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Geriatric Medicine Board Meeting Summary | Spring 2024

August 9, 2024  |  Posted by ABIM  |  Specialty Board Meeting Summaries

Jorge G. Ruiz, MD, Chair of the Geriatric Medicine Board

The Geriatric Medicine Board held its spring meeting on Wednesday, May 29, 2024. The agenda provided an opportunity to update the Geriatric Medicine Board on activity at ABIM and allowed for discussion of pressing issues in the field. The Specialty Board was joined for a portion of the meeting* by representatives of AMDA: The Society for Post-Acute and Long-Term Care Medicine (AMDA), the American Geriatrics Society (AGS) and the Gerontological Society of America (GSA).

The following is a summary of the spring meeting.

Conversation with the President*

Prior to the meeting, members and guests of the Geriatric Medicine Board had the opportunity to view a video update from Richard J. Baron, MD, MACP, President and Chief Executive Officer of ABIM and ABIM Foundation, reflecting on current issues for ABIM and the internal medicine community, including:

  • The ongoing collaboration between ABIM and internal medicine societies to address their members’ concerns and feedback about the Maintenance of Certification (MOC) program. More than 30 societies met with ABIM in fall 2023, in addition to ongoing discussions throughout the year. In part, the collaboration also explores the need for focused assessments in select subdomains of specific specialties where enough physicians are focusing their practice. Focused assessments have already launched in sleep medicine and internal medicine, with more to come in the future, including hematology in 2026.
  • ABIM’s work to mitigate the spread and negative impact of misinformation for physicians and patients. Most recently, ABIM updated the way it reports certification status for physicians to be more transparent about why some certificates are no longer active, such as being “Revoked,” “Suspended” or “Lapsed.”
  • The establishment of a dedicated innovation team at ABIM to explore how emerging technology and artificial intelligence (AI) can be used to assess physicians in the rapidly evolving context of their requisite skills and practice environments.
  • Dr. Baron’s approaching retirement later this year, the Board of Directors’ search for a new CEO and ABIM’s transition to new leadership. As of this report, Furman S. McDonald, MD, MPH, who currently serves as ABIM’s Senior Vice President, Academic and Medical Affairs, has been announced as ABIM’s new CEO, effective September 1, 2024.

Nancy Lundebjerg, MPA, CEO of AGS, continued the discussion on medical misinformation, encouraging ABIM to include other trusted health care professionals and highlighting the importance of inclusivity in efforts to mitigate misinformation. Dr. Baron agreed that collaboration with other trusted health professionals was important to addressing the spread of misinformation. There was also some discussion around the four-minute time limit on the Longitudinal Knowledge Assessment (LKA®) questions with clarification that it is based on data from the secure exam, and, on average, physicians completed questions in under two minutes across all disciplines in which the LKA is available.

Specialty Board Oversight of Assessments*

ABIM’s Specialty Boards are responsible for reviewing and approving the assessment blueprints and standards for certification, MOC and the LKA in their respective disciplines. Each spring, the Specialty Boards review data related to the population of new graduates entering the discipline, diplomates maintaining their certification, workforce information, and assessment performance trends and feedback. Periodic review of these data helps to inform the Specialty Boards’ assessment decisions. The Geriatric Medicine Board discussed assessment data in the discipline and provided feedback to ABIM staff about which data were most helpful for ongoing oversight of assessment. Some of the data the Specialty Board reviewed are publicly available on ABIM’s website, including:

Lorna Lynn, MD, Vice President of Medical Education Research for ABIM and Executive Sponsor for the Geriatric Medicine  Board, also spoke to the timing of fairness ratings on assessments, noting that physicians are providing fairness ratings (i.e., rating whether the examination was a fair assessment of clinical knowledge in the discipline) before they know their own exam results which indicates a commitment to impartial evaluation. She added that ABIM’s focused efforts on making it easier for enrolled in the LKA in 2023 to complete the end-of-year surveys led to a significant increase in response rates, which suggests that data from 2023 surveys are more likely representative of all those taking the LKA.

Combined Geriatrics and Hospice and Palliative Medicine Competency-Based Medical Education Pilot*

Helen Fernandez, MD, MPH, Vice Chair, Education at the Icahn School of Medicine at Mount Sinai, presented on the combined Geriatrics and Hospice and Palliative Medicine Competency-Based Medical Education (CBME) pilot that she has led since 2011. Dr. Fernandez has grown the pilot program to include nearly a dozen training programs and dozens of graduates. Together with the Hospice and Palliative Medicine Advisory Committee, the Geriatric Medicine Board was approached to consider approving the pilot program to become a standard training pathway for initial certification. The American Board of Family Medicine (which is a cosponsoring Board of the Advisory Committee) has already given approval to the program. At its spring meeting, the Hospice and Palliative Medicine Advisory Committee approved the pilot program to become a standard training pathway and the same step was required of the Geriatric Medicine Board.

Dr. Fernandez clarified that some physicians seeking geriatric and palliative care board certification are waiting to take their exams with a staggered approach for different specialties. She also explained the recruitment process for attracting physicians to the fields of geriatric medicine and palliative care, and how it could expand the pool of candidates for both specialties.

The Geriatric Medicine Board voted to approve the advancement of this initiative from pilot to pathway. Final steps include approval from the ABIM Council, which oversees cross-disciplinary issues at ABIM, and notifying the ABMS Committee on Certification and the Accreditation Council for Graduate Medical Education.

ABIM and Physician Feedback*

Though ABIM has long prioritized physician feedback in shaping its programs, the organization has placed renewed emphasis on addressing elements of the certification program that can and should be improved, as well as fostering the community’s perception of the value of certification and physician pride in maintaining certification. Richard G. Battaglia, MD, FACP, Chief Medical Officer for ABIM, gave the Geriatric Medicine Board an overview of recent physician feedback and actions that ABIM is considering, and invited the group to share their ideas and suggestions for ABIM to consider as it continues working with societies, diplomates and the broader internal medicine community.

Several members of the group offered suggestions, such as providing continuing medical education (CME) credits for participation in the LKA or completing the 10-year MOC exam, which might create a natural incentive for diplomates. Dr. Battaglia acknowledged that ABIM has heard the same from diplomates, however there are multiple issues related to moving in that direction. ABIM is not currently contemplating moving in that direction, which would require considerable vetting with key stakeholders.

Update on ABIM Geriatric Medicine Workforce Issues Research

Kathryn Ross, Research Associate at ABIM, presented an overview of ABIM’s research into geriatric medicine workforce issues over the last several years, most of which has been presented at annual meetings of AGS or been published in the Journal of the American Geriatrics Society (June 2023 and January 2024). To date, the research has yielded the following conclusions:

  • Some physicians became certified in geriatric medicine as a way to augment their primary specialty.
  • Preliminary results suggested that those who completed geriatric fellowships found the training valuable and believed certification was not a requirement to practice in the field.
  • Employers  perceived the value of certification in geriatric medicine as  low.
  • Results suggested that geriatricians prescribe potentially inappropriate medication at lower rates than general internists.

Ms. Ross then reviewed potential research questions for the future and asked the group for their suggestions and feedback. After hearing several ideas, Jorge G. Ruiz, MD, Chair of the Geriatric Medicine Board, proposed reconvening the conversation at a future meeting to allow time to  develop the ideas further.

Update on the International Medical Graduate (IMG) Pathway

In spring 2023, the Geriatric Medicine Board and other discipline-specific governance bodies discussed the idea of creating a pilot program for IMGs who have 1) completed their internal medicine training in another country (or completed a residency accredited by Accreditation Council for Graduate Medical Education (ACGME) International); 2) fulfilled the ACGME criteria to be considered an “exceptionally qualified candidate” (see ACGME Common Program Requirements (Fellowship), III.A.1.c); and 3) successfully completed ACGME-accredited fellowship training in the U.S. or Canada. The pilot program would allow these physicians to be admitted to the Internal Medicine Initial Certification Examination once their successful completion of accredited fellowship training is verified. Once the Internal Medicine Certification exam is passed, these physicians could then be eligible to take the Subspecialty Certification exam in the area in which they trained.

Following these discussions, the ABIM Council moved forward with asking ABIM staff to develop community outreach plans and collect external feedback from stakeholders. That process—which will include outreach to employers, the Federation of State Medical Boards, state medical societies and patient-facing organizations—began late in 2023 and was ongoing at the time of the spring 2024 Specialty Board meeting. The Geriatric Medicine Board received an update on this work and information about next steps, which involve a decision by the Council on whether to continue with moving into the next phase of public commentary. At its April 2024 meeting, the Council approved the development of a more detailed pilot model, which was approved in June for a public comment period slated to begin in summer 2024.

The group discussed the shortage of physicians in Tennessee—where recently passed legislation allows internationally trained physicians to be apprenticed to experienced doctors without repeating residency—and Missouri, where such physicians are designated “assistant physicians,” a new pathway, the impact of which is unknown. Specialty Board members also requested that ABIM collect data on whether pilot pathway participants go on to pursue initial internal medicine certification and subspecialty certification in the area in which they completed their accredited fellowship training.

Exploring Focused Assessment(s) in the Discipline*

ABIM currently offers focused versions of its assessments in internal medicine (the Internal Medicine: Inpatient LKA and traditional, 10-year MOC exam) and sleep medicine (the Sleep Medicine LKA: Obstructive Sleep Apnea Emphasis). Additional explorations have begun in gastroenterology and hematology with plans announced recently to develop malignant- and classical-focused versions of the Hematology LKA (in addition to the general Hematology LKA) to launch in 2026. ABIM plans to continue exploring the idea of focused assessments in other specialties with stakeholder input at multiple levels, including that of the Specialty Boards, to determine whether focused assessments are appropriate in those disciplines. Therefore, the Geriatric Medicine Board was asked to consider the question for geriatric medicine with clarification that focused assessments overlap the general assessment with about 70% of the same question content, and 30% focused in the identified specialty area.

After discussion, the Specialty Board agreed that there is not currently a need to explore focused assessments in geriatric medicine but would revisit the idea in the future.

Society guests departed at this point in the meeting.

Update on the Geriatric Medicine Approval Committees

Helen L. Chen, MD, University of California, San Francisco and the San Francisco Veterans Affairs Healthcare System; Chair of the Geriatric Medicine Traditional, 10-Year MOC Exam Approval Committee

Niharika N. Suchak, MD, Florida State University College of Medicine; (then) member of the Geriatric Medicine LKA Approval Committee[1]

ABIM Approval Committees are responsible for approving and editing all assessment content, and maintaining the blueprints for the Initial Certification Exam, the Traditional, 10-Year MOC Exam and the LKA. There are two ABIM Approval Committees working with the Geriatric Medicine Board: the Traditional, 10-year MOC Exam Approval Committee (which also develops the initial certification exam) and the LKA Approval Committee. Dr. Chen and Dr. Suchak provided a brief update for the Specialty Board on the composition of the Approval Committees, progress on item development in meetings this year and news about the Item-Writing Task Force.

Member Selection for the Geriatric Medicine Approval Committees

ABIM’s Specialty Boards are responsible for selecting members and chairs of the Approval Committees annually and as needed. At the spring meeting, the Geriatric Medicine Board reviewed candidate materials for a new chair and a new member of the Geriatric Medicine LKA Approval Committee. The group unanimously voted to approve the following appointments effective July 1, 2024:

  • Niharika N. Suchak, MD, was appointed Chair of the Geriatric Medicine LKA Approval Committee. Dr. Suchak has served as a member since 2022, and prior to that served on the Geriatric Medicine Board Exam Committee from 2019 to 2021.
  • Ecler Jaqua, MD, MBA, FAAFP, AGSF, FACLM, DipABOM, AAHIVS, of the Loma Linda University Health Education Consortium, was appointed to the Geriatric Medicine LKA Approval Committee as a new member.

There are still openings on the Geriatric Medicine Traditional, 10-Year MOC Exam Approval Committee and the Geriatric Medicine LKA Approval Committee with applicants under review as of the time of this report. Appointees will be announced in the fall for terms beginning retroactively in July 2024.

Openings for additional Approval Committee positions starting July 2025 will be posted online in October. Current openings are always posted on the ABIM website.

New Ways to Recognize Diplomates for Their Commitment to MOC

ABIM is exploring new ways to recognize physicians who participate in the MOC program. This includes finding new ways to celebrate assessment milestones and ongoing efforts to stay current. Nicole Welk-Joerger, Ph.D., Program Manager of Stakeholder Engagement for ABIM, shared information about the project with the Specialty Board, including a number of proposed tactics for early consideration. Dr. Welk-Joerger invited members to share their feedback and reactions on how diplomates want to be recognized and what forms of recognition are most impactful for physicians.

Among the ideas put forward by the group was the importance of educating patients about certification, such as through the certification verification function of the ABIM website and the ABMS website CertificationMatters.org. The group also discussed concerns with the cadence of the 10-year MOC exam, with some expressing hopes that ABIM will offer access to the LKA earlier than the 10-year mark for newly certified physicians. Some members suggested creating a more streamlined process that aligns with their other clinical and academic responsibilities.

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 getting involved?

If you have questions after reading this report, please connect with us through the following channels:

*Indicates society guests were present for this topic.

[1] Dr. Suchak was appointed Chair at this meeting, effective July 1; see below.

ABIM governance, Geriatric medicine, Geriatric Medicine Board, Jorge G. Ruiz, Summary Report

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