Internal Medicine Board Meeting Summary | Fall 2023

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

*Asher A. Tulsky, MD, Chair of the Internal Medicine Board*

The Internal Medicine Board held its fall meeting on Friday, November 3, 2023. The agenda provided an opportunity to update the Specialty Board on activity at ABIM and allowed for discussion of pressing issues in the field. The Internal Medicine Board was joined for a portion of the meeting* by guests from the Alliance for Academic Internal Medicine (AAIM), the American College of Osteopathic Internists (ACOI), the American College of Physicians (ACP), the Society of General Internal Medicine (SGIM) and the Society of Hospital Medicine (SHM).

The following is a summary of the fall meeting.

Conversation with the President*

Prior to the meeting, members and guests of the Internal 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. Dr. Baron invited the specialty boards to discuss these topics, including:

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.

Further discussion among the group focused on public sentiment surrounding the MOC program, which was acknowledged as being a topic among physicians but not patient communities. Dr. Baron described how ABIM has engaged in listening to feedback from diplomates and the Specialty Boards to better understand diplomates’ concerns and criticisms. He noted that in the past, ABIM evolved to better serve diplomates and the way they practice. ABIM is continuing to work with societies to identify areas for further improvement and listening to the diplomate community to enhance programs and products.

Guests representing ACP departed following this session.
Representatives of ACOI, SGIM and SHM remained as indicated below.

Diversity, Equity and Inclusion (DEI)*

The Specialty Board received an update on ABIM’s DEI work from Lorna Lynn, MD, Vice President of Medical Education Research; Kelly Rand, MA, CPH, Program Officer of 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 (ACCME) 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 presenters continued that defining equity in health care is a work in progress, and ABIM’s work in representing DEI in assessments would be driven by data. In discussion, some members of the Specialty Board noted the importance of diversity in regions like Mississippi and Louisiana, which have significant populations of Black patients and not necessarily corresponding diversity in their physician populations. Patients are more likely to seek providers that look like them, and when these providers are not available it can negatively affect patient outcomes.

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

Prior to the meeting, Specialty Board 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 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.

In answer to questions from Specialty Board members about specific features of the LKA, staff noted that ABIM is continuing to work on refinements and enhancements based on diplomate feedback and behavior on the LKA.

Additionally, ABIM has begun publishing “Specialty Knowledge Gaps” reports in each LKA that was released in 2022. The reports were created in response to feedback from medical specialty societies in order to help them develop educational materials for physicians. They display overall average performance (the average percentage of questions answered correctly) in the top-level blueprint areas for the discipline as well as performance across various demographic categorizations within that discipline.

LKA enrollment for diplomates with an assessment due in 2024 opens on December 1, 2023. Diplomates are encouraged to check their Physician Portal for upcoming requirements and eligibility.

Annual Maintenance of Certification Status Review*

Florence Mickens, Program Operations Manager for ABIM, and Weifeng Weng, Ph.D., Director of Research and Data Intelligence, reviewed the annual process through which ABIM evaluates certificates to determine whether an individual diplomate is meeting MOC requirements. The requirements are to be current with the MOC assessment requirement and MOC points (some points every two years and 100 points every five years). Certificates that do not meet these requirements will either experience a status change in certification or participation, or enter a grace period.

Dr. Weng explained that the 2023 cohort of “at-risk” certificates is comparatively large due to two primary contributing factors:

The number of physicians who earned initial certification prior to 2014 when the current MOC program requirements began are now due for their second five-year MOC point requirement. Physicians who earned certification in 2018 are also due for their first five-year point requirement in 2023.
The extension given to certificates in Critical Care Medicine, Infectious Disease and Pulmonary Disease as a result of the pandemic has ended.

ABIM engages in a robust and comprehensive communications strategy over several months to alert at-risk diplomates of upcoming deadlines in order to minimize the number of diplomates who miss the deadline and are subsequently reported as “Not Certified.” Tactics include email campaigns, postcards and e-newsletters.

New Proposal for ABIM’s Approved Quality Improvement (AQI) Program*

The AQI Program is the process through which ABIM recognizes externally developed quality improvement activities that physicians are doing in practice. It also allows diplomates to earn MOC points for activities that support their local improvement priorities. Approved activities grant 20 MOC points to physicians who meaningfully participate in the activity. Asher A. Tulsky, MD, Chair of the Internal Medicine Board, and Jonathan J. Roberts, MD, reviewed the following proposal for the program and provided their recommendation for approval:

“Cardiac Morbidity and Mortality Conference,” sponsored by HCA Florida Lawnwood Hospital and reviewed by Dr. Roberts. The activity will consist of monthly presentations of complications and mortality in catheterization laboratory, post-percutaneous coronary intervention and ST-elevation myocardial infarction with cardiology and cardiac surgery faculty, and discussion of procedures and how to handle complications.

After a brief discussion, the Internal Medicine Board voted to approve the AQI proposal for MOC credit.

ABIM welcomes proposals from sponsors that may include medical specialty societies, hospitals or departments within hospitals, medical groups, clinics or other health-related organizations that wish to approve a single activity. Organizations with a quality improvement activity to submit to ABIM for MOC credit recognition are encouraged to take the following steps:

Download the ABIM AQI Program Guide (PDF).
Download and complete the AQI Application (PDF).
Email completed applications to mocprograms@abim.org.

All remaining Society guests departed at this point in the meeting.

Opportunities for Engaging Early Career Physicians

ABIM is one of several organizations that nominate candidates for the ACGME Residency Review Committee for Internal Medicine (RC-IM). The RC-IM invited ABIM to nominate two physicians for the RC-IM program director position and two physicians in training in a discipline of internal medicine. Nominations were solicited from ACGME-accredited internal medicine residency and fellowship program directors. Members of each of the specialty boards will be part of the process by interviewing candidates, providing feedback and nominating two individuals.

Anamika Gavhane, Senior Director for Discipline-Specific Governance at ABIM, explained the candidate vetting process to the Internal Medicine Board and also shared ABIM’s plans to explore a convening of early career physicians (those within the first ten years of initial certification) across the disciplines of internal medicine. The convening would offer an opportunity to learn more from young physicians by gathering trainees and/or newly certified diplomates, including prospective nominees not chosen to serve on the RC-IM.

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 Internal Medicine Board members to share their own perspectives and discuss how ABIM can foster better understanding and enhance the perceived value of the MOC program among diplomates.

Members of the Specialty Board emphasized the importance of continuing to share updates and positive messaging about ABIM’s programs and value to the medical community, and suggested listening sessions with diplomates and groups that have voiced concerns and criticisms. Staff shared that ABIM is committed to continuing to listen to and engage with diplomates in order to enhance programs and products that better serve their interests and practices.

Update on the Internal Medicine Blueprint

Deirdre Derrick, Ph.D., Principal Exam Developer for ABIM, presented the Internal Medicine Board with an overview of the Internal Medicine Blueprint and the process whereby it is reviewed both within ABIM and by diplomates. Blueprints show content specifications for each assessment in the form of an outline of the content areas and the approximate percentage of questions that cover that area. The Internal Medicine Approval Committees maintain a blueprint for the Internal Medicine Initial Certification Exam and the MOC Exam and LKA. External blueprint reviews are conducted at regular intervals in every discipline in which ABIM offers certification to identify important and frequently performed tasks in the discipline and determine whether the assessment accurately reflects current physician practice. Detailed information about how the blueprints are created and maintained can be found on the ABIM Blog. The Internal Medicine Board has the final vote on blueprint content and the percentage of questions in a specific area, which is always informed by comprehensive physician feedback and the recommendation of the respective approval committee.

Selecting New Members of the Internal Medicine LKA Approval Committee

ABIM’s specialty boards are responsible for selecting members and chairs of the approval committees annually and as needed. At the fall meeting, the Internal Medicine Board discussed expanding the Internal Medicine LKA Approval Committee with an emphasis on creating greater diversity within the committee as a point of focus now and in the future. After discussion and review of the candidates, the group voted to approve Matthew Hollon, MD, MPH, FACP, of the University of Washington and MultiCare Rockwood Clinic, and Matthew Tuck, MD, M.Ed., of the George Washington School of Medicine and Veterans Affairs Washington DC Healthcare, as two new members of the Internal Medicine LKA Approval Committee for terms beginning January 1, 2024.

For more information on openings in ABIM Governance, including approval committees and the Item-Writing Task Force, visit the website.

Update on the Internal Medicine Approval Committees

Heather L. Heiman, MD, University of Illinois College of Medicine; Chair of the Internal Medicine LKA Approval Committee

Benjamin Hohmuth, MD, Geisinger Health System; Chair of the Hospital Medicine Traditional, 10-Year MOC Exam Approval Committee

Jensa Morris, MD, Yale New Haven Hospital; Chair of the Hospital Medicine LKA Approval Committee

John A. Raimo, MD, Hofstra Northwell School of Medicine; Co-Chair of the Internal Medicine Traditional, 10-Year MOC Exam Approval Committee

ABIM assessment 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. The Internal Medicine Board works with four approval committees: two dedicated to Internal Medicine and two dedicated to Hospital Medicine. Within each specialty is the Traditional, 10-Year MOC Exam Approval Committee (which also deals with the initial certification exam) and the LKA Approval Committee. Dr. Heiman, Dr. Hohmuth, Dr. Morris and Dr. Raimo provided brief updates 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. Dr. Morris added that the Hospital Medicine LKA Approval Committee will begin review of the portion of the blueprint specific to Focused Practice in Hospital Medicine now that the pathway has been retired in advance of the inpatient-focused assessment launch in 2024.

In Closing

The Internal Medicine Board values the feedback and commentary of the entire medical community, including diplomates and society partners.

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