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

The Endocrinology, Diabetes & Metabolism Board held its fall meeting on Thursday, October 13, 2022. The agenda provided an opportunity to update the Specialty Board on activity at ABIM, and allowed for discussion of pressing issues in the field. The Endocrinology, Diabetes & Metabolism Board was joined by guests from the American Association of Clinical Endocrinology (AACE), the Association of Program Directors in Endocrinology, Diabetes & Metabolism (APDEM) and the Endocrine Society.

The following is a summary of the fall meeting.

Leadership Update

Richard J. Baron, MD, President and Chief Executive Officer, ABIM

Dr. Baron presented an overview of ABIM’s progress on a number of fronts since the Endocrinology, Diabetes & Metabolism Board met in the spring, including:

  • The continued success and growth in participation of the Longitudinal Knowledge Assessment (LKA®), noting that the LKA will also be made available in three new specialties—Critical Care Medicine, Infectious Disease and Pulmonary Disease—in 2023. Enrollment for all assessments opens December 1, 2022.
  • ABIM’s concentrated efforts in advancing diversity, equity and inclusion work streams, including research, listening sessions, staff trainings, cultural celebrations and analysis of ABIM’s programs and services, while addressing any inequities discovered.
  • The ongoing campaign against medical misinformation, which remains a growing concern in the medical community. ABIM is actively working with organizations across the House of Medicine to build a comprehensive approach identifying strategies and tactics that can be employed to battle misinformation and promote accurate information.

Diversity, Equity and Inclusion (DEI) Update

The Endocrinology, Diabetes & Metabolism Board received an update on ABIM’s DEI work from Lorna Lynn, MD, Vice President of Medical Education Research, and Kelly Rand, MA, CPH, Manager of Diversity and Health Equity.

Ongoing work in DEI includes a pilot program incorporating differential item functioning analysis in ABIM assessments, design of a study investigating the impact of patient race and ethnicity identifiers in assessment questions, developing health equity questions and reporting on the demographic characteristics of the internal medicine workforce.

Specialty Board members then discussed using the exam blueprint to encourage education about social determinants of health and racial inequities. They agreed that the inclusion of these topics in ABIM’s assessments would impact the development of educational curricula in training and practice. Representatives from the American Association of Clinical Endocrinology (AACE), the Association of Program Directors in Endocrinology, Diabetes & Metabolism (APDEM) and the Endocrine Society noted that their organizations have begun introducing social determinants of health in continuing education curricula and clinical practice guidelines. The Endocrine Society is gathering feedback on the infrastructure needed to better train and empower endocrinologists on health equity issues. Because the Endocrine Society has an international membership, they are looking at the issue from both a North American and a global perspective.

Dobbs v. Jackson: Implications for Endocrinology, Diabetes & Metabolism

The Endocrinology, Diabetes & Metabolism Board held an open discussion on the implications of the 2022 Dobbs v. Jackson Women’s Health Organization ruling for the discipline of endocrinology, diabetes and metabolism, specifically those areas under the oversight of the Specialty Board, including training, assessments and stakeholder relationships within the endocrinology community.

The members noted that the Supreme Court’s ruling will impact reproductive endocrinology in several areas. Training and care in some states have already been affected as patients with endocrinopathic conditions no longer have the option to terminate their pregnancy, even in cases where it poses a danger to the life of the mother or where there is no chance of fetal viability. Restrictions could also expand to contraceptives and medications which may prompt patients to seek out their own sources, increasing the risk of harm and complicated outcomes.

Update from Society Partners
The American Association of Clinical Endocrinology (AACE)

Representatives from AACE reported on the medical society’s recent news and achievements. AACE held its first in-person cardiometabolic conference in early October, published a set of new diabetes guidelines and launched a podcast focused on the personal experiences of international medical graduates. Additionally, AACE is part of a large-scale quality improvement project to improve vaccination rates.

The Association of Program Directors in Endocrinology, Diabetes & Metabolism (APDEM)

APDEM reported on the recent publication of transgender and health equity curriculum, and the completion of a survey on interview preferences which found that virtual interviews are most preferred.

The Endocrine Society

News from the Endocrine Society included notice about ENDO 2023, the global, in-person meeting on endocrinology research and care to be held June 15-23 in Chicago. The Endocrine Society has relaunched the EndoCares® patient outreach program with a focus on underrepresented populations. In addition, the organization recently launched Comprehensive Care for Persons with Diabetes, a certificate program in partnership with the American College of Osteopathic Family Physicians to train primary and advanced care providers in diabetes care.

Update on the Endocrinology, Diabetes & Metabolism Initial Certifying Exam Pass Rate

During the spring 2022 meeting, the Endocrinology, Diabetes & Metabolism Board discussed the first-taker pass rates of the 2021 Endocrinology, Diabetes & Metabolism Certification Exam, which were lower compared to other disciplines and prior-year endocrinology first-taker pass rates. At the fall meeting, the Specialty Board received a follow-up presentation to review performance data on the initial certification assessment and discuss the potential “training effect” of the COVID-19 pandemic on 2021 endocrinology fellowship graduates. It was noted that this cohort of endocrinology fellows had performed well on the Internal Medicine Certification Exam but showed relatively lower performance on the Endocrinology Certification Exam, further raising the possibility of a COVID training effect. The presenters noted that the lower performance in endocrinology in 2021 was not due to changes in the assessment process: the performance standard was the same from 2018 to 2021 and any differences in form difficulty are taken into account through the equating process.

The group discussed possible causes like a decrease in endocrinology patients (especially at the onset of the pandemic), the introduction and rise of telehealth and the effect of virtual didactics. It was noted that other disciplines were expected to experience training effects to a greater extent, which raised the question of why endocrinology in particular was showing lower pass rates as a result. Discussion will continue next year after the 2022 certification exam pass rates are available to see whether they indicate an overall trend or whether 2021 was an anomalous year.

Maintenance of Certification (MOC) in 2023

The Endocrinology, Diabetes & Metabolism Board received an overview of upcoming MOC milestones from Natalie Trahey, Director of Program Operations, and Weifeng Weng, Ph.D., Director of Research Analysis. In January 2023, ABIM will resume evaluation of physician certification status following a two-year extension of MOC requirements for physicians in most disciplines due to the COVID-19 pandemic. (Four disciplines—Critical Care Medicine, Hospital Medicine, Infectious Disease and Pulmonary Disease—received extensions through 2023 due to the disproportionate impact of COVID on physicians in those specialties.) The presenters shared information about the number of diplomates at risk of losing certification and provided an overview of the robust communications strategy aimed at building awareness of the upcoming deadline in order to minimize the number of diplomates who become “Not Certified.” Communications include monthly targeted emails (June through January) highlighting opportunities for earning MOC points such as society meetings and activities, UpToDate® and thousands of other Continuing Medical Education activities. Some early career physicians who have not yet been through an MOC cycle are at risk because of their lack of familiarity with the MOC process. ABIM recommends that all physicians sign into their personalized Physician Portal to check on their requirements.

The presentation also highlighted an opportunity for physicians with lifetime certificates—that is, those who initially became certified before 1990—to enroll in the LKA as a way to meet their 2023 assessment requirement in order to remain “Participating in MOC.” As a reminder, lifetime certificates are never at risk of losing certification for not participating in MOC. The physician will be shown as “Certified” on the ABIM website, but listed as not participating in MOC unless they meet the assessment requirement. The change was instituted—among other reasons—in the interest of providing more information for patients on whether a physician is demonstrating that they are staying current in knowledge and practice.

Enrollment for all ABIM assessments, including the LKA, the traditional, 10-year MOC exam and the initial certification exam, opens December 1, 2022.

Longitudinal Knowledge Assessment (LKA®) Update

Jeff Miller, ABIM’s Chief Information Officer, provided an update on the progress of the LKA since spring 2022 which included overwhelmingly positive feedback from participants. Of more than 5,100 diplomates surveyed, 91% of respondents reported that they found the LKA useful for learning and 75% said they would recommend it to a colleague. ABIM will continue to gather data through interviews, a user panel, an in-depth study of learning and an annual survey. Several diplomates have shared their positive LKA experiences in short blog posts, reflecting on its flexibility, convenience and actionable feedback.

The Specialty Board then received a live demonstration of the LKA platform and user experience. (A video walk-through is also available online.) Among other things, it was pointed out that items (questions) on the LKA expire each quarter and are then “retired” from use so that diplomates will never see the same item twice if they continue in the LKA for multiple five-year cycles. This means that there is an emphasis on continually developing new items for the assessment and underscores the importance of the Item-Writing Task Force (IWTF) responsible for writing questions. ABIM is actively seeking item-writers, and instructions and criteria for application in endocrinology can be found on ABIM’s website. A full list of all governance openings with application instructions can also be found online.

ABIM is analyzing large amounts of data gathered during the initial roll-out of the LKA, and working on optimizing the ongoing development of the assessment.

Update from the Endocrinology, Diabetes & Metabolism Approval Committees and Recommendations on the Blueprint

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

Susan L. Samson, MD, Ph.D., FRCPC, FACE, Mayo Clinic Florida; Chair of the Endocrinology, Diabetes & Metabolism LKA Approval Committee

There are two ABIM Approval Committees working with the Endocrinology, Diabetes & Metabolism Board: the traditional, 10-year MOC exam Approval Committee (which also deals with the initial certification exam), and the LKA Approval Committee. Approval Committees are responsible for approving all assessment content and maintaining the assessment blueprints in their discipline. Dr. Basaria described the meeting process and the committees’ interaction with the IWTF, and identified the committees’ current challenges and recent successes.

Dr. Basaria then presented the committees’ recommendations on refining the blueprint for the discipline in terms of the composition of items on the MOC exam. At the Specialty Board’s spring meeting, it was noted that the current composition could be better aligned to practice patterns in endocrinology (e.g., increasing the percentage of items on the topics of diabetes and thyroid disorders). These practice patterns were assessed by an ABIM survey of diplomates earlier this year. In the spring, the Specialty Board tasked the Approval Committees with forming recommendations on content changes to make the exam more representative of current practice patterns. Dr. Basaria, Dr. Samson and ABIM staff carefully reviewed the results of the survey and made changes to the composition of items on the MOC exam with an intent to strike a balance between being responsive to diplomates and ensuring that the exam content adequately tests for all subdisciplines of endocrinology (which should promote a well-rounded knowledge base in the discipline for practicing physicians). The task force slightly increased the percentage of items in the subdisciplines of diabetes mellitus, hypoglycemia and thyroid disorders while slightly reducing the percentage of items on adrenal and reproductive disorders. This change was unanimously approved by all members of both Approval Committees. After Dr. Basaria’s presentation, the Specialty Board agreed that the recommendations struck an appropriate balance and voted to approve these changes to the exam content.

In Closing

The Endocrinology, Diabetes & Metabolism Board values the feedback and commentary of the entire medical community, including diplomates and society partners.

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