To the Editor:
The January issue of ANESTHESIOLOGY appeared as a theme issue regarding “Medical Education.” The article discussing objectively the Objective Structured Clinical Examination (OSCE) detailed OSCE’s inherent weaknesses: OSCE is especially costly and residency programs will need to incorporate OSCE training at all sites. OSCE is very time consuming, presents difficulty in development and evaluation of OSCE, regarding quality, reliability, and validity.1
The use of OSCE in medical student assessment has been in use for over a decade and recently dissected in a cost analysis there: it “provides a poor return on investment and little appreciable value to the U.S. healthcare system—and should therefore be eliminated.”2
The accompanying editorial authored by three individuals employed by the American Board of Anesthesiology, Inc. (ABA) appeared to promote the ABA’s planned introduction of the OSCE and their certification program overall.3
I was surprised to see this following statement declaring no conflicts of interests, where they clearly exist:
“Competing Interests: The authors are not supported by, nor maintain any financial interest in, any commercial activity that may be associated with the topic of this article.”
Upon review of the most recent available ABA 990 tax return from calendar year (January 1 to December 31) 2011, the two board member authors were listed as earning $18,000 and $78,000, respectively, whereas the Chief Assessment Officer author earned $127,000.*
It is assured that all authors still earn significant sums. They are currently listed on the ABA webpage as retaining the same offices in 2013, when this editorial was submitted. The ABA is a 501 (3) C corporation with corporate
balance books and prerogatives. As paid employees of any corporation and representing that corporation as paid authors, the declaration as stated is a gross misrepresentation even when the submission is designated as submitted from the ABA (there could actually be volunteers
writing). It is time that officers and employees of ANY corporation be required to declare these conflicts of interests at ALL times. All three authors work for the corporation and are clearly supported by that corporation, the ABA.
As the journal representing the membership of the American Society of Anesthesiologists, ANESTHESIOLOGY has a responsibility to provide balanced information and declarations. It is time to require clear identification of these conflicts of interests of all corporate interests (including Maintenance of Certification proponents) in all journals.4
Opposition to the regulatory capture of physicians is mounting.†
This includes objective editorials, critical of Maintenance of Certification, and the associated costs, in other professional journals.5
Important oppositional viewpoints should not be hidden from view by controlling journal content and allowing false declarations, especially in the American Society of Anesthesiologists’ own journal.
The author declares no competing interests.
Paul Martin Kempen, M.D., Ph.D.
, Cleveland Clinic, Cleveland, Ohio. email@example.com
* American Board of Anesthesiology, Inc.: 2011 IRS 990 tax declaration. Available at: http://www2.guidestar.org/FinDocuments/2011/060/646/2011-060646523-089e9493-9.pdf
. Accessed May 1, 2014. Cited Here...
† Pittman D: Meeting coverage: AMA House Disses Recertification Programs. Published June 18, 2013. Available at: http://www.medpagetoday.com/MeetingCoverage/AMA/39949
. Accessed May 1, 2014. Cited Here...
1. Hastie MJ, Spellman JL, Pagano PP, Hastie J, Egan BJ. Designing and implementing the objective structured clinical examination in anesthesiology. ANESTHESIOLOGY. 2014;120:196–203
2. Lehman EP IV, Guercio JR. The Step 2 Clinical Skills exam—A poor value proposition. N Engl J Med. 2013;368:889–91
3. Rathmell JP, Lien C, Harman A. Objective structured clinical examination and board certification in anesthesiology. ANESTHESIOLOGY. 2014;120:4–6
4. Kempen P. Maintenance of licensure. Ann Intern Med. 2013;158:219
5. Van Harrison R, Olson CA. Evolving health care systems and approaches to maintenance of certification. J Contin Educ Health Prof. 2013;33(suppl 1):S1–4
© 2014 American Society of Anesthesiologists, Inc.