The Hospice and Palliative Medicine Advisory Committee held its fall meeting on Monday, November 7, 2022. The agenda provided an opportunity to update the Advisory Committee on activity at ABIM and allowed for discussion of pressing issues in the field. The Hospice and Palliative Medicine Advisory Committee was joined by guests from the American Academy of Hospice and Palliative Medicine (AAHPM).
The Hospice and Palliative Medicine Advisory Committee comprises American Board of Medical Specialties (ABMS) member boards that cosponsor the discipline. Representatives include:
- Laura Dingfield, MD, MSEd, FAAHPM, Advisory Committee Chair; ABIM
- Stephen Hays, MD, American Board of Anesthesiology (ABA)
- Christine E. Kistler, MD, MASc, American Board of Family Medicine (ABFM)
- Michael McDuffie, Ph.D.
- Mary Lynn McPherson, Pharm.D., MA, MDE, BCPS
- David Nowels, MD, ABFM
- Christopher O’Hara, MD, American Board of Pediatrics (ABP)
- Jessica Stetz, MD, American Board of Emergency Medicine (ABEM)
- Martha Twaddle, MD, ABIM
The following is a summary of the fall meeting.
Administrative Board Update
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 Hospice and Palliative Medicine Advisory Committee met in the spring, including:
- The continued success and growth in participation of the Longitudinal Knowledge Assessment (LKA®). 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.
- The ongoing campaign against medical misinformation, which remains a growing concern in the medical community. ABIM is actively working with organizations across the House of Medicine to build a comprehensive approach identifying strategies and tactics that can be employed to battle misinformation and promote accurate information.
Diversity, Equity and Inclusion (DEI) Update
The Hospice and Palliative Medicine Advisory Committee 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 questions, developing health equity questions and reporting on the demographic characteristics of the internal medicine workforce.
Dr. Nowels asked whether the term “minoritized individuals” mentioned in the presentation was being used in the broad sense to include more than race and ethnicity, such as a lack of access to care in rural areas. Dr. Kistler added that religious affiliation is of particular importance to the discipline as it relates to patient preferences for end of life care and can be part of a minoritized individual’s identity. The presenters clarified that ABIM uses the term broadly to include any group with limited access to care.
Dr. Hays pointed out that there should be a greater emphasis on the importance of DEI in training programs, which Dr. Dingfield noted could be fostered by DEI content in the blueprint and corresponding curriculum from medical societies. ABMS recently received a proposal—strongly supported by ABFM, ABIM and ABP—for the member boards to work together on creating strong health equity content. The members emphasized that trainings and curriculum should incorporate community voices and collaborations, and provide useful information on how program directors can implement DEI efforts and trainings.
The Advisory Committee also discussed the ongoing collection of cross-specialty workforce data for the discipline. An update will be provided at the spring 2023 meeting.
Dobbs v. Jackson: Implications for Hospice and Palliative Medicine
The Hospice and Palliative Medicine Advisory Committee held an open discussion on the implications of the 2022 Dobbs v. Jackson Women’s Health Organization ruling for the discipline of hospice and palliative medicine, specifically those areas under the oversight of the Advisory Committee, including training, assessments and stakeholder relationships within the hospice community.
The conversation centered around the impact on training and the implications for privacy, bodily autonomy and how medicine is practiced as a whole. Advisory Committee members pointed out that the Supreme Court’s ruling raises concerns around providing adequate training for residents and fellows, and boards’ ability to meaningfully assess their knowledge in procedures now restricted or illegal. There are implications specifically for training in perinatal palliative medicine and medical aid for end of life care in the future, including training, assessment and clinical practice.
Members of the group also discussed the ruling’s implications for privacy rights and bodily autonomy. Some posited that Dobbs v. Jackson will cause medicine to be practiced differently in different states, and that medical practice across the country is in flux as new norms are established. It was also noted that the ruling would increase disparities in the care of low-income women and women of color, with additional impacts on patients’ mental health and bodily self-determination.
Certificates Transferring from Cosponsoring to Qualifying Boards
ABIM staff provided a review for the Advisory Committee of what it means for an ABMS member board to transition from a cosponsoring board to a qualifying board. Cosponsoring boards certify diplomates in their own discipline; qualifying boards delegate certification of diplomates in their discipline to the administrative board or another cosponsoring board. In the case of hospice and palliative medicine, ABIM is the administrative board, and the Advisory Committee partly comprises individuals who represent the cosponsoring boards.
The discipline of hospice and palliative medicine was established with 10 cosponsoring boards, but has since transitioned to five cosponsoring boards and five qualifying boards. The cosponsoring boards are:
- The American Board of Anesthesiology (ABA)
- The American Board of Emergency Medicine (ABEM)
- The American Board of Family Medicine (ABFM)
- The American Board of Internal Medicine (ABIM)
- The American Board of Pediatrics (ABP)
The qualifying boards are:
- The American Board of Obstetrics and Gynecology (ABOG)
- The American Board of Physical Medicine and Rehabilitation (ABPMR)
- The American Board of Psychiatry and Neurology (ABPN)
- The American Board of Radiology (ABR)
- The American Board of Surgery (ABS)
As a result, 464 physicians with certifications issued by the qualifying boards are now diplomates of ABIM and will maintain certification in hospice and palliative medicine through ABIM.
Additionally, the Advisory Committee chair announced that the Hospice and Palliative Medicine Certification Exam will be offered annually beginning in 2024. This is partially a result of an increased demand for physicians seeking to be certified in hospice and palliative medicine. More information will become available this spring.
Update from the American Academy of Hospice and Palliative Medicine (AAHPM)
Representatives from AAHPM reported on the organization’s DEI work, which includes the creation of a strategic plan comprising four principles. AAHPM is also involved in the Accreditation Council for Graduate Medical Education’s new DEI learning collaborative, named “Equity Matters.” As part of the Council of Medical Specialty Societies, AAHPM is working on an initiative called the “Next Gen Scholars for Equity in Hospice and Palliative Medicine,” designed to foster the expansion of the pipeline with sponsors and scholars.
In addition, AAHPM has developed two new outpatient quality care measures which the organization hopes to expand in the future. The organization has been advocating for the Palliative Care and Hospice Education and Training Act aimed at developing both the generalist and specialist palliative medicine workforce to meet the increased need for comprehensive, high quality palliative care in hospital programs across the country.
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 Advisory Committee 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 Item-Writing Task Force (IWTF) responsible for writing questions. ABIM is actively seeking item-writers, and instructions and criteria for application in hospice and palliative medicine 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.
Diplomates of cosponsoring ABMS member boards (specifically ABA, ABEM and ABP) should check with their certifying board about whether they have access to the LKA. Learn more about the features, benefits and other important details of the LKA at abim.org/LKA.
Update from the Hospice and Palliative Medicine Approval Committees
Martha Twaddle, MD, Northwestern Medicine; Chair, Hospice and Palliative Medicine LKA Approval Committee; member, Hospice and Palliative Medicine Advisory Committee
There are two ABIM Approval Committees working with the Hospice and Palliative Medicine Advisory Committee: 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.
Dr. Twaddle described the meeting process and the committees’ interaction with the IWTF, as well as current challenges, namely: the extensive editing process for assessment items and the pressing need for more item-writers to meet the higher content demands of the LKA. It was noted that some item-writers for the MOC assessment may transition to writing for the LKA given this higher demand. Membership of the hospice and palliative medicine IWTF includes members of other ABMS member boards.
ABIM is actively seeking item-writers. Instructions and criteria for application in hospice and palliative medicine can be found on ABIM’s website. Information about openings on the Hospice and Palliative Medicine Approval Committees can also be found online.
The Hospice and Palliative Medicine Advisory Committee values the feedback and commentary of the entire medical community, including diplomates and society partners.
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