Internal Medicine Board Meeting Summary | Spring 2024

The Internal Medicine Board held its spring meeting on Thursday, May 23, 2024. 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 Internal Medicine Board was joined for a portion of the meeting* by representatives of the Alliance for Academic Internal Medicine (AAIM), the American College of Osteopathic Internists (ACOI), the American College of Physicians (ACP), the Society of General Internal Medicine (SGIM) and the Society of Hospital Medicine (SHM).  

ABIM and the Specialty Board gratefully acknowledge the service of Asher A. Tulsky, MD, who served as chair 2018–2024, and Letitia Browne-James, Ph.D., LMHC-S, NCC, who joined the Specialty Board in 2018. Their terms ended June 30, 2024.

Richard M. Wardrop III, MD, who has served on the Specialty Board since 2020, assumed the role of chair on July 1, 2024.

The following is a summary of the spring meeting.

Conversation with the President*

Prior to the meeting, members and guests of the Internal Medicine 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, including:

• The ongoing collaboration between ABIM and internal medicine societies to address their members’ concerns and feedback about the Maintenance of Certification (MOC) program. More than 30 societies met with ABIM in fall 2023, in addition to ongoing discussions throughout the year. In part, the collaboration also explores the need for focused assessments in select subdomains of specific specialties where enough physicians are focusing their practice. Focused assessments have already launched in sleep medicine and internal medicine, with more to come in the future, including hematology in 2026.
• ABIM’s work to mitigate the spread and negative impact of misinformation for physicians and patients. Most recently, ABIM updated the way it reports certification status for physicians to be more transparent about why some certificates are no longer active, such as being “Revoked,” “Suspended” or “Lapsed.”
• The establishment of a dedicated innovation team at ABIM to explore how emerging technology and artificial intelligence (AI) can be used to assess physicians in the rapidly evolving context of their requisite skills and practice environments.
• Dr. Baron’s approaching retirement later this year, the Board of Directors’ search for a new CEO and ABIM’s transition to new leadership. Following the Specialty Board’s meeting, Furman S. McDonald, MD, MPH, who currently serves as ABIM’s Senior Vice President, Academic and Medical Affairs, was announced as ABIM’s new CEO, effective September 1, 2024.

The group discussed the role and impact of AI on ABIM, adapting assessments to remain relevant and ensure they effectively measure clinical understanding and critical thinking skills, and the prevalence of AI integration in tools that physicians use. Dr. Baron pointed out that once UpToDate^® was permitted as a resource during assessment, it did not affect who passed or failed, but the continued use of new AI technologies has new implications for the integrity of the assessment. While some member boards of the American Board of Medical Specialties (ABMS) have policies prohibiting the use of AI in assessments, ABIM’s current policy states that any reference other than another physician is acceptable for answering questions on the Longitudinal Knowledge Assessment (LKA^®).

Dr. Tulsky inquired about the application of several cardiology societies to ABMS to form a new certifying board—the proposed “American Board of Cardiovascular Medicine”—and the implications for ABIM diplomates. Dr. Baron reaffirmed that ABIM remains committed to offering certification and MOC in cardiovascular disease and has recused itself from any part of the ABMS discussion and decision-making process regarding the application. Dr. Baron noted that any cardiovascular certificates issued by ABIM must also be maintained through ABIM.

ABIM and Physician Feedback*

Though ABIM has long prioritized physician feedback in shaping its programs, the organization has placed renewed emphasis on addressing elements of the certification program that can and should be improved, as well as fostering the community’s perception of the value of certification and physician pride in maintaining certification. Richard G. Battaglia, MD, FACP, Chief Medical Officer for ABIM, gave the Internal Medicine Board an overview of recent physician feedback and actions that ABIM is considering, and invited the group to share their ideas and suggestions for ABIM to consider as it continues working with societies, diplomates and the broader internal medicine community.

One of the suggestions that arose was the idea of allowing additional time to answer questions on the LKA to reduce stress. To date, data across all the LKAs offered in every discipline indicate physicians answer questions in under two minutes on average. Dr. Battaglia noted that ABIM is exploring the question based on similar feedback received from physicians and societies over the last year.

Specialty Board Oversight of Assessments*

ABIM’s Specialty Boards are responsible for reviewing and approving the assessment blueprints and standards for certification, MOC and the LKA in their respective disciplines. Each spring, the Specialty Boards review data related to the population of new graduates entering the discipline, diplomates maintaining their certification, workforce information, and assessment performance trends and feedback. Periodic review of these data helps to inform the Specialty Boards’ assessment decisions. The Internal Medicine Board discussed assessment data in the discipline and provided feedback to ABIM staff about which data were most helpful for ongoing oversight of assessment. Some of the data the Specialty Board reviewed are publicly available on ABIM’s website, including:

• Relative distribution of fellows in training per discipline
• Percentage of first-year fellows who are female by subspecialty
• Initial certification pass rates by discipline
• MOC pass rates by discipline
• Number of candidates certified in each discipline each year

Exploring Focused Assessment(s) in the Discipline*

ABIM currently offers focused versions of its assessments in internal medicine (the Internal Medicine: Inpatient LKA and traditional, 10-year MOC exam) and sleep medicine (the Sleep Medicine LKA: Obstructive Sleep Apnea Emphasis). Additional explorations have begun in gastroenterology and hematology with plans announced recently to develop malignant- and classical-focused versions of the Hematology LKA (in addition to the general Hematology LKA) to launch in 2026. ABIM is exploring the idea of focused assessments in other specialties with stakeholder input at multiple levels, including that of the Specialty Boards, to determine whether focused assessments are appropriate in those disciplines.

The Internal Medicine Board discussed whether the current Internal Medicine traditional, 10-year MOC exam is more closely aligned with ambulatory practice than hospital practice. While they agreed that it would be helpful to develop a better understanding of that alignment and the relevance of content in internal medicine assessment options, they did not determine a need to pursue additional focused assessments in internal medicine. They also discussed the importance of a broad base of knowledge both for ambulatory physicians (to know and understand the episode of care for patients in the hospital) and for hospitalists (to know and understand the same for ambulatory patients).

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. Christopher Walsh, MD, member of the Internal Medicine Board, reviewed the following proposal for the program and provided his recommendation for approval:

• “Advanced Care Transformation (ACT) Program” sponsored by Bon Secours Mercy Health (BSMH). The 209 practices of BSMH participate in the ACT initiative, which recognizes and rewards process improvement plans and workflows, and creates opportunities to identify and share best practices with the wider group. Each practice documents baseline data within a number of established pathways and then updates the data quarterly.

After a brief discussion, the Internal Medicine Board voted to approve the AQI proposal for MOC credit. Any ACT participant will be eligible to receive credit for this activity.

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.

The society guests departed at this point in the meeting.

Update on the Internal Medicine Approval Committees

Heather L. Heiman, MD, University of Illinois College of Medicine; Chair of the Internal Medicine LKA Approval Committee

Benjamin Hohmuth, MD, Geisinger Health System; Chair of the Internal Medicine: Inpatient Traditional, 10-Year MOC Exam Approval Committee

Jensa Morris, MD, Yale New Haven Hospital; Chair of the Internal Medicine: Inpatient LKA Approval Committee

John A. Raimo, MD, Hofstra Northwell School of Medicine; Co-Chair of the Internal Medicine Traditional, 10-Year MOC Exam Approval Committee

Rachel P. Simmons, MD, Warren Alpert Medical School at Brown University; Co-Chair of the Internal Medicine Traditional, 10-Year MOC Exam Approval Committee

ABIM assessment approval committees are responsible for approving and editing all assessment content, and maintaining the blueprints for the initial certification exam, the MOC exam and the LKA. The Internal Medicine Board works with four approval committees: two dedicated to Internal Medicine and two dedicated to the Internal Medicine: Inpatient versions of the assessments (previously the Hospital Medicine Approval Committees). Within each specialty is the Traditional, 10-Year MOC Exam Approval Committee (which is also responsible for the initial certification exam) and the LKA Approval Committee. The chairs 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 Forces. Dr. Heiman noted that in response to prior feedback from the Specialty Board, the committee members have been concentrating on improvements to the written rationales that accompany items on the LKA.

The group also briefly discussed how some of their colleagues expressed concern about the time commitment involved with joining the Item-Writing Task Forces, and were not aware that item-writers receive 20 MOC points for each year of their service. ABIM is also working on initiatives within the Task Forces to foster a greater sense of community and communicating about opportunities to attract new item-writers.

Member Selection for the Internal Medicine Approval Committees

ABIM’s Specialty Boards are responsible for selecting members and chairs of the Approval Committees annually and as needed. At the spring meeting, the Internal Medicine Board reviewed candidate materials for an open position on the Internal Medicine: Inpatient Traditional, 10-Year MOC Exam Approval Committee. The group unanimously voted to approve Sharon Kim, MD, FACP, of the Southern California Permanente Medical Group, to join as a new member of the Approval Committee for a three-year term beginning July 1, 2024.

Join ABIM Governance

The ABIM Council has three openings for terms beginning July 1, 2025:

• An early career physician in any specialty (with initial ABIM certification within the past 10 years)
• A physician practicing in a non-university/community setting
• A patient or caregiver with perspective in internal medicine

Applications are due August 12, 2024, and appointments are expected to be announced in spring 2025.

Openings on ABIM’s Approval Committees will be announced fall 2024. Visit the website for a complete list of current openings.

Primary Care

The ABIM Board of Directors issued a charge to the ad hoc Primary Care Committee to make recommendations to the Internal Medicine Board about how ABIM might contribute to increasing the availability and capacity of primary care in the United States. Roger W. Bush, MD, member¹ of the Board of Directors and Chair of the ad hoc Primary Care Committee, reviewed the report of the committee’s recommendations to the Specialty Board. The committee made several recommendations and urged the Specialty Board to engage with the internal medicine community in answering two questions: 1) Is internal medicine part of primary care or not? If so, how does ABIM take this role and its corresponding responsibilities forward? And 2) What is the role of primary care in relation to subspecialties? What important boundaries/areas of distinction exist? These questions were issued in recognition that the role of the Specialty Board is to encompass “defining” what internal medicine is and is not in service to ABIM’s mission to be “of the profession and for the public,” and therefore necessarily limited to a certain sphere.

The group discussed the importance of the issue and contributing factors. Some suggested that the minimum training requirement for ambulatory training should be increased and remuneration for primary care providers considered to entice them to take on trainees. Others noted that compensation in general for primary care is inadequate—many primary care physicians feel undervalued and the group noted the high rates of burnout in the profession. Dr. Bush pointed out that the Primary Care Collaborative is working on the issue of compensation, which is outside of ABIM’s purview.

New Ways to Recognize Diplomates for Their Commitment to Staying Current

ABIM is exploring new ways to recognize physicians who participate in the MOC program. This includes finding opportunities to celebrate assessment milestones and ongoing efforts to stay current. Nicole Welk-Joerger, Ph.D., Program Manager of Stakeholder Engagement for ABIM, shared information about the project with the Internal Medicine Board, including a number of proposed tactics for early consideration. Dr. Welk-Joerger invited members to share their feedback and reactions on how diplomates want to be recognized and what forms of recognition are most impactful for physicians.

Some members of the Specialty Board shared that they do not feel a need for recognition because certification is an expectation for practice or employment. Others expressed interest in a form of recognition that would be visible to patients, such as sharing the length of time a physician has been certified on the ABIM webpage that discloses diplomates’ certification status (the “Verification of Certification” page). Overall, members emphasized the importance of making board certification meaningful and something diplomates can be proud of through public outreach and education as well as through collaborations that help increase the visibility of the work of certification (via search engines).

In Closing

The Internal 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:

• Subscribe to the ABIM blog.
• Call 1-800-441-ABIM (2246).
• Email request@abim.org.
• Join our Community Insights Network to share your feedback.

*Indicates society guests were present for this session.