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Laura E. Evans, MD, MSc, Chair of the Critical Care Medicine Board

The Critical Care Medicine Board held its spring meeting on Friday, May 3, 2024. The agenda provided an opportunity to update the Critical Care Medicine 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 representatives of 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).

The Critical Care Medicine Board gratefully acknowledges the service of departing Specialty Board members Jeffrey F. Barletta, Pharm.D., Daniel H. Gottlieb, Ph.D., and Rahul Nanchal, MD, and departing Approval Committee chairs Christopher F. Barnett, MD, and Margaret Pisani, MD, whose terms ended June 30, 2024.

The following is a summary of the spring meeting.

Conversation with the President*

Prior to the meeting, members and guests of the Critical Care Medicine 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updated the way it reports certification status for physicians to be more transparent about why some certificates are no longer active, such as being “Revoked,” “Suspended” or “Lapsed.”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. As of this report, Furman S. McDonald, MD, MPH, who currently serves as ABIM’s Senior Vice President, Academic and Medical Affairs, has been announced as ABIM’s new CEO, effective September 1, 2024.

The group’s conversation continued around AI and its role in assessment, and how specialty societies can help ABIM evolve assessments to meet the needs of physicians through targeted learning opportunities based on knowledge gaps identified in progress reports. A few society representatives present also asked for updates on ABIM’s progress in looking at ways to reduce burden and simplify the MOC program for diplomates, which were addressed at different points in the sessions outlined below.

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 Longitudinal Knowledge Assessment (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 Critical Care Medicine 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:

Laura E. Evans, MD, MSc, Chair of the Critical Care Medicine Board, noted that the majority of physicians holding a certificate in critical care medicine from the American Board of Emergency Medicine (ABEM) are maintaining their certificates through ABIM’s LKA, as ABEM requires them to do so when eligible. She also asked whether the higher proportion of women initially certified in critical care medicine in 2023 compared to those maintaining certification reflect a change in training demographics. Data show that more women are training in pulmonary critical care medicine over the last decade.

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 Critical Care Medicine 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.

Christopher F. Barnett, MD, Chair of the Critical Care Medicine Traditional, 10-Year MOC Exam Approval Committee, noted that many diplomates are confused about the requirements of the MOC program, and this confusion is fueling criticism. ABIM is actively working on solutions, including updates to the website, that will help address this confusion and make it easier for diplomates to find the information they need.

Other shared that physicians have expressed frustration over pre-test questions on the LKA and the feature of the LKA that requests feedback on the frequency and importance of topics covered in each question. ABIM identifies pre-test questions in the interest of transparency, and as the number of people who take the LKA increases over time, the number of pre-test questions seen by each diplomate will decrease.

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 group discussed the importance of intensivists having a broad base of knowledge in the discipline, even for medical conditions they encounter infrequently. Some also expressed concern that offering more focused assessments may contribute to fragmentation in the discipline. The Specialty Board agreed to revisit the issue at its fall meeting.

Procedural Requirements for Initial Certification in Critical Care Medicine

Last October, during a joint session with the Pulmonary Disease Board, the Critical Care Medicine Board discussed whether changes should be made to the procedural skills required for initial certification in their disciplines, part of a series of conversations on this topic that have been occurring since 2022. At that meeting, the two Specialty Boards reviewed survey data about how often certain procedures are performed in clinical practice and whether the procedural requirements for ABIM certification remain relevant to current practice. Since then, ABIM has been engaging with stakeholders in the discipline on policy questions, with plans to share findings with program directors later this year. Next, ABIM will begin the process of analyzing and publishing the survey results through a writing group comprising members of the two Specialty Boards. More information will be available in the fall.

Early Career Physician Engagement

Since last fall, the ABIM Council has led a planning group to explore how to better engage with early career physicians (those within the first 10 years of initial certification) across the disciplines of internal medicine. Dr. Evans provided an update on listening sessions that ABIM conducted with trainees and newly certified diplomates over the last few months and requested feedback from the Specialty Board.

Suggestions included making it easy for early career physicians to sign up for reminders and having a representative of the Critical Care Medicine Board join the early career events at the annual SCCM Congress.

Society guests departed at this point in the meeting.

Update on the Critical Care Medicine Approval Committees

Christopher F. Barnett, MD, University of California, San Francisco; Chair of the Critical Care Medicine Traditional, 10-Year MOC Exam Approval Committee

Margaret Pisani, MD, Yale University; Chair of the Critical Care Medicine 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 critical care medicine: the Traditional, 10-Year MOC Exam Approval Committee (which also deals with the initial certification exam) and the LKA Approval Committee. Drs. Barnett and Pisani 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.

For more information on the Item-Writing Task Forces, including applications to join, visit the website.

Member Selection for the Critical Care Medicine Approval Committees

ABIM’s Specialty Boards are responsible for selecting members and chairs of the Approval Committees annually and as needed. At the spring meeting, the Critical Care Medicine Board reviewed candidate materials for several positions on both committees. The group unanimously voted to approve the following appointments effective July 1, 2024:

  • Sarah Hadique, MD, FACP, FCCP, West Virginia University, will join as a member of the Critical Care Medicine LKA Approval Committee.
  • Gina Iacovella, MD, MS, Moffit Cancer Center and the University of South Florida, will serve as Chair of the Critical Care Medicine LKA Approval Committee. Dr. Iacovella has served as a member of the committee since 2022, and previously served on the defunct Critical Care Medicine Board Exam Committee from 2018 to 2021.
  • Ryan Maves, MD, FCCM, FCCP, FIDSA, Wake Forest University School of Medicine, will serve as Chair of the Critical Care Medicine Traditional, 10-Year MOC Exam Approval Committee. Dr. Maves has served as a member of the committee since 2023, and previously served as an item-writer from 2019 to 2023.
  • Jonathan Paladino, MD, Ph.D., Aloha Critical Care Associates, Hawai’i Pacific Health, Straub Medical Center, Pali Momi Medical Center and John A. Burns School of Medicine at the University of Hawaii, will join as a member of the Critical Care Medicine Traditional, 10-Year MOC Exam Approval Committee.

Openings for Approval Committee positions starting July 2025 will be posted online in October. Visit ABIM.org for more information and a list of current openings.

New Ways to Recognize Diplomates for Their Commitment to Staying Current

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 Critical Care Medicine 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.

Several members of the group agreed that recognition does not feel necessary to them because certification is a base requirement for the job of being a physician. Others noted the importance of making patients and the public more aware of what is required to maintain certification. The group made suggestions to this point, including potentially redesigning the ABIM website for multiple audiences to communicate what Board certification means. Members also noted that highly individualized communication about activity in the MOC program had some promise for early career physician outreach efforts.

In Closing

The Critical Care Medicine 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 Critical Care Medicine Board has an opening for a patient, caregiver or patient advocate who has experience in the needs of patients receiving critical care for a term beginning July 1, 2025. If you know a patient or caregiver who might be interested, please refer them to the application. Applications are due August 12, 2024.

In addition, the ABIM Council has three openings for terms beginning July 1, 2025:

Applications are due August 12, 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.