Nephrology Board Meeting Summary | Fall 2023

January 3, 2024 | Posted by ABIM | Specialty Board Meeting Summaries

*Rudolph A. Rodriguez, MD, Chair of the Nephrology Board*

The Nephrology Board held its fall meeting on Friday, September 29, 2023. The agenda provided an opportunity to update the Nephrology 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 guests from the American Society of Nephrology (ASN), the National Kidney Foundation (NKF) and the Renal Physicians Association (RPA).

The following is a summary of the fall meeting.

Diversity, Equity and Inclusion (DEI)*

The Nephrology 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, 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 Maintenance of Certification (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.

Specific to nephrology, Ms. Rand also reported that the new estimated glomerular filtration rate calculations are being used in pre-test assessment items, and new items developed since 2022 use the new formula by default.

The Specialty Board continued discussion on the fairness review pilots and examples of questions needing revision, and staff explained the process. The goal of fairness review is to ensure equal opportunity for physicians to demonstrate clinical knowledge and skills, regardless of demographic background such as training, gender and race/ethnicity. A diverse group of governance members and volunteers assembled for each discipline and reviewed questions that were flagged as potentially having bias in the previous year’s examination. Members of the review panels were provided with statistics about these questions that may suggest a difference in group performance based on a statistical model that compares a group of physicians who took the exam. Overall, across four disciplines, very few questions (0.0–2.1% of total questions analyzed) were found to be biased. The Approval Committees will review these questions and determine if they can be revised to be bias-free.

The low representation of physicians of color in the profession presented two limitations to the fairness review. In some disciplines, there was insufficient statistical power to accurately compare item performance between White and Black or Hispanic physicians. Additionally, while reviewers were gender diverse and were trained in different settings, White and Asian physicians completed the content review. Staff invited nearly 40 people to fill the six reviewer spots and expanded their pool to incorporate Black and Hispanic physician voices. The Specialty Board discussed several suggestions on how to expand recruitment.

The group also discussed DEI as a whole, noting challenges created by the Supreme Court’s ruling against affirmative action earlier this year. Rudolph A. Rodriguez, MD, Chair of the Nephrology Board, pointed out that advancing diversity is a long process that may stretch over decades, and added that physicians become more culturally competent as institutions continue to have conversations about the role of their organizations in health equity.

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

Alison Carey, Senior Director of Engagement and Digital Experience for ABIM, shared 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.

There was some discussion around the time limit on LKA items. Staff explained that the four-minute time limit was determined by analyzing data from previous ABIM assessments that allowed physicians to access an external resource (as the LKA does) and aligns with best practices in longitudinal assessment by measuring what physicians should know to provide high-quality patient care—i.e., “walking around knowledge.” Data from the LKA are being analyzed to determine whether more time should be added to the existing 30-minute time bank allotted per year in the LKA. Early analyses show that physicians are not using up the entire 30-minute time bank in one year.

Some members of the Nephrology Board asked about the LKA survey response rate, and staff noted that future LKA surveys will be incorporated more seamlessly into the LKA platform and those that have are already showing a much higher response rate. The LKA survey responses were very positive.

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, attestations (for interventional cardiology only) 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. Diplomates are encouraged to sign in to their Physician Portal to check their status regularly.

Ms. Mickens and 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.

Advancing Innovation in Residency Education (AIRE) Pilot Study Proposal*

The Advancing Innovation in Residency Education (AIRE) program is designed by the Accreditation Council for Graduate Medical Education (ACGME) to allow innovations in Competency-Based Medical Education (CBME) for which residencies and fellowships may seek variance from specific ACGME program requirements and, if needed, ABMS member board eligibility requirements. The Nephrology Board was joined by Christopher B. McFadden, MD, Head of the Division of Nephrology and Program Director of the Nephrology Fellowship at Cooper University, and Jonathan C. Webb, MD, Program Director of the Nephrology Fellowship at the University of Kentucky, to discuss a new proposal, “A Pilot Study for an Accelerated Internal Medicine/Nephrology Pathway,” submitted by their institutions proposing to combine their respective internal medicine and nephrology training programs. This proposal seeks to test the concepts of CBME by overlapping training in nephrology fellowship with the final years of internal medicine residency, resulting in the completion of both training programs in four—rather than five—total years of training.

Dr. McFadden noted some of the potential benefits, such as a more vested interest in the field earlier in physicians’ careers, and the ability to recruit physicians to enter practice sooner, possibly reducing the burden of debt. Training would be offered initially at the presenters’ institutions with one participant per year with the hope that it would spark interest at other institutions.

The group discussed how some programs have faced challenges in providing adequate experience for trainees in specific clinical practices, such as home dialysis, and how that would work in a compressed timeframe; Dr. McFadden noted that their institutions have sufficient patient populations to support training for competency but would continue to monitor this to ensure adequate training would be part of the curriculum.

After further discussion and identifying feedback for the proposers, the Nephrology Board voted to approve the AIRE proposal contingent on approval of accreditation issued by the ACGME Review Committee for Internal Medicine (RC-IM).

Conversation with the President*

Prior to the meeting, members and guests of the Nephrology 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 Board to discuss these topics, including:

Recent public conversations and press coverage around the value of ABIM’s 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.

The group had some further discussion around public criticisms of the MOC program. Dr. Baron encouraged the Specialty Board and members of ABIM Governance in general to engage in empathic listening with the physician community, to provide information and resources where helpful and to forward feedback to ABIM to help address diplomate concerns. ABIM is also continuing to work with medical specialty societies to identify areas for improvement and is listening to the diplomate community to evolve programs and products.

Dr. Baron also provided additional context of diplomate sentiment, highlighting that four out of every five physicians eligible for an assessment choose the LKA, and that survey data and metrics indicate a high level of satisfaction and engagement with the program.

The Society guests departed at this point in the meeting.

Update on Procedural Requirements for Initial Certification in Nephrology

At its spring meeting, the Nephrology Board discussed proposed changes to the nephrology initial certification procedural requirements, part of a larger process that has been conducted over the past two years inviting feedback from a broad scope of stakeholders in the discipline including all ABIM-certified nephrologists, program directors of ACGME-accredited Nephrology fellowships, the American Society of Nephrology (ASN), the Renal Physicians Association (RPA), the National Kidney Foundation (NKF) and the American Association of Kidney Patients (AAKP). Also in spring, ABIM shared the proposed changes with all stakeholders during a public comment period that closed on June 1, and invited feedback on the recommendations and rationales before bringing the item for a vote in the fall.

The Specialty Board and society guests discussed the findings from the public comment period and reviewed each of the proposed changes, such as whether to further strengthen the requirements for home hemodialysis and peritoneal dialysis with consideration of the challenges this might pose to fellowship programs.

The Nephrology Board voted to approve the revised procedural requirements for initial certification in nephrology resolution. The new requirements can be found on ABIM’s website. They will go into effect for fellows beginning their training in academic year 2024-2025.

Update on the Nephrology Approval Committees

Bernard G. Jaar, MD, Johns Hopkins School of Medicine; Chair of the Nephrology Traditional, 10-Year MOC Exam Approval Committee

Rajnish Mehrotra, MD, University of Washington School of Medicine; Chair of the Nephrology LKA Approval Committee

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

Selecting a Chair and Members of the Nephrology Approval Committees

ABIM’s Specialty Boards are responsible for selecting members and chairs of the Approval Committees annually and as needed. At the fall meeting, the Nephrology Board reviewed candidate materials for the chair and two open member seats on the Nephrology LKA Approval Committee. The Specialty Board voted unanimously to approve Helbert Rondon Berrios, MD, MS, FACP, FASN, FNKF, of the University of Pittsburgh School of Medicine and Gretchen Brandt, MD, of Kaiser Permanente and the George Washington University School of Medicine to join the Approval Committee as new members for terms beginning January 1, 2024.

The Specialty Board also voted to approved C. John Sperati, MD, of the Johns Hopkins University School of Medicine as the new chair of the Nephrology LKA Approval Committee. Dr. Sperati has served on the Approval Committee since 2020; he previously served on both the Item-Writing Task Force and the (now defunct) Nephrology Self-Assessment Committee. His term as chair will begin January 1, 2024.

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 Specialty Board 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 responded with examples of physician sentiments heard within their own communities but noted that there is still strong support for ABIM’s programs, including MOC. They encouraged ABIM to consider patient perspectives when promoting the value of MOC and to continue to listen to diplomate concerns in order to improve programs and products.

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 Nephrology 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.

In Closing

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

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