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Infectious Disease Board Meeting Summary | Spring 2023

April 24, 2023  |  Posted by ABIM  |  ABIM Governance, News

Erica N. Johnson, MD,
Chair, Infectious Disease Board
ABIM Board of Directors
Council Director, ABIM Council

The Infectious Disease Board held its spring meeting on Wednesday, March 8, 2023. The agenda provided an opportunity for staff to update the Infectious Disease Board on activity at ABIM, and fostered discussion around pressing issues in the field. The Specialty Board was joined by guests from the HIV Medicine Association and the Infectious Diseases Society of America.

The following is a summary of the spring meeting.

Conversation with the President

Richard J. Baron, MD, MACP, President and Chief Executive Officer, ABIM and ABIM Foundation

Dr. Baron provided an update to the Infectious Disease Board on ABIM’s leading priorities, including:

  • The planned release of the first Longitudinal Knowledge Assessment (LKA®) score reports to more than 28,000 diplomates who have completed the fifth quarter of their five-year LKA cycle. The score reports are designed to let participating diplomates know how they are performing relative to the passing score, and to help identify any areas they may want to focus on in their future studies.
  • Ongoing work in diversity, equity and inclusion (DEI), such as performing differential item functioning analysis of assessment items, developing health equity content in different disciplines, co-funding health equity projects for residencies and creating more inclusive opportunities for diplomates to self-identify on their Physician Portal.
  • ABIM Board of Directors’ strategic planning work, such as exploring how new technologies like artificial intelligence and machine learning may help ABIM work more efficiently and develop better programs for physicians.

Misinformation and Implications for Infectious Disease

The Specialty Board held an open discussion on the implications of misinformation for the discipline of infectious disease, including its effects on patient care, in order to contribute to ABIM’s ongoing strategic conversations about the issue. The discussion centered on three major areas:

  1. Misinformation about vaccines, specifically with regard to COVID-19. The consequences of misinformation range from burnout and workforce attrition to continued spread of the virus, leading to more hospitalizations and deaths.
  2. Misinformation about HIV, for example, that “the epidemic has ended,” that “a cure has been found and is being withheld” or that “antiretroviral therapy is fatal.” Specialty Board members also identified a lack of information about preexposure prophylaxis (PrEP) which has led to increased infections and a high rate of people who are eligible but not taking the preventive therapy.
  3. Misinformation and mistrust of health care providers, particularly by patients. Many patients are not merely misinformed but not informed at all, leaving them to their own recommendations. Similar to misinformation surrounding HIV, Specialty Board members discussed how some patients believe more effective treatments or cures are available for numerous infectious diseases and are being withheld, or that existing treatments lead to worse outcomes. These false claims are contributing to a breakdown of trust between patients and physicians, often causing patients to delay or avoid seeking care.

Special Consideration Pathways for International Medical Graduates

ABIM’s standard training requirements for certification include the satisfactory completion of accredited internal medicine residency and subspecialty fellowship training in the United States or Canada. In addition, there are four special consideration pathways to enable osteopathic or internationally trained physicians to obtain ABIM certification. The ABIM Council is exploring the idea of creating another special consideration pathway for international medical graduates who have completed their internal medicine training in another country and then completed accredited fellowship training in the U.S. or Canada. Like other ABIM diplomates, physicians in the proposed pathway would need to pass the ABIM Internal Medicine Certification Examination, and satisfactorily complete their accredited fellowship training to be eligible for subspecialty certification. The Specialty Board held a discussion on the implications of this possible policy change for infectious disease specialists.

In their discussion, the group raised concerns about how to assess the quality of training programs in other countries, the impact on initial certification pass rates, the quality of care in internal medicine and the response from the medical community. Program directors and training programs would have an important role in assessing candidates applying through this new pathway. However, they also affirmed that there are exceptional candidates completing international residencies who would benefit from having an additional pathway to ABIM certification, and that if these candidates meet all the standards, they should have opportunities similar to those who follow traditional training pathways.

Specialty Board Oversight of Assessments

The specialty boards that oversee each discipline of internal medicine are responsible for reviewing and approving the assessment blueprints and standards for certification, Maintenance of Certification (MOC) and the LKA. 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 Infectious Disease 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:

HIV Workforce

At its fall 2022 meeting, the Infectious Disease Board convened a panel of specialists working in HIV care and training to explore HIV workforce shortages and opportunities, and how ABIM and the Infectious Disease Board could contribute to the discipline. The Specialty Board continued the conversation at the spring meeting, discussing opportunities for HIV expertise to reach rural areas (e.g., telehealth) and how the COVID-19 pandemic highlighted the important role that infectious disease experts can play on health care teams. The group also discussed the role of the Specialty Board in sharing medical knowledge about HIV with other specialties, like geriatric medicine and family medicine, in order to help expand the workforce and support existing providers.

Andrea Weddle, Executive Director of the HIV Medicine Association (HIVMA), noted that HIVMA is supportive of leveraging multidisciplinary care teams to expand and improve access to HIV prevention and care, and encourages ABIM to look for opportunities to promote best practices in this area. She also shared some resources with the Specialty Board related to interdisciplinary education, including the National Clinician Consultation Center created by the AIDS Education & Training Center Program and an article about increasing access to PrEP in primary care settings.

Setting a Quality Agenda in Infectious Disease

In late 2021, the American Board of Medical Specialties—which comprises 24 medical certifying boards in the U.S., including ABIM—published new standards for continuing certification. The standards include a requirement for member boards like ABIM to facilitate the development of a discipline-specific quality agenda. Richard G. Battaglia, MD, FACP, Chief Medical Officer at ABIM, spoke to the Infectious Disease Board about the new standard. He emphasized that this standard is not resulting in an individual diplomate requirement to complete quality improvement activities for ABIM MOC. Dr. Battaglia invited the group to discuss how they envision ABIM engaging external stakeholders to identify issues that can serve as elements of a mutually agreed quality agenda in the discipline. Additionally, the Specialty Board discussed the role they can play in this process.

Jesse Milan Jr., JD, suggested that there might be opportunities to address DEI work within the standard and the Infectious Disease Board could help define what ABIM does in that area. Randall S. Edson, MD, Chair of the Infectious Disease Traditional, 10-Year MOC Exam Approval Committee, pointed out that the Approval Committees would be essential to developing a quality agenda and integrating it with the discipline-specific blueprints. ABIM Approval Committees, including the two for Infectious Disease, are responsible for proposing changes to the assessment blueprints in each discipline.

Revisions to the Accreditation Council for Graduate Medical Education (ACGME) Fellowship Program Requirements

The Infectious Disease Board briefly reviewed proposed changes to fellowship program requirements by the ACGME’s Review Committee in Internal Medicine (RC-IM). The proposed program requirements were opened for public comment in January and ABIM’s specialty boards provided their input in each discipline.

Qualitative Feedback on the Longitudinal Knowledge Assessment (LKA®)

Benjamin J. Chesluk, Ph.D., Senior Researcher for Ethnographic Research at ABIM, and Thorsten C. Odhner, Director of Diplomate Experience, provided a review of qualitative feedback obtained on the LKA experience since the program launched in January 2022. Feedback continues to be positive, describing the LKA as a welcome alternative to the traditional, 10-year MOC exam, and demonstrating a broad variety of approaches to when and how participants prepare for and answer questions. In surveys, the majority of participants responded that they find the LKA useful for learning, would recommend it to a colleague and plan to continue with the assessment, with no significant difference between participants taking the LKA in one or multiple disciplines.

ABIM has assembled a post-launch LKA physician advisory panel of 12 diplomates to aid in ongoing and future research about the LKA experience.

Dr. Chesluk and Mr. Odhner noted that there are still unknowns, such as how feedback will change for participants over time as the LKA continues, and how the quarterly formative score reports planned for release this spring will impact reactions. It also remains to be seen how the LKA affects individual practice, process, and outcome measures, which is planned for long term exploration.

Members of the Specialty Board who are taking the LKA expressed their agreement with the positive feedback, noting that they have found it user-friendly and conducive to ongoing learning.

The LKA for Infectious Disease was launched in 2023 and enrollment is open until June 30. Diplomates can visit to learn more and eligible diplomates can sign into their Physician Portal to enroll.

Recommending Specialty Board Members to ABIM Council

The Infectious Disease Board held a discussion about the physician candidates for an open position on the Specialty Board for an early career infectious disease physician. As part of the application process, the Specialty Board selects two candidates and recommends them to the ABIM Council for a final decision, taking into consideration the present and future composition of the Specialty Board as well as feedback obtained from candidate interviews and the Council.

ABIM recently instituted changes to the application process that make it more inclusive, such as expanding choices for racial, ethnic and gender identification, and adding a question to highlight a candidate’s personal or professional experiences in medicine that would add a unique dimension to Specialty Board representation (e.g., military service or nontraditional education pathways). ABIM has made significant progress in enhancing the diversity of the specialty boards to better reflect the physician population. Additionally, ABIM has been recruiting for early career physicians and offering opportunities for Governance members to participate in DEI training.

Prior to the meeting, the Infectious Disease Board interviewed multiple candidates who applied for the position and deliberated carefully before voting to recommend two candidates for the open position. The ABIM Council then reviews the recommendation before appointing a new member to the Infectious Disease Board for the term beginning July 1, 2023.

Communications and Governance Engagement

John Held, Senior Director of Communications, and Peter McConnell, Program Manager for Governance and Medical Society Communications, updated the Specialty Board on ABIM’s ongoing communications work with Governance (the ABIM Board of Directors, ABIM Council, Specialty Boards and Advisory Committees, and Approval Committees) and invited Specialty Board members to participate in engagement work. The communications team regularly engages ABIM Governance members to help give diplomates a better understanding of the individuals representing their interests in each discipline, and to help the community better understand the value of certification.

Specialty Board members provided feedback about how they could continue to take an active role in ABIM’s communications initiatives with diplomates, the medical community and the public, such as through media interactions, the ABIM blog and working with their colleagues and medical societies.

Update from the Infectious Disease Approval Committees

Howard Heller, MD, Massachusetts Institute of Technology; Member of the Infectious Disease Board; Chair of the Infectious Disease LKA Approval Committee

There are two ABIM Approval Committees working with the Infectious Disease Board: 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. Heller updated the Infectious Disease Board on recent revisions to the Infectious Disease Blueprint. The review process is lengthy but worthwhile, as it represents the greatest possible number of diplomates and their unique practices.

Dr. Heller also reminded the Specialty Board of the ongoing need for physicians to join the Item-Writing Task Force, the group responsible for writing all of the content for the LKA and the traditional, 10-year exam. Specialty Board members are encouraged to recommend candidates for the task force. Openings in Infectious Disease and all other specialties can be found online.

In Closing

The Infectious Disease 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? Connect with ABIM through the following channels:

Join our Community Insights Network to share your feedback.