Performance of Pediatric Rehabilitation Medicine Candidates on the Subspecialty Board Certification Examination from 2003 to 2015

Accepted Manuscript Performance of Pediatric Rehabilitation Medicine Candidates on the Subspecialty Board Certification Examination from 2003-2015 Sherilyn W. Driscoll, MD, Teresa L. Massagli, MD, Mary A. McMahon, MD, Mikaela M. Raddatz, PhD, David W. Pruitt, MD, Kevin P. Murphy, MD PII:

S1934-1482(17)30109-0

DOI:

10.1016/j.pmrj.2017.09.010

Reference:

PMRJ 1995

To appear in:

PM&R

Received Date: 6 February 2017 Revised Date:

26 September 2017

Accepted Date: 29 September 2017

Please cite this article as: Driscoll SW, Massagli TL, McMahon MA, Raddatz MM, Pruitt DW, Murphy KP, Performance of Pediatric Rehabilitation Medicine Candidates on the Subspecialty Board Certification Examination from 2003-2015, PM&R (2017), doi: 10.1016/j.pmrj.2017.09.010. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Performance of Pediatric Rehabilitation Medicine Candidates on the Subspecialty Board Certification Examination from 2003-2015

Teresa L. Massagli, MD University of Washington, Seattle Children’s Hospital, Seattle, WA

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Authors: Sherilyn W. Driscoll, MD Mayo Clinic, Mayo Clinic Children’s Center, Rochester, MN

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Mary A. McMahon, MD University of Cincinnati, Cincinnati Children’s Hospital Medical Center

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Mikaela M. Raddatz, PhD American Board of Physical Medicine and Rehabilitation, Rochester, MN David W. Pruitt, MD University of Cincinnati, Cincinnati Children’s Hospital Medical Center

Kevin P. Murphy, MD Sanford Health Systems, Bismarck, ND and Gillette Specialty Healthcare, Northern Minnesota Clinics, Duluth, MN

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Corresponding Author: Sherilyn W. Driscoll, MD 200 1st Street SW Mayo Clinic Rochester, MN 55905 P 507-266-8913 F 507-284-3431 [email protected]

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This material has not been presented at an AAPMR annual assembly

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Performance of Pediatric Rehabilitation Medicine Candidates on the Subspecialty Board

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Certification Examination from 2003-2015

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Abstract:

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Background: Pediatric Rehabilitation Medicine (PRM) physicians enter the field via several

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pathways. It is unknown if different training pathways impact performance on the American

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Board of Physical Medicine and Rehabilitation (ABPMR) PRM Examination and Maintenance of

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Certification (MOC) Examination.

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Objectives: To describe the exam performance of candidates on the ABPMR PRM Examination

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according to their type of training (physiatrists with a clinical PRM focus, accredited or

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unaccredited fellowship training, separate pediatric and PM&R residencies or combined

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Peds/PM&R residencies) and to compare candidates’ performance on the PRM Examination

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with their initial ABPMR certification and MOC Examinations.

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Setting: American Board of Physical Medicine and Rehabilitation office

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Design: A retrospective cohort study

Participants: 250 candidates taking the PRM subspecialty certification exam from 2003-2015

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Methods: Scaled scores on the PRM Examination were compared to the examinees’ initial

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certification scores as well as their admissibility criteria. Pass rates and scaled scores were also

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compared for those taking their initial PRM certification versus MOC.

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Main Outcome Measurements: Board pass rates and mean scaled scores for initial PRM

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Examination and MOC

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28 Results: The 250 physiatrists who took the subspecialty PRM Examination had an overall first

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time pass rate of 89%. There was no significant difference between first-time PRM pass rates or

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mean scaled scores for individuals who completed an Accreditation Council for Graduate

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Medical Education (ACGME) accredited fellowship versus those who did not. First time PRM

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pass rates were highest among those who were also certified by the American Board of

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Pediatrics (100%). Performance on Parts I and II of the initial ABPMR Certification Examination

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significantly predicted PRM Exam scores. There was no difference in mean scaled scores for

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initial PRM certification versus taking the PRM Examination for MOC.

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Conclusions: Several pathways to admissibility to the PRM Examination afforded similar

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opportunity for diplomates to gain the knowledge necessary to pass the PRM Examination.

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Once certified, physicians taking the PRM Examination for MOC have a high success rate of

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passing again in years 7-10 of their certification cycle.

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Keywords: Graduate Medical Education, Specialty Boards, Certification

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Introduction:

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Pediatric Rehabilitation Medicine (PRM) is a subspecialty within Physical Medicine and

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Rehabilitation (PM&R) encompassing the care of children and adolescents with a wide variety

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of medical conditions and disabilities. The means of acquiring training in PRM have varied and

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continue to evolve. PM&R residency programs were first required to include pediatric

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rehabilitation in their curricula in 1967, two decades after PM&R was recognized by the

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American Board of Medical Specialties (ABMS) [1]. At that time, physicians desiring to practice

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PRM had no option for additional Accreditation Council for Graduate Medical Education

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(ACGME) recognized training other than to complete residencies in both pediatrics and PM&R.

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Some completed formal but non-accredited PRM fellowships or mentorships of varying lengths.

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In 1987, the American Board of Physical Medicine and Rehabilitation (ABPMR) and the

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American Board of Pediatrics (ABP) acknowledged the need for additional formalized training in

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PRM and collaborated to create a five year combined Pediatrics and PM&R (Peds/PM&R)

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residency training program. The following year, 5 programs offered combined Peds/PM&R

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training, and by the 1990’s the number of these training programs peaked at 21 [2]. The early

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growth in the number of combined Peds/PM&R training programs exceeded the demand for

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training at the time and led to unmatched positions and challenges in Graduate Medical

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Education (GME) funding, ultimately resulting in a decline in the number of combined

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Peds/PM&R programs [3]. During this same time, the field of PRM advocated for and was

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granted subspecialty certification by the ABMS in 1999. Subspecialty certification by an ABMS

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Board requires formal fellowship training accredited by ACGME. When a new subspecialty is

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approved, ABMS grants the Board a period of several years during which diplomates already

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practicing in the field can sit for the subspecialty exam. Following the closure of that period,

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completion of fellowship training is expected for eligibility.

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The ACGME approved requirements for PRM fellowship training in 2002, which provided a

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mechanism for residents in PM&R training programs to obtain formal training in PRM and for

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the combined Peds/PM&R residents to obtain additional dedicated pediatric rehabilitation

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training. Fellowship duration was 1 year for those who completed a combined Peds/PM&R

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residency program and 2 years for those who completed a PM&R residency program. Most

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graduates from the combined Peds/PM&R training programs chose to forgo the additional year

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of fellowship training. The number of fellowship training programs has gradually grown over

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the years and presently is the most common mechanism of training, with 20 accredited

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fellowships as of July 2017 [4].

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The ABPMR offered the first subspecialty certification exam for PRM in 2003. From 2003 to

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2011, physicians with various training backgrounds could apply to take the examination.

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Eligibility to take the exam included ABPMR certified physiatrists who: 1) substantially included

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the care of children in their practice for at least three years; 2) completed consecutive

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residencies in pediatrics and PM&R but did not complete a PRM fellowship; 3) completed an

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accredited or an unaccredited fellowship in PRM after a PM&R residency; or 4) completed a

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combined 5 year Peds/PM&R residency with or without a one year fellowship. Beginning in

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2011, only ACGME-accredited fellowship trained physiatrists could sit for the PRM Examination.

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Starting with the 2015 exam, the ABPMR further revised the admissibility requirements for the

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PRM Examination to include: 1) individuals with PM&R residency and a 2 year PRM fellowship;

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2) combined Peds/PM&R with or without a 1 year PRM fellowship; or 3) separate pediatric and

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PM&R residencies that include a minimum of 6 months of training in pediatric rehabilitation.

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To maintain ABPMR PM&R certification and/or subspecialty PRM certification, physiatrists must

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participate in Maintenance of Certification (MOC). One aspect of MOC is passing a closed book

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proctored examination every 10 years. Candidates are eligible to take the MOC exam in years 7-

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10 of their MOC cycle. Initially, physiatrists could take the PRM subspecialty examination in lieu

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of the ABPMR MOC exam to maintain their primary ABPMR certificate. As of 2015, physiatrists

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who want to maintain both the PM&R and PRM certificates must take separate MOC exams for

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each certification. For the primary PM&R certificate, the MOC exam is distinct from the Part I

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Examination taken for initial certification. For the subspecialty PRM certificate, the MOC

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Examination is the same as the PRM Examination administered to initial PRM candidates. The

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ABPMR subspecialty exams for Spinal Cord Injury Medicine and PRM are used for both initial

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certification and respective MOC exams in order to maintain statistical reliability given the small

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number of candidates in these subspecialties.

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This study was undertaken to investigate the performance of PRM candidates on the

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subspecialty examination in the years 2003-2015. We evaluated performance on the PRM

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Examination compared to initial certification, by admissibility criteria, by year taken after

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completion of training, and by those taking it for initial PRM certification versus MOC.

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Methods:

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Initial certification by ABPMR requires passing 2 examinations, a computer-based exam (Part I

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Examination) and an oral exam (Part II Examination). Both the Part I Examination and the PRM

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Examination are secure, computer-based examinations administered simultaneously across the

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United States at secure testing centers once a year. The PM&R MOC Examination is offered

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twice a year. Examinations are developed by item writers trained by the ABPMR. The

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examinations consist of 325 (Part I Examination), 300 (PRM Examination), or 160 (MOC

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Examination) multiple choice questions with content apportioned according to an examination

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blueprint published on the ABPMR website [5].

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The Part I, PRM, and MOC Examinations are criterion-referenced exams with the pass point

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periodically set a priori by use of the best practice testing industry methods for standard setting

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techniques. Raw scores are converted to a scaled total score ranging from 0 to 800. Scaled

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scores for the Part I Examination were available for PRM candidates who took the exam in 1999

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or later. The Part II Examination for initial certification is an oral examination, which can only be

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taken once the candidate has successfully passed the Part I Examination. The current format,

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developed in 2005, consists of several case scenarios that test five clinical skills: data

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acquisition, problem solving, patient management, systems-based practice, and interpersonal

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skills. Each candidate is examined by three examiners who have been trained using standard

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methodology to evaluate and score candidates. Scores are statistically adjusted for the fact that

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some examiners grade easier than others, difficulty of the case, and the difficulty of the clinical

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skill. Using common examination elements, equating is used to assure stable reliability and

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difficulty across years of examination, and standard setting is used to set the pass point. Raw

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scores are converted to scaled scores ranging from 0 to 10. Scaled scores for the Part II

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Examination were available for those who took this examination beginning in 2005.

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For the purposes of our investigation, we defined 2 groups of PRM candidates based on training

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background. The “accredited fellowship track” includes individuals who completed an ACGME-

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accredited PRM fellowship of either 1 or 2 years duration. The “practice/non-accredited

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fellowship” track includes those who completed a PM&R residency and then took the PRM

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Examination based on years of PRM experience with or without prior non-accredited

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fellowship, as well as those who completed either a combined Peds/PM&R residency or

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consecutive PM&R and Pediatrics residencies without subsequent fellowships.

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This was a retrospective study. All physiatrists taking the PRM Examination from 2003 to 2015

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were included in the sample. Identifiers were removed from the dataset for analysis. The study

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protocol was approved by the Institutional Review Board of Mayo Clinic and by leadership of

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the ABPMR.

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Data analysis was performed with IBM SPSS Statistics Software (IBM, Armonk, NY). Descriptive

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statistics for PRM pass rates and scaled scores were calculated. Pass rates on the PRM

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Examination were compared to pass rates on the Part I and Part II Examinations. Linear

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regression models were conducted with the Part I and Part II Examination scores for initial

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certification used as predictor variables and the PRM score as the dependent variable. The

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relationship between Part I and Part II Examination scores and PRM Examination scores were

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also illustrated by scatterplots.

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Results:

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From 2003 to 2015, 250 physiatrists took the PRM Examination for initial PRM certification.

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Seventy-eight candidates (31%) were trained in ACGME-accredited fellowships. Out of the

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ACGME accredited fellowship group, 8 completed combined Peds/PM&R residencies, and one

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person in that group successfully achieved triple board certification (PM&R, PRM, and

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Pediatrics). One hundred seventy two candidates (69%) took the initial PRM examination

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without an accredited fellowship. Of the group without an accredited fellowship, 52

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completed a combined Peds/PM&R residency and 27 of those achieved triple boarding. An

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additional 28 achieved Pediatrics board certification after completing consecutive or separate

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PM&R and Pediatrics residencies. Twenty five of the non-fellowship group completed a

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combined Peds/PM&R residency but do not hold ABP board certification. Data is not available

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regarding the number of candidates who pursued consecutive but separate PM&R and

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Pediatric residencies.

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completed a PM&R residency followed by substantial practice experience or a PM&R residency

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with unaccredited fellowship or mentorship (Figure 1).

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The remaining practice/non-accredited fellowship candidates

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Table 1 summarizes the passing rates by year of examination. Two hundred and twenty-two of

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the 250 candidates for initial PRM certification passed on the first attempt for an overall first

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time pass rate of 89%. There was not a significant difference between first-time pass rates for

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accredited fellowship (91%) versus practice/non-accredited fellowship (88%) candidates (Χ2(1)≥

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.565, p = .452). The first time pass rate for the 55 candidates certified by both ABP and ABPMR

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was 100%. Of the 28 candidates who did not pass on their first attempt, 17 chose to attempt

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again, and an additional 11 candidates passed after one or more repeat examinations. Of the

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233 physiatrists certified in PRM, 13 also hold subspecialty certification in Brain Injury Medicine

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(BIM), 14 in Spinal Cord Injury Medicine (SCIM), and 1 in both BIM and SCIM.

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Table 2 compares the scaled scores of the candidates by whether or not the candidate was

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trained in an ACGME-accredited PRM fellowship. There is no significant difference in mean

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scaled scores between practice/non-accredited fellowship track and accredited fellowship track

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candidates as a whole. However, there is a significant difference in mean scaled scores between

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those in the practice/non-accredited fellowship pathway who were certified by both ABPMR

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and ABP versus all other groups. That is, diplomates in the practice/non-accredited fellowship

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pathway certified by both ABPMR and ABP have higher scaled scores than those in the same

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pathway certified by only ABPMR (p < .001) as well as those in the fellowship pathway who

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completed either a PM&R residency followed by a 2-year fellowship (p < .01) or a Peds/PM&R

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residency followed by a 1-year fellowship (p < .05). The mean scaled scores of repeat

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candidates are significantly lower than first time takers for those taking the PRM Examination

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for initial certification (398 vs 471, p < .001) or MOC (408 vs 476, p < .01). We also compared

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the mean scaled scores for individuals who passed the PRM Exam at varying times after

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completion of residency or fellowship training (Table 3). For example, some individuals who did

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not complete an ACGME-accredited fellowship sat for the PRM Examination multiple years

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after residency or fellowship training while others sat for the exam immediately upon

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completion of training. There was no difference in mean scaled scores among these groups.

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Of the 233 PRM diplomates, 217 (93%) passed the Part I Examination on their first attempt and

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215 (92%) passed the Part II Examination on their first attempt. From 2003 to 2015, the first

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time pass rate for all takers on the Part I Examination was 89% and on the Part II Examination

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was 86%. Figure 2 illustrates the relationship of Part I Examination scores and PRM Examination

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scores for the 159 candidates who took the Part I Examination in 1999 or later. Regression

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analysis demonstrated that Part I Examination scores significantly predicted PRM Examination

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scores (β = .36, t(157) = 6.45, p < .001). Part I Examination scores also account for a significant

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proportion of variance in PRM Examination scores (R2 = .21, p < .001). Figure 3 illustrates the

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relationship of Part II Examination scores and PRM Examination scores for the 105 candidates

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who took the Part II Examination in 2005 or later. The Part II Examination scores significantly

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predicted PRM Examination scores (β = 16.12, t(103) = 2.80, p < .01). The Part II Examination

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scores also account for a significant proportion of variance in PRM Examination scores (R2 = .07,

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p < .01).

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Eighty-eight candidates took the PRM Examination for MOC with a first time pass rate of 90%.

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There was no difference in mean scaled scores for first time takers for initial certification

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(mean=471, SD 56) versus for MOC (mean =476, SD 55) (p=0.74).

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Discussion

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Pediatric Rehabilitation Medicine diplomates have entered the field via multiple training

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pathways. For 9 years after the ABPMR initially offered the PRM Exam, those practicing in the

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field were allowed to sit for the exam along with those newly graduating from fellowship

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programs. Thus, from 2003-2011, physiatrists with a clinical PRM focus, accredited or

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unaccredited fellowship training, separate pediatric and PM&R residencies or combined

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Peds/PM&R residencies were eligible to take the PRM Examination. After 2011, per ABMS rules,

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eligibility for the subspecialty PRM Examination required additional ACGME accredited training.

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Currently, only those who have completed ACGME-accredited fellowship training and those

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with combined or sequential residencies in pediatrics and PM&R residencies with at least 6

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months of PRM training are eligible for the exam. In spite of the varied training pathways, we

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found no significant difference in pass rates or mean scaled scores. PRM fellowship training

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after PM&R residency as well as residency training in both PRM and Pediatrics prepare

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candidates equally well for the PRM Examination.

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The subset of candidates who successfully passed both the ABP and ABPMR boards had the

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highest scores on the PRM Examination. Not all individuals who completed combined or

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separate Peds/PM&R residencies took the ABP Examination. Nonetheless, passing the ABP

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Examination is correlated with higher scores on the PRM Examination. One possible

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explanation is that the stronger, more confident test takers might be willing to attempt all three

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board exams (Pediatrics, PM&R and PRM). Content overlap between pediatric training and the

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PRM Examination or the potential for studying for both boards in close proximity may also

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contribute to higher scores. If this were the case, however, one might expect the candidates

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who completed combined Peds/PM&R training plus a year of fellowship to score higher, yet this

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was not true. It could be that candidates who chose to pursue an additional fellowship year did

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so because they felt less prepared for the PRM Examination or this might reflect differences in

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training programs.

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We found a strong correlation between both Part I and Part II PM&R Examination scores and

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PRM Examination scores. This was not surprising since there is evidence of this pattern of

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performance throughout medical training. For example, USMLE and in-training examination

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scores have been found to correlate with board scores [6,7]. Overall, the PRM candidates are a

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strong test-taking group with first time pass rates on Part I and II (93% and 92% respectively)

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above the general PM&R average (89% and 86% for all test takers 2003-2015).

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When comparing scores and pass rates for initial PRM examinees with MOC examinees, there

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was no significant difference between the groups. In other words, those who are in practice

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for 7-10 years do not lose nor gain examination points overall. This should be reassuring to

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those who will take the PRM MOC exam. Not all who have been eligible for PRM MOC chose to

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sit for the exam. It may be that some people who took the PRM Examination early on were in

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practice for a number of years prior to taking the exam and were therefore at or close to

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retirement when it was time to sit for the PRM MOC Examination. It may also be that their

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practice or institution did not require this additional sub-specialty certification, so they opted

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not to take the exam. It is not clear what effect the Board’s decision to require the PM&R MOC

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in addition to the PRM MOC to maintain primary PM&R certification will have on the number of

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candidates. Diplomates have the option to maintain subspecialty certification without

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maintaining the primary PM&R certification, so this might increase the participation of some

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PRM diplomates in PRM MOC. Alternatively, as the PM&R MOC process moves toward a

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longitudinal, more formative approach to the exam with candidate customization, pediatric

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physiatrists might choose to continue participation in PM&R MOC.

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The field of Pediatric Rehabilitation Medicine remains small with 233 certified diplomates as of

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July 2016. In comparison, the American Board of Pediatrics has certified 775 physicians in

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Developmental and Behavioral Pediatrics and 255 physicians in Neurodevelopmental

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Disabilities [8]. The American Board of Psychiatry and Neurology has certified an additional 82

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physicians in Neurodevelopmental Disabilities and 2487 in Child Neurology [9]. Since the 2004-

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2005 academic year, the number of PRM fellowships has grown slowly from 2 to 20, while the

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number of combined Peds/PM&R programs has decreased from 5 to 3 [4]. As demonstrated in

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Table 1, approximately 10 new fellowship candidates take the PRM Examination each year. The

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3 combined programs graduate one to three additional candidates per year and a few more

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may complete consecutive Pediatric and PM&R residencies. These numbers are felt to be

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insufficient to replace PRM physicians who are retiring or reducing clinical effort or to satisfy

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unmet need [10].

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Although the number of fellowship positions has increased over the recent years, the number

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of fellows has grown only slightly as some of the fellowship positions go unfilled. The supply is

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much greater than the demand for graduates of PM&R training programs to care for children

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with disabilities. This could be addressed in a number of ways. One is to increase exposure and

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awareness to the field of pediatric physiatry in PM&R residency training. This has happened

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gradually with a slowly growing number of pediatric physiatrists and academic programs, but

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there are still many training programs with limited pediatric PM&R exposure. A number of

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residency training programs still fulfill program requirements for pediatric rehabilitation in core

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PM&R residencies with sole exposure to a pediatric orthopedic surgeon or neurologist. The

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field would need to consider opportunities to increase PM&R resident’s exposure to pediatric

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PM&R that could include promoting high quality pediatric rehabilitation away rotations,

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regional pediatric symposiums geared towards residents, or educational tool boxes that can be

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distributed to programs with limited pediatric rehabilitation exposure.

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Some have suggested that we should widen the proposed fellowship admissibility criteria to

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include pediatricians [10]. There is a potentially large applicant pool of pediatric residents who

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have discovered a desire to work with children with disabilities during their training. While it is

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reassuring that physiatrists with a wide variety of training backgrounds can pass the PRM

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Examination and those with pediatric training scored the highest on the exam, it is not clear

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that this would necessarily predict similar success of pediatricians completing PRM fellowships.

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Historically, one commonality in all training programs has been the completion of a PM&R

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residency and this may be a critical factor.

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Another option would be to promote the creation of a greater number of combined residency

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training programs. These have the potential of attracting medical students who have an early

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desire to enter the field of pediatric physiatry, but who also strongly desire general pediatric

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training. With the creation of the subspecialty exam, this could be promoted as a triple board

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program. It is possible that with a relatively larger number of pediatric physiatry practices

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affiliated with medical schools, the timing is optimal to consider this option. It would still likely

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require an intentional approach to increase awareness of the specialty and training program

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with medical students. The challenges of funding of new residency slots and the blending of

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two programs are hindrances in many institutions.

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Conclusion:

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In summary, the current cohort of ABPMR PRM certified physicians resulted from a variety of

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training pathways, although one commonality in all of the pathways is the completion of a

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PM&R residency. The results demonstrate that each of these pathways afforded similar

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opportunity for diplomates to gain the knowledge necessary to pass the PRM Examination and

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maintain certification. The ABMS requires that after a grandfathering period, subspecialty

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certification requires accredited subspecialty training. This study shows that those trained in

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PRM by fellowship after PM&R residency perform as well on the PRM Examination as those

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who receive training in both pediatrics and PM&R. Having multiple points of entry to

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subspecialization, both as a medical student or as a PM&R resident, can help address the

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shortage of PRM physicians.

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References:

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[2]

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Colloq Comb Resid Train Programs 1997;19:55–72. [3]

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DeLisa JA. Physical Medicine and Rehabilitation/Pediatrics. Proc Am Board Med Spec

Sneed RC, May WL, Stencel C, Paul SM. Pediatric physiatry in 2000: a survey of practitioners and training programs. Arch Phys Med Rehabil 2002;83:416–22.

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2009;1:1055–7. doi:10.1016/j.pmrj.2009.11.004.

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Turk MA, Neufeld JA. Pediatric rehabilitation medicine subspecialty training. PM R

Accreditation Council for Graduate Medical Education. Pediatric Rehabilitation Programs Academic Year 2016-2017 United States.

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https://apps.acgme.org/ads/Public/Reports/ReportRun?ReportId=1&CurrentYear=2016

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&SpecialtyId=137&IncludePreAccreditation=false (accessed January 6, 2017). [5]

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Diplomates. https://www.abpmr.org/index.html (accessed January 6, 2017). [6]

345

Massagli TL, Gittler MS, Raddatz MM, Robinson LR. Does the Physical Medicine and Rehabilitation Self-Assessment Examination for Residents Predict the Chances of Passing

346 347

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American Board of Physical Medicine and Rehabilitation. Information for Candidates and

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the Part 1 Board Certification Examination? PM R 2016. doi:10.1016/j.pmrj.2016.06.012.

[7]

Kay C, Jackson JL, Frank M. The relationship between internal medicine residency

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graduate performance on the ABIM certifying examination, yearly in-service training

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examinations, and the USMLE Step 1 examination. Acad Med 2015;90:100–4.

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doi:10.1097/ACM.0000000000000500.

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[8]

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American Board of Pediatrics, Inc. 2015-2016 Workforce Data. Chapel Hill, NC: American Board of Pediatrics, Inc.; 2016.

[9]

American Board of Psychiatry and Neurology, Inc. Certifications: Total and Active (As of

RI PT

351

354

April 2016). https://www.abpn.com/wp-content/uploads/2016/08/ABPN-Total-and-

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Active-Certifications.pdf.(accessed December 26, 2016).

Houtrow AJ, Pruitt DW. Meeting the Growing Need for Pediatric Rehabilitation Medicine

SC

357

[10]

Physicians. Arch Phys Med Rehabil 2016;97:501–6. doi:10.1016/j.apmr.2015.09.024.

M AN U

356

358 359 360

364 365 366 367 368 369 370 371 372

EP

363

AC C

362

TE D

361

ACCEPTED MANUSCRIPT

AC C

EP

TE D

M AN U

SC

RI PT

373

ACCEPTED MANUSCRIPT

374 375

Table 1: PRM Examination Candidate Summary 2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

15/18 83% 1/2 50%

20/22 91% 0/1 0%

15/17 88% 2/3 67%

33/35 94% 1/2 50%

4/5 80%

8/11 73% 1/2 50%

13/16 81% 3/5 60%

24/26 92% 1/4 25%

11/12 92%

9/9 100% 2/2 100%

8/9 89%

18/23 78% 0/1 0%

0

0

2/2 100%

0

4/4 100%

2/2 100%

5/5 100%

9/10 90%

9/10 90%

11/12 92%

10/10 100%

8/9 89%

18/24 75%

44/47 94%

16/20 80%

18/21 86%

17/20 85%

30/33 91%

2/3 67%

4/8 50%

7/11 64%

16/20 83%

0

1/1 100%

0

0

44/47 94%

16/20 80%

20/23 87%

17/20 85%

34/37 92%

4/5 80%

16/21 76%

25/30 83%

11/12 92%

11/11 100%

8/9 89%

18/24 75%

First Time

n/a

n/a

n/a

1/1 100%

2/2 100%

4/4 100%

4/4 100%

8/8 100%

10/12 83%

14/16 88%

Repeat

n/a

n/a

n/a

0

0

0

0

0

0

0

Total MOC

n/a

n/a

n/a

1/1 100%

2/2 100%

4/4 100%

4/4 100%

8/8 100%

10/12 83%

14/16 88%

19/22 86% 2/2 100% 21/24 88%

8/8 100% 3/5 60% 11/13 85%

9/11 82% 0/1 0% 9/12 75%

Total Candidates

44/47 94%

16/20 80%

20/23 87%

18/21 86%

36/39 92%

8/9 89%

13/17 77%

24/29 83%

35/42 83%

25/28 89%

32/35 91%

19/22 86%

27/36 75%

n/a

Accredited Fellowship Practice Track/ Non-Accredited Fellowship Total Initial Certification

EP AC C

376 377 378

TE D

MOC

0

SC

Repeat

44/47 94%

9/13 69%

M AN U

First Time

RI PT

Initial PRM Certification

0

0

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Table 2 PRM test performance of practice/non-accredited fellowship and accredited fellowship track candidates

472

60

55

504

46

117

457

60

78

469

61 17

Minimum

Maximum

RI PT

172

601

400

601

SC

305

305

591

47

342

559

470

44

342

559

466

55

350

558

M AN U

AC C

383 384

N

Standard Deviation

EP

Practice/nonaccredited fellowship pathway Certified by ABP & ABPMR Certified by ABPMR only ACGME accredited fellowship pathway PMR +2-year fellowship Peds/PMR + 1-year fellowship

Mean Scaled Score

TE D

379 380 381 382

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Table 3: Mean scaled scores on PRM Examination by year after training completed Delay (years) N Mean Scaled Score 0 (same year) 14 476 1 64 465 2 31 472 3+ 141 474

RI PT

385 386

387 388

AC C

EP

TE D

M AN U

SC

389

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Figure Legends

391

Figure 1: Pathways used for eligibility to sit for the PRM examination

392

Figure 2: Comparison of scaled scores on the PRM and part 1 ABPMR-CE

393

Figure 3: Comparison of scaled scores on the PRM and part 2 ABPMR-CE

RI PT

390

394

AC C

EP

TE D

M AN U

SC

395 396 397 398 399 400 401 402 403 404 405 406 407 408

250 Candidates for PRM Certification 20032015

78 Completed ACGMEAccredited Fellowship

52 Completed Combined Peds/PM&R Residency

27 Achieved Triple Board Certification

25 Achieved PM&R and PRM Certification

7 Achieved PM&R and PRM Certifcation

Unknown #

Consecutive or Subsequent Pediatric Residency

EP

TE D

28 Achieved Triple Board Accreditation

AC C

1 Acheived Triple Board Certification

120 Completed PM&R Training with additional experience

SC

8 Completed Combined Peds/PM&R Residency Prior to PRM Fellowship Training Program

M AN U

70 Completed PM&R Residency Prior to PRM Fellowship Training Program

172 Non-Fellowship Training Route

RI PT

ACCEPTED MANUSCRIPT

Unknown # Unaccredited Fellowship in Pediatric Rehab (prior to ABMS approval and ACGME accreditations)

Unknown # Practice Experience Track

AC C

EP

TE D

M AN U

SC

RI PT

ACCEPTED MANUSCRIPT

AC C

EP

TE D

M AN U

SC

RI PT

ACCEPTED MANUSCRIPT