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A word from the Specialty Board chair: Click to hear an introduction from Dr. Laura Evans.

The Critical Care Medicine Board held its fall meeting on Wednesday, October 4, 2023, including a special joint session with the Pulmonary Disease Board. The agenda included updates for the Specialty Board on activity at ABIM and allowed for discussion of pressing issues in the field, including issues that affect both disciplines.

The following is a summary of the fall meeting.

Update on the Critical Care Medicine Approval Committees

Christopher F. Barnett, MD, University of California, San Francisco; Chair of the Critical Care Medicine Traditional, 10-Year MOC Exam Approval Committee

Margaret Pisani, MD, Yale University; Chair of the Critical Care Medicine LKA Approval Committee

ABIM Approval Committees are responsible for approving and editing all assessment content, and maintaining the blueprints for the Initial Certification Examination, the Maintenance of Certification (MOC) Exam and the Longitudinal Knowledge Assessment (LKA®). There are two ABIM approval committees related to critical care medicine: the Traditional, 10-Year MOC Exam Approval Committee (which also deals with the initial certification exam) and the LKA Approval Committee. Drs. Barnett and Pisani provided a brief update 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. The group discussed the challenge faced by the Approval Committees of approving enough items to appear on the assessments, and how item-writers are given feedback about items that are revised or rewritten before final approval.

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 Specialty 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.

Insights offered by members of the Specialty Board included the increasing number of physicians experiencing burnout and a lack of widespread understanding about how MOC is associated with higher quality patient care. They suggested that communications should continue to aim to be transparent about how the MOC program works, the fee structure and how the program creates value for physicians.

New Proposals 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. The Specialty Board received information on two new activities for consideration:

  • “Improving the Care of the Patient with Cardiogenic Shock,” sponsored by the Florida Health Sciences Center and Tampa General Hospital, and recommended for approval by Alexander Sy, MD, MBA, MSL. The project aims to create a patient-centered, evidence-based, multidisciplinary team approach to caring for patients with cardiogenic shock and decreasing mortality rates.
  • “Implementation of Coordinated Spontaneous Awakening and Breathing Trials Using Telehealth-Enabled, Real-Time Audit and Feedback for Clinician Adherence (TEACH),” sponsored by Intermountain Health and recommended for approval by Jeffrey F. Barletta, Pharm.D. The project aims to use telehealth-enabled remote care to address implementation challenges in coordinated spontaneous awakening trials and spontaneous breathing trials in order to increase ventilator-free days and decrease mortality.

After a brief discussion, the Critical Care Medicine Board approved both AQI proposals 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.

Reviewing the Composition of the Specialty Board

In light of both recent changes in membership and an upcoming term ending in 2024, the Critical Care Medicine Board reviewed the current and projected composition of the Specialty Board and held a discussion to determine next steps for filling vacant positions. Among the options available is conducting an additional call for nominations or selecting from the current applicant pool (those who were not selected during the last recruitment cycle). The Specialty Board will move forward with the process of reviewing existing applications to determine the characteristics of the applicant pool before deciding which recruitment option to pursue.

Opportunities for Engaging Early Career Physicians

ABIM is one of several organizations that nominate candidates for the Accreditation Council for Graduate Medical Education (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 Critical Care Medicine 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.

The joint session with the Pulmonary Disease Board began on Thursday, October 5, 2023. The Specialty Boards were joined for this session* by guests from the American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians (CHEST), the American Thoracic Society (ATS), the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD) and the Society of Critical Care Medicine (SCCM).

Listening Session on the LKA®*

Prior to the meeting, Specialty Board members and guests had the opportunity to review 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.” Eligibility depends on when their requirements are due.
  • 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 (ADA), 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.

Thor Odhner, Program Officer, Diplomate Experience at ABIM, invited the group to offer perspectives from their own communities and discuss what information they would find useful for the future. He also noted that the LKAs in Critical Care Medicine and Pulmonary Disease were released in January 2023 (one year later than the first 12 specialties), so at the end of the year, ABIM will have one full year’s worth of data on LKA performance in those disciplines. So far, overall trends include a high participation rate among eligible diplomates and consistent enrollment numbers.

Additionally, ABIM has begun publishing “Specialty Knowledge Gaps” reports in each LKA that was released in 2022. The reports were created in response to feedback from medical specialty societies in order to help them develop educational materials for physicians. They display overall average performance (the average percentage of questions answered correctly) in the top-level blueprint areas for the discipline as well as performance across various demographic categorizations within that discipline. Mr. Odhner pointed out that the reports for Critical Care Medicine and Pulmonary Disease will be released next year once more data are available.

LKA enrollment for diplomates with an assessment due in 2024 opens on December 1, 2023. Diplomates are encouraged to check their Physician Portal for upcoming requirements and eligibility.

Annual Maintenance of Certification Status Review*

Florence Mickens, Program Operations Manager for ABIM, 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. Diplomates are encouraged to sign in to their Physician Portal to check their status regularly.

Ms. Mickens 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 who miss the deadline and are subsequently reported as “Not Certified.” Tactics include email campaigns, postcards and e-newsletters.

Conversation with the President*

Prior to the meeting, members and guests of the Critical Care Medicine and Pulmonary Disease Specialty Boards 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 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.

In discussion with the group about the MOC program, Dr. Baron noted that ABIM is continuing to work with societies to identify areas for improvement and listening to the diplomate community to evolve programs and products. He added that many physicians are still choosing the LKA as a flexible option to maintain their certification, and that surveys and internal metrics still indicate a high level of engagement and satisfaction with the assessment.

Procedural Requirements for Initial Certification in Critical Care Medicine and Pulmonary Disease*

For more than a year, the Critical Care Medicine and Pulmonary Disease specialty boards have been considering whether changes should be made to the procedural skills required for initial certification in their disciplines. It was most recently discussed at their spring meetings (see the Critical Care Medicine Board spring meeting summary and the Pulmonary Disease Board spring meeting summary), when they reviewed information about a survey prompted by a request from APCCMPD and a proposal from researchers at the University of Pennsylvania, who have a particular interest in training in endotracheal intubation during fellowship. The survey was intended to better understand how often certain procedures are performed in clinical practice and whether the procedural requirements for ABIM certification remain relevant to current practice. At the fall joint meeting, Siddharta G. Reddy, MPH, Senior Research Associate at ABIM, shared results of the survey that closed in August.

The group discussed the findings, noting that recent graduates of fellowship programs differed in various procedural frequencies compared to physicians who have been in practice longer. The next stage will involve ABIM sharing the information with stakeholders, including medical societies and patient advocacy groups, and inviting their feedback early in 2024.

Diversity, Equity and Inclusion (DEI)*

The specialty boards 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 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.

The group continued with some discussion around the fairness review pilots, inquiring about the timeline and how items can be flagged for cultural insensitivity. Dr. Lynn explained that the team aims to expand the fairness reviews to other disciplines as soon as feasible, and that it is already possible for diplomates to submit feedback on LKA items, which ABIM then takes action to address.

Some members also shared insights from their own experiences in DEI work and offered suggestions for staff to consider. Geneva Tatem, MD, of the Pulmonary Disease Board, inquired about the diversity of the Item-Writing Task Force and suggested providing item-writers with critical reading materials on race and racism in health care to avert bias in items. Dr. Lynn noted that the Item-Writing Task Force is a diverse group of physicians and that they are guided to remove race and ethnicity indicators from items unless clinically relevant.

In Closing

The Critical Care Medicine 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?

If you have questions after reading this report, please connect with us through the following channels:

*Indicates that Society guests were present for this session.