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Comment & Response
Less Is More
April 2015

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

Author Affiliations
  • 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

To the Editor Sirovich and colleagues present an interesting article on the association of the intensity of the internal medicine (IM) training environment and clinical management decisions made by graduates of US IM residency programs.1 However, their results have several limitations.

First, the American Board of Internal Medicine (ABIM) examination is an excellent test of applied knowledge and clinical management decisions on 1 day; it often reflects how well candidates have studied for the test and their ability to use effective test-taking strategies to select the right answer on the test. It does not necessarily correlate with a physician’s everyday management decisions, case mix, referral patterns, actual clinical practice, or outcomes. Examination scores on the Medical Council of Canada Qualifying Examination have been shown to predict practice performance over 4 to 7 years.2 However, there is no evidence that this is the case with the ABIM examination.3

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