The impact of early career specialization on licensing requirements and related educational implications

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Abstract
Purpose: It was hypothesized that physicians who pursue early career specialization in their first year of graduate medical education after medical school are likely to experience a decline in their scores on the medical licensing examination. Method: A longitudinal prospective design was used in which 1,927 physicians who graduated from Jefferson Medical College between 1980 and 1991 were studied. Type of first-year graduate training program was the independent variable, and performance on a medical licensing examination (Part III examination of the National Board of Medical Examiners [NBME]) was the dependent variable. Scores on Parts I and II of the NBME taken in medical school, medical school class rank, and gender were the control variables. Results: Findings showed significant differences on Part III scores among physicians in 12 different graduate programs despite statistical adjustments for baseline differences. Physicians in family medicine and emergency medicine programs obtained the highest adjusted Part III scores, followed by physicians in internal medicine and transitional programs. The next group consisted of physicians in pediatrics, obstetrics-gynecology, anesthesiology, and general surgery programs. The group with the lowest Part III scores included physicians in pathology, radiology, and psychiatry. Implications: These findings suggest that students who meet only the minimal standards in medical school should be advised to pursue a broad training program in the first year of graduate medical education to strengthen their general clinical competence as a means to increase their chances of passing licensing examinations.