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The American Board of Surgery (ABS) recertification process is required to maintain certification. We hypothesized that the percentage of women becoming certified in General Surgery (GS) has increased over the past 40 years and that they stay in the workforce for a shorter period of time than their male counterparts. This is a retrospective study using deidentified ABS data. Descriptive statistics and Chi-square were used to compare male and female recertification rates. Significance was set at a p-value less than 0.05. The percentage of women obtaining initial certification had a statistically significant increase over time. Female surgeons that achieved initial certification between 1998 and 2007 were seen to achieve first recertification at a higher rate. Despite that, maintaining recertification over subsequent decades lags behind that of male surgeons, specifically at the second recertification – 20-year time point. Overall, these data align with studies showing that female physicians exit the workforce at higher rates. This discrepancy in long-term recertification represents an opportunity to improve our clinical work environments so that all surgeons can thrive and have long, productive careers. •The percentage of women obtaining initial certification has increased over time.•Female surgeons with initial certification between 1998 and 2007 completed their first recertification at a higher recertification rate than their male counterparts.•Female surgeons' second recertification rates lag behind males.•Long-term recertification gaps highlight the need to improve environments for all surgeons.

Maintaining ABEM certification is associated with fewer state medical board disciplinary actions. To become ABEM-certified, candidates must pass the Qualifying Examination (QE) and then pass the Oral Certification Examination (OCE). The purpose of this study was to examine the relationship between certification examination performance and severe state medical board licensure actions for emergency physicians. The sample was residency-trained emergency medicine physicians who graduated in 1973 or after and attempted to gain ABEM certification from 1979 to 2016. After excluding physicians who did not take the QE, graduated from non-categorical residency programs, or received a disciplinary action prior to graduation, 35,321 physicians remained. Severe actions were defined as actions that resulted in the denial, revocation, surrender, or suspension of a medical license. Severe actions data from 2021 and earlier were obtained from the NPDB. Analysis included descriptive statistics and Cox proportional hazard regression. Physicians were divided into three groups based on their performance on the QE and OCE. Group 1 physicians (30,058; 85.1 %) passed both examinations on their first attempt; Group 2 (4694; 13.3 %) passed the QE and OCE after multiple attempts on either or both exams; and Group 3 (569; 1.6 %) never passed either the QE or OCE. There were 274 (0.9 %) physicians in Group 1 with severe actions; 96 (2.1 %) in Group 2; and 23 (4.0 %) in Group 3. Physicians in Group 1 had a lower rate of severe actions per 1000 person-years (0.52; 95 % CI, 0.46–0.59) than did physicians in Group 2 (1.02; 95 % CI, 0.81–1.22) or Group 3 (1.88; 95 % CI, 1.11–2.65). Compared to Group 1, Group 2 had a hazard ratio (HR) of 1.81 (95 % CI, 1.44–2.29); and Group 3 had an HR of 3.19 (95 % CI, 2.08–4.89). Compared to Group 2, Group 3 had a HR of 1.86 (95 % CI, 1.18–2.94). Additionally, female physicians were less likely to have severe actions than male physicians (Χ2(1) = 12.7, P < 0.01) when excluding physicians with no reported sex. Difficulty becoming ABEM-certified is associated with severe medical board licensure actions. Never achieving ABEM certification was associated with the highest risk of action.

Background Higher surgical trainees often struggle to attain endoscopy competencies. We aimed to obtain a national picture of higher surgical trainees’ endoscopy experience, highlight barriers to training, and explore potential solutions. Methods A 40-point electronic questionnaire was designed and disseminated to higher surgical trainees across the UK. Anonymous responses were collected and recorded from 26/10/2020 to 11/06/2021. Results A total of 139 higher surgical trainees from 16 out of the 19 regional UK deaneries responded. 75.9% (82/108) had some endoscopy training, and 19.4% (21/108) had no endoscopic training. 27.8% (30/108) had performed over 200 procedures. 77.8% (105/135) were not made aware of endoscopy training requirements by their Training Programme Directors (TPDs). 59.6% (65/109) had no named endoscopy supervisor. Only 49.1% (53/108) felt supported by their endoscopy trainers. Joint Advisory Group on GI Endoscopy (JAG) certification was infrequent, and the highest levels, 14.4% (15/104), were achieved in oesophagogastroduodenoscopy (OGD). Only 55.8% (24/43) of JAG-certified trainees felt competent in that procedure. 50.0% (7/14) of ST8 (final year trainee) respondents were not JAG certified in any procedure. 90.6% (96/106) faced challenges in gaining endoscopy training. The most common obstacles were the COVID-19 pandemic 87.9% (94/107), on-call commitments 80.2% (85/106), lack of allocated endoscopy sessions 80.2% (85/106), insufficient endoscopy training lists 76.4% (81/106), and competition with non-surgical trainees 64.2% (68/106). Conclusions Our survey provides detailed evidence of the challenges faced by surgical trainees in gaining endoscopy training. Suggested solutions include allocated endoscopy trainers, dedicated endoscopy-only training blocks, and early guidance about endoscopy training and certification.

BackgroundDifferences in the postgraduate training programs of neurosurgical residents are suspected throughout Europe. The influence of working hour restrictions by the European Working Time Directive (WTD) 2003/88/EC on the number of surgical procedures remains unclear. We designed a survey to collect information on the number of surgical procedures, performed by European neurosurgical trainees during residency. This article reports preliminary data.MethodsAn electronic survey was distributed among the European Association of Neurosurgical Societies (EANS) member countries by national delegates of the training committee, as well as by members of the Young Neurosurgeons’ committee. The EANS mailing list of individual members was also used for distribution. All responses received between 04/2018 and 12/2018 were considered.ResultsFrom n = 180 responses received, 42 were omitted as responders were still in residency and for 58 relevant information was missing. The final sample was n = 80, with a mean responder’s age of 43.0 years (SD 8.6) and 88.8% being male. Responses came from 16 European countries; board certification was received between the years of 1976–2018. The numbers of surgical procedures performed independently were 511 (mean, 95% confidence interval (CI) 413–610), supervised were 514 (95%CI 360–668) and assisted were 752 (95%CI 485–1019) throughout residency. More detailed numbers for specific procedure types are reported in the article. Independently performed cranial procedures outnumbered spinal procedures (p < 0.006), and adult procedures outnumbered pediatric procedures (p < 0.001). There was a strong decrease in caseload between 1976 and 2018, with trainees performing on average 65 cases less throughout residency for each calendar year increase in board certification (95% CI − 116 to − 15, p = 0.012). Trainees graduating residency before introduction of the European WTD 2003/88/EC participated in more procedures than those graduating afterwards (mean 2797 vs. 1418, p = 0.005).ConclusionsThe preliminary analysis of the first 80 responses now provides a first reference frame for caseload that can be used by current and future European residents to critically compare their own operative numbers to. There was a strong decline in surgical cases over time, and trainees graduating after introduction of the European WTD 2003/88/EC had less surgical exposure. The survey remains open, and we invite further European neurosurgeons to provide their data in order to get even more robust estimates.

The growing global health burden of kidney disease is substantial and the nephrology workforce is critical to managing it. There are concerns that the nephrology workforce appears to be shrinking in many countries. This study analyses trends in South Africa for the period 2002-2017, describes current training capacity and uses this as a basis for forecasting the nephrology workforce for 2030. Data on registered nephrologists for the period 2002 to 2017 was obtained from the Health Professions Council of South Africa and the Colleges of Medicine of South Africa. Training capacity was assessed using data on government-funded posts for nephrologists and nephrology trainees, as well as training post numbers (the latter reflecting potential training capacity). Based on the trends, the gap in the supply of nephrologists was forecast for 2030 based on three targets: reducing the inequalities in provincial nephrologist densities, reducing the gap between public and private sector nephrologist densities, and international benchmarking using the Global Kidney Health Atlas and British Renal Society recommendations. The number of nephrologists increased from 53 to 141 (paediatric nephrologists increased from 9 to 22) over the period 2002-2017. The density in 2017 was 2.5 nephrologists per million population (pmp). In 2002, the median age of nephrologists was 46 years (interquartile range (IQR) 39-56 years) and in 2017 the median age was 48 years (IQR 41-56 years). The number of female nephrologists increased from 4 to 43 and the number of Black nephrologists increased from 3 to 24. There have been no nephrologists practising in the North West and Mpumalanga provinces and only one each in Limpopo and the Northern Cape. The current rate of production of nephrologists is eight per year. At this rate, and considering estimates of nephrologists exiting the workforce, there will be 2.6 nephrologists pmp in 2030. There are 17 government-funded nephrology trainee posts while the potential number based on the prescribed trainer-trainee ratio is 72. To increase the nephrologist density of all provinces to at least the level of KwaZulu-Natal (2.8 pmp), which has a density closest to the country average, a projected 72 additional nephrologists (six per year) would be needed by 2030. Benchmarking against the 25th centile (5.1 pmp) of upper-middle-income countries (UMICs) reported in the Global Kidney Health Atlas would require the training of an additional eight nephrologists per year. South Africa has insufficient nephrologists, especially in the public sector and in certain provinces. A substantial increase in the production of new nephrologists is required. This requires an increase in funded training posts and posts for qualified nephrologists in the public sector. This study has estimated the numbers and distribution of nephrologists needed to address provincial inequalities and achieve realistic nephrologist density targets.

Children present to emergency departments regardless of their readiness to care for pediatric patients. The National Pediatric Readiness Project is an initiative to improve pediatric emergency care. Increased National Pediatric Readiness Project scores have been associated with decreased mortality. The purpose of this study is to examine the association between nurse pediatric competency, certification, and/or continuing education and weighted pediatric readiness scores. A sub-analysis of the 2021 National Pediatric Readiness Project Assessment examining nurse pediatric competencies and overall pediatric readiness scores of emergency department of United States includes descriptive statistics, testing for the association between hospital characteristics and pediatric patient volume using Fisher’s tests and Kruskal-Wallis tests, and Wilcoxon rank-sum tests of score and nurse pediatric competencies. The majority (89%) of emergency departments require some nurse competency evaluations. Only 20.1% of emergency departments require nurse specialty certification. Most emergency departments have a hospital-specific nurse competency evaluation policy (91.7%) and nurse continuing education policies (98.3%). Having policies for competencies is significantly associated with increased median weighted pediatric readiness scores above the national median: nursing continuing education policy weighted pediatric readiness scores 71.3 (P = .030), nurse specialty certification policy weighted pediatric readiness scores 83.5 (P<.001), and nurse hospital-specific competency evaluation policy weighted pediatric readiness scores 72.3 (P<.001). Most emergency departments have a requirement for nurse pediatric-specific competency evaluations, and having nursing competency requirements is associated with higher weighted pediatric readiness scores. This highlights the importance of emergency nurse pediatric competency, certification, and continuing education on pediatric readiness scores, and therefore, the potential reduction in pediatric mortality.

BACKGROUND:Access to physicians is a major concern for Medicaid programs. However, little is known about relationships between physician participation in Medicaid and the individual-level and practice-level characteristics of physicians. METHODS:We used the 2011 Massachusetts All Payer Claims Database, containing all commercial and Medicaid claims; we linked with data on physician characteristics. We measured Medicaid participation intensity (fraction of the physician’s patient panel with Medicaid) for primary care physicians (PCPs) and medical specialists. We measured influence of physicians within a patient referral network using eigenvector centrality. We used regression models to associate Medicaid intensity with physician individual-level and practice-level characteristics. FINDINGS:About 92.6% of physicians treated at least 1 Medicaid patient, but the median physician’s panel contained only 5.7% Medicaid patients. Medicaid intensity was associated with physician training and influence for PCPs and specialists. For medical specialists, a 1 percentage point increase in Medicaid intensity was associated with a lower probability of being board certified (−0.22 percentage points; 95% CI, −0.30, −0.14), lower probability of attending a domestic medical school (−0.14 percentage points; 95% CI, −0.22, −0.05), having attended a less well-ranked domestic medical school (0.23 ranks; 95% CI, 0.15, 0.30), and having slightly less influence in the referral network. PCPs displayed similar results but high Medicaid intensity physicians had substantially less influence in the referral network. CONCLUSIONS:Medicaid participation intensity shows substantial variation across physicians, indicating limits of binary participation measures. Physicians with more Medicaid patients had characteristics often perceived by patients to be of lower quality.

There is widespread geographic variation in healthcare quality, but we often lack clear strategies for improving quality in underserved areas. This study characterized geographic disparities in stroke care quality to assess whether improved access to neurological services has the potential to bridge the care quality gap, particularly in terms of alteplase (rt-PA) administration. This was a retrospective study using quality performance data from the 2015 Hospital Compare database linked to information on certification status from the Joint Commission and information on local access to neurological services from the Area Health Resources File. We used these data to compare stroke care quality according to geographic area, certification, and neurologist access. Non-metropolitan hospitals performed worse than metropolitan hospitals on all assessed stroke care quality measures. The most prevalent disparity occurred in the use of rt-PA for eligible patients (52.2% versus 82.7%, respectively). Certified stroke centers in every geographic designation provided higher quality of care, whereas large variation was observed among non-certified hospitals. Regression analyses suggested that improvements in hospital certification or access to neurologists were associated with absolute improvements of 44.9% and 21.3%, respectively, in the percentage of patients receiving rt-PA. The large quality gap in stroke care between metropolitan and non-metropolitan areas could be at least partly addressed through improved procedural efforts by stroke center certification increasing the supply of neurological services, (i.e. through training and hiring new neurologists) or by adopting decision support systems such as telemedicine.

Introduction FLS is an educational program developed by the Society of American Gastrointestinal and Endoscopic Surgeons and endorsed by the American College of Surgeons. The goal of the FLS program is to teach and assess the basic cognitive and psychomotor skills required to perform laparoscopic surgery. The purpose of this study is to review the results from the first 5 years of FLS certification testing. Methods FLS test data were prospectively collected for all participants taking the FLS certification examination since its inception. Deidentified data were reviewed and analyzed using standard descriptive statistics. Results The FLS examination was taken by 2,689 participants between October 2004 and December 2009. There was a yearly increase in the number of individuals seeking FLS certification. Complete demographic information was available for 1,882 participants: 12% were junior residents (PGY 1–3), 69% were senior residents (PGY 4–5) or fellows, and 19% were attending surgeons. A breakdown of participants by specialty revealed that 88% were general surgeons, 4% were gynecologists, 2% were urologists, and 6% were labeled as “other.” The mean (standard deviation, SD) score on the cognitive examination was 519 (157), with a 93% pass rate. The mean score on the technical skills examination was 525 (117), with a 92% pass rate. After combining both scores, the overall FLS certification pass rate was 88%. Conclusions The FLS certification examination has gained widespread acceptance among laparoscopic surgeons in training and practice, with a marked increase in testing since the American Board of Surgery mandate for certification was announced. The overall pass rate of 88% on the examination approaches the target pass rate of 90% established during the test-setting process.