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Critical Care Medicine Board Meeting Summary | Fall 2024

November 14, 2024  |  Posted by ABIM  |  Specialty Board Meeting Summaries

Laura E. Evans, MD, MSc, Chair, Critical Care Medicine Board

The Critical Care Medicine Board—which meets twice a year and is responsible for oversight of policy and assessment in the specialty—held its fall meeting on September 30, 2024. The Specialty Board reviewed updates on ABIM’s work in a number of key areas and discussed other pressing issues in the field. In addition, representatives from the following organizations joined for a portion of the meeting*:

  • The American Association of Critical Care Nurses (AACN)
  • The American Thoracic Society (ATS)
  • The Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD)
  • The Society of Critical Care Medicine (SCCM)

The following is a summary of the fall meeting. Reports of prior meetings can be found on the ABIM Blog.

Contents

Diplomate Professional Profile*

In summer 2023, ABIM invited a pilot group of diplomates to complete the newly developed Diplomate Professional Profile (DPP), a questionnaire required of all diplomates that is built into the Physician Portal. The questionnaire relates to clinical work and practice patterns and serves to inform ABIM’s ongoing efforts to update assessment options and exam blueprints, and develop policies for initial certification and MOC. Since last year, ABIM has continued to invite all remaining eligible diplomates on a rolling basis to complete the DPP. Diplomates receive a prompt to complete their professional profile when they sign in to their Portal.

Siddharta G. Reddy, MPH, Senior Research Associate at ABIM, reported to the Specialty Board that 31% of diplomates overall have completed their DPP; he also reviewed profile questions specific to critical care medicine.

Setting a Quality Agenda in the Discipline*

In 2021, the American Board of Medical Specialties (ABMS)—which comprises 24 medical certifying boards in the U.S., including ABIM—adopted new standards for continuing certification that include a requirement for member boards to work with stakeholders to facilitate the development of discipline-specific quality agendas. The Specialty Boards discussed this in their spring 2023 meetings and agreed on three key themes: addressing inherent bias and health disparities, enhancing physician well-being and improving access to quality care.

Members of the Critical Care Medicine Board mentioned additional points in discussion, such as the need to address the disconnect between training programs and the actual experiences of junior faculty, and the disparity between academic medical centers and community practice.

Diversity, Equity and Inclusion (DEI) Initiatives at ABIM*

Natalie S. Plummer, Esq., Manager, DEI Programs at ABIM, and Pamela White, Senior Vice President, Communications, and Chief DEI Officer, reported on the work of the DEI team at ABIM and recent advances in ABIM’s DEI initiatives. These include:

  • ABIM’s work with participating medical society partners, which led to the formation of the Diversity, Equity and Inclusion Collaborative Network. The goal of the network is to share best practices, coordinate resources and create strategies to support and move diversity work forward as a community dedicated to this work. 
  • Improvements to the ABIM Physician Portal that now allow diplomates to more accurately self-identify their race/ethnicity and gender with an expanded list of options. This also aligns with ABIM’s efforts to increase diversity in governance and eliminate bias in assessment questions. Since this effort began, ABIM has seen consistent growth in the number of physicians supplying information, with more than 77,000 diplomates updating their information.
  • A report led by Dr. Sara Ray, a medical historian from the University of Pennsylvania, to study the governance records of ABIM. The goal of this project was to determine whether ABIM’s practices within the context of the past caused harm to historically disadvantaged groups and whether that might require restorative action and transparency.

In addition, the group discussed other factors related to workforce diversity, namely the complexity of differing definitions of race and ethnicity between countries, increased diversity of physicians in the United States, increased rates of international medical graduates pursuing board certification in the U.S. and growing concerns in the community about representation in the leadership and membership of stakeholder organizations.

Revisions to Procedural Requirements for Initial Certification in Critical Care Medicine*

Since 2022, the Critical Care Medicine Board has been discussing potential changes to the initial certification requirements for the specialty. To inform these discussions, ABIM has gathered data on clinical practice and the relevancy of the current requirements through surveys of the diplomate population and other stakeholder groups. The Pulmonary Disease Board has followed the same process, including joint discussions between both Specialty Boards at times due to overlapping procedural requirements in their respective disciplines. The requirements have been unchanged since 1991.

In addition to current ABIM procedural requirements, the Specialty Board requested data collection on the following suggested procedural competencies: intubation, diagnostic and procedural guidance on point-of-care ultrasound (POCUS), percutaneous tracheostomy and non-tunneled vascular access for temporary dialysis. Next, ABIM will share the suggestions with the program director community before synthesizing all findings for the Specialty Boards’ final consideration and decision-making. There is also a distinction drawn between required procedures that all fellows must be trained to “perform competently” for board eligibility, and “opportunity to train” procedures, which training programs must offer for fellows who identify a need for proficiency (not for board eligibility).

Conversation with the Specialty Board centered on the need for clear guidelines and careful consideration of how changes to certification and training requirements affect medical education, credentialing and billing, among other factors.

ABIM News and Conversation with the President*

Prior to the meeting, members and guests of the Critical Care Medicine Board had the opportunity to view a recorded video update from Furman S. McDonald, MD, MPH, who assumed the role of President and Chief Executive Officer (CEO) of ABIM and ABIM Foundation on September 1, 2024. Dr. McDonald reflected on current transitions for ABIM as well as key topics for the Specialty Board’s consideration and awareness:

  • A proposed pilot model for “exceptionally qualified” international medical graduates (IMGs) pursuing accredited subspecialty fellowship in the U.S. or Canada to become eligible for ABIM Board Certification: ABIM invited commentary from the diplomate community throughout September for the ABIM Council to consider before making a final decision in early 2025, and Dr. McDonald noted that this timing coincides fortuitously with—but is distinct from—similar initiatives for state medical board licensure. Learn more through a video and FAQs on the ABIM website.
  • ABIM’s progress in engaging more closely with early career physicians (diplomates who earned initial certification less than 10 years ago): a task force of Governance members is making plans for the coming year to convene early career physicians, create a platform for their perspectives and provide opportunities for them to be more directly involved in ABIM.
  • The continued popularity of the Longitudinal Knowledge Assessment (LKA®), high rates of reported satisfaction and ongoing enhancements: on average, 80% of eligible diplomates continue to choose the LKA over the traditional, 10-year Maintenance of Certification (MOC) exam, and 70.7% of survey respondents agreed with the statement, “I am satisfied with my LKA experience so far.” Still, Dr. McDonald noted, ABIM continues to evolve and improve the assessment based on diplomate feedback.
  • The recently announced removal of the requirement to earn some MOC points every two years to be considered “Participating in MOC.” With the availability of more activities that earn physicians MOC points (e.g., continuing medical education for MOC, UpToDate®, the LKA), the ABIM Council determined that the two-year point requirement was no longer needed and that its removal would benefit physicians and help promote engagement by making the program simpler.

The group’s discussion continued around the importance of engaging early career physicians as well as community, non-academic practice physicians more broadly. Some spoke about the need for more communication about the relevance of certification to clinical practice and how staying current positively affects prognosis and patient outcomes. Others mentioned the need to communicate more clearly with newly certified diplomates about MOC requirements. ABIM teams are working on addressing these points, for example with updates to the website and communications sent to diplomates.

Society guests departed at this point in the meeting.

Engaging Early Career Physicians

As mentioned during the Specialty Board’s earlier discussion with Dr. McDonald, the ABIM Council has instituted a task force to work on engaging early career physicians and residents, which has so far included listening sessions and group discussions about the early career physician experience. The task force’s goals are to build long-term relationships, identify needs and potential impacts at ABIM and involve a diverse range of early career physicians—including first-generation physicians—in ABIM’s policy and decision-making work.

In discussing these priorities and progress made so far, members of the Specialty Board offered their viewpoints and suggestions. These centered on improving communications to tailor them toward a younger generation’s preferences and greater accessibility, the importance of transparency and how incorporating knowledge assessments (similar to the LKA) into training programs might be beneficial for younger physicians.

Recommending Candidates for the Specialty Board to ABIM Council

Each year, ABIM initiates the process to recruit candidates for open seats on the Specialty Boards; each member serves a three-year term with the option for one renewal, and positions open on a rolling basis.  ABIM posts all openings on its website and shares them with diplomates and other stakeholder groups. The Specialty Board pays close attention to its own present and future composition, namely how practice setting and region, career stage, educational background (U.S., international) and race and ethnicity are represented among its members. The ABIM Council makes final selections based on the Specialty Board’s top two recommendations for each open seat.

In June, ABIM issued notice about an opening on the Critical Care Medicine Board for a public member with patient or caregiver experience in critical care for a term beginning July 1, 2025. At the fall meeting, the Critical Care Medicine Board discussed the candidates they had interviewed and voted on two to recommend to the Council. ABIM will announce the final appointee in spring 2025 prior to the start of their terms.

Critical Care Medicine Blueprint Review

The blueprint is a document that defines the scope of content to be tested on ABIM assessments. It serves as a study guide for physicians preparing for an assessment and as a tool for item-writers and exam development staff creating the assessment. The Specialty Board and Approval Committees in each discipline work together to update the blueprint periodically and ensure that changes reflect diplomate and society input, and that assessment content remains relevant to current clinical practice.

The Critical Care Medicine Board received a brief overview of the blueprint review process, which involves gathering feedback from various diplomate and stakeholder groups, proposing revisions based on the feedback and securing final approval from the Specialty Board. The next step is a review of proposed changes to the blueprint and feedback gathered from society partners, which the Specialty Board will undertake in the first quarter of 2025 prior to vetting them through the broader diplomate community in Spring 2025.

Learn More

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

Are you interested in getting involved?

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Do you have questions? Contact ABIM directly:

*Indicates society representatives were present for discussion of this agenda topic.

ABIM governance, Critical Care Medicine, Critical Care Medicine Board, Laura Evans, LKA, Summary Report

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