title: Association between licensure examination scores and practice in primary care.
abstract: BACKGROUND
  Standards for licensure are designed to provide assurance to the public of a physician's competence to practice. However, there has been little assessment of the relationship between examination scores and subsequent practice performance.
  
  
  OBJECTIVE
  To determine if there is a sustained relationship between certification examination scores and practice performance and if licensing examinations taken at the end of medical school are predictive of future practice in primary care.
  
  
  METHODS
  A total of 912 family physicians, who passed the Québec family medicine certification examination (QLEX) between 1990 and 1993 and entered practice. Linked databases were used to assess physicians' practice performance for 3.4 million patients in the universal health care system in Québec, Canada. Patients were seen during the follow-up period for the first 4 years (1993 cohort of physicians) to 7 years (1990 cohort of physicians) of practice from July 1 of the certification examination to December 31, 1996.
  
  
  METHODS
  Mammography screening rate, continuity of care index, disease-specific and symptom-relief prescribing rate, contraindicated prescribing rate, and consultation rate.
  
  
  RESULTS
  Physicians achieving higher scores on both examinations had higher rates (rate increase per SD increase in score per 1000 persons per year) of mammography screening (beta for QLEX, 16.8 [95% confidence interval [CI], 8.7-24.9]; beta for Medical Council of Canada Qualifying Examination [MCCQE], 17.4 [95% CI, 10.6-24.1]) and consultation (beta for QLEX, 4.9 [95% CI, 2.1-7.8]; beta for MCCQE, 2.9 [95% CI, 0.4-5.4]). Higher subscores in diagnosis were predictive of higher rates in the difference between disease-specific and symptom-relief prescribing (beta for QLEX, 3.9 [95% CI, 0.9-7.0]; beta for MCCQE, 3.8 [95% CI, 0.3-7.3]). Higher scores of drug knowledge were predictive of a lower rate (relative risk per SD increase in score) of contraindicated prescribing for MCCQE (relative risk, 0.88; 95% CI, 0.77-1.00). Relationships between examination scores and practice performance were sustained through the first 4 to 7 years in practice.
  
  
  CONCLUSIONS
  Scores achieved on certification examinations and licensure examinations taken at the end of medical school show a sustained relationship, over 4 to 7 years, with indices of preventive care and acute and chronic disease management in primary care practice.
authors.affiliation: Department of Medicine, McGill University, Morrice House, 1140 Pine Ave W, Montréal, Québec, Canada H3A 1A3. robyn.tamblyn@mcgill.ca
authors.forename: Robyn
authors.initials: R
authors.lastname: Tamblyn
authors.forename: Michal
authors.initials: M
authors.lastname: Abrahamowicz
authors.forename: W Dale
authors.initials: WD
authors.lastname: Dauphinee
authors.forename: James A
authors.initials: JA
authors.lastname: Hanley
authors.forename: John
authors.initials: J
authors.lastname: Norcini
authors.forename: Nadyne
authors.initials: N
authors.lastname: Girard
authors.forename: Paul
authors.initials: P
authors.lastname: Grand'Maison
authors.forename: Carlos
authors.initials: C
authors.lastname: Brailovsky
mesh_terms: D002568:Certification; D002983:Clinical Competence; D005194:Family Practice / Q000193:education* / Q000592:standards*; D008007:Licensure, Medical; D011792:Quebec