Where Did Recertification Come From?

1. Where Did Recertification Come From? • Pre 1975 • Honorific credential - competency, quality. As much a reflection on good training as anything else. • Expansion of medical schools, numbers of physicians being produced • “Promoting professional competence and improving quality” • “That physicians have a professional responsibility to demonstrate maintenance of knowledge and skills” • Other Boards - Surgery, Family Practice • The Regulated ERA • Certification becoming expected, even required, by health plans, medical groups and hospitals

2. The Recertification Process (CPD Program) • The Components • The CPD program includes the four components for maintenance of certification required by the American Board of Medical Specialties (ABMS) or the federation of all recognized certifying boards in the U.S.

3. The Recertification Process (CPD Program) • Part 1. Credentials Verification • In the final year of certificate, you provide an attestation of good standing from the hospital or health care organization where you have clinical privileges. Periodically, ABIM will verify a valid and unrestricted medical license in the state where you practice or live.

4. The Recertification Process • Part 2. Self-Evaluation of Medical Knowledge • A variety of modules is available, and more are under development. To renew one certificate, you must complete a total of five modules. At least one must be Medical Knowledge in the area of your certificate.

5. Medical Knowledge or Skills Modules (Part 2) • Medical Knowledge • These “open-book” modules focus on clinical advances of the past decade. • All questions screened for relevance by clinically active internists or subspecialists. • These modules have a pass/fail standard. • Because the questions can be difficult, many diplomates do not pass on their first try. • May take the module as often as necessary in order to pass without additional charge. • Modules offered paper, CD, web based.

6. Medical Knowledge or Skills Modules (Part 2) • Physical Examination and Communications Skills • This module tests basic physical examination and communications skills used in clinical reasoning. • Simulates clinical scenarios using audio and video clips to represent diverse situations, such as auscultation of the heart and lungs, choice of examination maneuvers, and physician-patient interactions. • Each multiple-choice question contains one or more video, audio, or photographic enhancements. (A headset is included with the module for use with audio-based questions.) • Module given on CD with web access.

7. Medical Knowledge or Skills Modules (Part 2) • # of Modules • Type of ModuleAvailable • Internal Medicine Medical Knowledge • General Internal Medicine 3 • General Internal Medicine Recent Advances 1 • Inpatient Internal Medicine 1 • Outpatient Internal Medicine 1 • Women’s Health 1 • Clinical Skills • Physical Examination and Communications Skills 1

8. Medical Knowledge or Skills Modules(Part 2) • # of Modules • Type of Module Available • Subspecialty Medical Knowledge • Allergy and Immunology 2 • Cardiovascular Disease 3 • Cardiovascular Disease Recent Advances 1 • Clinical Cardiac Electrophysiology 2 • Critical Care Medicine 2 • Endocrinology, Diabetes and Metabolism 3 • Endocrinology Recent Advances 1 • Gastroenterology 3 • Gastroenterology Recent Advances 1 • Geriatric Medicine 2 • Hematology 3 • Infectious Disease 4 • Medical Oncology 3 • Nephrology 4 • Pulmonary Disease 3 • Rheumatology 4 • Rheumatology Recent Advances 1

9. Performance-Based Practice and Improvement (Part 4) • # of Modules • Type of ModuleAvailable • Practice Improvement • Asthma 1 • Clinical Preventive Services 1 • Diabetes 1 • Hypertension (October 2004) 1 • Preventive Cardiology 1 • Patient and Peer Assessment • Patient and Peer Assessment 1

10. The Recertification Process • Part 3. Secure Examination • The secure exam is offered in the Spring and Fall of each year. You must achieve an overall passing score. All questions have been tested for relevancy by groups of practicing internists. • Currently 200 testing centers available

11. The Recertification Process • 180 multiple choice, patient based • 60 questions per 2 hours • By 2005, all exams administered on computer • No restriction on number of opportunities for re-exam • Exam may be taken before completion of modules • Exam may be taken anytime in last 5 years of certificate

12. Certification Examination Blueprint • Cardiovascular Disease 14% • Gastroenterology 10% • Pulmonary Disease 10% • Infectious Disease 9% • Rheumatology/Orthopedics 8% • Endocrinology/Metabolism 7% • Oncology 7% • Hematology 6% • Nephrology/Urology 6% • Allergy/Immunology 5% • Psychiatry 4% • Neurology 4% • Dermatology 3% • Obstetrics/Gynecology 2% • Ophthalmology 2% • Miscellaneous 3%

13. Cross-Content Areas • Critical Care Medicine 10% • Geriatric Medicine 10% • Prevention 6% • Women’s Health 6% • Clinical Epidemiology 3% • Ethics 3% • Nutrition 3% • Palliative/End-of-Life Care 3% • Adolescent Medicine 2% • Occupational Medicine 2% • Substance Abuse 2%

14. The Recertification Process • Part 4. Self-Evaluation of Practice Performance and Improvement • The ABIM has developed a series of innovative modules that allow you to study your practice patterns and focus on quality improvement. Selecting one of these is optional at this time. • Modules are all CD with web access • Modules involve surveys/chart reviews • Confidentiality assured by ABIM • Process driven, not “Pass Fail”

15. Should ABIM be both the test maker and grader as well as simultaneously acting as paid educator e.g. modules for self education and quality practice parameters? “We make the exams so we know what you need to know and you also must use our products to qualify and pass.” Liberalization of self education material e.g. MKSAP, always an educational tool, now “counts” toward certificate Eventual CME accreditation, if genuine and enforced, to “count” toward certificate process Conflicts/Resolutions

16. Costs in time, dollars and aggravation to navigate through the recertification process Expansion to computer based secure exam given in more than 200 centers Post 2005, condensation of Part 2 (Self Evaluation and Education) and Part 4 (Evaluation of Performance and Practice) All components award CME thus also accomplishing this need for hospital privileges, license renewal, malpractice etc. Conflicts/Resolutions

17. What about subspecialists whose universe is quite different? e.g. The intensivist who no longer cares for office hypertension or diabetes Expanding universe of modules, which must be improved Develop a “core” internal medicine exam applicable to all. A difficult chore to be sure. However, RNR believes if we do not get this one right, entire process may fall. Conflicts/Resolutions

18. ACP Efforts to Streamline/Improve the Recertification Process • 200 computer based testing centers instead of 50 sites offering paper exam • ACP offers learning sessions allowing completion of self evaluation modules in hours • MKSAP can fulfill up to three self knowledge modules • Significant CME awarded through process • (?) Crafting alternative recertification pathways (?) e.g. literature based, CME based • (?) Create a core IM exam that will apply to both generalists and subspecialists (?)

19. Changes Coming in the Process (?2005) • Five module requirement will be two components - knowledge and practice evaluation • Up to three modules for self-assessment of knowledge (note MKSAP can fulfill three) • Remainder for practice performance evaluation • Driven by national regulatory movement toward physicians assessing and improving their performance

20. At the End of the Day • Education, life long learning is always good • There seems to be a trend toward a more “user friendly” process • The process (hopefully) will fulfill need and alleviate pressures from outside regulation • Always better to have evaluations, peer review, practice improvements and whatever to be administered by fellow professionals rather than the alternatives