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Certifying examination performance and patient outcomes following acute myocardial infarction


  • Received 31 August 2001; editorial comments to authors 2 January 2002; accepted for publication 16 April 2002

John J Norcini, PhD, Foundation for Advancement of International Medical Education and Research, 3624 Market Street, Fourth Floor, Philadelphia, PA 19104, USA


Objective  To establish whether successful certifying examination performances of doctors are associated with their patients’ mortality and length of stay following acute myocardial infarction.

Design  Risk adjusted mortality and survivors’ length of stay were compared for doctors who had satisfactorily completed training in internal medicine or cardiology and attempted the relevant examination. Specifically, the study investigated the joint effects of hospital location, availability of advanced cardiac care, doctors’ specializations, certifying examination performances, year certification was first attempted and patient volume.

Setting and participants  Data on all acute myocardial infarctions in Pennsylvania for the calendar year 1993 were collected by the Pennsylvania Health Care Cost Containment Council. These data were combined withphysician information from the database of the American Board of Internal Medicine.

Results  Holding all variables constant, successful examination performance (i.e. certification in internal medicine or cardiology) was associated with a 19% reduction in mortality. Decreased mortality was also correlated with treatment in hospitals located outwith either rural or urban settings and with management by a cardiologist. Shorter stays were not related to examination performance but were associated with treatment by high volume cardiologists who had recently finished training and who cared for their patients in hospitals located outwith rural or urban settings.

Conclusions  The results of the study add to the evidence supporting the validity of the certifying examination and lend support to the concept that fund of knowledge is related to quality of practice.