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Original Investigation |

Informal Peer Interaction and Practice Type as Predictors of Physician Performance on Maintenance of Certification Examinations

Melissa A. Valentine, PhD1,2; Sigal Barsade, PhD3; Amy C. Edmondson, PhD1; Amit Gal, MA, MsC4; Robert Rhodes, MD5
[+] Author Affiliations
1Harvard Business School, Harvard University, Boston, Massachusetts
2now with Department of Management Science and Engineering, Stanford University, Stanford, California
3Wharton School, University of Pennsylvania, Philadelphia
4Recanati Business School, Tel Aviv University, Tel Aviv, Israel
5American Board of Surgery, Philadelphia, Pennsylvania
JAMA Surg. 2014;149(6):597-603. doi:10.1001/jamasurg.2014.183.
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Importance  Physicians can demonstrate mastery of the knowledge that supports continued clinical competence by passing a maintenance of certification examination (MOCEX). Performance depends on professional learning and development, which may be enhanced by informal routine interactions with colleagues. Some physicians, such as those in solo practice, may have less opportunity for peer interaction, thus negatively influencing their examination performance.

Objective  To determine the relationship among level of peer interaction, group and solo practice, and MOCEX performance.

Design, Setting, and Participants  Longitudinal cohort study of 568 surgeons taking the 2008 MOCEX. Survey responses reporting the level of physicians’ peer interactions and their practice type were related to MOCEX scores, controlling for initial qualifying examination scores, practice type, and personal characteristics.

Exposures  Solo practice and amount of peer interaction.

Main Outcomes and Measures  Scores on the MOCEX and pass-fail status.

Results  Of the 568 surgeons in the study sample, 557 (98.1%) passed the examination. Higher levels of peer interaction were associated with a higher score (β = 0.91 [95% CI, 0.31-1.52]) and higher likelihood of passing the examination (odds ratio, 2.58 [1.08-6.16]). Physicians in solo (vs group) practice had fewer peer interactions (β = −0.49 [95% CI, −0.64 to −0.33), received lower scores (β = −1.82 [−2.94 to −0.82]), and were less likely to pass the examination (odds ratio, 0.22 [0.06-0.77]). Level of peer interaction moderated the relationship between solo practice and MOCEX score; solo practitioners with high levels of peer interaction achieved an MOCEX performance on a par with that of group practitioners.

Conclusions and Relevance  Physicians in solo practice had poorer MOCEX performance. However, solo practitioners who reported high levels of peer interaction performed as well as those in group practice. Peer interaction is important for professional learning and quality of care.

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Figures

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Figure 1.
Level of Peer Interaction by Practice Type

Data are from Maintenance of Certification Examination registration forms and participant surveys. Bar graphs report unadjusted bivariate relationships.

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Figure 2.
Surgeon Performance on the 2008 Maintenance of Certification Examination (MOCEX)

Data are stratified by practice type and level of peer interaction. A, Mean 2008 MOCEX scores stratified by practice type. B, Percentage of surgeons who failed the 2008 MOCEX by practice type. C, Mean 2008 MOCEX scores stratified by level of peer interaction. D, Percentage of surgeons who failed the 2008 MOCEX by level of peer interaction. Data were obtained from surveys linked with actual MOCEX performance. Bar graphs report unadjusted bivariate relationships.

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Figure 3.
Surgeon Performance on the 2008 Maintenance of Certification Examination (MOCEX)

Data are stratified by practice type and level of peer interaction. A, Mean 2008 MOCEX scores. B, Log-odds of passing the 2008 MOCEX for a 1-unit increase in the predictor variables. Data were obtained from surveys and actual MOCEX performance. Line graphs report adjusted interaction effect of practice type and level of peer interaction. Log-odds are based on the same underlying analysis as the odds ratios reported in the text and Table 2 but are easier to use to visualize interactions. The odds ratio can be computed by raising the mathematical constant e to the power of the log-odds coefficient (http://www.ats.ucla.edu/stat/stata/faq/oratio.htm).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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