On April 7, four members of CHEST staff and leadership, along with staff and leadership from other medical specialty societies, participated in the Internal Medicine Summit, hosted by the American Board of Internal Medicine, in Philadelphia. The meeting covered an array of topics related to certification and maintenance of certification (MOC), including the alternative assessment model announced in December 2016, quality improvement (QI) as part of MOC, and practicing medicine in an ever-changing political landscape.
The meeting began with Dr. Richard Baron, President and CEO of the ABIM, explaining how the notion of certification has changed over the years. According to Dr. Baron, the concept of lifetime certification no longer makes sense in the rapidly changing field of medicine. As part of the evolution of certification, the ABIM has moved away from “rules to follow” toward something, co-created with societies, that is more relevant and less burdensome. This shift includes aligning certification and MOC requirements with things physicians are already required to do by their states and institutions. Dr. Baron also stressed that in today’s cultural and political landscape, along with the prevalence of “fake news,” the need for trust in the doctor-patient relationship is increasing; trust is no longer a “given.” Therefore, in an age when credentials can be purchased online, there’s an increasing need for an external certification to build trust and boost credibility.
Dr. Marianne Green, member of the ABIM Board of Directors and the ABIM Council, gave an update on the recertification assessment options. While currently, only an every 2-year assessment option will be offered as an alternative to a 10-year higher stakes exam, the ABIM is looking to partner with societies to deliver education, based on the needs identified via the assessment. Furthermore, in addition to partnering with societies to address the identified knowledge gaps, the ABIM plans to collaborate with societies in future alternatives to both the 2-year and 10-year assessments, with the shared goal of “maintenance and support of a community of life-long learners who hold ourselves accountable to peer-defined standards.” Initially, the 2-year lower stakes assessment will cover the breadth of the knowledge in the specialty/subspecialty, but the ABIM is committed to taking a more modular approach in the future. When asked about the fee structure for the new assessment options, Dr. Green communicated that details regarding fees would be announced in fall 2017.
While the first part of the meeting focused on MOC Part 2, the conversation turned toward quality improvement, or QI, later part of the meeting. The practice improvement, or MOC Part 4, requirement is on hold through the end of 2018. Both the ABIM and represented societies value the importance of quality measures. Dr. Graham McMahon, president and CEO of Accreditation Council for Continuing Medical Education (ACCME), laid the framework for QI as being “activities that address a quality or safety gap with interventions intended to result in improvement and with specific, measurable goals. QI activities are learner-driven, as learner engagement is a key target of ACCME’s standard. Representatives from the Heart Rhythm Society, the Society of Hospital Medicine, the Arthritis Foundation, and the American College of Rheumatology shared their organization’s initiatives related to QI.
Apart from the focus on certification and MOC, the meeting also focused on the needs arising from a changing political world, including what is at stake with the repeal of the Affordable Care Act (ACA) and the challenges arising with the wide dissemination of questionable news and the general disregard of science. Stephen Welch, CHEST EVP/CEO, participated in a panel entitled “Practicing Medicine in a Fact-Free World.” He, along with other media professionals, discussed the challenges that physicians, patients, and physician educators encounter in a time when false facts are published as truth and information is sensationalized to attract more attention.
Since the meeting, CHEST leadership sent a letter to the ABIM leadership noting a desire to be one of the societies with whom the ABIM collaborates for both alternative assessment methods and the open-book resources selected. Additionally, CHEST expressed interest in receiving the data that are culled from the assessments, an interest aligned with CHEST’s current data analytics initiatives. CHEST will continue to collaborate with the ABIM to ensure CHEST members’ needs are represented and prioritized in future discussions.