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Nephrology Board Meeting Summary | Spring 2024

May 28, 2024  |  Posted by ABIM  |  Specialty Board Meeting Summaries

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

The Nephrology Board held its spring meeting on Tuesday, March 19, 2024. 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 Nephrology Board also gratefully acknowledges the service of departing member Paul T. Conway, whose term on the Specialty Board ends June 30. For more information on Mr. Conway, visit the ABIM Blog. The following is a summary of the spring meeting.

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, including:

  • The ongoing collaboration between ABIM and internal medicine societies to address their members’ concerns and feedback about the Maintenance of Certification (MOC) program. More than 30 societies met with ABIM in fall 2023, in addition to ongoing discussions throughout the year. In part, the collaboration also explores the need for focused assessments in select subdomains of specific 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updated the way it reports certification status for physicians to be more transparent about why some certificates are no longer active, such as being “Revoked”, “Suspended” or “Lapsed”.
  • 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.
  • Dr. Baron’s approaching retirement later this year, the Board of Directors’ search for a new CEO and ABIM’s transition to new leadership.

The Nephrology Board’s discussion delved further into a number of topics. Regarding the Longitudinal Knowledge Assessment (LKA®), they inquired whether the four-minute time limit on questions would ever be extended and whether diplomates would be able to enroll earlier than their assessment due year. ABIM is continuing to explore these questions with market tests and performance analysis, as well as careful consideration of alternative solutions in response to physician and governance feedback.

Staff also further explained how ABIM develops focused assessments for certain specialties, which includes collaborating with societies in those specialties to distribute and analyze survey data. It is a multi-year process that may or may not reveal a need for a focused assessment, and there is no target number for how many might be developed per discipline. In the case of hematology, data support the development of two—malignant and non-malignant (classical)—versions in addition to the existing general hematology LKA.

In conversation about AI, questions arose about the appropriate use and challenges of emerging technology now facing ABIM and other organizations. ABIM is considering what the role of AI tools in assessment should be as well as the development of policies that address its use, which other member boards of the American Board of Medical Specialties (ABMS) have already put into place. ABIM will collaborate with societies where possible on the implications of AI in the different specialties.

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 Nephrology Board an overview of recent physician feedback and actions that ABIM is considering, 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.

Rudolph A. Rodriguez, MD, Chair of the Nephrology Board, pointed out the challenges associated with the time and cost of maintaining multiple certificates. Dr. Battaglia shared that ABIM is documenting feedback from these physicians to identify “pain points” in their MOC journey and ways to make their experience more seamless and efficient.

Tod Ibrahim, Executive Vice President of ASN, inquired about the future of focused-practice designations, citing ABIM’s Focused Practice in Hospital Medicine (FPHM) pathway that was retired last year. ABIM introduced the Internal Medicine: Inpatient version of the LKA and traditional, 10-year MOC exam this year following the pathway’s retirement. This approach was developed to meet the needs of physicians practicing in a hospital setting who found that the customized assessment was the most valuable feature of the focused practice pathway.

The group also briefly discussed transplant nephrology and the implications of its accreditation by the Accreditation Council for Graduate Medical Education (ACGME), the creation of a separate subspecialty of nephrology by ABIM and the development of a focused version of the nephrology assessments (analogous to the Internal Medicine: Inpatient version cited above). The advantage of a focused assessment is a greater proportion of questions on the specialized field while the general discipline and certificate—nephrology—remain the same. This applies only to MOC and not initial certification which would still be in general nephrology.

Specialty Board Oversight of Assessments*

ABIM’s Specialty Boards are responsible for reviewing and approving the assessment blueprints and standards for certification, MOC and the LKA in their respective disciplines. 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 Nephrology 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:

Members of the group also asked for more information on the Advancing Innovation in Residency Education (AIRE) program pilot in nephrology and hospice and palliative medicine, as well as demographic information on the LKA, such as how age correlates to who chooses the LKA over the traditional, 10-year MOC exam.

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

The Nephrology Board discussed several points related to the exploration of a focused assessment in transplant nephrology or other areas like interventional nephrology, pulmonary nephrology and oncology nephrology. They clarified that the current general nephrology blueprint features 11% of content in transplant nephrology, while a focused assessment features 30% of content in the specialized area. Additionally, the certificate remains the same, indicating certification in nephrology only, partly to avoid limiting specialists to specific areas of practice and creating confusion.

Mr. Ibrahim noted that the ASN task force on the future of nephrology observed increased sub-specialization as a general trend in nephrology, and emphasized that defining the field of nephrology should lie with a broad group of specialty leaders. Furman S. McDonald, MD, MPH, Senior Vice President for Academic and Medical Affairs, agreed, adding that ABIM is meant to be the vehicle by which the profession sets standards for itself and supports specialists in defining their field through rigorous and collaborative procedures, such as the process by which the initial procedural requirements were recently updated.

Procedural Requirements for Initial Certification in Nephrology*

At its fall 2023 meeting, the Nephrology Board voted to approve proposed revisions to the procedural requirements for initial certification in nephrology, which were subsequently published in January and go into effect for fellows entering training in July 2024. (More information can be found on the ABIM Blog and in a detailed policy journey analysis published in The American Journal of Kidney Diseases.) Dr. Rodriguez asked the Nephrology Board to discuss how to evaluate the new procedural competencies and address the future of procedural competencies, noting that the recent revisions did not address some areas based on the data at hand. Others noted how in some cases, fellows are more competent in newer procedures than faculty.

Following discussion, Dr. Rodriguez concluded that there is no urgent need for further action on the part of the Specialty Board at this time.

ASN-AST Task Force on ACGME Accreditation for Transplant Nephrology*

Deborah B. Adey, MD, shared information with the Nephrology Board about a joint task force convened by ASN and the American Society of Transplantation (AST) to develop a proposal for ACGME-accreditation of transplant nephrology fellowships. The task force determined that current nephrology fellowship programs offer the required exposure to transplant nephrology as set by ACGME and that transplant nephrology is a distinct sub-specialization. If ACGME certification is approved, it would make transplant nephrology training eligible for medical education funding under Medicare and create a pathway for international medical graduates, increasing the population of qualified transplant nephrologists to meet patient needs. Several nephrology societies are involved in reviewing a draft application that was slated for submission to ACGME following the Nephrology Board’s meeting in May.

Dr. Adey presented this to the Specialty Board as an informational item; there was no action or decision taken.

Update on the International Medical Graduates Pilot Proposal*

In spring 2023, ABIM Specialty Boards, including the Nephrology Board, discussed the idea of creating a pilot program for International Medical Graduates (IMGs) who have 1) completed their internal medicine training in another country (or completed a residency accredited by ACGME International), 2) fulfilled the ACGME criteria to be considered an “exceptionally qualified candidate” (see ACGME Common Program Requirements (Fellowship), III.A.1.c) and 3) successfully completed ACGME-accredited fellowship training in the U.S. or Canada. The pilot program would allow these physicians to be admitted to the Internal Medicine Initial Certification Examination once their successful completion of accredited fellowship training is verified. Once the Internal Medicine examination is passed, these physicians could then be eligible to take the Subspecialty Certification Examination in the area in which they trained.

Following these discussions, the ABIM Council moved forward with asking ABIM staff to develop community outreach plans and collect external feedback from stakeholders. That process—which will include outreach to employers, the Federation of State Medical Boards, state medical societies and patient-facing organizations—began late in 2023 and was ongoing at the time of the spring 2024 Nephrology Board meeting. The Nephrology Board received an update on this work and information about next steps, which involve a decision by the Council on whether to continue with moving into the next phase of public commentary. At its April 2024 meeting, the Council approved the development of a more detailed pilot model to be presented in June. It the pilot model is approved, ABIM will hold a public comment period beginning in summer 2024.

Society guests departed at this point in the meeting.

Nephrology Board Candidate Appointed for RC-IM

ABIM is one of several organizations that nominate candidates for the ACGME Residency Review Committee for Internal Medicine (RC-IM). In fall 2023, 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 Specialty Board interviewed applicants from programs in their respective disciplines with additional volunteers interviewing candidates in internal medicine; each Specialty Board then nominated two for further consideration by the ABIM Council.

In December, the Council voted on two candidates from this pool to put forward to the RC-IM, which appointed Ann R. Finke, MD, a nephrology fellow at the University of Kentucky College of Medicine, who was one of the candidates nominated by the Nephrology Board in the fall. Dr. Rodriguez spoke briefly about the nomination process and shared the selection news with the Specialty Board.

Update on the Nephrology Approval Committees

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

C. John Sperati, MD, Johns Hopkins University 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 traditional, 10-year MOC exam and the LKA. There are two Approval Committees in 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. Sperati provided a brief update on the composition of the Approval Committees, progress on item development in meetings this year and news about the Nephrology Item-Writing Task Force.

Dr. Jaar also approached the Specialty Board with his concern about term limits for Approval Committee members, particularly as four of them have terms ending in 2025, and asked staff to consider extending terms for two members to balance the proportion of new members with more experienced members in the 2025–2028 cohort.

New Ways to Recognize Diplomates for Their Commitment to MOC

ABIM is exploring new ways to recognize physicians who participate in the MOC program. This includes finding opportunities 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 Nephrology Board, 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.

The Nephrology Board discussed how initial certification generates excitement and celebration from new diplomates and their colleagues, but the MOC program is more of a routine process that becomes part of the background of requirements for physicians. The conversation centered on forms of recognition that would better communicate the value of certification to patients.

For example, one recommendation was to create credentials or honorifics for physicians to list along with “MD” or “DO” to help distinguish ABIM-certified physicians and increase awareness in patients.

In Closing

The Nephrology 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?

If you have questions after reading this report, please connect with us through the following channels:

Join ABIM Governance:

The Nephrology Board 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 of the meeting.

ABIM governance, ASN, Collaboration, nephrology, Nephrology Board, NKF, RPA, Rudolph Rodriguez, Summary Report

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