The Critical Care Medicine Board held its fall meeting on Friday, October 28, 2022, which included a special joint session with the Pulmonary Disease Board. The agenda included updates for the Specialty Board on activity at ABIM and allowed for discussion of pressing issues in the field, including issues that affect both disciplines.
The following is a summary of the joint session and fall meeting.
Joint Session with the Pulmonary Disease Board | October 28, 2022
The fall meeting began Friday, October 28, 2022, with a joint session with the Pulmonary Disease Board. The Specialty Boards were joined for this session 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).
Richard J. Baron, MD, President and Chief Executive Officer, ABIM
Dr. Baron presented an overview of ABIM’s progress on a number of fronts since the Critical Care Medicine and Pulmonary Disease Boards met in the spring, including:
- The continued success and growth in participation of the Longitudinal Knowledge Assessment (LKA®), noting that the LKA is now available in three new specialties, including Critical Care Medicine, Pulmonary Disease and Infectious Disease, as of January 1, 2023. Enrollment for all assessments opened December 1, 2022.
- ABIM’s concentrated efforts in advancing diversity, equity and inclusion work streams, including research, listening sessions, staff trainings, cultural celebrations and analysis of ABIM’s programs and services, while addressing any inequities discovered.
- Medical misinformation, which continues to be a growing concern. ABIM is actively working with organizations across the medical community to build a comprehensive approach identifying strategies and tactics that can be employed to address misinformation and promote accurate information.
Diversity, Equity and Inclusion (DEI) Update
The Critical Care Medicine and Pulmonary Disease Boards received an update on ABIM’s DEI work from Lorna Lynn, MD, Vice President of Medical Education Research; Kelly Rand, MA, CPH, Manager of Diversity and Health Equity; and Pamela Browner White, Senior Vice President of Communications and Chief DEI Officer.
Ongoing work in DEI includes a pilot program incorporating differential item functioning analysis in ABIM assessments, design of a study investigating the impact of patient race and ethnicity identifiers in assessment items, developing health equity questions and reporting on the demographic characteristics of the internal medicine workforce.
Lynn T. Tanoue, MD, MBA, Chair of the Pulmonary Disease Board, provided a summary of the Pulmonary Disease Board’s discussion on race-based norms and race corrections for pulmonary function testing, which was held during the Pulmonary Disease Board’s fall meeting on October 27. At that discussion, the Pulmonary Disease Board voted to advise the Approval Committees and Item-Writing Task Force (IWTF) in Pulmonary Disease to move toward the use of race-neutral pulmonary function prediction equations, as can be found in the European Respiratory Society/American Thoracic Society (ERS/ATS) technical standard on interpretive strategies for routine lung function tests.
Members of both Specialty Boards continued the discussion, noting the importance of acknowledging developments in the field and continuing to align this work with ABIM’s DEI work and overall mission.
Laura E. Evans, MD, MSc, Chair of the Critical Care Medicine Board, commented on the recently recognized challenges with use of pulse oximetry in patients of different skin tones. She noted how this is another topic worthy of future considerations and further collaboration with specialty boards and societies.
Representatives from the societies in attendance added to the discussion with comments on activities at their own organizations.
- ATS is developing a yearlong plan for DEI work and will hold dedicated DEI sessions at the upcoming ATS 2023 annual meeting to be held May 19–24.
- SCCM shared the joint petition signed by the Critical Care Societies Collaborative (CCSC) regarding the accuracy of pulse oximetry across the spectrum of patient populations, particularly those with darker skin.
- AACN has established a dedicated program looking both internally and externally at equity, diversity, inclusion and belonging (EDIB) and how EDIB affects their employees and the community of nurses and patients they serve. Internally, AACN is in the process of analyzing projects and processes in each department that would benefit from an EDIB lens, for example the selection of subject matter experts in certification. Externally, AACN is one of the cosigners of the CCSC joint petition on pulse oximetry (see above).
- The DEI committee of APCCMPD is currently focused on providing leadership opportunities for physicians in underrepresented minority populations and externally discussing resources for fellowship programs to address areas such as bias in fellowship interviews and other training for its members.
- CHEST shared information about its dissemination of a new tool, First 5 Minutes™, which was developed to teach empathetic listening skills while recognizing implicit bias.
The discussion closed with agreement among participants about the importance and growth of DEI work within the medical profession and the need for continued collaboration and shared learning between all groups present.
Updates on Certification for Critical Care Medicine and Pulmonary Disease
Progress Report on Policy Coordination: Procedural Requirements for Initial Certification in Pulmonary Disease and Critical Care
Dr. Lynn updated the Specialty Boards on ABIM’s progress developing a survey around procedural requirements for initial certification in Critical Care Medicine and Pulmonary Disease. ABIM is working on a survey of Critical Care Medicine and Pulmonary Disease diplomates to better understand how often certain procedures are performed in clinical practice. This survey was prompted by a request by APCCMPD and researchers at the University of Pennsylvania. The new survey will be launched after being reviewed by members of the Critical Care Medicine and Pulmonary Disease specialty boards and APCCMPD.
Maintenance of Certification (MOC) in 2023
The Specialty Boards received an overview of upcoming MOC milestones from Natalie Trahey, Director of Program Operations, and Weifeng Weng, Ph.D., Director of Research Analysis. In January 2023, ABIM will resume evaluation of physician certification status following a two-year extension of MOC requirements for physicians in most disciplines due to the COVID-19 pandemic. (Four disciplines—Critical Care Medicine, Hospital Medicine, Infectious Disease and Pulmonary Disease—received extensions through 2023 due to the disproportionate impact of COVID on physicians in those specialties.)
The presenters shared information about the number of diplomates at risk of losing certification and provided an overview of the robust communications strategy aimed at building awareness of the upcoming deadline in order to minimize the number of diplomates who become “Not Certified.” Communications include monthly targeted emails (June through January) highlighting opportunities for earning MOC points such as society meetings and activities, UpToDate® and thousands of other Continuing Medical Education (CME) activities. Some early career physicians who have not yet been through an MOC cycle are at risk, possibly because of their lack of familiarity with the MOC process. ABIM recommends that all physicians sign into their personalized Physician Portal to check on their requirements.
The presentation also highlighted an opportunity for physicians with lifetime certificates—that is, those who initially became certified before 1990—to enroll in the LKA as a way to meet their 2023 assessment requirement in order to remain “Participating in MOC.” As a reminder, lifetime certificates are never at risk of losing certification for not participating in MOC. The physician will be shown as “Certified” on the ABIM website, but listed as not participating in MOC unless they meet the assessment requirement. The change was made and announced in 2013 to become effective in 2023 in the interest of providing more information for patients on whether a physician is demonstrating that they are staying current in knowledge and practice. Physicians with lifetime certificates can be challenging to reach as some have retired or changed their contact information. CHEST is assisting ABIM with outreach and Specialty Board members were invited to alert their colleagues to the change as well.
Enrollment for all ABIM assessments, including the LKA, the traditional, 10-year MOC exam and the initial certification exam, opened December 1, 2022.
Longitudinal Knowledge Assessment (LKA®) Update
Jeff Miller, ABIM’s Chief Information Officer, provided an update on the progress of the LKA since spring 2022, including overwhelmingly positive feedback from participants. Of more than 5,100 diplomates surveyed, 91% of respondents reported that they found the LKA useful for learning, and 75% said they would recommend it to a colleague. ABIM will continue to gather data through interviews, a user panel, an in-depth study of learning and an annual survey. Several diplomates have shared their positive LKA experiences in short blog posts, reflecting on its flexibility, convenience and actionable feedback.
The Specialty Boards then received a live demonstration of the LKA platform and user experience. (A video walk-through is also available online.) Among other things, it was pointed out that questions on the LKA expire each quarter, and that questions are “retired” from use so that diplomates will never see the same question twice if they continue in the LKA for multiple five-year cycles. This means that there is an emphasis on continually developing new items for the assessment and underscores the importance of the IWTF responsible for writing questions. ABIM is actively seeking item-writers, and instructions and criteria for application in both critical care medicine and pulmonary disease can be found on ABIM’s website. A full list of all governance openings with application instructions can also be found online.
ABIM is analyzing large amounts of data gathered during the initial roll-out of the LKA, and working on optimizing the ongoing development of the assessment.
In answer to several queries from the group, Mr. Miller noted that MOC points are earned for each correctly answered item but CME credit is not available at this time, although it could be considered in future. Mr. Miller also noted that items containing media (such as images or video) are preceded by a warning that allows the user to opt to answer the question at a more convenient time, rather than placed last in the order of items; this is to better reflect performance on the entire blueprint. Dr. Evans added that the rationales provided in LKA items are brief and designed to lead users to other resources outside the LKA. While the LKA is designed to help diplomates learn, ABIM is an assessment organization and not an educational one, and recognizes that the LKA is not intended to replace the need for other learning resources.
Enrollment for the 2023 LKA opened December 1, 2022. Physicians who are considering the LKA are encouraged to enroll early to take advantage of the most time possible to answer questions. The first round of questions became available January 1, 2023, and expire at the end of the quarter.
Fall Meeting of the Critical Care Medicine Board
Following the joint session with the Pulmonary Disease Board and society partners, the Critical Care Medicine Board continued its fall meeting separately.
Dobbs v. Jackson: Implications for Critical Care Medicine
The Critical Care Medicine Board held an open discussion on the implications of the 2022 Dobbs v. Jackson Women’s Health Organization ruling for the discipline of critical care medicine, specifically those areas under the oversight of the Specialty Board, including training, assessments and stakeholder relationships within the critical care medicine community.
Discussion among Specialty Board members touched on patient, provider and training impacts, as well as the larger issues at stake with the current intersection of politics and health care. Members noted that the Supreme Court ruling may affect training and care of high-risk pregnancies in the intensive care unit. There was also concern for the health needs of physicians who may be pregnant in the future and their ability to choose a program or practice, or attend a conference based on abortion laws in that state. Additionally, the disproportionate impact on lower income families’ ability to access health care, and concerns about an already stressed and burned out health care workforce were discussed as issues likely to increase. In general, it was observed that Dobbs limits the options and access available to patients and clinicians alike.
Update from the Critical Care Medicine Approval Committees
Naomi O’Grady, MD, National Institutes of Health Clinical Center; Critical Care Medicine Traditional 10-Year, MOC Exam Approval Committee
Margaret Pisani, MD, Yale University; Chair of the Critical Care Medicine LKA Approval Committee
There are two ABIM Approval Committees working with the Critical Care Medicine Board: the traditional, 10-year MOC exam Approval Committee (which also deals 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. Drs. O’Grady and Pisani described the meeting process and the committees’ interaction with the IWTF, and identified the committees’ current challenges and recent successes.
The Specialty Board discussed the challenges facing the Approval Committees, namely: training and retention of item-writers and providing the IWTF with feedback. Dr. O’Grady noted that only 50% of proposed pre-test items written for the assessments are approved to appear on the assessment. Item-writers are expected to write about two items per month, and there are 28 item-writers in the Critical Care Medicine IWTF. To address item-writers’ concerns about education, mentorship and opportunities to meet other physicians, ABIM is working on several upcoming initiatives, including a pathway for item-writers to advance to more senior roles, and improved feedback loops. Dr. Baron will be holding a town hall with IWTF members to demonstrate how important they are to the ABIM community, with the hope that this is one step in deepening their connection to ABIM.
Procedural Requirements for Initial Certification in Critical Care and Pulmonary Disease Survey Development
ABIM plans to survey Critical Care Medicine and Pulmonary Disease diplomates on how suggested procedural competencies for initial certification are currently performed in clinical practice. Staff at the fall meeting sought guidance from the Specialty Board on developing the survey in an increasingly complex critical care medicine environment.
Members responded by pointing out differences to consider, such as community hospitals that do not perform as many procedures as academic hospitals. Dr. Evans emphasized that the development of critical care medicine as a discipline needs to be considered, whether it becomes more specialized or more unified with greater independence from pulmonary medicine.
Dr. Lynn confirmed that the survey would be reviewed and tested by the Specialty Board. In the spring, ABIM plans to relaunch the Diplomate Professional Profile for Critical Care Medicine. This will be another means for collecting data on what critical care physicians do in practice.
The Critical Care Medicine Board values the feedback and commentary of the entire medical community, including diplomates and society partners.
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