable preventive cardiovascular disease care. Of those, 64 % (N = 14) were not general cardiologists. Our study presents a psychometrically defensible methodology for assessing physician performance in preventive cardiology while also providing relative feedback with the hope of heightening physician awareness about deficits and improving patient care.
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http://dx.doi.org/10.1007/s10459-013-9447-7DOI Listing
December 2013

A new tool to give hospitalists feedback to improve interprofessional teamwork and advance patient care.

Health Aff (Millwood) 2012 Nov;31(11):2485-92

American Board of Internal Medicine (ABIM), Philadelphia, Pennsylvania, USA.

Teamwork is a vital skill for health care professionals, but the fragmented systems within which they work frequently do not recognize or support good teamwork. The American Board of Internal Medicine has developed and is testing the Teamwork Effectiveness Assessment Module (TEAM), a tool for physicians to evaluate how they perform as part of an interprofessional patient care team. The assessment provides hospitalist physicians with feedback data drawn from their own work of caring for patients, in a way that is intended to support immediate, concrete change efforts to improve the quality of patient care. Our approach demonstrates the value of looking at teamwork in the real world of health care-that is, as it occurs in the actual contexts in which providers work together to care for patients. The assessment of individual physicians' teamwork competencies may play a role in the larger effort to bring disparate health professions together in a system that supports and rewards a team approach in hope of improving patient care.
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http://dx.doi.org/10.1377/hlthaff.2011.0611DOI Listing
November 2012

Development and growth of a large multispecialty certification examination: sleep medicine certification--results of the first three examinations.

J Clin Sleep Med 2012 Apr 15;8(2):221-4. Epub 2012 Apr 15.

Division of Sleep Medicine, Harvard Medical School, 401 Park Dr., 2nd Floor East, Boston, MA 02215, USA.

This paper summarizes the results of the first three examinations (2007, 2009, and 2011) of the Sleep Medicine Certification Examination, administered by its six sponsoring American Board of Medical Specialty Boards. There were 2,913 candidates who took the 2011 examination through one of three pathways-self-attested practice experience, previous certification by the American Board of Sleep Medicine, or formal Sleep Medicine fellowship training. The 2011 exam was the last administration in which candidates who had not previously been admitted could take it without completion of formal Sleep Medicine fellowship training. As expected, the number of candidates admitted to the 2011 examination through the practice experience pathway increased, and the overall scores of these candidates were on average lower than the other candidates. Consequently, the pass rate for all first takers of the 2011 examination (65%) was lower than that observed from the 2009 examination (78%) and the 2007 examination (73%). For each administration, candidates admitted through the fellowship training pathway scored the highest; over 90% of them passed the 2011 and 2009 examinations.
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http://dx.doi.org/10.5664/jcsm.1790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311423PMC
April 2012