Cardiovascular Board Meeting Summary | Fall 2023

January 25, 2024 | Posted by ABIM | Specialty Board Meeting Summaries

*Andrea M. Russo, MD, Chair of the Cardiovascular Board*

The Cardiovascular Board held its fall meeting on Thursday, November 30, 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 following is a summary of the fall meeting.

Conversation with the President

Prior to the meeting, members of the Cardiovascular Board as well as guests representing the Approval Committees in the discipline 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. These topics included:

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.

Dr. Baron invited the Specialty Board to share their own perspectives on current issues for the discipline of cardiovascular disease. The group discussed the announcement made by several cardiology specialty societies in September of their intent to apply to the American Board of Medical Specialties (ABMS) to form a new certifying board for cardiology, and how some colleagues expressed confusion about what it meant for them. In response, Dr. Baron referenced a public statement ABIM had issued in attempt to provide more clarity. The statement reads, in part, “ABIM plans to continue offering and administering its initial Certification and Maintenance of Certification (MOC) programs, including the current assessment choices offered for MOC, across all of these specialties today and in the future. Any physician choosing to maintain their ABIM certification in these disciplines will continue to have a pathway with ABIM to do so.”

Dr. Baron thanked the group for a robust and candid conversation. He emphasized ABIM’s willingness to collaborate with the community and desire to communicate clearly about its programs. He also acknowledged the potential confusion, and reaffirmed that diplomates holding ABIM certificates will still have a pathway to maintain certification through ABIM, fellows will still be able to take ABIM’s initial certification exams if they choose to do so, and ABIM is willing to continue its collaboration on the Collaborative Maintenance Pathway in cardiology.

Diversity, Equity and Inclusion (DEI)

The Specialty Board received an update on ABIM’s DEI work from Lorna Lynn, MD, Vice President 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. Dr. Lynn expressed appreciation for the leadership of the American College of Cardiology (ACC) in advancing health equity, and for the ACC including ABIM at the health equity summit earlier in 2023.
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.

The Specialty Board continued discussion, agreeing that there is a need and an opportunity for mentorship starting earlier than high school and acknowledging the lack of opportunities for physicians underrepresented in medicine to seek mentorship due to an absence of representation in their communities.

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, including cardiology.
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.

Benjamin Chesluk, Ph.D., Senior Researcher, Ethnographic Research at ABIM, invited the group to offer perspectives from their own communities and discuss what information they would find useful for the future. A few members of the Specialty Board asked for additional information, such as at what point in the quarterly cycle most diplomates are completing questions and how the LKA recognizes midnight (i.e., the time zone used to determine the cut-off point for each quarter, which is currently Eastern Standard Time). Rebecca S. Lipner, Ph.D., Senior Vice President, Assessment and Research, noted that ABIM staff is working on a solution to this technical issue.

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 at 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, attestations (for interventional cardiology only) 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’ activities for MOC points are reported to ABIM varies based on the activity itself and the provider. Most are generated by provider reports to ACCME and in turn ABIM. A few require staff to complete the process. 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.

Update on the Cardiovascular Approval Committees

Dimitri C. Cassimatis, MD, FACC, Emory University School of Medicine; Chair of the Cardiovascular Disease Traditional, 10-Year MOC Exam Approval Committee

Larry Dean, MD, University of Washington School of Medicine; Chair of the Cardiovascular Disease LKA Approval Committee

David E. Haines, MD, Oakland University-William Beaumont School of Medicine; Chair of the Clinical Cardiac Electrophysiology Traditional, 10-Year MOC Exam Approval Committee

Yuli Kim, MD, Philadelphia Adult Congenital Heart Center; Member of the Adult Congenital Heart Disease Traditional, 10-Year MOC Exam Approval Committee (Dr. Kim also serves as a member of the Cardiovascular Board.)

The Cardiovascular Board works with seven approval committees responsible for approving all assessment content and maintaining the assessment blueprints in Cardiovascular Disease and four subspecialties: Adult Congenital Heart Disease, Advanced Heart Failure and Transplant Cardiology, Clinical Cardiac Electrophysiology and Interventional Cardiology. Each discipline has a Traditional, 10-Year MOC Exam Approval Committee (which also deals with the initial certification exam). In addition, there is an LKA Approval Committee in Cardiovascular Disease and Interventional Cardiology.

Drs. Cassimatis, Dean, Haines and Kim provided a brief update for the Cardiovascular Board on the composition of the Approval Committees, progress on item development in meetings this year and news about the Item-Writing Task Force. As of this report, there are 38 certified cardiologists serving across the seven Approval Committees and 94 cardiologists writing questions for assessments on the Item-Writing Task Force. These cardiologists bring their expertise and a broad range of experience to their work creating ABIM’s assessments.

Selecting the New Chair of the Interventional Cardiology LKA Approval Committee

ABIM’s Specialty Boards are responsible for selecting members and chairs of the Approval Committees annually and as needed. The position of Chair of the Interventional Cardiology LKA Approval Committee will open in July, and the Specialty Board had spent time leading up to the fall meeting in reviewing applications and interviewing candidates. After discussion, the Cardiovascular Board voted to approve George Bittar, MD, of Providence Medical Group and the Union Hospital System, as Chair of the Interventional Cardiology LKA Approval Committee for a term beginning January 1, 2024. Dr. Bittar has served as a member of the Approval Committee since 2020, and previously served on the Item-Writing Task Force.

Recommending Specialty Board Candidates to ABIM Council

With one position on the Cardiovascular Board for an interventional cardiologist becoming vacant in July 2024, the group held a discussion about the many highly qualified physician candidates that applied during the application period in the summer of 2023. As part of the process, the Specialty Board selects two candidates and recommends them to the ABIM Council for a final decision. The group gave special consideration to early career physicians (those within the first ten years of initial certification in the discipline) and international medical graduates when discussing the future composition of the Specialty Board.

After some deliberation, the Cardiovascular Board voted for two candidates to recommend to Council. Once approved by the Council, the new member’s term will begin July 1, 2024.

Nominating Candidates for the Review Committee for Internal Medicine (RC-IM)

ABIM is one of several organizations that nominate candidates for the Accreditation Council for Graduate Medical Education (ACGME) RC-IM. The RC-IM invited ABIM to nominate two physicians for the committee who will still be in training during their two-year term. Nominations were solicited from ACGME-accredited internal medicine residency and fellowship program directors.

The Specialty Board was asked to interview candidates who applied for a position from a cardiovascular training program. After discussion, they agreed on and voted for one candidate to nominate for the trainee position on the RC-IM. The candidate chosen by the Cardiovascular Board will go forward for consideration by the ABIM Council along with candidates put forward by other ABIM Specialty Boards, from which two will be sent to the RC-IM for a final selection.

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. Simbo Chiadika, MD, reviewed the following proposal for the program and provided her recommendation for approval:

“Cardiology Outcomes Quality Improvement,” sponsored by WakeMed Heart and Vascular. The activity will aim to improve critical cardiovascular outcomes at the cardiology group and hospital system levels for acute myocardial infarction, congestive heart failure and percutaneous coronary intervention mortality and readmissions.

After a brief discussion, the Cardiovascular 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:

Download the ABIM AQI Program Guide (PDF).
Download and complete the AQI Application (PDF).
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. They 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.

The group offered suggestions that might resonate with cardiologists, such as greater transparency, simple visual or graphic guides to the MOC program, and highlighting the fact that many cardiologists in ABIM Governance are also active in specialty society leadership roles to better underscore overlaps in the cardiology community.

In Closing

The Cardiovascular 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: