Critical Care Medicine Board Meeting Summary | Spring 2023

July 5, 2023 | Posted by ABIM | ABIM Governance

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

The Critical Care Medicine Board held its spring meeting on Friday, May 12, 2023. The agenda included updates for the Specialty Board on activity at ABIM and allowed for discussion of pressing issues in the field. The Specialty Board was joined 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)

The following is a summary of the spring meeting.

Specialty Board Oversight of Assessments

The specialty boards that oversee each discipline of internal medicine are responsible for reviewing and approving the assessment blueprints and standards for certification, Maintenance of Certification (MOC) and the LKA. 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 Critical Care 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:

In a continuation of their conversation at the fall Specialty Board meeting, the group discussed the work of the Item-Writing Task Force—the group responsible for writing all of the content for the LKA and the Traditional, 10-Year MOC Exam in each specialty, as well as the initial certification exams—and how to address some of the ideas expressed in the fall about building stronger connections between item-writers and Approval Committees. Members of the Specialty Board made suggestions on recruitment, such as recruiting at national annual society meetings. ABIM is recruiting for new task force members on an ongoing basis.

The Specialty Board and guests also learned about early experience with the LKA. To date, 79% of eligible critical care medicine diplomates who are due for an assessment in 2023 have chosen the LKA to meet their assessment requirement. The LKA in Critical Care Medicine was among three disciplines released this past January and participation may increase ahead of the enrollment deadline of June 30. Staff also confirmed that data gathered over the first year of the LKA’s availability in disciplines that launched in 2022 indicate that the median response time across all questions is under two minutes.

Staff also reviewed some information about the Neurocritical Care Certification Program, ABIM’s newest subspecialty cosponsored certificate. Of the total ABIM diplomate exam takers, 90% were previously certified in Critical Care Medicine. It was noted that numbers may decline after the end of the practice pathway as has happened in other disciplines.

Misinformation and Implications for Critical Care Medicine

The Specialty Board held an open discussion on the implications of misinformation for the discipline of critical care medicine, including its effects on patient care, in order to contribute to ABIM’s ongoing strategic conversations about the issue. In discussion, the group’s comments fell into three themes:

Misinformation surrounding vaccines, specifically COVID-19 vaccine safety and efficacy. Misinformation about vaccines has consequences including worse patient outcomes and sometimes threats to physicians and other health care providers. It was noted that this is contributing to further erosion of trust in physicians.
Misinformation surrounding medicine and procedures, such as unrealistic expectations about end-of-life care, the belief that opioids always lead to addiction, concern that mechanical ventilation is lethal and the false impression that blood products can be screened for the vaccination status of the donor. Misinformation is leading to patients who have unrealistic expectations about the effectiveness of health care, impacting morale among physicians and other health care providers.
Misinformation and mistrust of physicians, exacerbated through patients who research topics but do not validate their sources. This makes it more challenging for physicians to re-educate patients about accurate information. Some patients still request unproven and even harmful treatments, and this can cause conflict when their demands are not met. Members of the group also noted that, in some cases, physicians themselves are promulgating misinformation and that the scope of misinformation is so vast it is hard to determine how big the problem really is.

The group also identified that misinformation connects to other issues in the discipline, such as physician burnout, and one member noted that nursing staff serve as a valuable resource for anti-misinformation strategies as a direct source of connection to families at the bedside.

Conversation with the President

Prior to the meeting, members and guests of the Critical Care Medicine Board received a video update from Richard J. Baron, MD, MACP, President and Chief Executive Officer of ABIM and ABIM Foundation, highlighting progress and inviting discussion from the Specialty Board on some of ABIM’s leading priorities, including:

The release of the first Longitudinal Knowledge Assessment (LKA^®) quarterly formative score reports to more than 28,000 diplomates who completed the fifth quarter of their five-year LKA cycle. The score reports are designed to let participating diplomates know how they are performing relative to the passing score and help identify any areas they may want to focus on in their future studies.
Ongoing work in diversity, equity and inclusion (DEI), such as performing differential item functioning analysis of assessment items, developing health equity content in different disciplines, and co-funding health equity projects for residencies.
Developments from the ABIM Board of Directors’ strategic planning work, such as exploring how new technologies like artificial intelligence (AI) and machine learning may help ABIM work more efficiently and develop better programs for physicians.

Continued work with a coalition of national medical organizations to address medical misinformation and promote evidence-based information. Dr. Baron recently coauthored an article in the New England Journal of Medicine and spoke at both the University of California San Francisco Department of Medicine Grand Rounds and South by Southwest on the topic of misinformation.

Some members of the group asked clarifying questions about the LKA, including its attrition rate. Dr. Baron noted attrition remains low, adding that only a small percentage of participants are not meeting the LKA participation requirement. In response to a question about the high rate of burnout among pulmonary and critical care physicians, Dr. Baron pointed to the LKA as a possible contribution to the solution because the assessment is designed to be less time-intensive and burdensome.

Some present also inquired further about the impact of recent advances in chatbot technology, and Dr. Baron responded that ABIM is in the beginning stages of exploring what AI will do within the assessment industry and how to use advanced technology to help the organization be more efficient and effective in doing its work.

Special Consideration Pathways for International Medical Graduates

ABIM’s standard training requirements for subspecialty certification include the satisfactory completion of accredited internal medicine residency and subspecialty fellowship training in the United States or Canada. In addition, there are four special consideration pathways that enable osteopathic or internationally trained physicians to obtain ABIM certification. The ABIM Council—which comprises the chairs of the individual specialty boards and advisory committees, as well as public and patient members—is exploring the idea of creating another special consideration pathway for international medical graduates who have completed their internal medicine training in another country and then completed accredited fellowship training in the U.S. or Canada. Like other ABIM diplomates, physicians in the proposed pathway would need to pass the ABIM Internal Medicine Certification Examination and satisfactorily complete their accredited fellowship training to be eligible for subspecialty certification.

The Specialty Board held a discussion on the implications of this possible policy change for critical care medicine, with some questions arising around international training standards and why ABIM only accepts accredited training from the U.S. and Canada. Pairing certification eligibility with completion of accredited U.S. or Canadian training is a longstanding requirement of ABIM. Members of the Specialty Board cautioned that the pathway should serve the needs of training programs and not alienate internal medicine program directors, while also asking if current fellows in accredited U.S. or Canadian programs who completed international residencies have expressed a desire for the pathway. Staff reported that ABIM has received requests from many to whom the pathway would apply and was encouraged by data demonstrating probable demand for the pathway.

Progress Report on Policy Coordination: Procedural Requirements for Initial Certification in Critical Care Medicine and Pulmonary Disease

ABIM is currently conducting a survey around procedural requirements for initial certification in Critical Care Medicine and Pulmonary Disease. The purpose of the survey is 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. This survey was prompted by a request from the Association of Pulmonary and Critical Care Medicine Program Directors (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 discussed at the Critical Care Medicine Board’s fall 2022 meeting and more recently at the Pulmonary Disease Board’s spring 2023 meeting; conversation continued with the Critical Care Medicine Board with an update from Siddartha G. Reddy, MPH, Senior Research Associate at ABIM.

Mr. Reddy reviewed preliminary data, noting that the survey period has been extended into July, so the research team anticipates additional feedback to be forthcoming. Members of the group expressed an interest in seeing the complete data set analyzed in the future with a breakdown of performance data according to practice setting and years since training. Additional analysis of the complete survey data will be provided at the Critical Care Medicine Board’s fall 2023 meeting.

Selecting New Members of the Approval Committees

The specialty boards are responsible for selecting members and chairs of the approval committees. At the spring meeting, the Critical Care Medicine Board reviewed physician candidates for an open position on the Critical Care Medicine Traditional, 10-Year MOC Exam Approval Committee. After discussion and reviewing the current composition of the committee, the Specialty Board voted to approve Ryan Maves, MD, FCCM, FCCP, FIDSA, of Wake Forest University School of Medicine for a term beginning July 1, 2023.

Update on the Critical Care Medicine Approval Committees

There are two ABIM Approval Committees working with the Critical Care Medicine Board: the Traditional, 10-Year MOC Exam Approval Committee (which also works with the initial certification exam), and the LKA Approval Committee. Approval Committees are responsible for approving all assessment content and maintaining the assessment blueprints in their discipline.

The Specialty Board received an update on the composition and work of the approval committees and item-writers in critical care medicine. They were reminded of the ongoing need for item-writers and encouraged to recommend candidates. A full list of openings is available online.

Supporting a Quality Agenda in Critical Care Medicine

In late 2021, American Board of Medical Specialties (ABMS)—which comprises 24 medical certifying boards in the U.S., including ABIM—published new standards for continuing certification. The standards include a requirement for member boards like ABIM to facilitate the development of a discipline-specific quality agenda. Richard G. Battaglia, MD, FACP, ABIM’s Chief Medical Officer, spoke to the Critical Care Medicine Board about the new standard. He emphasized that this standard is not resulting in an individual diplomate requirement to complete quality improvement activities for ABIM MOC. Dr. Battaglia invited the group to discuss how they envision ABIM engaging external stakeholders to identify issues that can serve as elements of a mutually agreed quality agenda in the discipline and the role the Specialty Board can play in this process.

Suggestions from the Specialty Board and staff included pulse oximetry as a quality area relevant for disparities, as well as health equity test content, misinformation and burnout.

Communications and Governance Engagement

John Held, Senior Director of Communications, and Peter McConnell, Program Manager for Governance and Medical Society Communications, updated the Specialty Board on ABIM’s ongoing communications work with Governance (the ABIM Board of Directors, ABIM Council, Specialty Boards and Advisory Committees, and Approval Committees) and invited Specialty Board members to participate in engagement work. The communications team regularly engages ABIM Governance members to help give diplomates a better understanding of the individuals representing their interests in each discipline, and to help the community better understand the value of certification.

Specialty Board members provided feedback about how they could continue to take an active role in ABIM’s communications initiatives with diplomates, the medical community and the public, such as through media interactions, the ABIM blog and working with their colleagues and medical societies.

In Closing

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

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