Fall 2021 Geriatric Medicine Board Summary

Fall 2021 Geriatric Medicine Board Summary

Bruce A. Leff, MD, Chair, Geriatric Medicine Board

The Geriatric Medicine Board met virtually on September 24, 2021 to discuss recent and upcoming changes at ABIM, as well as many other important issues facing the discipline. The Specialty Board was joined by two guests, Sharon Levine, MD, a former member, and Nancy E. Lundebjerg, CEO of the American Geriatric Society (AGS).

Below is a summary of the key takeaways from the meeting:

Leadership Update

Richard J. Baron, MD, ABIM President and CEO, joined the Geriatric Medicine Board to provide members with recent updates, including:

  • Reflecting on the spring 2021 Internal Medicine Summit, and how ABIM and specialty societies could collaborate to advance diversity, equity and inclusion (DEI) efforts across internal medicine.
  • Sharing reactions to a joint statement issued by ABIM, the American Board of Family Medicine (ABFM), and the American Board of Pediatrics (ABP) cautioning physicians about disseminating misinformation on COVID-19.
  • Previewing the Longitudinal Knowledge Assessment (LKA), slated to launch in January 2022 in 12 specialties.

Exploring Why Fellowship-Trained Physicians Let their Geriatric Medicine Certification Lapse

ABIM staff members Lorna A. Lynn, MD, Vice President for Medical Education Research, and Kate Ross, Research Associate, previewed a survey being conducted by ABIM and AGS that will attempt to better understand why physicians certified in geriatric medicine choose to allow their certification in the specialty to lapse more often than physicians in other specialties. This survey will add to the understanding of why physicians choose to pursue fellowship training in geriatrics, and the barriers and disincentives to maintaining certification in geriatric medicine.

The survey will run from October through the end of November, and results will be presented at the next Geriatric Medicine Board meeting in April and at an AGS meeting in May.

Mid-Career Training Pathway for Geriatric Medicine Survey

Dr. Leff presented the results of a survey on Mid-Career Training Pathways for Geriatric Medicine, a collaboration between AGS, the Association of Directors of Geriatric Academic Programs (ADGAP) and the ABIM Geriatric Medicine Board.

He noted that Dr. Sharon Levine, whose term on the Geriatric Medicine Board recently ended, but was in attendance as a guest, had been a strong advocate of investigating the viability of mid-career training pathways. Dr. Leff explained that the survey was sent to geriatric medicine fellowship directors to learn about issues related to the potential viability of future mid-career training pathways.

The survey was sent to 167 fellowship directors in June 2021.

  • 59 (35%) directors replied, with nearly 75% saying they believed there is a demand for mid-career training options in geriatric medicine.
  • 20% said they did not believe there was a demand for mid-career training and that they did not believe it was worth the effort of creating training.
  • More than 50% said they already had a geriatric medicine training program engaged in mid-career training.
  • The majority of those with training programs had full-time training programs (70%) with the majority of the training completed in 12 months; 90% of these were supported by GME training slots while 30% of the training programs were interrupted full-time training (full-time training periods of at least one month duration alternating with time away from training of variable lengths).
  • Of those who participated in mid-career training, around 33% were switching careers, and 80% said they were motivated to do the additional training to learn more about geriatrics.

Dr. Levine said she believes that there is a need for mid-career training, but that physicians may find mid-career training difficult because of compensation issues and human resources practicalities, such as maintaining malpractice insurance. However, interrupted training opportunities over two years are worth considering.

Dr. Levine noted, “I think that there are some barriers for people who are mid-career and have to support themselves on a fellow’s salary.” She said she believed that mid-career training options should be developed and she has no doubt that a mid-career physician could be trained in geriatric medicine in a year, and suggested the Accreditation Council for Graduate Medical Education (ACGME), ADGAP and AGS should be consulted and the discussion continued.

Meeting guest Nancy E. Lundebjerg, the CEO of AGS, was less optimistic about development of a one–size-fits-all AIRE Pathway (Advancing Innovation in Residency Education) given the different ways geriatric academic programs had structured this opportunity. She commented that she sees an opportunity in bringing together fellowship directors who have offered mid-career training to learn more about how they have done it.  She mentioned that AGS/ADGAP are stretched in terms of staff support and resources, and noted that this idea would be added to a list of projects they can consider in the future.

Furman S. McDonald, MD, MPH, ABIM’s Senior Vice President for Academic and Medical Affairs, congratulated AGS/ADGAP on creating another AIRE pilot, an ACGME program focused on competency advancement blending IM residency with geriatrics fellowship. He explained that the goal of AIRE is to outline the competency criteria that would be measured in a training program that may be structured differently than traditional, sequential time-based training in disciplines (residency, then fellowship, relying heavily on time in training in addition to competencies achieved in training).

The program ADGAP put forward is a blended model that includes geriatrics training during the course of internal medicine training. He said there is a very successful mid-career, part-time training AIRE program proposal in Hospice and Palliative Medicine at the University of Colorado crossing multiple disciplines, which shows there is some precedent in the AIRE program for mid-career training. He also shared that the ABIM Council approved a resolution that allows part-time training in specialties and double counting across fellowships, which were two things that hindered some pilots in the past. He believes if there were pilots fitting those parameters they could be approved by ABIM in conjunction with the AIRE program.

Diversity, Equity and Inclusion: Progress Report

Pamela Browner White, Senior Vice President of Communications and Chief Diversity, Equity and Inclusion Officer; Lorna Lynn, MD, Vice President for Medical Education Research and the Staff Administrator for the Board of Director’s Committee on Diversity, Equity and Inclusion; and Weifeng Weng, PhD, Director of Research Analysis, updated the Geriatric Medicine Board on ABIM’s progress in advancing DEI and becoming an actively anti-racist organization.

Ms. Browner White noted that she has been Chief Equity, Diversity and Inclusion Officer for a year almost to the day of the meeting, and encouraged Specialty Board members to visit the year in review post on the ABIM blog.

She also reminded the Specialty Board of ABIM and ABIM Foundation’s Racial Justice statement: “It’s not simply enough to say passively we will do no harm; we pledge actively to do our part in opposing and dismantling systems and policies that cause harm to our patients and disproportionately affect those in Black and Brown communities.”

She said much of the work has been guided by this statement, and updated Specialty Board members in a number of areas ABIM is making progress.

Dr. Lynn and Dr. Weng then provided an overview of race and ethnicity data for the overall internal medicine diplomate population and for geriatric medicine diplomates. Dr. Lynn noted that while the current reports rely on external data, in the future, ABIM will ask diplomates to self-identify with regards to their gender, race and ethnicity.

ABIM will collaborate with society partners and others to decide on what identifiers will be used.  Making the reasons clear as to why we will begin to the collect this information is vitally important; it’s all about assuring that our programs are fair, and that we make sure a broad range of voices are included in our discussions.

Geriatric Medicine Board members shared their reactions to these data and their ideas for how ABIM can best move this work forward, as well as their personal experiences working within their own institutions.

As ABIM continues this work it will keep the community informed on its progress. More information can be found in a special section of our blog entitled ABIM’s Commitment to Health Equity.

 Candidate Recruitment

Dr. Leff reminded the Geriatric Medicine Board that his term will end in June, and that it needs to start considering the applicants for the open seat.

Christine L. McCloskey, ABIM Board Committee Program Manager, reviewed the process for recruiting and selecting new members. Later in the fall the Geriatric Medicine Board will discuss the qualifications of applicants who have self-nominated or been nominated by a peer for the open position. Members will eventually recommend two candidates to the ABIM Council, who will make the final decision on which recommended candidate will join the Geriatric Medicine Board.

ABIM is currently seeking geriatricians to serve on its Item-Writing Task Force to assist with creating exam content. Learn more about the opportunity and how to apply on ABIM’s website.

Longitudinal Knowledge Assessment (LKATM) Update

Alison Carey, Senior Director of Engagement and Digital Experience, gave the Specialty Board a preview of the Longitudinal Knowledge Assessment (LKA) Platform and updated them about how ABIM has engaged physicians throughout the development process to ensure it will meet their needs and provide a good user experience.

The engagement work included establishing a Physician Advisory Panel of 10 board certified physicians, who met on a monthly basis to share feedback on a variety of areas, such as the LKA assessment platform, communications materials, and other program design elements.

The Panel’s insights were enhanced through regular user-testing sessions, additional physician interviews, surveys and feedback gleaned from diplomate phone calls and emails. In addition, in August 2021, 26 physicians volunteered to serve as beta testers for the LKA platform to help identify bugs and any user experience issues; their feedback resulted in important improvements to the assessment platform prior to launch.

All of this physician feedback also helped generate a comprehensive LKA Physician Journey, outlining physician opportunities and challenges. Some of the top challenges were discussed during the meeting to help prepare members in case colleagues approach them with questions.

For example, one challenge identified was that enrolling and participating at the beginning of a physician’s assessment due year is a departure from how many diplomates engage with MOC, and may not be intuitive. To address this challenge, ABIM will communicate clearly through multiple channels, including emails, social media, its website and more to ensure physicians are informed about this new process.

ABIM plans to continue engaging with the community beyond the LKA launch and make improvements based upon physician feedback. All ABIM Board Certified physicians are encouraged to join the Community Insights Network where they may receive occasional requests to share their thoughts about various ABIM programs or topics.

Enrollment for the 2022 LKA opens December 1, 2021, and the first batch of questions will be delivered January 4, 2022. Learn more about its features, benefits, and other important details at abim.org/lka.

Geriatric Medicine Board members asked whether LKA could be used to earn CME. Richard Battaglia, MD, ABIM’s Chief Medical Officer, shared that ABIM will be reaching out to other ABMS Member Boards to understand their experience, though only a small number currently offer CME for their longitudinal assessments. Dr. McDonald stated that many states accept MOC points in fulfilling licensure requirements.

 Exploring Opportunities to Enhance Trust Between ABIM and the Community

In an effort to continually improve its programs and relationships with the diplomate community, Specialty Board members engaged in an exercise aimed at identifying opportunities to enhance trust between ABIM and the physicians it serves. Insights previously gleaned through Governance member feedback have informed other important changes at ABIM, including advancing DEI initiatives, better accommodations for nursing mothers, and the LKA launching in 2022.

A number of ideas emerged during this session such as ways to better communicate and engage with the community, possible program enhancements, and potential collaborations with other groups, including advocacy that would help attract physicians to the field of geriatrics and advocating against administrative burdens. Other ideas included more opportunities to “double count” activities such as CME and MOC, a public awareness campaign of the value of an ABIM credential, and reducing the complexity of MOC.

Similar sessions are being held at each ABIM Specialty Board meeting throughout the fall. The top ideas will be presented to the ABIM Council for further consideration of future implementation.

 In Closing

The Geriatric 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 how to get involved?

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