Acp observer 2004_recert_reprint


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Acp observer 2004_recert_reprint

  1. 1. REPRINTACP Observer American College of Physicians News for Internists www.acponline.orgVol. 24 No. 3 April 2004 Pages 2-3The forces driving recertification ininternal medicineBy Christine K. Cassel, MACP holders, we do not have “members,” marking sistent with other ABMS boards, we beganI t has been eight years since, as President of ACP, I wrote an article for ACP Observer.I appreciate the opportunity to return to a key difference between the ABIM and ACP. Like the College, however, the ABIM is issuing 10-year certificates. Time-limited cer- tification asserts a philosophical view that physicians have a professional responsibilitythese pages in my role as president of the committed to promoting professional com- to demonstrate maintenance of knowledgeAmerican Board of Internal Medicine petence and improving quality. Our mission and skills.(ABIM). statement spells out this goal clearly: “To Many other specialties already required Consistent with my new role, I took the assure patients and the profession that certi- diplomates to renew their certificates. Theexam that is part of the Continuous Pro- fied internists are competent to provide high- American Board of Family Practice, forfessional Development (CPD) process in quality medical care in a compassionate, instance, has issued seven-year certificatesgeriatric medicine last November, and humanistic, and ethical manner.” since its inception in 1974, while surgery hasthankfully, I passed. After completing one had 10-year limited certificates since 1969.more self-evaluation module, I will have Certification definedrenewed my geriatrics certificate. This Board certification has always been a The role of the ABMSprocess has given me first-hand knowledge of voluntary but highly respected credential The ABMS is the self-governing feder-internists’ experience with the ABIM. recognized throughout the world. Certi- ation of recognized certifying boards that sets Aside from shoring up my knowledge fication demonstrates that a physician has consistent standards. The ABMS plays sig-of geriatrics, I’ve also learned in my initial completed intensive study, undertaken self- nificant roles in both certification and main-months at ABIM that internists don’t always assessment and received good evaluations for tenance of certification (the phrase we nowfully understand the role of the Board. practice performance. Although substantial use for recertification).Perhaps a little history might shed some data support the view that certification is a A good example of the ABMS’ unifyinglight. marker of physician quality, it is just one step role is reflected in the framework it adopted in physicians’ lifelong process of evaluation. in 1999 with the Accreditation Council forThe ABIM’s roots Certification used to be considered an Graduate Medical Education (ACGME). The ABIM was established in 1936 by honorific credential. With changes in health After working through a five-year processACP and the AMA. It is the only internal care financing and delivery, however, certifi- involving many stakeholders, both groupsmedicine board recognized by the American cation is becoming expected—and even endorsed six general competencies for all spe-Board of Medical Specialties (ABMS), and required—by some health plans, medical cialties. That joint endorsement means thatonly one of 24 specialty boards to be recog- groups and hospitals. Currently, 87% of physicians will be expected to demonstratenized by the ABMS. U.S. physicians are certified. these competencies in both training and cer- Like all boards that belong to the For most of the ABIM’s history, certifi- tification.ABMS, the ABIM is a private, not-for-prof- cation was a once-in-a-lifetime event that Those six competencies are in the fol-it standard-setting organization that refers to was connected to completing residency lowing areas:the physicians we certify as “diplomates.” training. But in 1974, the ABIM introduced Ⅺ patient care;While certifying boards have many stake- voluntary recertification. In 1990, con- Ⅺ medical knowledge;Page 1 of 3
  2. 2. Commentary Ⅺ practice-based learning and im- ducible test. A national network of practic- how CPD functions—and how Board re-provement; ing internists reviews all potential questions, quirements affect practicing internists. Ⅺ interpersonal and communications and only questions that receive very high rat- From the beginning, the ABIM has beenskills; ings for relevance to clinical practice appear committed to a process that is efficient and Ⅺ professionalism; and on exams. congruent with internists’ other quality Ⅺ systems-based practice. Currently, most ABIM exams are improvement efforts. We realize that CPD administered on paper at approximately 50 must be credible and rigorous, yet easy toThe ABMS framework for sites, but the Board is converting to comput- understand, relevant and flexible enough torecertification er-based testing. By 2005, all CPD exams will apply to the entire range of internists’ inter- The ABMS has used these competencies be administered at more than 200 profes- ests and the basis for a “maintenance of certifica- sional centers throughout the United States, To help meet these commitments, thetion” framework that consists of four compo- saving diplomates travel time and offering Board has sought collaborations with ACPnents and is relevant to all the boards. In more flexibility. and other specialty societies. We also ini-adopting this framework, each board agreed Ⅺ Part 4: Evaluation of performance tiated discussions with national organiza-to promulgate a program suited to its spe- in practice. This ABMS requirement for tions, including the Joint Commission oncialty with all components present. (See CPD represents the first time we are asking Accreditation of Healthcare Organizations“How CPD recertification meets the ABMS physicians to participate in a quality im- and the National Committee on Qualityrequirements” on this page.) provement project, an increasing expecta- Assurance. Here is a closer look at how the CPD tion in health care. New ABIM tools will We hear diplomates’ concerns from in-program addresses each of the four ABMS guide diplomates through the study of their ternists directly or through their professionalcomponents. own practice. society representatives. I encourage you to Ⅺ Part 1: Professional standing. The The first of these tools, practice im- talk to ABIM representatives at societyABIM verifies diplomates’ credentials by provement modules, are now available for meetings, visit our Web site (,assuring a clean license in the state or states preventive cardiology, asthma and diabetes, or contact us by e-mail ( orwhere they practice. We also confirm good and other modules are being developed. phone (800-441-2246).standing with local credentialing bodies. Because this is a new area, the modules Ⅺ Part 2: Lifelong learning and self- are optional, although they count toward ABIM and medical societiesassessment. Traditional ABIM self-evalua- self-evaluation credit. To facilitate communication withtion modules consist of 60 multiple-choice Diplomates may also select a module that medical societies, the ABIM and ACP estab-questions focused on medical knowledge andjudgment. New types of modules have beenintroduced to allow diplomates to evaluatetheir clinical skills or focus on recent ad- How CPD recertification meets the ABMS requirementsvances by specialty. We continue to work ABMS maintenance of certification ABIM’s CPD componentwith professional societies to find new andinnovative ways to help diplomates complete Professional standing Credentials verificationself-evaluation. Life-long learning and self-assessment Self-evaluation modules Ⅺ Part 3: Cognitive expertise. Thesecure, proctored exam is sometimes per- Cognitive expertise Secure examceived as the biggest hurdle in the CPD Evaluation of performance in practice Practice improvement or patient-peerprocess. All ABIM examinations are scored feedback modulesusing an absolute standard, which means thatanyone who answers enough questions cor-rectly will pass. In other words, there is no solicits feedback from patients and peers. This lished the Liaison Committee on Recer-grading curve. module includes materials that are similar to tification (LCR) in 2002. This group While I can attest that the exam requires the patient satisfaction surveys that practice includes representatives from many of thepreparation, our data suggest that the vast groups and Medicare regularly use. professional societies that collaborate on themajority of diplomates are well-prepared. CPD process.Between 1996 and 2003, 91% of diplomates Efforts to improve CPD We’re also working together to createpassed the CPD exam on their first attempt, To improve the CPD process, we at the concrete programs and resources. Forand 98% succeeded on repeated attempts. ABIM are investing considerable time and instance, five societies last fall offered work- CPD exams are based on the same psy- effort in the process. To serve on the Board, shops at their annual meetings, with expertchometric standards as ABIM certifying all directors and committee members must panels leading participants through a self-exams, and all meet the highest industry enroll in CPD and work to renew their cer- evaluation module.standards for an objective, reliable repro- tificates. This ensures that we understand Diplomates were able to attend an edu-Page 2 of 3
  3. 3. Commentarycational session with CME credit and then ticipate in a formal practice improvement Achieving and maintaining certificationsubmit their answers to the ABIM for CPD activity. sends a respectful message to our patientscredit. Because those sessions were so well- We’re also enthusiastic about an ACP about how the profession sets standards andreceived, they are being expanded in number proposal to substitute MKSAP modules for upholds public expectations.and frequency. ABIM-developed self-evaluation modules. As a standard-setting organization, the Medical societies are now providing We’re making good progress on developing a ABIM takes its role in advancing physicianeducational resources to help diplomates process and standards that will enable quality very seriously. At the same time, wecomplete self-evaluation modules at home, MKSAP to count for up to two CPD knowl- recognize that the Board is just one elementthrough printed syllabi or electronic edge modules. That credit should be avail- in a wide network of individuals and organi-resources. (ACP provides CME credit to able by the end of this year. zations, all working toward the same goal ofdiplomates who complete modules on their improving quality. My hope is that our col-own, as well as to those who pass the exam.) Why maintain certification? lective efforts will help us realize that goalThe ABIM and ACP recently received joint Historically, achieving certification has much more effectively than any one of us canapproval to use the Board’s new practice signaled that a physician has demonstrated a achieve alone. ■improvement modules in an AMA pilot high level of to assess a new type of CME credit. Demonstrating quality is a critical part Christine K. Cassel, MACP, is presidentThat credit will reward physicians who par- of our profession’s societal obligation. of the American Board of Internal Medicine.Page 3 of 3