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In This Issue of JAMA
December 10, 2014


JAMA. 2014;312(22):2315-2317. doi:10.1001/jama.2013.279879
Medical Education

Edited by Robert M. Golub, MD; and guest co-editor, Catherine R. Lucey, MD

Cover design by Robert M. Golub, MD, and Cassio Lynm, MA

The American Board of Internal Medicine (ABIM) 10-year Maintenance of Certification (MOC) requirement took effect in 2000. In a quasi-experimental study that compared outcomes of care for 154 045 Medicare beneficiaries treated by ABIM-certified general internists—either initially certified in 1991 and subject to MOC in 2001 (n=956) or initially certified in 1989 and not subject to the MOC requirement (n=974)—Gray and colleagues found that imposition of the MOC requirement was not associated with growth in ambulatory care–sensitive hospitalizations but was associated with a small reduction in the growth of Medicare costs. In an Editorial, Lee discusses the evolution of physician certification.

Editorial and Related Article

Author Audio Interview

In a retrospective analysis of performance data from internists who had time-limited (n=71) or time-unlimited (n=34) American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) and were providing primary care to 68 213 patients at 4 Veterans Health Administration medical centers, Hayes and colleagues found no significant differences between physicians’ ABIM certification type and patient outcomes on 10 primary care performance measures.

Editorial and Related Article

Patel and colleagues assessed the association between the 2011 Accreditation Council for Graduate Medical Education duty hour reforms and mortality and hospital readmissions in an analysis of 2009-2012 data from nearly 6.4 million Medicare beneficiaries. In analyses that accounted for hospital teaching intensity, the authors found no difference in the change in 30-day mortality or 30-day readmission rates in the year after implementation of duty hour reforms compared with the 2 years before implementation. In an Editorial, Arrighi and Hebert discuss the continuing debate over duty hours, quality graduate medical education, and patient safety.

Editorial and Related Articles 1 and 2

Author Video Interview and Continuing Medical Education

In an analysis of data from 204 641 patients undergoing general surgery at 23 teaching and 31 nonteaching hospitals 2 years before and 2 years after implementation of the Accreditation Council for Graduate Medical Education resident duty hour reform, Rajaram and colleagues found no association between implementation of the revised residency duty hour requirements and change in patient outcomes.

Editorial and Related Articles 1 and 2

In an analysis of Medicare claims data for care provided by a random sample of 2581 family medicine and internal medicine physicians who completed residency training between 1992 and 2010, Chen and colleagues found that the Medicare spending pattern in the region of residency training was associated with expenditures for care provided to Medicare beneficiaries when the physicians were in practice.

To evaluate a common assumption that graduate medical education is associated with increased resource use, Pitts and colleagues compared resources used by attending-supervised residents compared with attending physicians alone in a nationally representative sample of 29 182 emergency department (ED) visits. The authors report that compared with attending-only visits, supervised visits were associated with a greater likelihood of hospital admission and use of advanced imaging, and with longer ED stays.

Clinical Review & Education

Observational studies are a common method to evaluate change in outcomes following implementation of new policies or modifications in existing policies. In this JAMA Guide to Statistics and Methods article, Dimick and Ryan discuss application and interpretation of the difference-in-differences study design for evaluating changes in health care policy.

Related Articles 1 and 2