The Rheumatology Board held its spring meeting on Tuesday, March 28, 2023. The agenda provided an opportunity to update the Rheumatology Board on activity at ABIM and allowed for discussion of pressing issues in the field. The Specialty Board was joined by guests from the American College of Rheumatology.
The following is a summary of the spring meeting.
Conversation with the President
Prior to the meeting, members and guests of the Rheumatology Board received a video update from Richard J. Baron, MD, MACP, President and Chief Executive Officer of ABIM and ABIM Foundation, highlighting progress and inviting discussion from the Specialty Board on some of ABIM’s leading priorities, including:
- The planned release of the first Longitudinal Knowledge Assessment (LKA®) quarterly formative score reports to more than 28,000 diplomates who have completed the fifth quarter of their five-year LKA cycle. Diplomates participating in the LKA will receive these score reports as a way to let them know how they are performing relative to the passing score and 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.
- Developments from the 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.
- Continued work with a coalition of national medical organizations to address medical misinformation and promote evidence-based information. Dr. Baron recently coauthored an article in the New England Journal of Medicine and spoke at both the University of California San Francisco Department of Medicine Grand Rounds and South by Southwest on the topic of misinformation.
Misinformation and Implications for Rheumatology
The Specialty Board held an open discussion on the implications of misinformation for the discipline of rheumatology, including its effects on patient care, in order to contribute to ABIM’s ongoing strategic conversations about the issue. The discussion revolved around two themes:
- Misinformation surrounding vaccines, such as the belief that vaccines are experimental, and cases of patients receiving misinformation about the negative consequences of vaccines from their own providers. Specialty Board members noted that the recent rise in diseases like influenza, pneumonia, shingles and other viruses typically vaccinated for in childhood is likely a manifestation of more generalized fear surrounding COVID-19 vaccines.
- Patient confidence and skepticism, meaning patients have more confidence in unsupported views and recommendations published on blogs and social media than in the opinion of their health care provider. In some cases, patients are unable to distinguish between reliable, accurate information and false information, leading to mistrust of their physicians, even to the point where they refuse medication. Some members pointed out that misinformation has become politically polarized, leading to challenges in having conversations with patients about their conditions and treatment.
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—which comprises the chairs of the individual specialty boards and advisory committees, as well as public and patient members—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 rheumatologists.
Many members of the Specialty Board expressed enthusiasm for creating a new pathway but cautioned that for the discipline of rheumatology, additional accredited fellowship positions would be needed in order for the pathway to lead to a significant increase in the number of physicians applying and matriculating, since most rheumatology positions are currently filled in the match.
Dobbs v. Jackson
In their fall 2022 meetings, the ABIM specialty boards (including the Rheumatology Board) held open conversations on the implications of the Dobbs v. Jackson Women’s Health Organization decision for their respective disciplines. Each specialty board identified unique areas in which the Supreme Court ruling might impact physicians working in their specialties. Since then, the ABIM Council has been working on aggregating the product of those conversations into a paper. Dr. Kazi is leading the project with the Council.
Dr. Kazi updated the Rheumatology Board on this work, noting that he and Shannon Scielzo, Ph.D., have identified some themes common across the feedback from the specialty boards. They are inviting the Council to help organize individual comments from their disciplines within the thematic framework. Once work on the perspective piece concludes, ABIM will seek to make it available in order to raise awareness within the internal medicine community of the cascade effects of the 2022 Supreme Court decision.
Update from the American College of Rheumatology (ACR)
Steven Echard, Executive Vice President of ACR, and Dawn McEvoy, Vice President of Education, shared news about ACR. It will be deferring an update to its self-assessment program and has created a task force to determine the best way to move forward. In addition, ACR has recently onboarded a new staff member working in DEI and is developing a new training program in DEI.
They also noted some (at the time) upcoming meetings: the Education Exchange in April, which combines the State-of-the-Art Clinical Symposium and other meetings, including training program directors, division directors and the Fellows in Training meeting; a recording of the Education Exchange will be offered on demand. ACR Convergence will be held in November in San Diego with an in-person poster hall and a livestream component. Continuing medical education credits will be available.
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 Rheumatology 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:
- Relative distribution of fellows in training per discipline
- Percentage of first-year fellows who are female by subspecialty
- Initial certification pass rates by discipline
- MOC pass rates by discipline
- Number of candidates certified in each discipline each year
In a continuation of their conversation at the fall Specialty Board meeting, the group discussed the performance of the Item-Writing Task Force—the group responsible for writing all of the content for the LKA and the traditional, 10-year exam in each specialty—and how to approach some of the concerns expressed in the fall about member attrition, fostering connection between members and the delivery of more immediate feedback from the Approval Committees.
The Specialty Board and guests also heard some information about the LKA. To date, 80% of eligible Rheumatology diplomates (those due for an assessment in 2023) have chosen the LKA pathway. Staff also confirmed that data gathered over the first year of the LKA’s availability indicate that most questions on the LKA are answered in under two minutes. Members of the Specialty Board inquired about how ABIM notifies diplomates who are due for an assessment and whether diplomates can be engaged in the LKA sooner than their exam due year. ABIM sends regular, targeted email campaigns to eligible diplomates about their assessment options and has prioritized communications about the LKA.
Qualitative Feedback on the Longitudinal Knowledge Assessment (LKA®)
Jeffrey Miller, MSIS, Chief Information Officer 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 largely 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.
ABIM staff 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 weighed in with their own experiences of the LKA, agreeing with the positive feedback, particularly in regard to the time limit on questions and the amount of time required to complete 30 questions in one quarter. They also shared suggestions from their peers, such as providing an opportunity to comment on assessment items in the LKA after reviewing the rationale for the answer, not before.
Selection of Candidates for the Rheumatology Approval Committees
The Rheumatology Board reviewed the physician candidates for open positions on the Rheumatology Approval Committees. After discussion, the Specialty Board voted unanimously to approve one physician for an open position, for a term beginning July 1, 2023.
Setting a Quality Agenda in Rheumatology
In late 2021, the American Board of Medical Specialties (ABMS)—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, ABIM’s Chief Medical Officer, spoke to the Rheumatology 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.
Elise Carlson, MD, suggested engaging patient advocacy groups, ACR and others to help gather information for developing a quality agenda in the discipline.
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.
The Rheumatology Board values the feedback and commentary of the entire medical community, including diplomates and society partners.
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