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Kenneth R. DeVault, MD, Chair of the Gastroenterology Board

The Gastroenterology Board held its fall meeting on Friday, September 22, 2023. The agenda provided an opportunity to update the Gastroenterology 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 guests from the American Association for the Study of Liver Diseases (AASLD), the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA) and the American Society for Gastrointestinal Endoscopy (ASGE).

The following is a summary of the fall meeting.

Conversation with the President*

Prior to the meeting, members and guests of the Gastroenterology Board had the opportunity to review 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 Board 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 encouraged the Specialty Board and members of ABIM Governance in general to engage in empathic listening with the physician community, providing information and resources where helpful and sharing feedback with ABIM to help address diplomate concerns. The group discussed the importance of ensuring that board certification remains a valuable credential for physicians, and a clinically relevant one for specialists in particular. Dr. Baron noted that ABIM works to find the balance between assessing general and specialist knowledge for a national credential that is meaningful for the community as a whole. ABIM is continuing to work with societies to identify areas for improvement and listening to the diplomate community to evolve programs and products.

Diversity, Equity and Inclusion (DEI)*

The Gastroenterology 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. Members of the team conducting these pilots provided a detailed report on the findings for gastroenterology. A second phase of the pilot will be conducted over the coming year.

Members of the Specialty Board expressed satisfaction with the work in identifying bias in items, noting how bias can impact practice unconsciously and that this work could have a profound impact on how patients are treated.

Annual Maintenance of Certification Status Review*

Florence Mickens, Program Operations Manager 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 requirements. The requirements are to be current with the MOC assessment requirement, attestations (for interventional cardiology only) 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. Diplomates are encouraged to sign in to their Physician Portal to check their status regularly.

Ms. Mickens and 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.

The group discussed how national specialty society meetings are an option for earning MOC points that some diplomates may not be aware of. AASLD, ACG, AGA and ASGE award MOC points for many courses at their national meetings that provide continuing medical education credits, and their representatives suggested an increase in communications around how to earn MOC points around the time of these meetings.

Listening Session on the Longitudinal Knowledge Assessment (LKA®)*

Benjamin Chesluk, Ph.D., Senior Research, Ethnographic Research for ABIM, and Thor Odhner, ABIM’s Program Officer of Diplomate Experience, shared recent insights about diplomates’ engagement in the LKA and their experience and feedback, inviting the group to offer perspectives from their own communities. The presenters noted that 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 takers are taking less than two minutes to answer each question, less than one hour per quarter in total.

The group discussed both positive feedback and criticisms heard from their own communities about the relevance of the LKA to practice and the fairness of questions, with some pointing out an increased interest in practice profiles for specialists to better reflect their clinical work.

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.

Implementation of MELD 3.0 in ABIM Gastroenterology Assessments*

The Specialty Board was informed that the Model for End-stage Liver Disease (MELD) score methodology used for estimating patients’ chances of survival has recently implemented a new formula known as MELD 3.0. Marwan Ghabril, MD, Chair of the Transplant Hepatology Traditional, 10-Year MOC Exam Approval Committee, proposed that ABIM adopt the MELD 3.0 score in its own calculations, noting that additional study of assessment items would be needed to determine what disciplines and stakeholders would be impacted by this change. The Gastroenterology Board expressed approval for examining the matter further with ABIM staff and the Transplant Hepatology Approval Committee.

Update on the Gastroenterology Approval Committees

Charlene Prather, MD, Ph.D., Saint Louis School of Medicine; Chair of the Gastroenterology LKA Approval Committee

Marwan S. Ghabril, MD, Indiana University; Chair of the Transplant Hepatology Traditional, 10-Year MOC Exam 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. The Gastroenterology Board works with three Approval Committees: two dedicated to Gastroenterology and one for Transplant Hepatology. Within each subspecialty is the Approval Committee for the Traditional, 10-year MOC Exam (which also deals with the initial certification exam); Gastroenterology also has an LKA Approval Committee. Dr. Prather and Dr. Ghabril 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. DeVault and Dr. Lynn also acknowledged the work of the approval committees and their chairs undertaken this year to begin revising the Gastroenterology Blueprint, a process that will include diplomate feedback on the proposed blueprint at a future date.

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 to share their own perspectives and discuss how ABIM can foster better understanding and enhance the perceived value of the MOC program among diplomates.

Members of the Gastroenterology Board offered suggestions, encouraging ABIM to research patient perspectives on certification and engage patient advocates to help with understanding and communicating this perspective.

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 RC-IM program director position and two physicians in training in a discipline of internal medicine. Nominations were solicited from ACGME-accredited internal medicine residency and fellowship program directors. Members of each of the specialty boards will be part of the process by interviewing candidates, providing feedback and nominating two individuals.

Anamika Gavhane, Senior Director for Discipline-Specific Governance at ABIM, explained the candidate vetting process to the Gastroenterology 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.

In Closing

The Gastroenterology Board values the feedback and commentary of the entire medical community, including diplomates and society partners.

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*Indicates that Society partners were present for this session.