The American Board of Pediatrics

1. The American Board of Pediatrics The American Board of Pediatrics Open Forum Subspecialty Clinical Training and Certification Gail A. McGuinness, MD Robert L. Spicer, MD David K. Stevenson, MD April 28, 2012 PAS Boston Training Requirements for Subspecialty Certification APPD Meeting – May 2, 2009 Forum for Fellowship Directors Presented By:

2. We have no conflicts to declare

3. Why the focus on clinical training and certification? • Mission of the ABP and Public Accountability • Why NOW? • Natural Extension of Residency Review and Redesign (R3P) Project re: flexibility, innovation and career oriented training • Focus on competency-based training and assessment

4. American Board of Pediatrics Standard Setting & Evaluation Training ACGME Review Committee for Pediatrics Advocacy & Education American Academy of Pediatrics and Subspecialty Societies

5. Accreditation vs. Certification Accreditation: Training programs are reviewed by the ACGME’s Review Committee to ensure that they are meeting certain pre-specified criteria. Certification: Individuals are evaluated after training to determine whether or not they meet the standards set forth by the ABP for certified specialists and subspecialists.

6. Where Does ABP Fit Into Process of Accreditation? • Decision to offer a subspecialty certificate usually leads to a petition to ACGME to accredit training programs • ABP provides substantial input to the development of initial subspecialty program requirements and periodic revisions via the subboards • ABP’s standards for certification influence the content of program requirements

7. Subspecialty-Specific ACGME Training Requirements • Overall duration and scope of training • Personnel and resources, including patient population • Medical knowledge and patient care experiences • Technical and procedural skills, if appropriate • Scholarly Activity requirements are identical across all subspecialties

8. Subspecialty-Specific ACGME Training Requirements • Numerical requirements notably absent in most • subspecialties with rare exception:

9. Subspecialty-Specific ACGME Training Requirements • RC for Pediatrics FAQ on ACGME Website: • RC expects at least 12 months of clinical experience • RC recommends approximately 12 months for scholarly activity

10. Subspecialty Clinical Training and Certification (SCTC) • ABP undertook initiative to consider nonclinical aspects (research/scholarly activity) of subspecialty training and made recommendations for changes in its requirements for certification that were implemented in 2004. • There have been no recommendations about clinical training despite increasing interest in a competency-based approach to expectations for clinical performance. • All subspecialists are held to the same training model: three years of training , including a scholarly component without specification of duration of time of the latter.

11. Invitational Conference on SCTC July 2010, Durham, North Carolina • Sponsored by ABP Foundation; chaired by David Stevenson • Wide range of stakeholders invited with interest in subspecialty GME representing: ABP, AAP, ACGME, AMSPDC, APPD, CoPS, ABIM, NACHRI • Representatives from fourteen subspecialties: • AAP Sections • Subspecialty Societies • Program Director Organizations • ABP Subboards

12. Common Themes • One size training of three years for all subspecialties requires reevaluation • Considerable inter/intra subspecialty training program variation already exists, as well as variation in career paths of graduates. • Many felt the three years for all subspecialties served • no one: • Physician scientist needs longer training with protected time and financial support • Clinicians may benefit from shortened training or training in which third-tier competencies or advanced clinical training is embedded.

13. Common Themes • Discussion about how individual subspecialties • should determine core professional activities • (clinical, scholarly, and procedural) and what should be expected upon completion of training • Strong sentiment that scholarship is a core value and fellows must learn to analyze, interpret and apply research evidence at the point of care • Need for flexibility during fellowship; yet the flexibility that is currently available is not fully utilized

14. Task Force on Subspecialty Clinical Training and Certification • Charge to the Task Force • The Task Force is charged with: • examining the current model of pediatric subspecialty fellowship training and certification with emphasis on competency-based clinical training and • recommending changes in the current requirements if warranted.

15. Members of the SCTC Task Force John D. Bancroft  Debra M. Boyer  Alan R. Cohen Joseph T. Gilhooly  Mary Fran Hazinski  Eric S. Holmboe  M. Douglas Jones  Sarah S. Long  Victoria F. Norwood  Joseph W. St Geme Daniel J. Schumacher  Daniel C. West  David K. Stevenson, Chair Carol L. Carraccio, guest  Gary Freed, guest  Marshall L. Land, guest  Theodore C. Sectish, guest James A. Stockman, ex officio  Gail A. McGuinness, ex officio

16. SCTC Initiative The Role of CoPS • Summer 2011 partnered with ABP in the SCTC Initiative • Presentations / workshops / forum at AAP, ABP sub-boards, AMSPDC, and APPD • Communication strategies developed • Lists of “who”, “what”, “how” created • Web site utilization implemented

17. SCTC Initiative The Role of CoPS • Determine how to reach “grassroots” of subspecialties (newsletters, social networking) • Distribute information to key organizations and personnel • Structure specific questions to be asked • Determine optimal feedback vehicles

18. ABP Surveys (Gary Freed) • Pediatric Fellowship Program Directors: Perspectives on Fellowship Training • Perspectives on Fellowship Training: Current Fellows • Early Career Pediatric Subspecialists: Perspectives on Fellowship Training • Mid-Career Pediatric Subspecialists: Perspectives on Fellowship Training

19. Timeline of SCTC Initiative Spring 2012 Meeting with Stakeholders FOPO, AMSPDC, AAP, APPD, ACGME, PAS May 2012 Task Force meets to review survey results and feedback from stakeholders Fall 2012 Task Force begins to formulate specific recommendations Spring/Summer 2013 Finalize recommendations

20. Questions for Today What in the current training requirements should be preserved? How closely should training align with the diversity of professional practice in a subspecialty? If more flexibility is desirable, what specifically is meant by this notion? How should each discipline determine its core competencies (i.e., clinical, scholarly, and procedural)?

21. Alignment with Professional Practice Is the expectation for a scholarly experience with a Scholarship Oversight Committee (SOC) important to retain? Does a trainee need to create new knowledge to understand the principles of evaluating new knowledge? Could there be a purely clinical track?

22. Flexibility and Career Orientation • Should training in different subspecialties vary in length with a shorter minimum requirement (e.g., two years?) • Should tracking in fellowship be explored (e.g., extended research training, clinical educator tracks, advanced clinical tracks, etc)? • Should non-core clinical time be more flexible? For example: incorporating advanced clinical training or third-tier competencies

23. Core Competencies Are entrustable professional activities (EPAs) a better way to understand and evaluate competence in subspecialty training? Is a Clinical Oversight Committee (CLOC) a desirable addition to the requirements for subspecialty training?

24. Issues Under Consideration • Certification Issues: • What is the purpose of certification? • Should the ABP require specific documentation of clinical competence, especially in subspecialties with high-risk procedures (similar to surgical boards?) • Should the length of training and requirement for scholarship be based on the nature of discipline?

25. Issues Under Consideration • Certification Issues: • Should third-tier competencies incorporated into core training be recognized with a credential or a certificate that reflects differences in training? How would “niching” in advanced clinical training in subspecialties change the cognitive examination and the certificate awarded? • Are there subspecialties in which maintenance of certification in general pediatrics is essential?