Amy Opalek

Background: Ensuring a sufficient supply and distribution of health care professionals is essential to meeting public health needs. Regulatory agencies protect their communities by ensuring that new health professionals have the required qualifications to practice safely and by tracking the volume and distribution of those professionals on an ongoing basis. The speed and accuracy of sharing these data could be greatly improved through the adoption of a data standard for information about health professionals. To date, however, no internationally accepted standard has emerged for this purpose. Purpose: This study examines three existing XML standards designed for the representation of individual worker data to determine if, and to what degree, each could be used for the tracking of health professionals. Methods: The data elements of the Europass schema, the HR Open Standard Recruiting specification, and the MedBiquitous Healthcare Professional Profile standard were fully examined and matching elements were mapped to the 200+ elements identified from a prior content analysis as required by a sample of 20 international regulatory agencies. Results: None of the schemas examined addressed more than half of the information elements required by regulators. All three schemas are found lacking in some key areas of interest, especially vital information that could disqualify ineligible applicant practitioners. Conclusions: The three standards could all be improved by including new elements essential to regulatory agencies. Regulatory agencies should be consulted in the development of new standards for representing potentially disqualifying information about candidates for professional practice.

Background: Ensuring a sufficient supply and distribution of health care professionals is essential to meeting public health needs. Regulatory agencies protect their communities by ensuring that new health professionals have the required qualifications to practice safely and by tracking the volume and distribution of those professionals on an ongoing basis. The speed and accuracy of sharing these data could be greatly improved through the adoption of a data standard for information about health professionals. To date, however, no internationally accepted standard has emerged for this purpose. Purpose: This study examines three existing XML standards designed for the representation of individual worker data to determine if, and to what degree, each could be used for the tracking of health professionals. Methods: The data elements of the Europass schema, the HR Open Standard Recruiting specification, and the MedBiquitous Healthcare Professional Profile standard were fully examined and matching elements were mapped to the 200+ elements identified from a prior content analysis as required by a sample of 20 international regulatory agencies.Results: None of the schemas examined addressed more than half of the information elements required by regulators. All three schemas are found lacking in some key areas of interest, especially vital information that could disqualify ineligible applicant practitioners.Conclusions: The three standards could all be improved by including new elements essential to regulatory agencies. Regulatory agencies should be consulted in the development of new standards for representing potentially disqualifying information about candidates for professional practice.

Educational outcome measures, known to be associated with the quality of care, are needed to support improvements in graduate medical education (GME). This retrospective observational study sought to determine whether there was a relationship between the specialty board certification rates of GME training institutions and the quality of care delivered by their graduates. It is based on 7 years of hospitalizations in Pennsylvania (N = 354,767) with diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal hemorrhage, or pneumonia. The 2,265 attending physicians were self-identified internists, and they completed their training in 59 institutions. The percentage of board-certified physicians from each training institution, excluding the physician herself or himself, was calculated and an indicator of whether it exceeded 80% was created. This was analyzed against inhospital mortality and length of stay, adjusted for patient/physician/hospital characteristics. There were significantly lower odds of mortality (adjusted Odd’s ratio [OR] = .92, 95% CI [0.86, 0.98]) and log length of stay (adjusted OR = .98, 95% CI [.94, .99]) when the attending physician trained in a residency program with an 80% or greater certification rate. The results suggest that specialty certification rates may be a useful educational outcome for residency training programs.

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This paper discusses the information needs of regulators in the face of increasing globalization in medical education and practice, the history of information resources cataloging the world's medical education institutions, and the development of a tool that can fill an information gap concerning where and how physicians around the world are educated — the World Directory of Medical Schools. The World Directory was developed to meet the needs of medical regulators and other stakeholders who rely on specific data about medical schools and their educational programs. Its data model captures information about schools and programs as separate entities, allowing for greater flexibility and utility in the areas of regulation and workforce research.

Context: There is an apparent contradiction between the findings of studies indicating that patient outcomes are better when physicians have a greater volume of practice and those that find outcomes to be worse with increased time since training, which implies greater volume. Objectives: This study was designed to estimate the adjusted relationships between physicians’ characteristics, including recent practice volume and time since medical school graduation, and patient outcomes. Methods: This is a retrospective observational study based on all Pennsylvania hospitalisations over 7 years for acute myocardial infarction, congestive heart failure, gastrointestinal haemorrhage, hip fracture and pneumonia. It refers to 694 020 hospitalisations in 184 hospitals attended by 5280 internists and family physicians. Patient severity of illness at admission and in‐hospital mortality, hospital location and volume, and the physician's recent practice volume, time since medical school graduation, board certification, and citizenship or medical school location were analysed. Results: After adjustment, recent practice volume did not have a statistically significant association with in‐hospital mortality for all of the conditions combined. By contrast, each decade since graduation from medical school was associated with a 4.5% increase in relative risk for patient mortality. Conclusions: Recent practice volume does not mitigate the increase in patient mortality associated with physicians’ time since medical school graduation. These findings underscore the need to finds ways to support and encourage learning.

Context: That few data are available on the characteristics of medical schools or on trends within medical education internationally constitutes a major challenge when developing strategies to address physician workforce shortages. Quality and up‐to‐date information is needed to improve health and education policy planning. Methods: We used publicly available data from the International Medical Education Directory and Avicenna Directories , and an internal education programme database to gather data on medical education provision worldwide. We sent a semi‐structured questionnaire to a selection of 346 medical schools, of which 218 (63%) in 81 different countries or territories replied. We contacted ministries of health, national agencies for accreditation or similar bodies to clarify inconsistencies among sources. We identified key informants to obtain country‐level specific information. Descriptive statistics were used to analyse current medical school data by country. Results: There are about 2600 medical schools worldwide. The countries with the largest numbers of schools are India ( n = 304), Brazil ( n = 182), the USA ( n = 173), China ( n = 147) and Pakistan ( n = 86). One‐third of all medical schools are located in five countries and nearly half are located in 10 countries. Of 207 independent states, 24 have no medical school and 50 have only one. Regionally, numbers of citizens per school differ: the Caribbean region has one school per 0.6 million population; the Americas and Oceania each have one school per 1.2 million population; Europe has one school per 1.8 million population; Asia has one school per 3.5 million population, and Africa has one school per 5.0 million population. In 2012, on average, there were 181 graduates per medical school. Conclusions: The total number and distribution of medical schools around the world are not well matched with existing physician numbers and distribution. The collection and aggregation of medical school data are complex and would benefit from better information on local recognition processes. Longitudinal comparisons are difficult and subject to several sources of error. The consistency and quality of medical school data need to be improved to accurately document potential supply; one example of such an advancement is the World Directory of Medical Schools .

The Step 2 Clinical Knowledge (CK) examination of the United States Medical Licensing Examination sequence is a requirement for the certification of international medical graduates (IMGs) by the Educational Commission for Foreign Medical Graduates. An association between scores on the test and the quality of care later provided by those who take it is central to its use in certification and licensure. The purpose of this study was to determine whether there is a relationship between scores on Step 2 CK and patient outcomes for IMGs. This is a retrospective observational study of the 60,958 hospitalizations from 2003 to 2009 in Pennsylvania where the principal diagnosis was acute myocardial infarction or congestive heart failure and the attending physician (N = 2,525) was an IMG who had taken the Step 2 CK. The main measures were the three-digit scores on Step 2 CK and in-hospital mortality. After adjustment for severity of illness, physician characteristics, and hospital characteristics, performance on Step 2 CK had a statistically significant inverse relationship with mortality. Each additional point on the examination was associated with a 0.2% (95% CI: 0.1%-0.4%) decrease in mortality. The size of the effect is noteworthy, with each standard deviation (roughly 20 points) equivalent to a 4% change in mortality risk. These findings provide evidence for the validity of Step 2 CK scores. Given the magnitude of its relationship with patient outcomes, the results support the use of the examination as an effective screening strategy for licensure.