title: Performance on the American Board of Family Medicine Certification examination by country of medical training.
abstract: BACKGROUND
  Performance on the American Board of Family Medicine (ABFM) Certification and Recertification Examinations by country of medical school training has not been examined. Based on internal medicine patterns, we hypothesize that examinees trained in the United States and Canada would outperform examinees trained in other countries.
  
  
  METHODS
  In this retrospective cohort study from 2004 to 2011, data on the ABFM examinations were obtained from the ABFM. Fisher exact and χ(2) tests were performed across years based on the country of examinee training. Simple linear regression was performed to evaluate pass rates over time. All statistics were performed using an α = 0.05.
  
  
  RESULTS
  The overall pass rate over the study period was 84.4% (74,821 of 88,680). The pass rate for US medical graduates (USMGs) was 88.3% (60,328 of 68,332). The pass rate for Canadian medical graduates (CMGs) was 93.8% (872 of 930). The pass rate for non-Canadian foreign medical gradates (NC-FMGs) was 70.1% (13,621 of 19,418). CMGs had a higher pass rate than USMGs (P < .001) and NC-FMGs (P < .001). Simple linear regression showed significant decreasing trends over time for all examinees (P = .02), for USMGs (P = .02), and for CMGs (P = .02).
  
  
  CONCLUSIONS
  USMGs and CMGs outperform NC-FMGs on the ABFM certification and recertification examinations. These findings may alter acceptance patterns for Family Medicine residency programs.
authors.affiliation: University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Department of Surgery, Pittsburgh, PA 15213, USA. falconej@upmc.edu
authors.forename: John L
authors.initials: JL
authors.lastname: Falcone
authors.forename: Donald B
authors.initials: DB
authors.lastname: Middleton
mesh_terms: D002170:Canada; D002568:Certification / Q000706:statistics & numerical data* / Q000639:trends; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004504:Education, Medical, Undergraduate; D005194:Family Practice / Q000193:education*; D005550:Foreign Medical Graduates / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency; D016014:Linear Models; D012189:Retrospective Studies; D014481:United States