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Richard M. Wardrop III, MD, MACP, Chair, ABIM Internal Medicine Board

The Internal Medicine Board—which meets twice a year and is responsible for oversight of policy and assessment in the specialty—held its fall meeting on October 22, 2024. The Specialty Board 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 Alliance for Academic Internal Medicine (AAIM)
  • The American College of Osteopathic Internists (ACOI)
  • The American College of Physicians (ACP)
  • The Society of Hospital Medicine (SHM)

ABIM and the Internal Medicine Board are pleased to honor Chair Richard M. Wardrop III, MD, who was recognized as a Master of the American College of Physicians (MACP) in October.

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

Contents:

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 Specialty Board that 31% of diplomates overall had completed their DPP to date. He also reviewed profile questions specific to internal medicine and diplomates who indicate a percentage of clinical time spent in hospital medicine will receive further questions about hospital medicine on the profile. The group discussed questions specific to hospital medicine and further topics to consider exploring through the DPP in future.

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

Natalie S. Plummer, Esq., Manager, DEI Programs at ABIM, 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 governance and eliminate bias in assessment questions. Since this effort began, ABIM has seen consistent growth in the number of physicians supplying information, with more than 77,000 diplomates updating their information.
  • 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 group discussed concerns about digital redlining and how to improve access to technology in underserved areas, particularly to electronic medical records, which Ms. Plummer suggested could be a topic for the collaborative network to explore further. They also discussed the need for further collaboration with organizations that reach high school students, STEM fields and college programs in rural regions to increase the diversity of medical schools and residency applicant pools.

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—adopted new standards for continuing certification that include a requirement for member boards to work with stakeholders to support the development of discipline-specific quality agendas. The Specialty Boards discussed this in their spring 2023 meetings and agreed on three key themes: addressing inherent bias and health disparities, enhancing physician well-being and improving access to quality care. Richard G. Battaglia, MD, FACP, Chief Medical Officer of ABIM, reviewed the Internal Medicine Board’s progress on this area following the initial conversation and indicated that further discussions with society involvement would be happening soon.

Engaging Early Career Physicians*

As mentioned during the Specialty Board’s earlier discussion with Dr. McDonald, the ABIM Council has instituted a task force to work on engaging early career physicians and residents, which has so far included listening sessions and group discussions about the early career physician experience. The task force’s goals are to build long-term relationships, identify needs and potential impacts at ABIM and involve a diverse range of early career physicians—including first-generation physicians—in ABIM’s policy and decision-making work.

The Specialty Board discussed what ABIM should try to learn from early career physicians and what the planning group might do specific to the discipline. Their suggestions included creating informational material about certification and Maintenance of Certification (MOC) for program directors to share with residents who are finishing training, engaging candidates for board certification before they take the exam, engaging patients and introducing less measurable competencies like professionalism into board certification. They also discussed ways to integrate different competencies as well as new methods and technologies into the certification process and exam content.

Primary Care and ABIM: A Discussion with Societies*

Earlier this year, the ad hoc Primary Care Committee of the ABIM Board of Directors asked the Internal Medicine Board to engage the internal medicine community in answering questions about the roles of internal medicine and its subspecialties in primary care. The Internal Medicine Board discussed these questions at the spring meeting, and invited societies to join the discussion for the fall meeting.

Richard M. Wardrop III, MD, MACP, Chair of the Internal Medicine Board, initiated discussion by reviewing the Specialty Board’s areas of oversight: assessment, continuing certification, training, and diplomate and society relations, and noting that every organization has a role to play and specific strengths, but they can all work together to amplify each other’s work.

William E. Fox, MD, MACP, Chair of the ACP Board of Regents, spoke about how ACP supports primary care through policy and advocacy work, educational resources and collaboration, and how ACP is working to highlight the role and value of internal medicine physicians. ACP has identified a strategic priority to address the changing dynamics of the internal medicine workforce. Dr. Fox noted that 37.8% of physicians identifying as primary care physicians are internal medicine physicians, but fewer internal medicine residents are likely to choose primary care, and this could contribute to the projected shortage of primary care physicians.

Polly Parsons, MD, President and CEO of AAIM, shared that AAIM’s Internal Medicine Education Advisory Board had met with a focus on the future of academic internal medicine. She noted concerns that the rising number of subspecialties is changing the landscape of internal medicine, with the potential to decrease or dilute residents’ exposure to primary patient care. Other changes in traditional structures of medicine—e.g., subspecialty divisions leaving the Department of Medicine at health systems, medical schools operating without a Department of Medicine, the expansion of clinical networks and plans for competency-based medical education to bridge undergraduate/graduate medical education and subspecialty training—all have the potential to draw resources away from internal medicine, affecting education, staffing and research support.

The group discussed other challenges around primary care, such as some physicians entering primary care practice without adequate preparation for the scope and depth of outpatient practice from their residency training and the need to address this.

New Proposal for ABIM’s Approved Quality Improvement (AQI) Program*

The AQI Program is the process through which ABIM recognizes externally developed quality improvement activities that physicians are doing in practice. It also allows diplomates to earn MOC points for activities that support their local improvement priorities. Approved activities grant 20 MOC points to physicians who meaningfully participate in the activity. Ali Khan, MD, MPP, member of the Internal Medicine Board, reviewed the following proposal for the program and provided his recommendation for “Hand Hygiene Initiative,” sponsored by Orlando Health. The initiative aims to achieve greater than 90% hand hygiene compliance at Orlando Health St. Cloud Hospital in Florida through the identification and mitigation of barriers to hand hygiene. The hospital had a hand hygiene compliance of 35% before the team formed the initiative to address it.

After a brief discussion, the Internal Medicine Board voted to approve the AQI proposal for MOC credit. Any participant will be eligible to receive credit for this activity.

ABIM welcomes proposals from sponsors that may include medical specialty societies, hospitals or departments within hospitals, medical groups, clinics or other health-related organizations that wish to approve a single activity. Organizations with a quality improvement activity to submit to ABIM for MOC credit recognition are encouraged to take the following steps: 

  1. Download the ABIM AQI Program Guide (PDF). 
  2. Download and complete the AQI Application (PDF). 
  3. Email completed applications to mocprograms@abim.org.

ABIM News and Conversation with the President*

Prior to the meeting, members and guests of the Internal Medicine Board 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 Specialty Board’s consideration and awareness:

  • A proposed pilot model for “exceptionally qualified” international medical graduates (IMGs) pursuing accredited subspecialty fellowship in the U.S. or Canada to become eligible for ABIM Board Certification: ABIM invited commentary from the diplomate community throughout September for the ABIM Council to consider before making a final decision early in 2025, and Dr. McDonald noted that this timing coincides fortuitously with—but is distinct from—similar initiatives for state medical board licensure. Learn more through a video and FAQs on the ABIM website.
  • 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 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 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 recently announced removal of the requirement to earn some MOC points every two years to be considered “Participating in MOC.” With the availability of more activities that earn physicians MOC points (e.g., continuing medical education for MOC, UpToDate®, the LKA), the ABIM Council determined that the two-year point requirement was no longer needed and that its removal would benefit physicians and help promote engagement by making the program simpler.

In response to a question about patient engagement, Dr. McDonald went into more detail about how ABIM has taken steps to include patients on its governance, which has created a positive shift in the Specialty Boards’ dialogues over the last few years. ABIM is working on identifying further opportunities to engage patients and broaden the reach of communications to patient populations.

A society representative expressed concerns that people perceive the LKA as an educational tool and the impact this might have on pursuing continuing medical education through other resources. Dr. McDonald replied that ABIM is first and foremost an assessment organization and that the LKA was not designed to be a comprehensive learning tool, but rather as an assessment with more learning value—a feature that diplomates and societies requested before and during its development. Diplomates participating in the LKA receive quarterly progress reports after the fifth quarter of participation until the end of the five-year cycle showing them their performance in specific areas. ABIM also publishes the LKA Specialty Knowledge Gaps reports annually, which provide aggregate data regarding areas of relative strength and weakness based on physician performance on the LKA so societies can develop targeted educational tools offerings to address these potential gaps in each specialty.

Society representatives departed at this point in the meeting.

Recommending Candidates for the Specialty Board to ABIM Council

Each year, ABIM initiates the process of recruiting candidates for open seats on the Specialty Boards; 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 Specialty Board 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. The ABIM Council makes final selections based on the Specialty Board’s top two recommendations for each open seat.

In June, ABIM issued notice about two openings on the Internal Medicine Board for terms beginning July 1, 2025: one for an internal medicine physician practicing in primary care and one for an internal medicine physician who completed training outside of the U.S. (IMG). At the fall meeting, the Internal Medicine Board discussed the candidates they had interviewed and voted on two to recommend to the Council for each opening. 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, the blueprint is used to create item writer assignments, to assemble exams, and to maintain the item bank. Externally, the blueprint is used as a study guide for physicians preparing for an assessment and in exam performance reports. The Specialty Board and 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.

ABIM plans to conduct an external blueprint review—i.e., inviting input on the existing blueprint from diplomates and other stakeholder groups outside of ABIM—for both the Internal Medicine Blueprint and the Internal Medicine: Inpatient Blueprint in 2025. In preparation for this, staff reviewed the process with the Internal Medicine Board. They noted that the blueprints for the Initial Certification Examination and the Traditional, 10-Year MOC Exam feature the same topics but with different percentages (proportion of questions on each topic relative to the total number of questions) and criticality (how each topic is weighted). The group also discussed the possibilities and challenges of including questions that test knowledge of professional competencies as opposed to strictly clinical skills and understanding.

Learn More

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