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. 2024 May 1;7(5):e2410127.
doi: 10.1001/jamanetworkopen.2024.10127.

Variation in Oral Board Examination Accommodations Among Specialties

Dana G Rowe  1 , Antoinette J Charles  1 , Emily J Luo  1 , Alissa M Arango  1 , James E Herndon 2nd  2 , Harrison Hockenberry  3 , Cynthia K Shortell  4 , C Rory Goodwin  3 , Melissa M Erickson  5
Affiliations

Variation in Oral Board Examination Accommodations Among Specialties

Dana G Rowe et al. JAMA Netw Open. .

Abstract

Importance: Board certification can have broad implications for candidates' career trajectories, and prior research has found sociodemographic disparities in pass rates. Barriers in the format and administration of the oral board examinations may disproportionately affect certain candidates.

Objective: To characterize oral certifying examination policies and practices of the 16 Accreditation Council for Graduate Medical Education (ACGME)-accredited specialties that require oral examinations.

Design, setting, and participants: This cross-sectional study was conducted from March 1 to April 15, 2023, using data on oral examination practices and policies (examination format, dates, and setting; lactation accommodations; and accommodations for military deployment, family emergency, or medical leave) as well as the gender composition of the specialties' boards of directors obtained from websites, telephone calls and email correspondence with certifying specialists. The percentages of female residents and residents of racial and ethnic backgrounds who are historically underrepresented in medicine (URM) in each specialty as of December 31, 2021, were obtained from the Graduate Medical Education 2021 to 2022 report.

Main outcome and measures: For each specialty, accommodation scores were measured by a modified objective scoring system (score range: 1-13, with higher scores indicating more accommodations). Poisson regression was used to assess the association between accommodation score and the diversity of residents in that specialty, as measured by the percentages of female and URM residents. Linear regression was used to assess whether gender diversity of a specialty's board of directors was associated with accommodation scores.

Results: Included in the analysis were 16 specialties with a total of 46 027 residents (26 533 males [57.6%]) and 233 members of boards of directors (152 males [65.2%]). The mean (SD) total accommodation score was 8.28 (3.79), and the median (IQR) score was 9.25 (5.00-12.00). No association was found between test accommodation score and the percentage of female or URM residents. However, for each 1-point increase in the test accommodation score, the relative risk that a resident was female was 1.05 (95% CI, 0.96-1.16), and the relative risk that an individual was a URM resident was 1.04 (95% CI, 1.00-1.07). An association was found between the percentage of female board members and the accommodation score: for each 10% increase in the percentage of board members who were female, the accommodation score increased by 1.20 points (95% CI, 0.23-2.16 points; P = .03).

Conclusions and relevance: This cross-sectional study found considerable variability in oral board examination accommodations among ACGME-accredited specialties, highlighting opportunities for improvement and standardization. Promoting diversity in leadership bodies may lead to greater accommodations for examinees in extenuating circumstances.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Rowe reported receiving grants from Duke Bass Connections and the Duke Clinical Translational Science Institute outside the submitted work. Dr Goodwin reported receiving grants from the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program, the US Food and Drug Administration, and the National Institutes of Health and personal fees from Medtronic, Spine, and Stryker outside the submitted work. Dr Erickson reported receiving grants from Medtronic and Globus Medical; personal fees from DePuy Synthes and Globus Medical; and owns product design and holds stock in Restor3D outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Association Between Accommodation Score and Percentage of Female Residents and Underrepresented in Medicine (URM) Residents
Figure 2.
Figure 2.. Association Between Percentage of Female Board Members and Accommodation Score
See this image and copyright information in PMC

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