Thomas O'Neill

remendous progress has beenmade in the physical sciences inthe last 500 years and the rate ofchange has been increasing, especially over the last 100 years . The discovery that some traits are transmitted genetically has led to the genetic engineering offruits and vegetables, the cloning of mammals, and the promise of successful genetically engineered solutions to medical prob-leas. Military technology has been changed not only by the invention of the mass-produced rifle, but also by the radio, microchips, satellites, airplanes, and missiles which can deliver explosives or non-conventional weapons (chemical, biological, or nuclear) . Medical technology has been changed not only by the invention ofantibiotics, anesthesia and the development ofa germ theory ofdisease, but also by dialysis technology, replacement joints and the development ofsophisticated surgical technologies (i .e . micro, orthoscopic, laser, etc .) . Human organs can be replaced with organs from other people or some...

Family medicine is a specialty of breadth, providing comprehensive health care for the individual and the family that integrates the broad scope of clinical, social, and behavioral sciences. As such, the scope of practice (SOP) for family medicine is extensive; however, over time many family physicians narrow their SOP. We sought to provide a nationally representative description of the most common and the most critical diagnoses that family physicians see in their practice. Data were extracted from the 2012 National Ambulatory Medical Care Survey (NAMCS) to select all ICD-9 codes reported by family physicians. A panel of family physicians then reviewed 1893 ICD-9 codes to place each code into an American Board of Family Medicine Family Medicine Certification Examination test plan specifications (TPS) category and provide a rating for an Index of Harm (IoH). An analysis of all 1893 ICD-9 codes seen by family physicians in the 2012 NAMCS found that 198 ICD-9 codes could not be assign...

Due to the Accreditation Council for Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) single-accreditation model, the specialty of family medicine may see as many as 150 programs and 500 trainees in AOA-accredited programs seek ACGME accreditation. This analysis serves to better understand the composition of physicians completing family medicine residency training and their subsequent certification by the American Board of Family Medicine. We identified residents who completed an ACGME-accredited or dual-accredited family medicine residency program between 2006 and 2016 and cross-tabulated the data by graduation year and by educational background (US Medical Graduate-MD [USMG-MD], USMG-DO, or International Medical Graduate-MD [IMG-MD]) to examine the cohort composition trend over time. The number and proportion of osteopaths completing family medicine residency training continues to rise concurrent with a decline in the number and proportion of IMGs. Take Ra...

Using a paired comparison data collection procedure and a one-faceted Rasch model, a stable construct of frequency is derived using 43 non-numeric quantitative descriptors, such as never, almost never, rarely, sometimes, often, etc. This construct is acontextual in that only the words or phrases were compared. The raters were not supplied with any particular context. To make the paired comparison survey more manageable certain assumptions were made that would result in a sparse, but connected 43 x 43 data matrix. Three hundred ninety-six pairs were selected and each pair was assigned to one of two forms. The quality control procedures to detect pair-order effects, fatigue effects, aberrant raters, model misfit, etc. are discussed. The results were mapped onto a continuum, which seems to represent the common understanding of frequency using non-numeric quantitative descriptors. These results have implications for how many different strata of frequency people can reliably differentiat...

To examine the predictive validity of the National Board of Osteopathic Medical Examiners' Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) series with regard to the American Board of Family Medicine's (ABFM's) In-Training Examination (ITE) and Maintenance of Certification for Family Physicians (MC-FP) Examination. A repeated-measures design was employed, using test scores across seven levels of training for 1,023 DOs who took the MC-FP for the first time between April 2012 and November 2014 and for whom the ABFM had ITE scores for each of their residency years. Pearson and disattenuated correlations were calculated; Fisher r to z transformation was performed; and sensitivity, specificity, and positive and negative predictive values for the COMLEX-USA Level 2-Cognitive Evaluation (CE) with regard to the MC-FP were computed. The Pearson and disattenuated correlations ranged from 0.55 to 0.69 and from 0.61 to 0.80, respec...

This study addresses item exposure in a Computerized Adaptive Test (CAT) when the item selection algorithm is permitted to present examinees with questions that they have already been asked in a previous test administration. The results indicate that the combined use of an adaptive algorithm to select items and latent trait theory to estimate person ability provides substantial protection from score contamination. The implications for constraints that prohibit examinees from seeing an item twice are discussed.

Our objective was to examine the predictive validity of the American Board of Family Medicine's (ABFM) In-Training Examination (ITE) with regard to predicting outcomes on the ABFM certification examination. This study used a repeated measures design across three levels of medical training (PGY1--PGY2, PGY2--PGY3, and PGY3--initial certification) with three different cohorts (2010--2011, 2011--2012, and 2012--2013) to examine: (1) how well the residents' ITE scores correlated with their test scores in the following year, (2) what the typical score increase was across training years, and (3) what was the sensitivity, specificity, positive predictive value, and negative predictive value of the PGY3 scores with regard to predicting future results on the MC-FP Examination. ITE scores generally correlate at about .7 with the following year's ITE or with the following year's certification examination. The mean growth from PGY1 to PGY2 was 52 points, from PGY2 to PGY3 was 34 points, and from PGY3 to initial certification was 27 points. The sensitivity, specificity, positive predictive value, and negative predictive value were .91, .47, .96, and .27, respectively. The ITE is a useful predictor of future ITE and initial certification examination performance.

Purpose: Training to provide a broad scope of practice is a key feature of family medicine; however, the factors associated with scope of practice are poorly understood. Rural areas have fewer physicians and as a consequence, family physicians in rural locations may have a broader scope of practice out of necessity. Practice organization may also be associated with scope as integrated systems may incentivize referrals. Objective: Determine the relationship between scope of practice, rural/urban location, and practice organization. Design: Cross sectional study of family physicians seeking recertification with the American Board of Family Medicine (ABFM) linking a scope of practice index, the Scope of Practice for Primary Care (SP4PC) scale, with self-reported practice location and organization. Linear regression models determined adjusted associations between scope, location and organization. Setting: United States. Participants: 11,231 family physicians seeking ABFM recertification...

Our objective was to examine the predictive validity of the American Board of Family Medicine's (ABFM) In-Training Examination (ITE) with regard to predicting outcomes on the ABFM certification examination. This study used a repeated measures design across three levels of medical training (PGY1--PGY2, PGY2--PGY3, and PGY3--initial certification) with three different cohorts (2010--2011, 2011--2012, and 2012--2013) to examine: (1) how well the residents' ITE scores correlated with their test scores in the following year, (2) what the typical score increase was across training years, and (3) what was the sensitivity, specificity, positive predictive value, and negative predictive value of the PGY3 scores with regard to predicting future results on the MC-FP Examination. ITE scores generally correlate at about .7 with the following year's ITE or with the following year's certification examination. The mean growth from PGY1 to PGY2 was 52 points, from PGY2 to PGY3 was 34...

The American Board of Family Medicine (ABFM) has used a 60-item Multiple Choice Question (MCQ) section followed by a Virtual Patient (VP) exercise in Maintenance Of Certification (MOC) since 2004, and has had an asthma module since 2005. The original asthma VP criteria anticipated some Expert Panel Report-3 recommendations, such as home peak flow monitoring and a written plan, that were added to the MCQ section only when the guideline was updated in 2007. VP completion rates for these criteria improved markedly with the MCQ update, while other criteria completion rates were stable. Asthma criteria completion rates are not predicted by the strength of evidence for the criteria. User interface details influence criteria completion rates, but did not affect the changes observed in 2007. Asthma MCQ content affects Diplomate performance on asthma VP: this translational step suggests that MOC exercises could result in improved care for real patients.

Certification examinations used by American specialty boards have been the sine qua non for demonstrating the knowledge sufficient for attainment of board certification in the United States for more than 75 years. Some people contend that the examination is predominantly a test of superior test-taking skills rather than of family medicine decision-making ability. In an effort to explore the validity of this assertion, we administered the American Board of Family Medicine (ABFM) Certification to examinees who had demonstrated proficiency in taking standardized tests but had limited medical knowledge. Four nonphysician experts in the field of measurement and testing were administered one version of the 2009 ABFM certification examination. Scaled scores were calculated for each examinee, and psychometric analyses were performed on the examinees responses to examination items and compared with the performance of physicians who took the same examination. The minimum passing threshold for the examination was a scaled score of 390, corresponding to 57.7% to 61.0% of questions answered correctly, depending on the version of the examination. The 4 nonphysician examinees performed poorly, with scaled scores that ranged from 20 to 160 (mean, 87.5; SD, 57.4). The number of questions answered correctly ranged from 24.0% to 35.1% (mean, 29.2%; SD, 0.05%). Rasch analyses of the examination items revealed that the nonphysician examinees were more likely to use guessing strategies in an effort to answer questions correctly. Distracter analysis suggest near-complete randomness in the nonphysician responses. Though all 4 nonphysician examinees performed better than would have been predicted by chance alone, none performed well enough to even fall within 8 SE below the passing thresholds; their performance was far below that of almost all physicians who completed the examination. Given that the nonphysicians relied heavily on the identifying cues in the phrasing of items and the manner in which response options were presented, the results affirm the notion that the ABFM certification examination is not primarily a measure of generic test-taking ability but measures information critical to the estimation of a family physician's knowledge sufficient for certification. Item analysis confirmed that items were well written, provided minimal cueing, and required medical knowledge to answer correctly.

ABSTRACT Jehn (e.g., 1997) offered three distinct types of team conflict, namely, task conflict, relationship conflict, and process conflict. Despite existing meta-analyses, there remain important and ongoing issues that warrant further meta-analytic investigation. Our contribution is threefold. First, we report novel meta-analytic findings involving moderators of the conflict–team performance relationship. Second, we report on meta-analytic correlations involving all three conflict types and team innovation. Third, we report on the relations involving task conflict and relationship conflict with previously unexamined, but critical, teamwork variables: team potency, cooperative behaviors, competitive behaviors, and avoidance behaviors. Input for the current meta-analysis included 89 independent samples, 6,122 teams, and approximately 28,000 team members.

The TNF receptor superfamily member CD27 is best known for its important role in T-cell immunity but is also recognized as a cell-surface marker on a number of B- and T-cell malignancies. In this article, we describe a novel human monoclonal antibody (mAb) specific for CD27 with properties that suggest a potential utility against malignancies that express CD27. The fully human mAb 1F5 was generated using human Ig transgenic mice and characterized by analytical and functional assays in vitro. Severe combined immunodeficient (SCID) mice inoculated with human CD27-expressing lymphoma cells were administered 1F5 to investigate direct antitumor effects. A pilot study of 1F5 was conducted in non-human primates to assess toxicity. 1F5 binds with high affinity and specificity to human and macaque CD27 and competes with ligand binding. 1F5 activates T cells only in combination with T-cell receptor stimulation and does not induce proliferation of primary CD27-expressing tumor cells. 1F5 significantly enhanced the survival of SCID mice bearing Raji or Daudi tumors, which may be mediated through direct effector mechanisms such as antibody-dependent cellular cytotoxicity. Importantly, administration of up to 10 mg/kg of 1F5 to cynomolgus monkeys was well tolerated without evidence of significant toxicity or depletion of circulating lymphocytes. Collectively, the data suggest that the human mAb 1F5, which has recently entered clinical development under the name CDX-1127, may provide direct antitumor activity against CD27-expressing lymphoma or leukemia, independent of its potential to enhance immunity through its agonistic properties.

The vaccinia virus expression system was used to determine the role of human immunodeficiency virus type 1 (HIV-1) protease in viral morphogenesis and maturation. The unprocessed p55 gag precursor polyprotein alone was assembled to form HIV-1 particles which budded from cells. The particles were spherical and immature, containing an electron-dense shell in the particle submembrane; there was no evidence of core formation. Expression of both gag and pol proteins from a recombinant containing the complete gag-pol coding sequences resulted in intracellular processing of gag-pol proteins and the production of mature particles with electron-dense cores characteristic of wild-type HIV virions. To ascertain the role of protein processing in particle maturation, the pol ORF in the gag-pol recombinant was truncated to limit expression of the pol gene to the protease domain. With this recombinant expressing p55 gag and protease, intracellular processing was observed. Some of the resultant particles were partially mature and contained processed gag protein subunits. In contrast, particle maturation was not observed when the HIV-1 protease and p55 gag were coexpressed from separate recombinants, despite evidence of intracellular gag processing. These findings suggest that HIV-1 protease must be an integral component of the full-length gag-pol precursor for optimal processing and virion maturation.

Abstract: Background: Two medical specialty boards offer certification in family medicine: the American Board of Family Medicine (ABFM) and the American Osteopathic Board of Family Physicians (AOBFP). The AOBFP certification is offered only to graduates of osteopathic colleges; however, graduates of both osteopathic and allopathic medical schools who have successfully completed a residency program accredited by ACGME may seek ABFM certification. Some family medicine residency programs are accredited by both the ...