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Ashok Balasubramanyam, MD Chair, Endocrinology, Diabetes & Metabolism Board

The Endocrinology, Diabetes & Metabolism Board held its fall meeting on Thursday, October 19, 2023. The agenda included updates for the Specialty 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 Clinical Endocrinology (AACE), the American Diabetes Association (ADA), the Association of Program Directors in Endocrinology, Diabetes and Metabolism (APDEM) and the Endocrine Society.

The following is a summary of the fall meeting.

Conversation with the President*

Prior to the meeting, members and guests of the Endocrinology, Diabetes & Metabolism 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. Dr. Baron invited the specialty boards to discuss these topics, including:

  • 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 remarked that ABIM is continuing to listen to diplomates’ concerns about the MOC program and working with Governance and society partners to identify areas for improvements.

The group continued the discussion on misinformation, asking Dr. Baron about resources designed for physicians in training and how to counter the spread of misinformation in the age of social media. Dr. Baron pointed out that misinformation is a complex, multidimensional issue and ABIM’s response is focused on demonstrating that board certification is a credential that supports trust in physician expertise and physicians’ commitment to promoting factual information.

Diversity, Equity and Inclusion (DEI)*

The Specialty Board 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 possibilities for 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 presenters invited the Specialty Board members to share experiences from their own communities regarding DEI work and health equity. Some of the issues raised during a rich conversation include:

  • Ashok Balasubramanyam, MD, Chair of the Endocrinology, Diabetes & Metabolism Board, mentioned a new law in his home state of Texas (Senate Bill 17) prohibiting state-funded colleges and institutions from establishing or maintaining a DEI office, and from hiring or assigning staff to perform DEI duties. He said that despite this and removing the title from staff, the Baylor College of Medicine, where he serves as Senior Associate Dean for Academic Affairs, has continued to focus on diversity in a broader sense and increased diversity at the school.
  • Others on the Specialty Board reflected on the importance of mentorship and exposing medical students to professionals in the field who look like them and represent a diverse population.
  • Alyson K. Myers, MD, member of the Endocrinology, Diabetes & Metabolism Board, spoke about meeting with Mark Henderson, MD, Associate Dean of Admissions and Vice Chair for Education at the University of California, Davis, about his work in diversifying the medical school class at the University of California, San Francisco, in the aftermath of Regents of the University of California v. Bakke. She shared his point that creating a majority of underrepresented in medicine in the class took work, culture change and philanthropic support. Dr. Myers has been working with the Montefiore Einstein Department of Medicine—where she is Associate Chair for Diversity, Equity and Inclusion—to connect with existing pathway programs like Mentoring in Medicine and Rocking the Boat in Bronx, New York.
  • Dr. Balasubramanyam raised the question of whether disparities in health care may get worse with the rise of precision medicine; access to advances may not be available to all. 

Updates from the Medical Specialty Societies*

Representatives from each of the guest societies were invited to give the Specialty Board a brief update on activity and news from their respective organizations.

  • AACE is continuing to develop a new program that will offer certificates that cover different disease states, and is in the second year of a quality improvement project on the role endocrinologists play in vaccination rates. The society also recently launched patient journeys in thyroid conditions and obesity. Finally, the AACE Annual Meeting will be held in May 2024 and focus on artificial intelligence and the future.
  • The ADA recently launched the Institute of Learning, a free, educational platform for primary care physicians and community educators offering continuing medical education (CME) credits/MOC points for participants.
  • APDEM shared that its membership covers 88% of all fellowship programs, provides oversight for the all-in-match policy and holds professional development events for program directors and outreach events at academic meetings. The organization has launched a new mentorship program that pairs veteran program directors with new ones, and is updating its core curriculum including assessing implementation of the health equity section and best practices for milestones.
  • In October, the Endocrine Society launched its inaugural Obesity Fellows Program with an in-person training session in Washington, D.C., chaired by obesity expert Amy Rothberg, MD, DABOM. The society is also working on rolling out new formats and modalities for its Center for Learning to include more educational resources based on scenarios and not exclusively didactic training.

Pass Rates in the Endocrinology, Diabetes & Metabolism Initial Certification Exam*

The Endocrinology, Diabetes & Metabolism Board discussed the results of an investigation into the difference in initial certification exam pass rates in the discipline over the last two years, part of a larger series of conversations on this topic, the most recent of which took place at the Specialty Board’s spring meeting. The investigation was launched in collaboration with the Endocrine Society to look into the possible root causes of lower pass rates for first-time exam-takers. The results explored potential differences in initial ability, fellowship training and the exam itself. The Specialty Board discussed why the field of endocrinology is seeing this particular drop in pass rates. The discussion is expected to continue at the Specialty Board’s spring 2024 meeting after the release in January of the 2023 certification exam pass rates for all disciplines.

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:

  • 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.
  • Diplomates certified before 1990 can now 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 (ADA), 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.

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.

Some members of the Specialty Board shared the positive feedback they heard from people participating in the LKA and encouraged ABIM staff to continue broadcasting success stories in its communications efforts. Mr. Odhner noted that ABIM is also working on developments to address suggestions for improvement, such as participants’ ability to provide feedback on the rationales and references following questions on the assessment.

LKA enrollment for diplomates with an assessment due in 2024 opens on December 1, 2023. Diplomates are encouraged to check their Physician Portal for upcoming requirements and eligibility.

Annual Maintenance of Certification Status Review*

Natalie Trahey, Director of Program Operations for ABIM, and Weifeng Weng, Ph.D., Director of Research and Data Intelligence, reviewed the annual process through which ABIM evaluates certificates to determine whether an individual diplomate is meeting MOC. 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. Ms. Trahey added that the process for claiming MOC points for activities varies by CME provider. Diplomates are encouraged to check their Physician Portal regularly to ensure that their MOC points have been reported.

Dr. Weng 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 of diplomates who miss the deadline and are subsequently reported as “Not Certified.” Tactics include email campaigns, postcards and e-newsletters.

Society guests departed at this point in the meeting.

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.

Suggestions from the group included highlighting patient voices in ABIM’s communications about the importance of certification. 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.

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.

Ms. Gavhane explained the candidate vetting process to the Specialty Board and also shared ABIM’s plans to explore a convening of early career physicians (those within the first ten years of initial certification) 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.

Update on the Endocrinology, Diabetes & Metabolism Approval Committees

Shehzad S. Basaria, MD, Harvard Medical School, Brigham and Women’s Hospital; Chair of the Endocrinology, Diabetes & Metabolism Traditional, 10-Year MOC Exam Approval Committee

Susan L. Samson, MD, Ph.D., FRCPC, FACE, Mayo Clinic Florida; Chair of the Endocrinology, Diabetes & Metabolism LKA 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 endocrinology, diabetes and metabolism: the Traditional, 10-Year MOC Exam Approval Committee (which also deals with the initial certification exam) and the LKA Approval Committee. Dr. Basaria and Dr. Samson 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. Dr. Samson added that diplomate feedback on the LKA has been helpful in identifying whether items are relevant to current practice; the approval committee has been working to update references cited in items to ensure they were published within the last 3–5 years as part of an overall objective to maintain the high quality of assessment items.

In Closing

The Endocrinology, Diabetes & Metabolism 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?

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*Indicates that Society guests were present for this session.