The Pulmonary Disease Board held its fall meeting on Thursday, October 5, 2023, including a special joint session with the Critical Care Medicine Board. The agenda included updates for the Specialty Board on activity at ABIM and allowed for discussion of pressing issues in the field, including issues that affect both disciplines.
The following is a summary of the fall meeting.
The meeting began with a joint session with the Critical Care Medicine Board on Thursday, October 5, 2023. The specialty boards were joined for this session by guests from the American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians (CHEST), the American Thoracic Society (ATS), the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD) and the Society of Critical Care Medicine (SCCM).
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:
- Physicians continue to choose the LKA over the traditional, 10-year Maintenance of Certification (MOC) exam at a rate of 4:1 on average across all 15 subspecialties in which it is offered.
- Diplomates certified before 1990 can use the LKA to meet their assessment requirement to remain publicly reported as “Participating in MOC.”
- 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.
- 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.
Thor Odhner, Program Officer, Diplomate Experience at ABIM, invited the group to offer perspectives from their own communities and discuss what information they would find useful for the future. He also noted that the LKAs in Critical Care Medicine and Pulmonary Disease were released in January 2023 (one year later than the first 12 specialties), so at the end of the year, ABIM will have one full year’s worth of data on LKA performance in those disciplines. So far, overall trends include a high participation rate among eligible diplomates and consistent enrollment numbers.
Additionally, ABIM has begun publishing “Specialty Knowledge Gaps” reports on 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. Mr. Odhner pointed out that the reports for Critical Care Medicine and Pulmonary Disease will be released next year once more data are available.
LKA enrollment for diplomates with an assessment due in 2024 opened 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, 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. Diplomates are encouraged to sign in to their Physician Portal to check their status regularly.
Ms. Mickens 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 who miss the deadline and are subsequently reported as “Not Certified.” Tactics include email campaigns, postcards and e-newsletters.
Conversation with the President
Prior to the meeting, members and guests of the Critical Care Medicine and Pulmonary Disease specialty boards 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:
- 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.
- Recent public conversations and press coverage around the value of ABIM’s MOC program.
In discussion with the group about the MOC program, Dr. Baron noted that ABIM is continuing to work with societies to identify areas for improvement and listening to the diplomate community to evolve programs and products. He added that many physicians are still choosing the LKA as a flexible option to maintain their certification, and that surveys and internal metrics still indicate a high level of engagement and satisfaction with the assessment.
Procedural Requirements for Initial Certification in Critical Care Medicine and Pulmonary Disease
Over the past year, the Critical Care Medicine and Pulmonary Disease specialty boards have been considering whether changes should be made to the procedural skills required for initial certification in their disciplines. It was most recently discussed at their spring meetings (see the Critical Care Medicine Board spring meeting summary and the Pulmonary Disease Board spring meeting summary), when they reviewed preliminary information about the results of a survey of diplomates in Pulmonary Disease and Critical Care Medicine regarding current practice. The survey was initially prompted by a request from APCCMPD and a proposal from researchers at the University of Pennsylvania, who have a particular interest in training in endotracheal intubation during fellowship. The survey is intended to better understand how often procedures relevant to the disciplines are performed in clinical practice and whether the procedural requirements for ABIM certification remain appropriate to current practice. The survey closed in July. At the fall joint meeting, Siddharta G. Reddy, MPH, Senior Research Associate at ABIM, shared further results of the survey.
The group discussed the findings, noting that recent graduates of fellowship programs differed in various procedural frequencies compared to physicians who have been in practice longer. The next stage will involve ABIM sharing the information with stakeholders, including medical societies and patient advocacy groups, and inviting their feedback early in 2024.
Diversity, Equity and Inclusion (DEI)
The specialty boards 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 group continued with some discussion around the fairness review pilots, inquiring about the timeline and how items can be flagged for cultural insensitivity. Dr. Lynn explained that the team aims to expand the fairness reviews to other disciplines as soon as feasible, and that it is already possible for diplomates to submit feedback on LKA items, which ABIM then takes action to address.
Some members also shared insights from their own experiences in DEI work and offered suggestions for staff to consider. Geneva Tatem, MD, member of the Pulmonary Disease Board, inquired about the diversity of the Item-Writing Task Force and suggested providing item-writers with critical reading materials on race and racism in health care to avert bias in items. Dr. Lynn noted that the Item-Writing Task Force is a diverse group of physicians and that they are currently guided to remove race and ethnicity indicators from items unless clinically relevant; ABIM will be conducting research on the impact of such identifiers in the coming year.
Society guests departed following this session.
Following the joint session with the Critical Care Medicine Board and society guests, the Pulmonary Disease Board continued the remainder of its fall meeting separately.
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 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 offered suggestions on how to engage with diplomates and promote clarifying information about ABIM’s MOC program in public and trade publications. Some added that perceptions of ABIM in general are more positive than in the past, thanks in part to changes that ABIM undertook to make in response to physician feedback over the last ten years, including the development of the LKA. They encouraged the Communications staff to continue offering public clarification about how the MOC program works, its value and its fee structure. ABIM is committed to continuing to listen to and engage with diplomates in order to evolve programs and products that better serve their interests and practices.
Update on the Pulmonary Disease Approval Committees
Corey Ventetuolo, MD, Brown University; Member of the Pulmonary Disease Traditional, 10-Year MOC Exam 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 pulmonary disease: the Traditional, 10-Year MOC Exam Approval Committee (which also deals with the initial certification exam) and the LKA Approval Committee. Dr. Corey Ventetuolo, on behalf of the Chairs of the Approval Committees, 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 New Approval Committee Members
ABIM’s specialty boards are responsible for selecting members and chairs of the approval committees annually and as needed. At the fall meeting, the Pulmonary Disease Board reviewed candidate materials for two vacant member seats on the Pulmonary Disease Traditional, 10-Year MOC Exam Approval Committee. The Specialty Board voted to approve Rita Bakhru, MD, of the Medical University of South Carolina, and Jennifer Svetlecic, MD, of Saint Luke’s Health System Kansas City, for the two open positions for terms beginning immediately.
Recommendation to ABIM Council of Candidates for the Specialty Board
The Pulmonary Disease Board reviewed the member selection process for the Specialty Board, which has one opening for an interprofessional health care team member (e.g., nurse, advanced practice provider (PA or APRN), respiratory therapist, Doctor of Pharmacy, licensed social worker) starting July 1, 2024. All openings were posted on ABIM’s website on June 26, 2023; applications were accepted through September 18.
Upon completion of the application process, the Specialty Board Chair reviews all applications and asks members of the Specialty Board to conduct candidate interviews and make recommendations. At the fall meeting, the Pulmonary Disease Board reviewed the candidates they had interviewed and voted on two to recommend to the ABIM Council, which will make the final decision and appoint the new member in January.
Opportunities for Engaging Early Career Physicians
ABIM is one of several organizations that nominate candidates for the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for Internal Medicine (RC-IM). The RC-IM invited ABIM to nominate two physicians for the committee who will still be in training during their two-year term. Nominations were solicited from ACGME-accredited internal medicine residency and fellowship program directors.
Anamika Gavhane, Senior Director, Discipline-Specific Governance, explained the candidate vetting process to the Specialty Board and also shared ABIM’s plans to explore a convening of early career physicians 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.
The Pulmonary Disease Board values the feedback and commentary of the entire medical community, including diplomates and society partners.
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