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

The Sleep Medicine Advisory Committee—which meets twice a year and is responsible for oversight of policy and assessment in the specialty—held its fall meeting on November 12, 2024. The Advisory Committee reviewed updates on ABIM’s work in a number of key areas and discussed other pressing issues in the field. In addition, representatives from the following organizations joined for a portion of the meeting*:

  • The American Academy of Sleep Medicine (AASM)
  • The American Board of Family Medicine (ABFM)
  • The American College of Chest Physicians (CHEST) Sleep Medicine Network
  • The American Thoracic Society (ATS) Sleep and Respiratory Neurobiology Assembly (SRNA)

The following is a summary of the fall meeting. For reports of prior meetings, visit the ABIM Blog.

Contents:

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 and an interprofessional member with experience in the field. The members are:

Conversation with the Administrative Board President*

Prior to the meeting, members and guests of the Sleep Medicine Advisory Committee had the opportunity to view a recorded video update from Furman S. McDonald, MD, MPH, who assumed the role of President and Chief Executive Officer (CEO) of ABIM and ABIM Foundation on September 1, 2024. Dr. McDonald reflected on current transitions for ABIM as well as key topics for the Advisory Committee’s consideration and awareness:

  • ABIM’s progress in engaging more closely with early career physicians (diplomates who earned initial certification less than 10 years ago): a task force of ABIM Governance members is making plans for the coming year to convene early career physicians, create a platform for their perspectives and provide opportunities for them to be more directly involved in ABIM.
  • The continued popularity of the Longitudinal Knowledge Assessment (LKA®), high rates of reported satisfaction and ongoing enhancements: on average, 80% of eligible diplomates continue to choose the LKA over the traditional, 10-year Maintenance of Certification (MOC) exam, and 70.7% of survey respondents agreed with the statement, “I am satisfied with my LKA experience so far.” Still, Dr. McDonald noted, ABIM continues to evolve and improve the assessment based on diplomate feedback.**
  • The removal of the requirement for ABIM diplomates to earn some MOC points every two years to be considered “Participating in MOC.” With the availability of more activities that earn ABIM diplomates MOC points (e.g., continuing medical education for MOC, UpToDate®, the LKA), the ABIM Council determined that the requirement was no longer needed and that its removal would benefit diplomates and make the program simpler.**

Dr. McDonald spoke more about ABIM’s priorities for the future, emphasizing the importance of creating a stable and simpler program that ensures ABIM diplomates know what to expect from their interactions with ABIM and minimizes confusion. He noted that innovation is a priority and ABIM’s overall goal is to be a reliable and predictable institution while remaining receptive to meaningful change. He also spoke about the impact of misinformation on certification and ABIM’s commitment to upholding evidence-based care.

One Advisory Committee member raised the issue of aligning certification requirements and varying licensure requirements across the state medical boards. Dr. McDonald explained how ABIM has worked with the Accreditation Council for Continuing Medical Education (ACCME) to expand the number of continuing medical education (CME) activities that qualify for MOC points and create a seamless reporting structure for diplomates. to approve However, he noted there are still opportunities to streamline requirements further in order to reduce the administrative burden on physicians.

**MOC program updates noted above apply to ABIM diplomates. Physicians maintaining certification with the other cosponsoring ABMS Member Boards should refer to their Board with questions or for more information about their program.

Diplomate Professional Profile*

In summer 2023, ABIM invited a pilot group of diplomates to complete the newly developed Diplomate Professional Profile (DPP), a questionnaire required of all diplomates that is built into the Physician Portal. The questionnaire relates to clinical work and practice patterns and serves to inform ABIM’s ongoing efforts to update assessment options and exam blueprints and develop policies for initial certification and MOC. Since last year, ABIM has continued to invite all remaining eligible diplomates on a rolling basis to complete the DPP. Diplomates receive a prompt to complete their professional profile when they sign in to their Portal.

Siddharta G. Reddy, MPH, Senior Research Associate at ABIM, reported to the Advisory Committee that 31% of diplomates overall had completed their DPP to date. He also reviewed profile questions from other disciplines as examples of the type of data that could be gathered for sleep medicine. The DPP is only available to ABIM diplomates and making it available for non-ABIM diplomates would be a substantial IT lift, but the Advisory Committee agreed that these kinds of data are important for their own ABMS member boards to collect as well. Some members pointed out additional considerations, such as the differences in practice between sleep centers and how data gathered in sleep medicine compare to data in other specialties where physicians practice very little in sleep medicine.

Diversity, Equity and Inclusion (DEI) Initiatives at ABIM*

Natalie S. Plummer, Esq., Manager, DEI Programs at ABIM, Lorna Lynn MD, Administrator for the Equity Committee, and Pamela White, Senior Vice President, Communications, and Chief DEI Officer, reported on the work of the DEI team at ABIM and recent advances in ABIM’s DEI initiatives. These include:

  • ABIM’s work with participating medical society partners, which led to the formation of the Diversity, Equity and Inclusion Collaborative Network. The goal of the network is to share best practices, coordinate resources and create strategies to support and move diversity work forward as a community dedicated to this work.
  • Improvements to the ABIM Physician Portal that now allow diplomates to more accurately self-identify their race/ethnicity and gender with an expanded list of options. This also aligns with ABIM’s efforts to increase diversity in its governance and eliminate bias in assessment questions. Since this effort began, ABIM has seen consistent growth in the number of its diplomates supplying information, with more than 77,000 updating their information. It should be noted that ABIM’s data represents only its own diplomates. Some of the cosponsoring ABMS Member Boards gather similar data but have not yet aggregated them with ABIM’s, while other Boards do not yet capture this information. Therefore, a complete representation of the demographics of sleep medicine presents an opportunity for further analysis.
  • A report led by Dr. Sara Ray, a medical historian from the University of Pennsylvania, to study the governance records of ABIM. The goal of this project was to determine whether ABIM’s practices within the context of the past caused harm to historically disadvantaged groups and whether that might require restorative action and transparency. The team noted that they planned to share findings from this project in 2025.

The Advisory Committee discussed challenges in promoting DEI initiatives in medical education in an environment with evolving restrictions on how demographic information factors into the selection of fellows and residents. In some cases, private medical school policies prohibit the use of certain demographic information during the selection process. This can contribute to the challenges of ensuring equity and diversity in competitive applicant pools. They noted how the geographical location of the program often influences the success of DEI-focused strategies. Some members suggested solutions such as cultivating a more diverse applicant pool rather than focusing on selected applicants.

AASM Advancing Innovation in Residency Education (AIRE) Pilot Update*

Last year, members of AASM’s Innovative Fellowship Models Task Force presented the Advisory Committee with an update on the AIRE pilot program. Task force chair David T. Plante, MD, Ph.D., FAASM, presented at the Advisory Committee’s fall meeting with further updates:

  • Pilot fellows’ performance on Accreditation Council for Graduate Medical Education (ACGME) Sleep Medicine Milestones 2.0 final assessment
  • Pilot fellows’ performance on Sleep Medicine Objective Structured Clinical Examination performance
  • Pilot fellows’ performance on Sleep Medicine In-Training Examinations
  • Information on pilot fellows’ board certification status

Dr. Plante also presented survey data from key stakeholders (program directors and faculty, standard track fellows) about their experience with the program. Dr. Plante shared that pilot participants practice in a variety of settings, including private practice, blended roles and exclusive focuses. He noted that the task force has explored the idea of a blended pathway from other fields such as neurology and psychiatry to sleep medicine with ABPN, but current regulations for AIRE emphasize one-year training fellowships, limiting that expansion for the present.

Members of the Advisory Committee expressed enthusiasm for the pilot program and asked about next steps. Erica N. Johnson, MD, FACP, FIDSA, Senior Vice President for Academic and Medical Affairs, explained that the outcomes of the pilot program will determine its future as a permanent pathway, and depend on whether the program meets its goals. She noted that similar programs in the past have taken multiple years to transition from pilot status to permanent status, and that in this case, the program may also need more time to accumulate cohorts of data. The Advisory Committee plans to review data in the spring and will determine when it is appropriate to move the program forward.

The Sleep Medicine Workforce*

Adam Sorscher, MD, Advisory Committee member for ABFM, led a discussion with the Advisory Committee about the sleep medicine workforce and invited feedback on a proposed survey about the experience of physicians who are certified in both family medicine and sleep medicine. Members of the Advisory Committee offered a few considerations, such as the fact that academic and healthcare systems often place sleep medicine within pulmonology or critical care divisions, limiting the hire of physicians to those board certified in these specialties. Financial factors and practice setting (rural, urban, academic, private, etc.) also influence hiring decisions. The group discussed financial disparities and structural barriers in the field complicated by the way many sleep specialists hold multiple board certificates, and how sleep medicine is not recognized as a primary specialty. The group agreed on the need for further exploration and greater advocacy for sleep medicine as a distinct specialty.

Update on the Special Consideration Pathway for International Medical Graduates Pilot*

Dr. Johnson provided an update on a proposed pilot model for “exceptionally qualified” international medical graduates (IMGs) pursuing accredited subspecialty fellowship in the U.S. to become eligible for ABIM Board Certification. ABIM invited commentary from the ABIM diplomate community throughout September, and the ABIM Council considered all feedback in advance of making a final decision in December. The Council voted to approve the pilot and ABIM will move forward with submitting the pilot to the ABMS Committee on Certification for consideration.

Learn more about the pilot through a video and FAQs on the ABIM website.

Setting a Quality Agenda in the Discipline*

In 2021, the American Board of Medical Specialties (ABMS)—which comprises 24 medical certifying boards in the U.S., including ABIM and the other cosponsoring boards of the Advisory Committee—adopted new standards for continuing certification that include a requirement for member boards to work with stakeholders to facilitate the development of discipline-specific quality agendas. The Specialty Boards and Advisory Committees discussed this in their spring 2023 meetings.

Richard G.  Battaglia, MD, FACP, Chief Medical Officer, reviewed the requirement with the Sleep Medicine Advisory Committee and summarized the themes that emerged last year: addressing healthcare disparities, improving patient wellbeing, improving diagnosis and treatment of obstructive sleep apnea (OSA), improving determination of risk factors for patients and addressing the impact of the shortage of sleep medicine physicians.

The group discussed adjustments to the themes, such as broadening to all sleep disorders (not just OSA) and all sleep medicine healthcare providers (not just physicians), as well as incorporating artificial intelligence as an emerging issue relevant to provider shortage.

Society and other external organization representatives departed at this point in the meeting.

Recommending Candidates for the Advisory Committee to ABIM Council and the Cosponsoring Committee

Each year, ABIM as the administrative board initiates the process to recruit candidates for open seats on the Advisory Committee. Each member serves a three-year term with the option for one renewal, and positions open on a rolling basis. ABIM posts all openings on its website and shares them with diplomates and other stakeholder groups. The ABIM Council has final approval of physician members representing ABIM; the other member boards have final approval for physician members representing them. The Sleep Medicine Cosponsoring Committee—which oversees the Advisory Committee—has final selection of the public and interprofessional members. The Advisory Committee pays close attention to its own present and future composition, namely how practice setting and region, career stage, educational background (U.S., international), and race and ethnicity are represented among its members before selecting two candidates for each opening to recommend to Council, the cosponsoring member boards or the Cosponsoring Committee as the case may be.

In June, ABIM issued notice about two openings on the Sleep Medicine Advisory Committee for terms beginning July 1, 2025: one for a sleep medicine physician and one for an interprofessional health care team member with experience in sleep medicine. At the fall meeting, the Sleep Medicine Advisory Committee discussed the candidates they had interviewed and voted on two physician candidates to recommend to the Council. The Advisory Committee will review and vote on additional candidates for the health care team member opening early in 2025. ABIM will announce the final appointees in spring 2025 prior to the start of their terms.

Blueprint Review

The blueprint is a document that defines the scope of content to be tested on ABIM assessments. Internally, ABIM uses the blueprint to create item-writer assignments, assemble exams and maintain the item bank. Externally, physicians use the blueprint as a study guide to prepare for an assessment; ABIM also references the blueprint in exam performance reports. The Sleep Medicine Advisory Committee and the Sleep Medicine Approval Committees in each discipline work together to update the blueprint periodically, ensure that changes reflect diplomate and society input, and that assessment content remains relevant to current clinical practice. Both the Advisory Committee and the Approval Committees comprise representatives of the cosponsoring ABMS Member Boards, so the perspectives of each respective discipline factor into the review process. Staff reviewed ABIM’s plans to conduct an external blueprint review via surveys of ABIM diplomates and diplomates of the cosponsoring Member Boards on the existing Sleep Medicine Blueprint.

The group discussed feedback various members had heard in their respective communities, such as the proportion of assessment content on pediatrics and other areas. They also discussed plans for the survey, which as proposed would be sent to diplomates with an active certificate and minimum 50% time performing clinical activities. The group questioned whether the limit was for clinical activities only in Sleep Medicine, a threshold that some felt would too greatly limit the survey pool in this discipline. The survey design team has confirmed that clinical activities in all disciplines in which diplomates are certified will count toward the minimum.

Learn More

The Sleep Medicine Advisory Committee values the feedback and commentary of the entire medical community, including diplomates and society partners.

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*Indicates that society representatives were present for this agenda topic.