Endocrinology, Diabetes & Metabolism Board Meeting Summary | Spring 2024

The Endocrinology, Diabetes & Metabolism Board held its spring meeting on Tuesday, April 30, 2024. 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 for a portion of the meeting* by representatives of the American Association of Clinical Endocrinology (AACE) and the Association of Program Directors in Endocrinology, Diabetes and Metabolism (APDEM).

The Endocrinology, Diabetes & Metabolism Board also gratefully acknowledges the service of Ashok Balasubramanyam, MD, whose term as chair ended June 30. Dr. Balasubramanyam has served on the Specialty Board since 2014, including two terms as chair.

Christine Twining, MD, who has served on the Specialty Board since 2018, 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 Endocrinology, Diabetes & Metabolism 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updated the way it reports certification status for physicians to be more transparent about why some certificates are no longer active, such as being “Revoked,” “Suspended” or “Lapsed.”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. (As of the time of this report, the new CEO has been announced.)

Members of the Specialty Board asked Dr. Baron to speak more on the role and regulation of AI in assessment, how new treatments and health equity are integrated into assessment questions and how medical societies can work together to address misinformation. Dr. Baron stated that what makes board certification meaningful and relevant evolves with the profession itself. The way physicians practice is already changing due to emerging technologies; therefore, the assessment must also evolve to continue assessing how physicians practice. He noted, however, that there are as yet no clear answers about what that evolution will look like.

Dr. Baron also pointed out that the initial certification and MOC exams have evolved from being identical exams to distinct assessments with different expectations for what a physician will know at different stages in their career. He explained that ABIM integrates health equity throughout its operations, including question writing and test development, and that ABIM has analyzed assessment questions for bias.

Elizabeth Lepkowski, MATD, Chief Learning Officer for AACE, asked how medical societies can work together to address misinformation. Dr. Baron shared that ABIM has been partnering with medical specialty societies, member boards of the American Board of Medical Specialties, state medical boards and other stakeholder organizations in a coalition over the past two years to identify strategies and tactics that can be employed to battle misinformation and promote accurate information. He invited societies broadly to stand with ABIM against misinformation and educate their members about ABIM’s stance and actions, such as ABIM’s use of an established unprofessional conduct process.

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 Endocrinology, Diabetes & Metabolism 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.

Dr. Balasubramanyam noted that, in his opinion, the most significant “pain point” in the diplomate experience remains the MOC point requirement. In general, however, the Specialty Board expressed satisfaction with ABIM’s work in responding to criticism, identifying areas of concern for physicians and developing plans to address them and reduce pain points.

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 Longitudinal Knowledge Assessment (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 Endocrinology, Diabetes & Metabolism 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

In discussion, it was also noted that the discipline overall has grown: 10 more fellowship programs and 50 more positions between 2020 and 2024. In addition, the traditional, 10-year MOC exam in endocrinology, diabetes and metabolism will transition to being offered only once annually, in the fall, starting in 2025. ABIM determines the number of exam administrations for initial certification and MOC based upon the number of projected takers in a given discipline and making any changes through a data-driven approach. More physicians are choosing the LKA over the traditional, 10-year MOC exam at a rate of about four to one. Because fewer physicians are choosing the latter, there are not enough takers to accurately score assessments for two administrations in a calendar year.

Finally, Dr. Balasubramanyam noted an apparent correlation between pass rates and fairness ratings on the assessment, but staff explained that the correlation varies across disciplines and time, and no trend has been identified.

Pass Rates in the Endocrinology, Diabetes & Metabolism Initial Certification Exam*

At the fall 2023 meeting, the Endocrinology, Diabetes & Metabolism Board discussed the results of a study looking into the difference in initial certification exam pass rates in the discipline over the last two years, part of an ongoing series of conversations on the possible root causes of lower pass rates for first-time exam-takers beginning in 2021. ABIM worked with the Endocrine Society and APDEM to convene a task force and write a paper examining the issue. Dr. Balasubramanyam updated the Specialty Board on the paper’s progress, highlighting the pass rate from 2018 to 2023 and the potential factors associated with the observed data. A few members of the group added questions and suggestions, such as including pass rates for the traditional, 10-year MOC exam (which have not decreased), looking at the correlation between society self-assessment products and pass rates, and explaining in more detail how virtual education may be associated with pass rates.

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 plans to continue 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. Therefore, the Endocrinology, Diabetes & Metabolism Board was invited to discuss whether exploring focused assessments in the discipline is warranted.

This topic was previously explored in 2019, when the Endocrinology, Diabetes & Metabolism Board reviewed a community survey and Medicare data and decided that creating a focused assessment did not appear to be warranted for this discipline. Rather, the blueprint was modified at that time to reflect what physicians reported as relevant to their clinical practice while also assessing physicians for a well-rounded base of knowledge. Given this history, and especially the recent changes to the blueprint, the Specialty Board determined it would not be warranted to explore focused assessments in endocrinology at this time.

Update from the Medical Societies*

Matthew J. Levine, MD, President-Elect of the APDEM Council, shared some general information, including that APDEM comprises both program directors and fellowship programs, which includes associate program directors and coordinators, and that 84% of endocrinology fellowships are APDEM members; 41% of members are involved in various APDEM committees. Among other updates, Dr. Levine shared that APDEM would have booths at the AACE and Endocrine Society annual meetings and has launched a mentorship program. APDEM is also working on updating and integrating transgender and health equity education into its general curriculum, along with tools for program directors to assess how programs are implementing curricula. APDEM has been working with ABIM on creating a quality agenda for improving health and health care within the discipline and is partnering with other organizations to attract early learners to the discipline and create unconscious bias training webinars for program directors.

Regarding AACE, Ms. Lepkowski noted that AACE has a new CEO, Johnnie White, MBA, CAE, CMP, who joined in March. She also shared information about AACE’s annual meeting in May, including that AI would be the theme of the keynote session, and that there would be a signature event on diversity, equity and inclusion and microaggressions in the workplace. In addition, AACE has been advancing its global footprint with the Cardiometabolic Conference in Abu Dhabi and the annual Middle East North Africa Conference in Dubai slated for November. AACE is working on finding positive ways to address misinformation and provide patients with evidence-based, patient-focused educational materials, which now include open access patient journeys centered on thyroid disease, diabetes, and obesity and weight loss. Finally, AACE is in the midst of a quality improvement collaborative as part of a grant from the Centers for Disease Control and Prevention on improving adult vaccinations in persons living with diabetes. They presented the first few abstracts as a result of that collaborative at the annual meeting in May.

Society guests departed at this point in the meeting.

Update on the Endocrinology, Diabetes & Metabolism Approval Committees

Shehzad S. Basaria, MD, Harvard Medical School, Brigham and Women’s Hospital; Chair of the Endocrinology, Diabetes & Metabolism Traditional, 10-Year MOC Exam Approval Committee

Susan L. Samson, MD, Ph.D., FRCPC, FACE, Mayo Clinic Florida; Chair of the Endocrinology, Diabetes & Metabolism LKA 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. There are two ABIM approval committees related to endocrinology, diabetes and metabolism: the Traditional, 10-Year MOC Exam Approval Committee (which is also responsible for the initial certification exam) and the LKA Approval Committee. Dr. Basaria and Dr. Samson 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. In addition, they answered questions about qualifications and term lengths for item-writers. Item-writers serve two-year terms with the option to renew.

Learn more about opportunities to create items for ABIM assessments on the Item-Writing Task Force.

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 new ways 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 Specialty 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.

In discussion, the Specialty Board suggested that recognition should be based on generation or career phase, as different generations of physicians respond differently to recognition approaches. For example, while some in the group focused on the importance of the certificate design, others emphasized the need to better educate the public about the value of board certification. Other suggestions included notifying employers when physicians achieve a milestone, such as completing a 10-year assessment, or in recognition of continuous certification milestones (10-, 20- and 30-year marks, for instance) with the dedication and effort involved in maintaining certification.

In Closing

The Endocrinology, Diabetes & Metabolism 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.

Join ABIM Governance

The Endocrinology, Diabetes & Metabolism Board does not currently have any openings for new members, but there are still opportunities to 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 July 22, 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.

*Indicates society guests were present for this session.