This study was granted exemption from review by the institutional review board at Rutgers University. An online search of VOT forms for DOs, USMDs, and FMGs was performed by a team of current and former PDs and educators from 6 different medical specialties (M.G., M.H., D.M., A.K., M.A., L.P., N.K., T.M.). We obtained VOT forms from 56 medical boards in all 50 US states, Washington, DC, and US territories (Guam, US Virgin Islands, Northern Mariana Islands, American Samoa, and Puerto Rico), and 14 DO boards (Arizona, California, Florida, Maine, Michigan, Nevada, New Mexico, Oklahoma, Pennsylvania, Tennessee, Utah, Vermont, Washington, and West Virginia) in May 2019. Notation of the optional or required use of the Federation Credentials Verification Service (FCVS) by each state board was made, and we noted whether different VOT forms were required for DOs or FMGs. Researchers confirmed with the medical licensing board via email or telephone in circumstances when the VOT form could not be located using an online search.
We reviewed VOT forms for questions about trainee academic performance only in states where VOT forms differed for USMDs, DOs, and FMGs. We defined academic performance as the level of achievement in the 6 core competencies. The VOT questions from all forms were collected and categorized as follows: disciplinary actions, documents placed on file, actions taken by residents, and nondisciplinary actions taken by the program. Questions were categorized as “disciplinary actions” if they queried whether the applicant had ever been formally disciplined, placed on probation, dismissed, suspended, had privileges restricted, was terminated, expelled, asked to resign, removed from patient care, investigated or placed under investigation, or if they had adverse charges or reactions. Questions were categorized as “actions taken by residents” if they queried whether the trainee had taken a leave of absence or break during training, requested to be transferred from the program, or had any unexcused absences. Questions categorized as “nondisciplinary actions taken by the program” related to remediation, partial credit, extra training, nonpromotion, and nonrenewal. The final category, “documents placed on file,” included questions regarding negative reports or documents related to limitations or special requirements. In the instances where FCVS was optional, only data from the state's own VOT form were included.
A data abstraction form was created and used to tally the results. There was an agreement of all categories by 3 authors (T.M., M.H., N.K.) before data collection. Blank abstraction forms were given to 2 authors (D.M., M.G.) who reviewed all VOT forms and application requirements independently; their results were compared. This data was then confirmed by 2 independent reviewers (M.H., T.M.) and all discrepancies were jointly resolved. States or territories that had either licensure forms with no questions regarding resident performance or had no VOT form were also noted. Questions about mental health and substance use disorders were not included in this review. Data obtained from the review of the VOT forms for DO and FMG's was compared with that of USMDs.