Hospice and Palliative Medicine Advisory Committee Meeting Summary | Fall 2023

January 29, 2024 | Posted by ABIM | Specialty Board Meeting Summaries

*Laura Dingfield, MD, MSEd, FAAHPM, Chair of the Hospice and Palliative Medicine Advisory Committee*

The Hospice and Palliative Medicine Advisory Committee held its fall meeting on Thursday, November 16, 2023. 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 representatives from the American Academy of Hospice and Palliative Medicine (AAHPM).

The following is a summary of the fall meeting.

A Note on the Advisory Committee’s Composition

The Advisory Committee comprises physician representatives of five American Board of Medical Specialties (ABMS) member boards (referred to as the “cosponsoring boards”) as well a public member with a patient or caregiver background in the field and an interprofessional member with experience in the field. For more detailed information about the history and composition of the Advisory Committee, visit the ABIM Blog.

The Advisory Committee members are:

Laura Dingfield, MD, MSEd, FAAHPM, Advisory Committee Chair; ABIM
Ilanit Brook, MD, MSHS, American Board of Pediatrics (ABP)
Stephen Hays, MD, American Board of Anesthesiology (ABA)
Christine Kistler, MD, MASc, American Board of Family Medicine (ABFM)
Michael McDuffie, Ph.D. (public member)
Mary Lynn McPherson, Pharm.D., MA, MDE, BCPS (public member)
David Nowels, MD, ABFM
Jessica Stetz, MD, American Board of Emergency Medicine (ABEM)
Martha Twaddle, MD, ABIM

Conversation with the Administrative Board*

Prior to the meeting, members and guests of the Hospice and Palliative Medicine Advisory Committee 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. The topics included:

Recent public conversations and press coverage around the value of ABIM’s Maintenance of Certification (MOC) program.
Engagement of early career physicians and trainees in ABIM’s work and how members of ABIM governance can facilitate conversations with colleagues and leaders in their disciplines to foster better understanding of ABIM’s mission and programs.
The ongoing and evolving challenges in addressing misinformation, and the historical roots of mistrust in science and medicine, as explored at the ABIM Foundation Forum in July.

In continued discussion about the MOC program, Dr. Baron drew a distinction between continuing medical education (which some physicians posit is a sufficient demonstration of remaining current, although research has repeatedly shown it to be insufficient) and programs like the Longitudinal Knowledge Assessment (LKA®), which ABIM offers as a robust and flexible demonstration of a physician remaining current with medical knowledge. He added that ABIM continues to engage in active listening with the diplomate community to better understand how to enhance its programs and offer clinically relevant and meaningful ways for diplomates to demonstrate that they are staying current.

The conversation also touched on misinformation and how ABMS member boards can coordinate their efforts in this area. Dr. Baron mentioned the Coalition for Trust in Health & Science, which comprises numerous organizations and boards, and pointed out the joint statement made in 2021 by ABFM, ABIM and ABP about misinformation.

Diversity, Equity and Inclusion (DEI)*

The Advisory Committee received an update on ABIM’s DEI work from Lorna Lynn, MD, Vice President of Medical Education Research, Kelly Rand, MA, CPH, Program Officer, Diversity and Health Equity, and Pamela Browner White, Senior Vice President of Communications and Chief DEI Officer.

Their central points included:

A September meeting in collaboration with 24 medical specialty societies around DEI and how ABIM can collaborate with and support societies in this work. This meeting highlighted work that societies and ABIM can do together in the areas of shared resources, developing pathway programs to diversity the health care workforce and providing support for mentorship programs.
Collaboration with the Accreditation Council for Continuing Medical Education to explore the possibilities of offering continuing medical education credit and MOC points for mentoring activities based on feedback that identified the importance of mentorship for students, trainees and underrepresented groups who face barriers to success because of personal characteristics.
Fairness review pilots conducted in cardiovascular disease, gastroenterology, internal medicine and nephrology over the past year using statistical analysis and content review to identify bias in ABIM assessment questions (items) in those disciplines.

The group continued discussion on the fairness review pilots, with one member noting the special importance of a cultural framework in hospice and palliative medicine. Joe Rotella, MD, MBA, HMDC, FAAHPM, Chief Medical Officer of AAHPM, suggested that the reported proportion of items with detectable bias was only one of many possible indicators and by itself would likely underestimate the true extent to which structural racism in health care may be reflected in assessments, and asked how ABIM would continue to work to ensure assessments are truthful, equitable and inclusive. Dr. Lynn noted that the Item-Writing Task Force represents the most diverse group of ABIM volunteers ever assembled and will provide the breadth of perspective that will help assure items are unbiased. In addition, physicians who take the LKA have the opportunity to provide feedback on items where they identify bias or other issues, and ABIM is working on additional studies to identify bias in assessment items.

Listening Session on the Longitudinal Knowledge Assessment (LKA®)*

Prior to the meeting, Advisory Committee members and guests had the opportunity to view a video update sharing recent insights about diplomates’ engagement in the LKA and their experience and feedback. Some key points included:

The relatively small number of diplomates unenrolling from the LKA may be physicians who find they prefer the traditional, 10-year MOC exam, or who find that the commitment to 30 questions per quarter does not align with their availability.
Diplomates certified before 1990 can now use the LKA to meet their assessment requirement to remain publicly reported as “Participating in MOC.”
Physicians continue to choose the LKA over the traditional, 10-year MOC exam at a rate of 4:1 on average across all 15 subspecialties in which it is offered.
On average, LKA participants are taking less than two minutes to answer each question, equating to less than one hour per quarter in total. ABIM also offers accommodations in compliance with Title III of the Americans with Disabilities Act, which can include time added to the standard four minutes that physicians have to answer each question as well as the 30-minute time bank, if approved.

The LKA in Hospice and Palliative Medicine is available to diplomates of the cosponsoring boards (ABA, ABEM, ABFM, ABIM and ABP) in the year in which their assessment is due.

The group discussed communications efforts for diplomates of the cosponsoring boards and how to better disseminate information about the program to each board’s diplomates. The topic will be raised with the Cosponsoring Committee, which comprises executives of the cosponsoring member boards.

LKA enrollment for diplomates with an assessment due in 2024 opened on December 1, 2023. The first 30 questions will be delivered on January 1, 2024. ABIM diplomates are encouraged to check their Physician Portal for upcoming requirements and eligibility.

Update from the American Academy of Hospice and Palliative Medicine*

Dr. Rotella provided an update for the Advisory Committee about AAHPM, first noting the recent publication of an article by Committee Chair Laura Dingfield, MD, MSEd, FAAHPM, in AAHPM Quarterly: Fall 2023 about the history, composition, mission and role of the Advisory Committee. AAHPM is engaged in significant updates to its organizational and DEI strategic plans to better serve the field of hospice and palliative care, including the 10% of their members who are interprofessional.

Naming the Certificate*

At its spring meeting, the Hospice and Palliative Medicine Advisory Committee held an exploratory conversation about the name of the certificate and the implications of changing the name to focus more on palliative medicine. Dr. Dingfield took a moment to revisit the topic, stating that the Advisory Committee’s role is not to lead change on this issue but rather to respond to a call for change from the diplomate community, should one arise. There does not seem to be a significant call for change at this time, so the Advisory Committee will take no further action.

Revisions to Program Requirements by the Review Committee for Family Medicine (RC-FM) of the Accreditation Council for Graduate Medical Education (ACGME)*

The RC-FM is taking the lead on the 10-year major revision of ACGME program requirements for hospice and palliative medicine. The RC-FM invited the Advisory Committee as an organization of standing in the discipline to provide commentary on specific requirements or topics that should be addressed in the revision process. David Nowels, MD, one of two representatives of ABFM on the Advisory Committee who also sits on the RC-FM, explained that the goal is to complete the revisions by July 2025.

The group discussed several topics for consideration to share with the RC-FM:

The expansion of training in ambulatory care environments and telehealth.
The challenges of long-term care as a robust training environment.
An emphasis on team-based learning in a variety of environments.
The difficulties of finding hospice in-patient training sites in some parts of the country.
The recommendation to remove the requirement for maintenance of a primary ABMS certificate for program directors who hold the Hospice and Palliative Medicine Certificate, since the cosponsoring boards vary on their requirements for maintaining the underlying primary certificate.

As of the publication of this report, the Advisory Committee has submitted a statement to the RC-FM.

The Society guests departed at this point in the meeting.

Communications and Governance Engagement

John Held, Senior Director of Communications and Brand Management for ABIM, and Peter McConnell, Program Manager for Governance and Medical Society Communications, provided an update on ABIM’s communications work and current trends in the community. The presenters invited the Advisory Committee members to share their own perspectives and discuss how ABIM and the cosponsoring boards can foster better understanding and enhance the perceived value of the MOC program among diplomates.

Members of the Advisory Committee shared some suggestions, such as partnering with patients and patient advocacy organizations to promote the value of MOC, but also emphasized the importance of communicating with and through physicians. ABIM is committed to continuing to listen to diplomate feedback in order to enhance its programs.

Update on the Hospice and Palliative Medicine Approval Committees

Robert C. Macauley, MD, Oregon Health and Science University; Chair of the Hospice and Palliative Medicine Traditional, 10-Year MOC Exam Approval Committee

Martha Twaddle, MD, Northwestern Medicine and Northwestern University Feinberg School of Medicine; Chair of the Hospice and Palliative Medicine LKA Approval Committee (Dr. Twaddle also serves as a member representative of ABIM on the Hospice and Palliative Medicine Advisory Committee.)

ABIM Approval Committees are responsible for approving and editing all assessment content, and maintaining the blueprints for the Initial Certification Examination, the MOC Examination and the LKA. There are two ABIM Approval Committees related to hospice and palliative medicine: the Traditional, 10-Year MOC Exam Approval Committee (which also deals with the initial certification exam) and the LKA Approval Committee.

Dr. Macauley and Dr. Twaddle provided a brief update for the Advisory Committee on the composition of the Approval Committees, progress on item development in meetings this year and news about the Item-Writing Task Force. They discussed the challenge of producing the needed volume of questions for the assessments and the percentage devoted to specific topics on the blueprint, any changes to which would be a reflection of program requirements and expected competencies. The Approval Committees will work with ABIM staff to identify areas for improvement with the goal of bringing the topic to the spring 2024 Advisory Committee meeting.

Advisory Committee Oversight of the Discipline

ABIM staff led the Advisory Committee in a review of its role in relation to identified domains of cosponsored discipline-specific oversight (assessments, discipline-specific activities in continuing certification, diplomate and society relations, and training). The group discussed how their activities influence the hospice and palliative medicine community:

Approval of the exam blueprints and choosing the passing standard for exams.
Recommending whether innovative training pilots will become official pathways to certification.
Approving discipline-specific activities related to quality improvement that can be eligible for MOC credit.
Building relationships within the field to better support diplomates and partner organizations.

The group was asked to consider for the future if there were any substantive issues happening in the discipline that weren’t already reflected in the Advisory Committee’s oversight activities, and whether they wished to be more active in specific domains.

In Closing

The Hospice and Palliative Medicine Advisory Committee 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 are certified by ABIM and have questions after reading this report, please connect with us through the following channels: