SAMs fit into the second component – demonstration of cognitive expertise – and consist of both a knowledge assessment based on a 60-item multiple choice questionnaire on the specific content area and a clinical simulation, Dr. Hagen explained, noting that family physicians are required to complete SAMs of their choice periodically, in addition to other maintenance-of-certification requirements and accumulation of 150 continuing medical education credits every 3 years.
“So two processes have to occur for the creation of a SAM: the development of content for the knowledge assessment and development of a simulation model,” said Dr. Hagen, who is also with the department of family and community medicine at the University of Kentucky, Lexington.
The knowledge assessment would require not only applicable questions, but readily accessible references and critiques that provide a rationale for why an answer is correct or incorrect, and the simulation would require “quite a bit of development of information that we put into a knowledge base to generate a clinical scenario,” he said.
Typically, three to five family physicians, a content expert or specialist in the area being addressed, two ABFM editorial staff members, and one or two informaticists are involved in the process.
“The team is charged with creating a template of what the content should look like for a particular SAM, then the content areas are divided among the team members, who then write their respective items,” he said, noting that this process can take up to 9 months
The simulation aspect of the SAM is created at the same time, and in all – with necessary meetings and revisions – SAM finalization may take 12-15 months.
The process costs about $75,000 to $100,000, excluding periodic updates and other maintenance, so the decision to create a SAM is not made lightly, he said.
Dr. Prine said she hopes that the volunteer labor of the team of highly qualified family physicians she has brought together will keep the costs down for the ABFM.
Once the petition is delivered to the ABFM, the Maintenance of Certification Committee will review the matter, look at all of the related competencies, consider whether family planning is an area of importance with respect to content areas, and determine whether family physicians require educational materials in the area, Dr. Hagen said, noting that the topic is scheduled for review at the May ABFM meeting.
Should a family planning SAM be approved, it will join “medical genomics” as the first new SAMs created in nearly 4 years. SAMs have been used since about 2004, and at that time a decision was made to create SAMs for the top 20 areas of priority identified by the Institute of Medicine, including lung disease, diabetes, heart failure, hypertension, and depression, just to name a few. SAMs for those areas were developed over a decade, and the ABFM recently began entertaining possible new topics for development.
“Family planning obviously is a component of family medicine … How much interest there is among the 80,000-plus diplomates, I don’t know, but that’s one of the things the interest group is trying to assess and inform us about. We will look carefully at where this fits in the ongoing anticipated need for development,” he said.
Both Dr. Hagen and Dr. Prine reported having no relevant disclosures aside from their respective roles within the ABFM and the AAFP member interest group.