The Gastroenterology (GI) Board met virtually on March 12, marking approximately one year since the beginning of the COVID-19 pandemic. During that time, physicians certified in internal medicine and its subspecialties have been greatly affected by the novel coronavirus and the additional stress it placed not only on them personally, but on the entire health care system as well. While the pandemic has permeated all aspects of society and was a topic of conversation throughout the Specialty Board meeting, the eight members of the GI Board also addressed many other important issues facing the discipline.
Below is a recap of the key discussion topics from the meeting:
Richard J. Baron, MD, ABIM President and CEO, joined the Gastroenterology Board and highlighted ABIM’s response to the pandemic in light of the additional burdens it has placed on so many physicians. After announcing in May 2020 that no one would lose certification if they weren’t able to complete a Maintenance of Certification (MOC) requirement that year, ABIM made a similar decision with a March 2021 announcement that deadlines for MOC requirements would be extended until the end of 2022. This means:
- Physicians who have an assessment, attestation or points due in 2020 or 2021 will now have until 12/31/22 to complete them.
- Those who are due for an assessment in 2020, 2021 or 2022 will be able to participate in the Longitudinal Knowledge Assessment (LKA) when it launches in their specialty.
- Gastroenterology launches in 2022; (see the full LKA availability and rollout schedule).
- All ABIM assessments will be offered as scheduled this year to allow physicians the flexibility to take an assessment if they would like to take one, even though it is not required.
- The Knowledge Check-In will not be offered after 2021.
Dr. Baron referenced information that was subsequently shared with all ABIM diplomates in the Spring 2021 News and Notes, including his message to ABIM diplomates acknowledging the challenges that the pandemic has wrought on the physician community.
Dr. Baron elaborated on ABIM’s response to COVID-19 and illustrated the important role board certified physicians play as trusted voices in medicine. One example can be seen by numerous ABIM Governance members sharing their vaccination ‘selfies’ on social media through the #MyCOVIDVax campaign. One member of the GI Board, Scharles Konadu, MD shared her experience on Instagram to illustrate the importance of getting vaccinated, as did many others. Read their stories on the ABIM blog.
Dr. Baron also reflected on another pillar of ABIM’s strategic efforts in 2021: Diversity, Equity and Inclusion (DEI). He connected the nation’s negative health outcomes caused by the novel coronavirus and the disturbing reality of health disparities in Black and Brown communities that are now being further exacerbated by the pandemic, and stressed the important role ABIM and the ABIM Foundation play in addressing these issues. He referenced the organization’s joint Statement on Racial Justice issued in summer 2020 and the tangible next steps to realize this vision, including a grant program to build trust and equity in internal medicine training.
Diversity, Equity and Inclusion: Opportunities for Collaboration and Advancement
Echoing Dr. Baron’s report, ABIM’s Senior Vice President of Communications and Chief Diversity, Equity and Inclusion Officer, Pamela Browner White, stressed ABIM’s commitment to addressing racism and structural inequalities by integrating DEI into all facets of ABIM both as a professional standard setting organization and as an employer, and she expressed pride in ABIM’s Commitment to Health Equity one year after its Statement on Racial Justice.
Ms. Browner White was joined by Lorna Lynn, MD, Vice President for Medical Education Research and the Staff Administrator for the Board of Directors’ Committee on Diversity, Equity and Inclusion, with representation from ABIM’s Board, Council and Exam Committees, and from ABIM Foundation’s Board of Trustees. Pilar Padilla, ABIM’s Communications Integration Manager at the time of the meeting, also helped to facilitate the discussion.
Leaders from four GI societies were in attendance during this session:
- American Association for the Study of Liver Diseases (AASLD)
- American College of Gastroenterology (ACG)
- American Gastroenterological Association (AGA)
- American Society of Gastrointestinal Endoscopy (ASGE)
After a brief presentation, Ms. White, Dr. Lynn, the GI Board and society guests engaged in a conversation framed around a number of questions:
1) What are the opportunities for collaboration with other organizations around DEI?
2) With respect to race and ethnicity, what does the workforce look like in the field? How can the specialty recruit and retain a more diverse physician workforce, to better serve patients?
3) What are the known inequities in health and health care in the specialty? What role can ABIM play in mitigating these inequities?
A rich discussion ensued, focusing on challenging issues such as the ethics of data collection for physician demographics, and the difficulty of finding metrics that accurately measure success. All in attendance agreed that the road to achieving health equity would be a long one and that conversations to explore DEI collaborations would continue.
Review of GI Society DEI Initiatives
In addition to staff leadership from the four GI societies, Darrell Gray II, MD, MPH, Associate Professor, College of Medicine, The Ohio State University; Medical Director, Healthy Communities, OSUWMC; Chair, Health Equity Steering Committee, OSUWMC; Deputy Director, Center for Cancer Health Equity, OSUCCC-The James Cancer Hospital; Co-Chair of the GI Intersociety Group on Diversity and Chair of the ACG Diversity, Equity, and Inclusion Committee, was a guest at the meeting. Dr. Gray represented all four GI societies and outlined the inroads the organizations have made in the DEI space.
Dr. Gray’s presentation first illustrated the importance of DEI in providing culturally competent care and in addressing the structural inequities that are evident throughout society. ASGE’s Membership and Diversity Committee provided valuable commentary on the issues facing GI back in 2016 with a Gastrointestinal Endoscopy journal article entitled, ‘Diversity in Gastroenterology in the United States: Where Are We Now? Where Should We Go?’, and Dr. Gray noted how the discipline has come a long way since that time. He then shared some of the ways in which the four GI societies are making an impact as individual organizations.
The ASGE developed a five-year Action Plan to address DEI in GI. The goal of this plan is for ASGE to be intentional and collaborative in enhancing DEI throughout the society, profession and patient care initiatives. Several initiatives are currently underway, including: an annual $50K Research award dedicated to health care disparities and equity; the development of quality improvement projects that GI practices can use in the area of health equity; and development of an educational series on health disparities and equity in GI for its members through its podcasts—the Advocate. In addition, their journal, GIE: Gastrointestinal Endoscopy is leading the way in showcasing authors who have made a conscious effort to incorporate diversity into their studies.
AASLD issued a public Statement on Diversity and Call to Action that outlines its tangible next steps to address racism and inequality by ensuring equitable access to resources and opportunities for leadership. To that end, AASLD is developing a global speakers’ database that will allow members to submit information that includes demographic data, clinical and research interests, and professional accomplishments. This database will guide AASLD committees and special interest groups (SIGs) to ensure a more diverse selection of speakers and moderators in AASLD programs.
AGA has committed to a multi-year effort spanning all aspects of its organization to achieve equity and eradicate disparities in digestive diseases. In July 2020, the AGA Equity Project was launched to make a significant impact on the goals enumerated in AGA’s diversity policy. The multi-year Equity Project strategic plan aims to achieve the following:
- A just world free of health disparities in digestive diseases and free of inequities in access and effective health care delivery.
- State-of-the-art and well-funded research that aligns with the realities of the current multicultural patient population and disease states to achieve health equity for all.
- A world where it is expected and normal that both members and society leadership structures are diverse, and people of color and women are included in organizational decision making.
- Recognition of accomplishments of diverse leaders. In addition, all leaders recognize, inspire and cultivate the next generation of prominent, diverse leaders.
- An engaged AGA membership and staff educated about unconscious bias and committed to the eradication of racism and prejudice towards patients, colleagues, and communities.
- The existence of a diverse, culturally and socially aware, large and vocal early career membership that leads the field towards achieving the vision.
ACG has a suite of programs focused on enhancing diversity in clinical GI, both among clinicians and patients. Projects include educational programs at high schools that serve minority and healthcare focused student populations, research opportunities for underrepresented minority medical students to encourage an interest in GI, abstract awards and clinical research awards to encourage research in the area of health equity. ACG also has undertaken efforts to track and enhance inclusion across its educational and other programs. On the social media front, ACG has instituted a #DiversityinGI campaign to “engage the new class of first-year GI fellows-in-training and to extend messages to medical students, residents, and even high school students, as they consider career opportunities.”
The DEI topic was explored in greater depth in June at ABIM’s Internal Medicine Summit and Dr. Gray was the Summit’s keynote speaker. During the Summit, ABIM and 23 professional societies held action-oriented conversations on how the organizations can collaborate in DEI to amplify collective impact.
Discipline-Specific Topics (Continued from Previous Specialty Board Meetings)
Update on Collaborative Work with GI Societies Regarding a Practice Profile Survey
As part of an ongoing effort to ensure ABIM’s assessments are relevant to today’s practicing gastroenterologist, ABIM’s Strategic Alliances team has continued to engage in collaborative discussions with the four GI societies. The ABIM GI Board, GI Exam Committee and the societies all provided useful feedback on a survey that was sent last year to ABIM diplomates who are certified in gastroenterology.
The goal of the survey is to inform ABIM and the societies about how gastroenterologists and hepatologists spend their clinical time. This practice data will help determine what patterns of clinical specialization are seen in gastroenterology. Common ‘Practice Profiles’ can potentially be used to create MOC assessments for generalist gastroenterologists, who may see a range of patients but have a concentration in a particular area. The survey data will be crosswalked with additional data from other relevant sources such as Medicare or registry data, then a determination made if there are sufficient numbers of physicians in each Practice Profile to create specialized assessments for the LKA after all disciplines have launched.
Liver Biopsy Requirement for Initial Certification
As a follow-up to previous Specialty Board meeting discussions, Gastroenterology Board member Richard K. Sterling, MD, Transplant Hepatology Fellowship Director at Virginia Commonwealth University (VCU), shared AASLD’s recent recommendation to remove ABIM’s procedural requirement for performance of 20 liver biopsies by fellows in order to be eligible for ABIM Board Certification in Transplant Hepatology. In 2016, after a request from AASLD, the Gastroenterology Board reduced the number of required liver biopsies to be performed in transplant hepatology fellowship from 30 to 20. AASLD continues to support the requirement for interpreting 200 native and allograft liver biopsies as a requirement for ABIM Board Certification in Transplant Hepatology.
Specialty Board members gave feedback on the plan to engage transplant hepatologists, gastroenterologists, fellowship program directors and other stakeholders for their views on the issues. This structured outreach has been occurring over Spring and Summer 2021. The GI Board will use that feedback to make the policy decision at a future meeting.
Longitudinal Knowledge Assessment (LKA): Communications and Governance Engagement Update
ABIM Communications staff joined the meeting to share new developments on the name, branding and a preview of forthcoming communications in support of the longitudinal assessment, which will launch in Gastroenterology in 2022. In early April 2021, ABIM announced the official name of the new assessment option – the Longitudinal Knowledge Assessment (LKATM) – via its quarterly newsletter distributed to more than 215,000 diplomates. In addition to the name, ABIM also revealed LKA-specific branding and imagery, along with a new mini website available at abim.org/lka. ABIM Governance members are featured prominently on the new site and supporting collaterals in an effort to deepen connections between ABIM and the internal medicine community. The presentation also touched on the forthcoming launch of a new ABIM Physician Portal App that allows diplomates easy access to their MOC program requirements and to track progress towards fulfilling those requirements. The app is available for download now in the Google Play Store or the Apple App Store.
Specialty Board members were able to ask clarifying questions about how the LKA will work, including how to earn MOC points using the LKA and updated MOC fees for 2022 (with the LKA included). Members and staff then discussed how ABIM Governance can help get the word out to their colleagues about the positive changes to come. Some members shared their experience engaging with the community on behalf of ABIM through participation in activities such as Grand Rounds or presentations at society meetings, and they revealed tips on proven tactics to reach gastroenterologists and transplant hepatologists effectively.
ABIM Research Update
ABIM Senior Vice President of Assessment and Research, Rebecca Lipner, PhD, and her team shared ABIM’s research strategy that was developed by a joint Board of Directors–ABIM Council Research Strategy Subcommittee composed of Vineet Arora, MD, Seth Landefeld, MD and Susan Edgman-Levitan. The strategy outlines three broad areas for ABIM to focus its efforts:
- Foundational Science
- External Validation Studies
- Public Awareness Research
The recent research of Dr. Lipner’s team sought to improve our understanding of trends in healthcare and how MOC performance is linked with better patient care outcomes. Read more about recently published research on ABIM’s blog, including the following articles:
- Critical Care Medicine Journal: Critical Care Physicians Treating COVID-19 Patients Report Continued High Levels of Stress and Staff and PPE Shortages
- Academic Medicine: Gender Differences in Milestone Ratings and Medical Knowledge Examination Scores Among Internal Medicine Residents
- BMJ Open: The Association Between Primary Care Physician Diagnostic Knowledge and Death, Hospitalization and Emergency Department Visits Following an Outpatient Visit at Risk for Diagnostic Error: A Retrospective Cohort Study Using Medicare Claims
The Specialty Board was asked for ideas and topics for research that could be conducted on health care outcomes in gastroenterology and transplant hepatology to explore further links between Board Certification status and patient care.
Specialty Board Oversight of Discipline-Specific Assessments
Specialty Boards serve as the governing body that has oversight of the assessments and of the Exam Committees in their respective discipline, and have the responsibility of periodically approving the assessment blueprints and standards for Certification and MOC. At this session, staff from the ABIM Assessment and Research team presented members with workforce information for their specialty, training pipeline trends, and assessment outcome trends, to better inform future decisions related to assessments.
The Gastroenterology Board values the feedback and commentary of the entire medical community, including diplomates and society partners.
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