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Morie Gertz, MD, MACP, Chair of the Hematology Board

The Hematology Board held its fall meeting on Tuesday, November 7, 2023. The agenda provided an opportunity to update the Specialty Board on activity at ABIM and allowed for discussion of pressing issues in the field. The Hematology Board was joined by guests from the American Society of Hematology (ASH)*.

The following is a summary of the fall meeting.

Conversation with the President*

Prior to the meeting, members and guests of the Hematology Board had the opportunity to view a video update from Richard J. Baron, MD, MACP, President and Chief Executive Officer of ABIM and ABIM Foundation, reflecting on current issues for ABIM and the internal medicine community. Dr. Baron invited the specialty boards to discuss these topics, including:

  • Recent public conversations and press coverage around the value of ABIM’s Maintenance of Certification (MOC) program.
  • Engagement of early career physicians and trainees in ABIM’s work and how members of ABIM governance can facilitate conversations with colleagues and leaders in their disciplines to foster better understanding of ABIM’s mission and programs.
  • The ongoing and evolving challenges in addressing misinformation, and the historical roots of mistrust in science and medicine, as explored at the ABIM Foundation Forum in July.

Some members of the Hematology Board mentioned the recent public discussion of the MOC program and asked Dr. Baron to expand more on ABIM’s plans to address concerns expressed by diplomates and medical specialty societies. Dr. Baron commented on the importance of listening to the community while maintaining the value and integrity of assessment, noting that ABIM has been receiving feedback from a broad range of perspectives, particularly from physicians practicing highly specialized medicine. ABIM remains committed to creating the best possible MOC program for the entire diplomate population. This may include the development of more focused assessments within some disciplines where the physician data supports a significant number of physicians dedicating their practice in particular areas of the specialty. But this work takes time and must be evidence-based. He added that the Longitudinal Knowledge Assessment (LKA®) is an example of ABIM offering a more flexible and adaptable program for different learning styles.

Diversity, Equity and Inclusion (DEI)*

The Specialty Board received an update on ABIM’s DEI work from Lorna Lynn, MD, Vice President of Medical Education Research; Kelly Rand, MA, CPH, Program Officer of Diversity and Health Equity; and Pamela Browner White, Senior Vice President of Communications and Chief DEI Officer.

Their central points included:

  • A September meeting in collaboration with 24 medical specialty societies around DEI and how ABIM can collaborate with and support societies in this work. This meeting highlighted work that societies and ABIM can do together in the areas of shared resources, developing pathway programs to diversity the health care workforce and providing support for mentorship programs.
  • Collaboration with the Accreditation Council for Continuing Medical Education (ACCME) to explore the possibilities of offering continuing medical education credit and MOC points for mentoring activities based on feedback that identified the importance of mentorship for students, trainees and underrepresented groups who face barriers to success because of personal characteristics.
  • Fairness review pilots conducted in cardiovascular disease, gastroenterology, internal medicine and nephrology over the past year using statistical analysis and content review to identify bias in ABIM assessment questions (items) in those disciplines.

Morie Gertz, MD, MACP, Chair of the Hematology Board, inquired whether the Item-Writing Task Force could develop health equity items that could be used across disciplines in assessments. Dr. Lynn confirmed that this, along with discipline-specific health equity content, is an organizational goal, and shared that ABIM is learning a great deal from early experience in health equity content development. Dr. Gertz encouraged ABIM to engage early career physicians in DEI work and education.

Listening Session on the Longitudinal Knowledge Assessment (LKA®)*

Prior to the meeting, Specialty Board members and guests had the opportunity to view a video update sharing recent insights about diplomates’ engagement in the LKA and their experience and feedback. Some key points included:

  • The relatively small number of diplomates unenrolling from the LKA may be physicians who find they prefer the Traditional, 10-Year MOC Exam, or who find that the commitment to 30 questions per quarter does not align with their availability.
  • Diplomates certified before 1990 can use the LKA to meet their assessment requirement to remain publicly reported as “Participating in MOC.”
  • Physicians continue to choose the LKA over the Traditional, 10-Year MOC Exam at a rate of 4:1 on average across all 15 subspecialties in which it is offered.
  • On average, LKA participants are taking less than two minutes to answer each question, equating to less than one hour per quarter in total. ABIM also offers accommodations in compliance with Title III of the Americans with Disabilities Act, which can include time added to the standard four minutes that physicians have to answer each question as well as the 30-minute time bank, if approved.

Diplomates with an assessment due in 2024 can enroll in the LKA or register for the traditional, 10-year MOC exam as of December 1, 2023. The first quarter’s LKA questions were released on January 1. Diplomates are encouraged to check their Physician Portal for upcoming requirements and eligibility, and to enroll early in the quarter to ensure they have as much time as possible to answer questions before they expire on March 31.

Annual Maintenance of Certification Status Review*

Florence Mickens, Program Operations Manager for ABIM, and Weifeng Weng, Ph.D., Director of Research and Data Intelligence, reviewed the annual process through which ABIM evaluates certificates to determine whether an individual diplomate is meeting MOC requirements. The requirements are to be current with the MOC assessment requirement and MOC points (some points every two years and 100 points every five years). Certificates that do not meet these requirements will either experience a status change in certification or participation or enter a grace period. The way diplomates log activities for MOC points varies based on the activity itself, including some that require reporting points manually and others that are reported to ABIM through the ACCME’s activity provider reporting system. Diplomates are encouraged to check their Physician Portal regularly to ensure that their MOC points are being reported accurately.

Dr. Weng explained that the 2023 cohort of “at-risk” certificates is comparatively large due to two primary contributing factors:

  • The number of physicians who earned initial certification prior to 2014 when the current MOC program requirements began are now due for their second five-year MOC point requirement. Physicians who earned certification in 2018 are also due for their first five-year point requirement in 2023.
  • The extension given to certificates in Critical Care Medicine, Infectious Disease and Pulmonary Disease as a result of the pandemic has ended.

ABIM engages in a robust and comprehensive communications strategy over several months to alert at-risk diplomates of upcoming deadlines in order to minimize the number of diplomates who miss the deadline and are subsequently reported as “Not Certified.” Tactics include email campaigns, postcards and e-newsletters.

Dr. Gertz asked for additional information about the Physician Portal and how many physicians log in at least once a year. Staff confirmed that on average, 70–80% of diplomates log in at least once a year, with an increase in inquiries about requirements following scheduled email reminders about MOC due dates.

Update from the American Society of Hematology (ASH)*

Josel Fritz, MPH, Deputy Director of Career Development & Service for ASH, shared the results of a study that ASH conducted on burnout in hematology/oncology clinicians, including both physician members of ASH, and physician assistants and nurse practitioners. These groups recommended the creation of a working group to develop best practices for collaboration and disseminate educational resources to advanced practice providers.

At its spring meeting, the Hematology Board received an update on the ASH Hematology-Focused Fellowship Training Program, which funded the creation of ten new hematology-focused fellowship tracks at nine institutions. Ms. Fritz updated the Specialty Board on the success of this program, which is slated to lead to 75 new fellows graduating by 2030, rather than the 50 originally anticipated.

Charles Clayton, Chief Professional Development and Diversity Officer, Emeritus, also discussed a statement released earlier in the year regarding concerns about ABIM’s MOC program. He affirmed ASH’s support of ABIM as the certifying board for hematologists, expressed the organization’s faith in focused assessments for the discipline and mentioned that ASH had identified some areas for improvement on the LKA. ABIM congratulated Mr. Clayton on his career commitment to the American Society of Hematology

Society guests departed at this point in the meeting.

Review of the Specialty Board Membership Selection Process

Sarah Joy Wartinger, Program Manager for Medical Specialties at ABIM, reviewed the process whereby ABIM recruits and selects new members for the Specialty Boards. ABIM recruited for a planned opening for a physician practicing in a non-academic community setting on the Hematology Board to begin on July 1, 2024. The Specialty Board will review these candidates early in 2024 and make a recommendation to the ABIM Council at its spring meeting to make a final selection of candidates.

Recruitment for new openings on the Specialty Boards will begin in the summer of 2024; diplomates and society partners will be notified of all openings.

Opportunities for Engaging Early Career Physicians

ABIM is one of several organizations that nominate candidates for the ACGME Residency Review Committee for Internal Medicine (RC-IM). The RC-IM invited ABIM to nominate two physicians for the RC-IM program director position and two physicians in training in a discipline of internal medicine. Nominations were solicited from ACGME-accredited internal medicine residency and fellowship program directors. Members of each of the specialty boards will be part of the process by interviewing candidates, providing feedback and nominating two individuals.

Anamika Gavhane, Senior Director for Discipline-Specific Governance at ABIM, explained the candidate vetting process to the Hematology Board and also shared ABIM’s plans to explore a convening of early career physicians (those within the first ten years of initial certification) across the disciplines of internal medicine. The convening would offer an opportunity to learn more from young physicians by gathering trainees and/or newly certified diplomates, including prospective nominees not chosen to serve on the RC-IM.

Some members of the Hematology Board had conducted interviews with applicants and shared their feedback. ABIM staff will continue to find ways to engage with applicants who will not be nominated for the RC-IM as part of the initiative mentioned above.

Selecting New Members of the Hematology Approval Committees

ABIM’s Specialty Boards are responsible for selecting members and chairs of the Approval Committees annually and as needed. With Dr. Gertz’s recent appointment as Chair of the Hematology Board in July, he chose to step down as Chair of the Hematology LKA Approval Committee, and the Specialty Board spent time leading up to the fall meeting in reviewing applications and interviewing candidates. After discussion, the Hematology Board voted to approve Ming Lim, MD, of the University of Utah, as the Chair of the Hematology LKA Approval Committee effective immediately. Dr. Lim has served as a member of the Approval Committee since 2020, after previously serving on the Hematology Item-Writing Task Force from 2018 to 2020.

Update on the Hematology Approval Committees

Morie Gertz, MD, MACP, Mayo Clinic Rochester; Immediate Past Chair of the Hematology LKA Approval Committee

Robert T. Means, Jr., MD, East Tennessee State University James H. Quillen College of Medicine; Chair of the Hematology Traditional, 10-Year MOC Exam Approval Committee

ABIM Approval Committees are responsible for approving and editing all assessment content, and maintaining the blueprints for the Initial Certification Examination, the MOC Examination and the LKA. There are two ABIM Approval Committees working with the Hematology Board: the Traditional, 10-Year MOC Exam Approval Committee (which also deals with the initial certification exam) and the LKA Approval Committee. Dr. Gertz and Dr. Means provided brief updates for the Specialty Board on the composition of the Approval Committees, progress on item development in meetings this year and news about the Item-Writing Task Force. Dr. Means noted that the LKA Approval Committee has a need more additional members to meet the need for more items for the practice profiles in hematology. Members of the Approval Committee are also serving as mentors for the Item-Writing Task Force to facilitate item development.

New Proposal for ABIM’s Approved Quality Improvement (AQI) Program

The AQI Program is the process through which ABIM recognizes externally developed quality improvement activities that physicians are doing in practice. It also allows diplomates to earn MOC points for activities that support their local improvement priorities. Approved activities grant 20 MOC points to physicians who meaningfully participate in the activity. Paul T. Adams, MD, reviewed the following proposal for the program and provided their recommendation for approval:

  • “Mobile Video Interpreting to Optimize Communication Across Languages (mVOCAL),” sponsored by Seattle Children’s Research Institute and reviewed by Dr. Adams. The study will give enrolled primary care providers access to educational modules about accessing and communicating effectively through professional interpreters.

After a brief discussion, the Hematology Board voted to approve the AQI proposal for MOC credit.

ABIM welcomes proposals from sponsors that may include medical specialty societies, hospitals or departments within hospitals, medical groups, clinics or other health-related organizations that wish to approve a single activity. Organizations with a quality improvement activity to submit to ABIM for MOC credit recognition are encouraged to take the following steps: 

  1. Download the ABIM AQI Program Guide (PDF)
  2. Download and complete the AQI Application (PDF). 
  3. Email completed applications to mocprograms@abim.org.

Communications and Governance Engagement

John Held, Senior Director of Communications and Brand Management for ABIM, and Peter McConnell, Program Manager for Governance and Medical Society Communications, provided an update on ABIM’s communications work and current trends in the community. The presenters invited the Hematology Board members to share their own perspectives and discuss how ABIM can foster better understanding and enhance the perceived value of the MOC program among diplomates.

In discussion, the group identified the need for more communication about how the MOC program works and the promotion of more positive reactions to and feedback about the LKA. Dr. Gertz added that the value of assessment is not solely for the benefit of physicians but for the benefit of patients as the people that physicians treat.

In Closing

The Hematology Board values the feedback and commentary of the entire medical community, including diplomates and society partners.

Do you have any questions? Are you interested in getting involved?

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*Indicates that Society guests were present for this session.