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Sleep Medicine Advisory Committee Meeting Summary | Fall 2023

February 16, 2024  |  Posted by ABIM  |  Specialty Board Meeting Summaries

Robert Stansbury, MD, Chair of the Sleep Medicine Advisory Committee

The Sleep Medicine Advisory Committee held its fall meeting on Monday, December 11, 2023. The agenda provided an opportunity to update the Advisory Committee on activity at ABIM and allowed for discussion of pressing issues in the field. The Sleep Medicine Advisory Committee was joined by guests from the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Sleep Disorders Committee, the American Academy of Sleep Medicine (AASM), the American College of Chest Physicians (CHEST), the American Thoracic Society (ATS) and the North American Prodromal Synucleinopathy (NAPS) Consortium for Rapid Eye Movement (REM) Sleep Behavior Disorder.

The following is a summary of the fall meeting.

A Note on the Advisory Committee’s Composition

The Advisory Committee comprises physician representatives of six American Board of Medical Specialties (ABMS) member boards (referred to as the “cosponsoring boards”) as well a public member with a patient or caregiver background in the field and an interprofessional member with experience in the field. The members are:

Conversation with the Administrative Board*

Prior to the meeting, members and guests of the Sleep Medicine Advisory Committee 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. These topics included:

  • 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.

Dr. Baron invited further discussion from the Advisory Committee. Some of them posed questions about diplomate criticism of ABIM’s MOC program and engagement with the Longitudinal Knowledge Assessment (LKA®). Dr. Baron emphasized that ABIM is committed to continuing to listen to diplomate feedback and considering feasible improvements to the program, such as the LKA, where ABIM is working on evolving the program based on some of the “pain points” identified by users. He noted that it is still unknown how diplomates will interact with the LKA over the full course of its five-year cycle and whether they will still continue to prefer it over the traditional, 10-year MOC exam after the first pass/fail decision is made.

Diversity, Equity and Inclusion (DEI)*

The Advisory Committee 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 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 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.

Dr. Lynn told the group about research that ABIM will conduct to study the impact of including race and ethnicity identifiers as part of patient descriptions in assessment questions. A few members of the Advisory Committee voiced concerns about removing all racial identifiers from items, as they can sometimes form an important element in diagnosis—for example, the variations in effect of a continuous positive airway pressure machine in African American populations. Dr. Lynn affirmed that race and ethnicity identifiers are currently included when needed to answer the question and said that examples like this are also exactly what ABIM is considering in the process of developing health equity content.

Discussion on the Sleep Medicine LKA: Obstructive Sleep Apnea (OSA) Emphasis*

Part of ABIM’s work is the development of assessments with enhanced relevance for physicians practicing in a more specialized area within their specialty. Examples of this are the Internal Medicine: Inpatient assessment, launched in 2024 in the LKA as well as the traditional, 10-year MOC exam format, and the Sleep Medicine LKA: OSA Emphasis, which covers the entire sleep medicine blueprint but with a higher percentage of items on OSA emphasis than the general sleep medicine assessment. There is still a substantial overlap with the general Sleep Medicine blueprint so that the full blueprint is assessed in both options. The remaining content includes questions on OSA and related disorders, including bruxism, snoring, gastrointestinal reflux disease and home sleep apnea testing. Of note, the general sleep medicine blueprint contains approximately 11% of content on OSA and related disorders, while the OSA Emphasis assessment contains approximately 37%.

The Sleep Medicine Advisory Committee has held several discussions—some including society partners—about both the positive and potential negative impacts of the OSA Emphasis assessment option on the discipline (most recently at the spring 2023 meeting). At the fall meeting, the Advisory Committee’s conversation focused on identifying measures of success and countervailing measures of unintended consequences for the assessment.

Members of the Advisory Committee shared specific data they would be interested in seeing in the future, including overall pass rates and performance between subgroups on both the general Sleep Medicine LKA and the OSA Emphasis, as well as comparative performance on various aspects of the blueprint, and the demographics of populations that enroll in each version (e.g., primary specialty, practice setting). This kind of information will aid in the decision-making process. ABIM will continue to analyze the performance of the OSA Emphasis and Internal Medicine: Inpatient assessment as more physicians engage with the LKA.

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

Prior to the meeting, Sleep Medicine Advisory Committee members and guests had the opportunity to review a video update sharing recent insights about ABIM diplomates’ engagement in the LKA and their experience and feedback. Some key points included:

  • The relatively small number of ABIM 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.
  • ABIM 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.

The Advisory Committee discussed how the LKA is designed both to measure a physician’s knowledge at a point in time (the pass/fail decision made at the end of the five-year cycle) and provide a learning opportunity through the feedback and rationales that are part of the assessment. They also asked about the percentage of diplomates who provided feedback about the LKA, which was initially relatively low at about 30% but has since risen to a level comparable with that of the traditional, 10-year MOC exam. When asked about the rationale behind the five-year cycle, Rebecca S. Lipner, Ph.D., Senior Vice President, Assessment and Research, explained the evidence—noting the rapid changes in medical knowledge in a five-year span—and how it aligns with the practice of other ABMS member boards.

LKA enrollment for ABIM diplomates with an assessment due in 2024 opened on December 1, 2023. The first 30 questions were made available on January 1, 2024. ABIM diplomates are encouraged to check their Physician Portal for upcoming requirements and eligibility.

Update from AASM*

Members of AASM’s Innovative Fellowship Models Task Force—Chair David T. Plante, MD, Ph.D., FAASM, Lawrence J. Epstein, MD, FAASM, and Ilene M. Rosen, MD, MSCE, FAASM—presented the Advisory Committee with an update on AASM’s Advancing Innovation in Residency Education (AIRE) pilot program. Initial results show that the AIRE pilot fellows scored similar to or better than other fellows on the competency-based assessments.

When the pilot is completed, the Advisory Committee will make a recommendation about whether the pilot becomes a permanent pathway to eligibility for initial certification in sleep medicine. If so, it would be submitted to the Cosponsoring Committee (a body comprising executives of the cosponsoring ABMS member boards) and then to the ABMS Committee on Certification.

The Society guests departed at this point in the meeting.

REM Sleep Behavior Disorder (RBD) Study

Marta Bianciardi, Ph.D., of Massachusetts General Hospital, presented on a study she is conducting on RBD to build a brainstem atlas using the 7-Tesla MRI. The study is seeking participants through May 11, 2024. John Poma, MBA, JD, a member of the Advisory Committee, is involved in the study as well.

Advisory Committee Oversight of the Discipline

The Advisory Committees and Specialty Boards that oversee each discipline of internal medicine are responsible for reviewing and approving the assessment blueprints and standards for certification, MOC and the LKA in their respective subspecialties. At its spring meeting, the Sleep Medicine Advisory Committee reviewed data related to the population of new graduates entering the discipline, diplomates maintaining their certification, workforce information, and assessment performance trends and feedback as part of an annual process to inform assessment decisions.

ABIM staff led the Advisory Committee in a review of its role in relation to identified domains of cosponsored, discipline-specific oversight (assessments, discipline-specific activities in continuing certification, diplomate and society relations, and training). The group discussed how the work of the Advisory Committee influences certification and MOC in sleep medicine:

  • Approval of the assessment blueprints and choosing the passing standard for assessments.
  • Approving training requirements for initial certification eligibility in sleep medicine, including recommending whether innovative training pilots will become official pathways to certification.
  • Approving discipline-specific activities for ABIM diplomates related to quality improvement that can be eligible for MOC points.
  • Building relationships within the field to better support diplomates and partner organizations.

The Advisory Committee also discussed its overarching mission within the context of cosponsored governance.

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 Advisory Committee 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.

Some thoughts from members of the Advisory Committee included the importance of acknowledging the many other requirements of physicians from different state, federal and society groups when communicating about MOC requirements, and focusing on how MOC positively impacts patients and patient care.

Update on the Sleep Medicine Approval Committees

Dennis H. Auckley, MD, Case Western Reserve University, Chair of the Sleep 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. There are two ABIM approval committees related to sleep medicine: the Traditional, 10-Year MOC Exam Approval Committee (which also deals with the initial certification exam) and the LKA Approval Committee. Dr. Auckley provided a brief update for the Advisory Committee on the composition of the Approval Committees, progress on item development in meetings this year and news about the Item-Writing Task Force.

In Closing

The Sleep Medicine Advisory Committee 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 are certified by ABIM and have questions after reading this report, please connect with us through the following channels:

*Indicates Society guests were present for this session.

AASM, ABIM governance, ABMS, DEI, governance engagement, LKA, MOC, sleep medicine, Sleep Medicine Advisory Committee, Sleep Medicine LKA: Obstructive Sleep Apnea Emphasis, Summary Report

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