Academic Journal
Association between physician licensing and certification examination performance and quality of patient care: a systematic review.
| Title: | Association between physician licensing and certification examination performance and quality of patient care: a systematic review. |
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| Authors: | Pugh D; University of Ottawa, Ottawa, ON, Canada.; Medical Council of Canada, Ottawa, ON, Canada., Roy M; Medical Council of Canada, Ottawa, ON, Canada., Wood TJ; University of Ottawa, Ottawa, ON, Canada., Bartman I; Medical Council of Canada, Ottawa, ON, Canada., Ly V; University of Ottawa, Ottawa, ON, Canada., Touchie C; University of Ottawa, Ottawa, ON, Canada. |
| Source: | Academic medicine : journal of the Association of American Medical Colleges [Acad Med] 2026 Aug 01; Vol. 101 (8), pp. 1012-1026. |
| Publication Type: | Journal Article; Systematic Review; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins Country of Publication: England NLM ID: 8904605 Publication Model: Print Cited Medium: Internet ISSN: 1938-808X (Electronic) Linking ISSN: 10402446 NLM ISO Abbreviation: Acad Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: Philadelphia, PA : Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins Original Publication: [Philadelphia, Pa. : Hanley & Belfus, c1989- |
| MeSH Terms: | Licensure, Medical*/standards , Certification*/standards , Clinical Competence*/standards , Quality of Health Care*/standards , Physicians*/standards , Educational Measurement*, Humans ; United States |
| Abstract: | Purpose: Licensure and certification examinations have traditionally served to ensure physicians possess the knowledge and skills required for independent practice. However, with the growing emphasis on workplace-based assessment, the role and relevance of these point-in-time examinations are increasingly debated. This systematic review aimed to explore the association between physician performance on national licensing and certification examinations and subsequent measures of quality of care in practice. Method: The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Six databases were searched through November 2025. Original research studies were included if they examined the relationship between performance on medical licensing or certification examinations and physician performance in independent practice, including patient outcomes and fitness to practice. Data were extracted and analyzed using content analysis to identify patterns and trends across studies. Results: A total of 44 studies involving 1,021,187 physicians were included. The findings demonstrated that examination performance was consistently associated with quality of patient care and fitness-to-practice concerns. Better examination performance was linked to improved adherence to mammography screening recommendations, appropriate prescribing practices, improved care of patients with diabetes, lower patient morbidity and mortality, fewer complaints to regulatory bodies, and lower malpractice payments. The association was observed across examination formats and medical specialties. Conclusions: The results suggest that national licensing and certification examinations are valuable predictors of future clinical performance. They provide a uniform benchmark to ensure physicians meet rigorously defined criteria. The findings support continued use of these examinations as part of a comprehensive assessment program to promote high-quality patient care and physician competence. This is critical in an era of increased physician mobility, where many physicians have trained in jurisdictions with widely varying curricula and assessment practices. National examinations help ensure that all licensed physicians meet a consistent standard for clinical competence. (© The Author(s) 2026. Published by Oxford University Press on behalf of the AAMC. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.) |
| Grant Information: | Medical Council of Canada |
| Contributed Indexing: | Keywords: certification examination; clinical competence; fitness to practice; licensure |
| Entry Date(s): | Date Created: 20260323 Date Completed: 20260731 Latest Revision: 20260804 |
| Update Code: | 20260804 |
| DOI: | 10.1093/acamed/wvag065 |
| PMID: | 41872000 |
| Database: | MEDLINE |
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| Items | – Name: Title Label: Title Group: Ti Data: Association between physician licensing and certification examination performance and quality of patient care: a systematic review. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AU" term="%22Pugh+D%22">Pugh D</searchLink>; University of Ottawa, Ottawa, ON, Canada.; Medical Council of Canada, Ottawa, ON, Canada.<br /><searchLink fieldCode="AU" term="%22Roy+M%22">Roy M</searchLink>; Medical Council of Canada, Ottawa, ON, Canada.<br /><searchLink fieldCode="AU" term="%22Wood+TJ%22">Wood TJ</searchLink>; University of Ottawa, Ottawa, ON, Canada.<br /><searchLink fieldCode="AU" term="%22Bartman+I%22">Bartman I</searchLink>; Medical Council of Canada, Ottawa, ON, Canada.<br /><searchLink fieldCode="AU" term="%22Ly+V%22">Ly V</searchLink>; University of Ottawa, Ottawa, ON, Canada.<br /><searchLink fieldCode="AU" term="%22Touchie+C%22">Touchie C</searchLink>; University of Ottawa, Ottawa, ON, Canada. – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%228904605%22">Academic medicine : journal of the Association of American Medical Colleges</searchLink> [Acad Med] 2026 Aug 01; Vol. 101 (8), pp. 1012-1026. – Name: TypePub Label: Publication Type Group: TypPub Data: Journal Article; Systematic Review; Research Support, Non-U.S. Gov't – Name: Language Label: Language Group: Lang Data: English – Name: TitleSource Label: Journal Info Group: Src Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Published+for+the+Association+of+American+Medical+Colleges+by+Lippincott+Williams+%26+Wilkins%22">Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins </searchLink><i>Country of Publication: </i>England <i>NLM ID: </i>8904605 <i>Publication Model: </i>Print <i>Cited Medium: </i>Internet <i>ISSN: </i>1938-808X (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2210402446%22">10402446 </searchLink><i>NLM ISO Abbreviation: </i>Acad Med <i>Subsets: </i>MEDLINE – Name: PublisherInfo Label: Imprint Name(s) Group: PubInfo Data: <i>Publication</i>: Philadelphia, PA : Published for the Association of American Medical Colleges by Lippincott Williams & Wilkins<br /><i>Original Publication</i>: [Philadelphia, Pa. : Hanley & Belfus, c1989- – Name: SubjectMESH Label: MeSH Terms Group: Su Data: <searchLink fieldCode="MM" term="%22Licensure%2C+Medical%22">Licensure, Medical*</searchLink>/<searchLink fieldCode="MM" term="%22Licensure%2C+Medical+standards%22">standards</searchLink> <br /><searchLink fieldCode="MM" term="%22Certification%22">Certification*</searchLink>/<searchLink fieldCode="MM" term="%22Certification+standards%22">standards</searchLink> <br /><searchLink fieldCode="MM" term="%22Clinical+Competence%22">Clinical Competence*</searchLink>/<searchLink fieldCode="MM" term="%22Clinical+Competence+standards%22">standards</searchLink> <br /><searchLink fieldCode="MM" term="%22Quality+of+Health+Care%22">Quality of Health Care*</searchLink>/<searchLink fieldCode="MM" term="%22Quality+of+Health+Care+standards%22">standards</searchLink> <br /><searchLink fieldCode="MM" term="%22Physicians%22">Physicians*</searchLink>/<searchLink fieldCode="MM" term="%22Physicians+standards%22">standards</searchLink> <br /><searchLink fieldCode="MM" term="%22Educational+Measurement%22">Educational Measurement*</searchLink><br /><searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22United+States%22">United States</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Purpose: Licensure and certification examinations have traditionally served to ensure physicians possess the knowledge and skills required for independent practice. However, with the growing emphasis on workplace-based assessment, the role and relevance of these point-in-time examinations are increasingly debated. This systematic review aimed to explore the association between physician performance on national licensing and certification examinations and subsequent measures of quality of care in practice.<br />Method: The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Six databases were searched through November 2025. Original research studies were included if they examined the relationship between performance on medical licensing or certification examinations and physician performance in independent practice, including patient outcomes and fitness to practice. Data were extracted and analyzed using content analysis to identify patterns and trends across studies.<br />Results: A total of 44 studies involving 1,021,187 physicians were included. The findings demonstrated that examination performance was consistently associated with quality of patient care and fitness-to-practice concerns. Better examination performance was linked to improved adherence to mammography screening recommendations, appropriate prescribing practices, improved care of patients with diabetes, lower patient morbidity and mortality, fewer complaints to regulatory bodies, and lower malpractice payments. The association was observed across examination formats and medical specialties.<br />Conclusions: The results suggest that national licensing and certification examinations are valuable predictors of future clinical performance. They provide a uniform benchmark to ensure physicians meet rigorously defined criteria. The findings support continued use of these examinations as part of a comprehensive assessment program to promote high-quality patient care and physician competence. This is critical in an era of increased physician mobility, where many physicians have trained in jurisdictions with widely varying curricula and assessment practices. National examinations help ensure that all licensed physicians meet a consistent standard for clinical competence.<br /> (© The Author(s) 2026. Published by Oxford University Press on behalf of the AAMC. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.) – Name: GrantInfo Label: Grant Information Group: Grant Data: Medical Council of Canada – Name: SubjectMinor Label: Contributed Indexing Group: Data: <i>Keywords: </i>certification examination; clinical competence; fitness to practice; licensure – Name: DateEntry Label: Entry Date(s) Group: Date Data: <i>Date Created: </i>20260323 <i>Date Completed: </i>20260731 <i>Latest Revision: </i>20260804 – Name: DateUpdate Label: Update Code Group: Date Data: 20260804 – Name: DOI Label: DOI Group: ID Data: 10.1093/acamed/wvag065 – Name: AN Label: PMID Group: ID Data: 41872000 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1093/acamed/wvag065 Languages: – Code: eng Text: English PhysicalDescription: Pagination: StartPage: 1012 Subjects: – SubjectFull: Humans Type: general – SubjectFull: United States Type: general – SubjectFull: Licensure, Medical standards Type: general – SubjectFull: Certification standards Type: general – SubjectFull: Clinical Competence standards Type: general – SubjectFull: Quality of Health Care standards Type: general – SubjectFull: Physicians standards Type: general – SubjectFull: Educational Measurement Type: general Titles: – TitleFull: Association between physician licensing and certification examination performance and quality of patient care: a systematic review. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Pugh D – PersonEntity: Name: NameFull: Roy M – PersonEntity: Name: NameFull: Wood TJ – PersonEntity: Name: NameFull: Bartman I – PersonEntity: Name: NameFull: Ly V – PersonEntity: Name: NameFull: Touchie C IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 08 Text: 2026 Aug 01 Type: published Y: 2026 Identifiers: – Type: issn-electronic Value: 1938-808X Numbering: – Type: volume Value: 101 – Type: issue Value: 8 Titles: – TitleFull: Academic medicine : journal of the Association of American Medical Colleges Type: main |
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