title: Informal Peer Interaction and Practice Type as Predictors of Physician Performance on Maintenance of Certification Examinations.
abstract: OBJECTIVE
  Physicians can demonstrate mastery of the knowledge that supports continued clinical competence by passing a maintenance of certification examination (MOCEX). Performance depends on professional learning and development, which may be enhanced by informal routine interactions with colleagues. Some physicians, such as those in solo practice, may have less opportunity for peer interaction, thus negatively influencing their examination performance.
  
  
  OBJECTIVE
  To determine the relationship among level of peer interaction, group and solo practice, and MOCEX performance.
  
  
  METHODS
  Longitudinal cohort study of 568 surgeons taking the 2008 MOCEX. Survey responses reporting the level of physicians' peer interactions and their practice type were related to MOCEX scores, controlling for initial qualifying examination scores, practice type, and personal characteristics.
  
  
  METHODS
  Solo practice and amount of peer interaction.
  
  
  METHODS
  Scores on the MOCEX and pass-fail status.
  
  
  RESULTS
  Of the 568 surgeons in the study sample, 557 (98.1%) passed the examination. Higher levels of peer interaction were associated with a higher score (β = 0.91 [95% CI, 0.31-1.52]) and higher likelihood of passing the examination (odds ratio, 2.58 [1.08-6.16]). Physicians in solo (vs group) practice had fewer peer interactions (β = -0.49 [95% CI, -0.64 to -0.33), received lower scores (β = -1.82 [-2.94 to -0.82]), and were less likely to pass the examination (odds ratio, 0.22 [0.06-0.77]). Level of peer interaction moderated the relationship between solo practice and MOCEX score; solo practitioners with high levels of peer interaction achieved an MOCEX performance on a par with that of group practitioners.
  
  
  CONCLUSIONS
  Physicians in solo practice had poorer MOCEX performance. However, solo practitioners who reported high levels of peer interaction performed as well as those in group practice. Peer interaction is important for professional learning and quality of care.
authors.affiliation: Harvard Business School, Harvard University, Boston, Massachusetts2now with Department of Management Science and Engineering, Stanford University, Stanford, California.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Valentine
authors.affiliation: Wharton School, University of Pennsylvania, Philadelphia.
authors.forename: Sigal
authors.initials: S
authors.lastname: Barsade
authors.affiliation: Harvard Business School, Harvard University, Boston, Massachusetts.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Edmondson
authors.affiliation: Recanati Business School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Gal
authors.affiliation: American Board of Surgery, Philadelphia, Pennsylvania.
authors.forename: Robert
authors.initials: R
authors.lastname: Rhodes
mesh_terms: D000328:Adult; D000368:Aged; D002568:Certification; D002983:Clinical Competence; D004521:Educational Measurement; D005260:Female; D013502:General Surgery / Q000193:education* / Q000592:standards*; D006123:Group Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D011331:Private Practice; D013044:Specialty Boards; D014481:United States