Critical Care Plus: ABIM’s Recertification Program Sets Compromise
Two controversial parts changed, at least for now
As every critical care physician knows, for the past couple of years the American Board of Internal Medicine (ABIM) has been in the process of implementing Continuous Professional Development (CPD), a completely new re-certification system that’s brought fire from a number of quarters for two of its components.
According to ABIM Recertification Committee member Joseph S. Alpert, MD, professor of medicine and chairman of the Department of Medicine at the University of Arizona, ABIM’s intent was to set up a recertification process in which applicants would have a continuous educational experience over 10 years using a self-evaluation program (SEP). The SEP involves modules for clinical skills, medical knowledge, practice improvement, and professionalism. Ideally, says the ABIM, a diplomate will spread CPD over 10 years.
Beginning in 1990, board certifications became good for only 10 years. The initial re-exams were quite clinically oriented. According to Alpert, the ABIM board became concerned that people would go 9½ years before doing the necessary continuing medical education (CME) work, then cram and take the exam.
Compromise Reached on Peer/Patient Review Controversy
Not surprisingly, Alpert says, no one was happy about the extra CME work the temporary certificates created. But the point of greatest controversy arose over the patient and peer-review module that allows patients and colleagues to have input. "There was a fair amount of anxiety about colleagues’ ability to nail each other," Alpert says. "The American College of Physicians sort of took this as their issue of the year’ and battled it." CME credit is not available for the Patient and Peer Assessment module.
The process had been going on for a while before Alpert joined the board. "I plopped down in the middle of a war," he says. "And I saw we needed to figure out some kind of compromise."
The compromise, announced last October, is that patient and peer assessment has been made optional until Dec. 31, 2009. ABIM Executive Director Harry Kimball, MD, acknowledges the patient/peer piece sparked controversy among the diplomates. But he also says that those who do it find they like it. "The data that comes out of it is very good, but a lot of people object to it on principle," Kimball says.
Kimball says it is now board policy that to be recertified, the various sub-specialists as well as the internists must complete the required number of SEP modules. Diplomates can decide which ones they want to take until the end of this decade, by which time the board will have decided what it wants to require beyond that. "It isn’t useful to speculate on that now," Kimball says.
Candidates are asked to complete five modules from any of the four module groups at a rate of no more than one per year. While at least one SEP module is currently available in each of these categories, the full complement will not be ready until 2005. Kimball estimates there are presently 55 medical-knowledge modules, two clinical-skills modules and one peer and patient assessment. There will be as many as 35 practice improvement modules.
Most modules are available on CD-ROM. For non-clinicians, a module being developed is the Critical Appraisal of the Literature/Clinical Reasoning. Until then, diplomates may choose from any available modules as long as one is a medical knowledge module in the discipline being recertified.
Some Non-ABIM Modules Now Approved
While declining to name which subspecialty groups favored and which opposed the compromise proposal, Kimball confirmed that the October compromise included a second major change. Currently, diplomates can take up to two of the five required self-assessment modules from subspecialty organizations other than ABIM, such as modules available through the Medical Knowledge Self-Assessment Program (MKSAP) run by the American College of Physicians.
"My own opinion is that I think it’s a good idea to have a variety of modules available," Alpert says. "The cardiology board spent a lot of time and effort developing our product."
Kimball says that criteria for modules from other sub-specialty groups must meet standards set by the ABIM board. "The modules have to be scored by the ABIM board, feedback has to come from our board, and questions have to be vetted by our test-writing committee, so they have to be reviewed for relevance and pre-tested for performance," he says.
Alpert, who recently took the first cardiology module despite the fact his certificate is old enough to be eternal, says the compromise offers a reasonable incentive. "I thought the questions were very fair and clinically oriented," Alpert says. "I thought it was perfectly reasonable. I just sent away for the second module, the physical exam one that comes with a CD-ROM. I’ve heard it’s very well done and interesting."
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