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Comment & Response |

Evaluating Clinical Management Decisions by Recent Graduates in the Era of High-Value, Cost-Conscious Care—Reply

Brenda E. Sirovich, MD, MS1; Eric S. Holmboe, MD2; Rebecca S. Lipner, PhD3
[+] Author Affiliations
1Veterans Affairs Medical Center, VA Outcomes Group (111B), White River Junction, Vermont
2Accreditation Council for Graduate Medical Education, Chicago, Illinois
3American Board of Internal Medicine, Philadelphia, Pennsylvania
JAMA Intern Med. 2015;175(4):652-653. doi:10.1001/jamainternmed.2014.8090.
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In Reply We thank Abegunde and Mba for their inquiry regarding our recent article.1 In that study, we demonstrated that newly minted internists trained in environments characterized by more resource-intensive practice patterns were consistently less capable of recognizing when the right thing to do for a patient was less (ie, to spare the patient unnecessary medical care).

The first and final points raised by Abegunde and Mba address an important concern: what exactly is being measured by the American Board of Internal Medicine (ABIM) certifying examination, the platform on which our outcome measure was constructed? Abegunde and Mba worry that examination performance primarily reflects candidates’ test-taking skills and preparation. Offered as conjecture, there may yet be some validity to this assertion, but an explanation of how this phenomenon would explain our findings is notably absent—and difficult to conjure. In fact, the strength and consistency of the relationship we observed, despite underlying variation in examination-taking strategies and preparation across residency programs, testifies to the robustness of the finding.


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April 1, 2015
Ayokunle T. Abegunde, MBBS, MSc, DTM&H, MRCGP; Benjamin Mba, MD, MRCP(UK), FHM
1Oklahoma University Health Sciences Center, Oklahoma City
2John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
JAMA Intern Med. 2015;175(4):651-652. doi:10.1001/jamainternmed.2014.8087.
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