The Medical Oncology Board met virtually on October 27, 2021 to discuss recent and upcoming changes at ABIM, as well as many other important issues facing the discipline. Jamie Von Roenn, MD, Vice President of Education, Science, and Professional Development at the American Society of Clinical Oncology (ASCO), was a guest at the meeting.
Below is a summary of the key takeaways from the meeting:
Richard J. Baron, MD, ABIM President and CEO, joined the Medical Oncology 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. He noted that 30 years of research show how structural racism has impacted health outcomes, and ABIM believes that part of remaining current in medical knowledge includes physicians being cognizant of that literature and incorporating it into practice. As such, ABIM will begin collecting data on race and ethnicity and will research how to incorporate questions about DEI on assessments.
- 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. Baron said the reaction was overwhelmingly positive with many thanking ABIM for making the statement. He noted there were a few people who saw this as infringement on freedom of speech and chilling the conversation between physicians and patients. He said he found that disconcerting, because ABIM and the medical community should ground its decisions and statements in science and evidence, with COVID-19 vaccination widely accepted as safe and effective.
- Previewing the Longitudinal Knowledge Assessment (LKA), slated to launch in January 2022 in 12 specialties including Medical Oncology. Dr. Baron noted that beginning in 2022, physicians will have the opportunity to pay less for Maintenance of Certification (MOC) if they enroll in the LKA, even if they hold multiple certificates, because the LKA will be included in the annual MOC program fee.
Medical Oncology Board Chair Robert D. Siegel, MD, reminded Medical Oncology Board members that his term will end in June 2022, and that the Specialty Board needs to start looking for applicants to fill the open member seat.
The Specialty Board is currently seeking a medical oncologist practicing in a non-university/community setting. Special consideration will be given to those located in the southern part of the country. Those interested in serving on the ABIM Medical Oncology Board should submit an application by 1/17/22.
ABIM is also currently seeking oncologists to serve on its Item-Writing Task Force to assist with creating assessment content. Learn more about the opportunity and how to apply. ABIM will actively continue to recruit until all the openings are filled.
Innovation in Oncology Training
Furman S. McDonald, MD, MPH, Senior Vice President for Academic and Medical Affairs, gave a brief introduction to the Advancing Innovation in Residency Education (AIRE) program of the Accreditation Council for Graduate Medical Education (ACGME). These programs promote competency-based medical education. The ABIM Council has allowed for “double counting,” i.e., giving credit from a single rotation or training experience toward ABIM initial certification eligibility in more than one discipline in combined fellowship programs using the AIRE model. The ABIM Council also allows for part-time training if needed in the AIRE programs.
Jamie Von Roenn, MD, ASCO’s Vice President of Education, Science, and Professional Development, then presented an innovative proposal that would combine medical oncology and hospice and palliative medicine into a single fellowship program, accomplishing training in both disciplines in less time than would be required for sequential training in each area.
Dr. Von Roenn said the idea for the program came about because incorporating palliative care into the treatment plans for cancer patients represents optimal cancer care. Requests from fellows and oncologists led to research into how a combined fellowship in medical oncology and palliative care could be created. Twenty-two institutions were interested in the proposal, and six are prepared to move forward with a pilot program. Currently 485 oncologists (of 15,163 total or about 3.2%) are also certified in palliative care. It is hoped this combined competency-based training model may see this number grow in the future.
The proposed program allows integrated programs of medical oncology and hospice and palliative medicine to be completed in 24 months (all clinical training) and a combined training in hematology, medical oncology and hospice and palliative medicine to be completed in 36 months with a minimum 30 months of clinical training. Because of the request for double counting rotations (i.e., counting them for both palliative care and medical oncology), there is time for research initiatives by the fellows.
The proposal has been submitted to ACGME for approval and feedback should be provided shortly. If approved, a new track in the match will be developed and it is anticipated that the first fellows in this program will begin in July 2023.
Questions about the proposed program can be directed to Dr. Von Roenn via email at Jaime.VonRoenn@asco.org.
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 Medical Oncology 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 little more than a year at the time of the meeting, and encouraged Specialty Board members to visit the year in review post on the ABIM blog.
She noted that the organization is beginning with race and ethnicity data but the committee understands that diversity is much broader than that.
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 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 medical oncology 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 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.
Medical Oncology 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.
There was some discussion about what efforts have been made over time to increase the share of physicians Underrepresented in Medicine in general practice and in subspecialties, such as medical oncology. A member noted that DEI has been spotlighted for a few years but it doesn’t seem to be yielding results. Some members indicated this may be a pipeline problem, where potential students have to be approached earlier in their education, including before medical school. Individual medical schools have tried make progress in that area by opening pathways to encourage younger children to go into STEM. It was also pointed out that in addition to access, provisions must be made to allow for continued success.
Quality Improvement Program
Specialty Board members considered an Approved Quality Improvement (AQI) Program request to consider an activity that would yield 20 MOC points to participants. The proposal, made by The University of Texas MD Anderson Cancer Center, has the goal of reducing missed opportunities for tobacco counseling and cessation services within the cancer prevention center. Suresh Nair, MD reviewed the proposal and outlined it for members saying it met all the requirements for an AQI program, and it was subsequently approved by the Specialty Board. Participation in this activity is limited to physicians at MD Anderson. More information on how an institution can submit an AQI Program application can be found 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.
Medical Oncology Board members also shared concerns about the number of questions someone would need to answer if they participated in the LKA for more than one certificate, and learned that staff are exploring ways to realize efficiencies for aligned disciplines in the future that could reduce the number of questions needed. It was also recognized that diplomates often have assessments due in different years, and for some they may decide to mix and match by choosing LKA in one discipline and the traditional, 10-year MOC exam in another.
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 for 12 disciplines, including medical oncology. The first set of questions will be delivered January 4, 2022 and the quarter ends March 31, 2022, so enrolling early ensures physicians will have enough time to access and answer questions for that quarter. Learn more about the features, benefits, and other important details of LKA at abim.org/lka.
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 adding roles for trainees in ABIM Governance and programs where they can become ambassadors for early career physicians, promoting what ABIM does beyond assessments, especially its advocacy and learning experiences, and creating structured listening sessions or town halls where Governance can speak directly to diplomates and explain ABIM policy.
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.
The Medical Oncology Board values the feedback and commentary of the entire medical community, including diplomates and society partners.
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