Volume 53 | Number 3 | June 2018

Abstract List

Jonathan L. Vandergrift M.S., Bradley M. Gray Ph.D., Weifeng Weng Ph.D.


To evaluate the effect of state continuing medical education () requirements on physician clinical knowledge.

Data Sources

Secondary data for 19,563 general internists who took the Internal Medicine Maintenance of Certification () examination between 2006 and 2013.

Study Design

We took advantage of a natural experiment resulting from variations in requirements across states over time and applied a difference‐in‐differences methodology to measure associations between changes in requirements and physician clinical knowledge. We measured changes in clinical knowledge by comparing initial and examination performance 10 years apart. We constructed difference‐in‐differences estimates by regressing examination performance changes against physician demographics, county and year fixed effects, trend–state indicators, and state change indicators.

Data Collection

Physician data were compiled by the American Board of Internal Medicine. State policies were compiled from American Medical Association reports.

Principal Findings

More rigorous credit‐hour requirements (mostly implementing a new requirement) were associated with an increase in examination performance equivalent to a shift in examination score from the 50th to 54th percentile.


Among physicians required to engage in a summative assessment of their clinical knowledge, requirements were associated with an improvement in physician clinical knowledge.