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Hospice and Palliative Medicine Advisory Committee Meeting Summary | Spring 2024

June 27, 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 spring meeting on Wednesday, April 10, 2024. 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 spring 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. Additionally, a host of candidates belonging to other boards (referred to as the “qualifying boards”) attain certification in hospice and palliative medicine through ABIM and other cosponsoring boards. For more detailed information about the history and composition of the Advisory Committee, visit the ABIM Blog.

The Advisory Committee members are:

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 topics of priority for the administrative board 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. ABIM and more than 30 societies met in fall 2023, in addition to ongoing discussions throughout the year. In part, the collaboration also includes exploring the need for focused assessments in specific subdomains of select 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,” in alignment with American Board of Medical Specialties (ABMS) policies.
  • 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. Among other things, ABIM is exploring a policy related to AI and assessments.
  • Dr. Baron’s approaching retirement later this year, the ABIM Board of Directors’ search for a new CEO and the transition to new leadership. (As of the time of this report, the new CEO has been announced.)

The Advisory Committee discussed newly certified physicians’ expectations and understanding of MOC requirements and how to improve these during training or early in their professional development. Dr. Baron pointed out ABIM’s initiative to engage with early career physicians, which started last year and has included listening sessions about their perceptions of ABIM. Dr. Dingfield, who has been part of the committee interacting with early career physicians, added that they have characterized the MOC program as opaque but understand the importance of certification to patients and employers.

Continued discussion also touched on relationships with medical specialty societies given public criticisms of the MOC program. Dr. Baron noted that ABIM is continuing to work closely with its society partners to receive their members’ feedback, and to identify and enact improvements to the MOC program where possible while still upholding its commitment to providing a consequential assessment.

Advisory Committee Oversight of Assessments*

The Hospice and Palliative Medicine Advisory Committee is responsible for reviewing and approving the assessment blueprints and standards for certification, MOC and the Longitudinal Knowledge Assessment (LKA®) in the discipline. Each spring, the Advisory Committee reviews data from the administrative board related to the population of new graduates entering the discipline, diplomates maintaining their certification through ABIM, workforce information, and assessment performance trends and feedback. Periodic review of these data helps to inform the Advisory Committee’s assessment decisions. The Advisory Committee 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 Advisory Committee reviewed are publicly available on ABIM’s website, including:

Joe Rotella, MD, MBA, HMDC, FAAHPM, Chief Medical Officer for AAHPM, noted the comparatively low match rate in geriatric medicine and his hope that hospice and palliative medicine does not follow suit in the future. Furman S. McDonald, MD, MPH, Senior Vice President for Academic and Medical Affairs and incoming CEO for ABIM, pointed out that geriatric medicine is unique as a specialty in that diplomates are more likely to maintain their internal medicine certificate than their geriatric medicine certificate, and that the Geriatric Medicine Board is looking at the match rates as well. The group also discussed how diplomates holding certificates from cosponsoring boards have higher rates of LKA participation, which may be related to what other cosponsoring boards offer in assessments.

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 Geriatric Medicine Board, the Hospice and Palliative Medicine Advisory Committee was approached to consider approving the pilot program to become a standard training pathway for initial certification. Of the other cosponsoring boards, ABFM has already given approval to the program.

Dr. Fernandez answered clarifying questions from Advisory Committee members about the pilot, noting that the goal is to produce leaders in the fields of hospice and palliative medicine and geriatrics, and augment opportunities for recruiting physicians to become geriatric and hospice and palliative medicine specialists. She shared that there is interest in further expansion of the combined program to other training sites. Transition to a standard training pathway from pilot status would allow program directors wishing to implement the pathway for to do so more easily.

After the presentation by Dr. Fernandez and some deliberation, the Hospice and Palliative Medicine Advisory Committee enthusiastically endorsed and unanimously voted to advance this initiative from pilot to pathway. In order to become a standard training pathway, the pilot must be also be approved by the Geriatric Medicine Board before seeking approval from the ABIM Council which oversees cross disciplinary issues at ABIM. If approved, the ABMS Committee on Certification and the Accreditation Council for Graduate Medical Education would be notified.

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 Advisory Committee an overview of recent physician feedback and actions that ABIM is considering in response, 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. He noted that feedback from LKA participants has been largely positive, but that ABIM has received constructive criticism from both diplomates and medical societies.

Some ABMS member boards offer varied approaches to addressing physician concerns about potentially reducing redundancy in continuing certification requirements, with those approaches including the offer of continuing medical education (CME) credit hours for board-based activities, or waiving some self-assessment and professional development activity requirements for those actively engaged in longitudinal assessments. The group briefly discussed considerations to keep in mind when exploring this idea, namely that there is no one-size-fits-all solution because requirements for CME vary across states. ABIM is considering suggestions like this one to limit redundancies for physicians participating in the MOC program and also trying to meet their CME requirements.

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 and Advisory Committees, to determine whether focused assessments are appropriate in those disciplines.

In discussion, the group clarified that the advantage of a focused assessment is to more closely reflect a physician’s practice in a specialized area without creating a different designation on their certificate. For example, a focused assessment in hospice and palliative medicine might be in an area like pediatrics , but the certificate would remain “Hospice and Palliative Medicine,” which gives the diplomate more flexibility in practice while also assessing them for their more focused specialization. The group acknowledged the existing certification for hospice medical directors (which is issued by another organization not part of the ABMS family of member boards) and that a focused assessment might be seen to overlap that. After discussion, the Advisory Committee agreed that exploring a focused assessment in hospice and palliative medicine would be a good idea and asked staff to begin exploring this possibility.

Update from AAHPM*

Dr. Rotella and Julie Bruno, LSW, MCSW, Chief Learning Officer for AAHPM, reviewed AAHPM’s updated strategic plan for the Advisory Committee—which notably highlights its commitment to interprofessional team-based practice—and provided an update on AAHPM’s support for serious illness researchers that includes the creation of a part-time science advisor position. Dr. Rotella also reported on the Palliative Care and Hospice Education and Training Act, currently introduced in the Senate with broad bipartisan support, which would create new education centers and establish career development awards for physicians and other health professionals to address current and future gaps in the hospice and palliative care workforce. The bill would also implement a public awareness campaign and direct funding towards palliative care research.

The society guests departed at this point in the meeting.

Update on the Hospice and Palliative Medicine Approval Committees

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. Twaddle briefly updated the Advisory Committee on the composition of the Approval Committees, recent work on item review and activities of the Hospice and Palliative Medicine Item-Writing Task Force.

Learn more about opportunities to create items for ABIM assessments on the Item-Writing Task Force.

Member Selection for the Hospice and Palliative Medicine Approval Committees

The Advisory Committees are responsible for selecting members and chairs of the ABIM Approval Committees in their disciplines annually and as needed. At the spring meeting, the Hospice and Palliative Medicine Advisory Committee reviewed candidate materials for a new member on the Hospice and Palliative Medicine Traditional, 10-Year MOC Exam Approval Committee.

The group unanimously voted to approve Carolyn Lefkowits, MD, MPH, MS, University of Colorado School of Medicine, to join the Hospice and Palliative Medicine Traditional, 10-Year MOC Exam Approval Committee for a term beginning July 1, 2024.

The next Approval Committee opening is slated for 2025 and will be posted online. For more information about openings in ABIM Governance and volunteer Item-Writing Task Forces, visit the website.

New Ways to Recognize Diplomates for Their Commitment to Staying Current

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 Advisory Committee, 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.

In discussion, some members noted that for diplomates, recognition is secondary to certification itself, which is seen as essential. Others suggested that small, periodic recognition and congratulatory or otherwise positive messages can go a long way toward making people feel appreciated for their work. They suggested combining these forms of recognition with updates about progress in the MOC program and upcoming due dates to help diplomates stay on track while also acknowledging work they have already done.

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:

Get Involved

The Hospice and Palliative Medicine Advisory Committee has two openings for terms beginning July 1, 2025:

In addition, the ABIM Council has three openings for terms beginning July 1, 2025:

Applications are due July 22, 2024, and appointments are expected to be announced in spring 2025.

Openings on ABIM’s Approval Committees will be announced fall 2024. Visit the website for a complete list of current openings.

*Indicates society guests were present for this session.

ABIM governance, Hospice and Palliative Medicine, Hospice and palliative medicine advisory committee, Laura Dingfield, Summary Report, women in medicine

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