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A Word from the Specialty Board Chair: Click to hear an introduction from Dr. Erica N. Johnson.

The Infectious Disease Board held its fall meeting on Thursday, September 14, 2023. The agenda provided an opportunity for staff to update the Infectious Disease Board on activity at ABIM and fostered discussion around pressing issues in the field. The Specialty Board was joined for a portion of the meeting* by guests from the Infectious Diseases Society of America (IDSA).

The following is a summary of the fall meeting.

Conversation with the President*

Prior to the meeting, members and guests of the Infectious Disease 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.

Erica N. Johnson, MD, FACP, FIDSA, Chair of the Infectious Disease Board, invited Dr. Baron to offer further reflections on the call for changes to the MOC program, and he noted how in explorations with specialty societies, the field of infectious disease was identified as one of the disciplines currently facing greater challenges than others. The Specialty Board discussed how this topic is prevalent on social media platforms and being covered in trade media. In particular, some members shared concerns heard from their own communities, such as confusion about the annual MOC fee structure and how fees are used in the organization, and that many diplomates feel disconnected from ABIM. Chris Busky, CAE, Chief Executive Officer of IDSA, asked how and how often ABIM analyzes the cost of MOC for physicians, and Dr. Baron explained that regular analysis is conducted to ensure the fees are reasonable for individual physicians while ensuring ABIM has the resources necessary to create and administer certification and MOC assessments and programs across 20 disciplines. The group continued discussing what changes ABIM might consider for the future and how to demonstrate that ABIM is listening to physician concerns.

Diversity, Equity and Inclusion (DEI)*

The Infectious Disease 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.
  • Updates to the ABIM Physician Portal to introduce more inclusive options for self-identification of gender, race and ethnicity based on feedback from diplomates who engaged in listening sessions.
  • 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 Specialty Board expressed their support of the presenters’ work in these areas, pointing out how it is being reflected in medical education with the removal of racial identifiers and reflecting on the complexity of social determinants of health in this country. Some also shared experiences from their own communities and institutions with regards to DEI and health equity, agreeing that younger physicians and residents are very motivated to get involved and are raising concerns about current systems that do not support DEI work. Others emphasized the importance of continuing to include and reach out to less visible groups such as LGBTQ+ and people with disabilities in conducting DEI work.

Jesse Milan, Jr., JD,  also raised concerns over the struggle at the time to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR). This initiative, passed under the George W. Bush Administration, was reported to have saved more than 25 million lives, including 5.5 million infants born HIV-free. Because many of the organizations funded under PEPFAR also provide reproductive services and services for LGBTQ+ people, the reauthorization was facing criticism and reluctance from conservatives in Congress. Reauthorization expired in September.

Visit the ABIM Blog to watch a video discussion about PEPFAR with Dr. Lynn and Dr. Milan.

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.

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.

Dr. Chesluk added that researchers at ABIM are developing a survey to discover what LKA participants are learning and applying to their practice as a result of the assessment. LKA participants have indicated that they are applying what they learn through the LKA to their practice, and the survey is intended to provide more in-depth information.

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*

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 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 for those failing an assessment in their due year but meeting the five-year 100-point requirement, 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.

In response to some questions from members of the Specialty Board, Furman S. McDonald, MD, MPH, Senior Vice President for Academic and Medical Affairs at ABIM, offered additional clarification regarding certification status changes. Lifetime certificate holders (those initially certified before 1990) who are at-risk would see a status change to “Certified, Not Participating in MOC,” while the remaining population would be reported as “Not Certified” if they do not complete the requirements by the end of the year. Diplomates must be current with their MOC fees in order to process earned MOC points towards their requirement, but an unpaid fee alone will not result in a status change.

The group also discussed how the LKA is designed to facilitate diplomates staying current and meet their requirements through one activity. In some instances, it is possible for a physician to earn all of their MOC points through the LKA alone, and those participating in the LKA for multiple certificates will earn more than enough MOC points to meet the requirement. However, it should be noted that the LKA cycle may not align with a diplomate’s existing MOC points cycle, so it may be necessary to earn points through other activities to meet the five-year requirement when it is due. Diplomates should log in to their Physician Portal for complete information on their status and upcoming due dates.

Conversation with the Infectious Diseases Society of America (IDSA)*

Mr. Busky held a discussion with the Specialty Board about concerns rising within the infectious disease community about the MOC program, emphasizing that patient care should be at the center of all conversations. He asked about the evidence supporting better patient outcomes, noting that this information—particularly if it were discipline-specific—would be critical for diplomates to understand the value of the MOC program and that IDSA could help communicate it with its members. Mr. Busky also invited the group to discuss the current cost of the MOC program and how to foster discussion with multiple viewpoints on the issue at hand. Dr. Johnson acknowledged that these are important questions, and members of the group added that it is important for ABIM to continue listening to diplomate concerns and criticism.

(While the discussion at the Specialty Board meeting did not directly respond to Mr. Busky’s question about evidence, a number of research studies have been published that support the value of MOC, and are available on ABIM’s website.)

Update on a Proposed Special Consideration Pilot Program for Exceptionally Qualified International Medical Graduates*

At its spring meeting, the Infectious Disease Board discussed the ABIM Council’s plan to explore the proposed new special consideration pathway for international medical graduates (IMGs) who have completed their internal medicine training in another country and then completed accredited fellowship training in the U.S. or Canada. Anamika Gavhane, Senior Director of Discipline-Specific Governance for ABIM, provided an update on plans for the proposal:

  • Begin with a pilot program which results in the ability to answer key questions in order to build a data-informed decision about whether to create a formal pathway.
  • Connect the pilot to principles of competency-based medical education.
  • Connect eligibility for the pilot to IMGs who have met criteria of the Accreditation Council for Graduate Medical Education (ACGME) to be considered “exceptionally qualified” to enter accredited fellowship training. (See Section III.A.1.c) of ACGME Common Program Requirements for Fellowships.)

Before any decision is made, ABIM plans to conduct stakeholder outreach. Stakeholders would include the ACGME, ACGME International, medical specialty and professional societies, program directors, physician employers, state medical boards, patient advocacy groups, graduate medical education societies and state public health organizations. Data collected from these groups would inform the Council’s recommendation which, if positive, would lead to a public comment period prior to a final decision by the Council on whether to apply to the American Board of Medical Specialties (ABMS) Committee on Certification to formally implement the pilot program.

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 group encouraged ABIM to communicate in a way that shows the organization is listening to diplomates’ concerns and criticisms of the MOC program.

Opportunities for Engaging Early Career Physicians

ABIM is one of several organizations that nominate candidates for the 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 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.

Review of the Composition of the Specialty Board

With one Specialty Board seat becoming vacant in July 2024, the group reviewed the current and projected composition of the Infectious Disease Board and discussed desirable qualifications for future candidates. Applications for the vacant seat are being accepted through January 8, 2024.

For more information and to apply to the opening, visit ABIM’s website.

Selecting the Chair of the Approval Committee

ABIM’s specialty boards are responsible for selecting members and chairs of the Approval Committees annually and as needed. At the fall meeting, the Infectious Disease Board reviewed candidate materials for the chair of the Infectious Disease LKA Approval Committee. The group unanimously voted to approve Anthony K. Leung, DO, FACP, FIDSA, FASCP, of the Cleveland Clinic, as the new chair of the Approval Committee, effective immediately. Dr. Leung joined the Approval Committee as a member in 2022 after serving as a member of the Item-Writing Task Force for several years.

Update on the Infectious Disease Approval Committees

Kimberly Hanson, MD, University of Utah; Member, Infectious Disease Traditional, 10-Year MOC Exam Approval Committee

Howard Heller, MD, Massachusetts General Hospital; Immediate Past Chair of the Infectious Disease LKA 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. There are two Approval Committees in Infectious Disease: the Traditional, 10-Year MOC Exam Approval Committee (which also deals with the initial certification exam) and the LKA Approval Committee.

Dr. Hanson and Dr. Heller provided a brief update on the composition of the approval committees, work done in recent meeting and the work of the Item-Writing Task Force in infectious disease. Dr. Hanson also discussed the Traditional, 10-Year MOC Exam Approval Committee’s goal for the next fiscal year to re-examine the blueprint for initial certification in infectious disease.

In Closing

The Infectious Disease 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?

If you have questions after reading this report, please connect with us through the following channels:

*Indicates that Society guests were present for this session.