Christine K. Cassel, M.D. President and CEO ABIM-At-A-Glance

1. Christine K. Cassel, M.D.President and CEOABIM-At-A-Glance

2. American Board of Internal Medicine • Established 1936 as a not-for-profit, independent organization • All revenues come from certification fees • 29 Directors, voluntary/staff model • Examines 30,000 candidates each year for certification and recertification

3. ABIM Mission Statement “To enhance the quality of health care available to the American public by continuously improving the process and maintaining high standards for certifying internists and subspecialists who possess the knowledge, skills and attitudes essential for the provision of excellent care.”

4. ABIM’s Core Values • Assuring the public of the highest quality patient care • Professionalism and excellence in the practice of medicine • Science-based medicine and intellectual rigor • Leadership in evaluation and standard setting • Maintaining autonomy to preserve these values

5. Specialty Board Certification • Time-limited certification is offered by twenty-four officially recognized specialty boards. • Specialty boards are private, non-profit certifying organizations with many stakeholders but no true constituency. • Certification is voluntary but 87% of all U.S. doctors possess this credential.

6. Requirements for IM Certification Candidates must: • complete the required pre-doctoral medical education • meet the post-doctoral training requirements • demonstrate clinical competence in the care of patients • meet the licensure requirements • pass the secure examination

7. Annual Program Director Ratings • Clinical judgment • Medical knowledge • Clinical skills • Medical care • Humanistic qualities • Professionalism • Moral-ethical behavior

8. Internal Medicine Training 408 Internal Medicine training programs 1,400 Subspecialty training programs

9. ABIM Certification Examination • Objective, reproducible, and valid method for assessing medical knowledge and clinical judgment. • Indispensable to board certification in internal medicine and the medical subspecialties.

10. 2002 ABIM Internal Medicine Certification Examination: Group Size & Pass Rates Total Exam Group 7,074 % Passing 87

11. Subspecialty Internal Medicine • Rapid growth beginning about 1970 • 16 areas now recognized • Effect of market forces on subspecialization

12. Requirements for Certification in a Subspecialty or Added Qualification Candidates must: • be previously certified in Internal Medicine by the ABIM • complete the requisite training • demonstrate clinical competence in the care of patients • meet the licensure requirements • pass the secure examination in a subspecialty or area of added qualifications

13. IM Subspecialty Certificates • Allergy and Immunology • Cardiovascular Disease • Endocrinology, Diabetes, and Metabolism • Gastroenterology • Hematology • Infectious Disease • Medical Oncology • Nephrology • Pulmonary Disease • Rheumatology

14. IM Certificates of Added Qualifications • Adolescent Medicine • Clinical Cardiac Electrophysiology • Critical Care Medicine • Geriatric Medicine • Interventional Cardiology • Sports Medicine

15. ABIM Subspecialty Examinations Year 2002 N % Pass First-time Taker Pass Rates Cardiology 701 83%CCEP 89 78%Critical Care Medicine 393 86%Endocrinology 227 88%Gastroenterology 339 84%Geriatrics 311 86%

16. ABIM Subspecialty Examinations Year 2002 N % Pass First-time Taker Pass Rates Hematology 260 75%Infectious Diseases 274 83%Interventional Cardiology 570 63%Medical Oncology 458 77%Nephrology 367 89%Pulmonary Disease 427 83%Rheumatology 171 87%

17. Changing Environment • Public expectation • Payer pressures • Government concerns

18. Challenges of Recertification • Clinical relevance • Quality improvement • Practice environments • Advancing science • Computer-based testing

19. ABIM Foundation • Physician quality • Professionalism

20. Lynn O. Langdon, MSSenior Vice President, SubspecialtyMedicine and Chief Program Officer

21. Educational Support Some of our Collaborators American College of Physicians American Association for the Study of Liver Disease American College of Cardiology American College of Chest Physicians American College of Rheumatology American Gastroenterological Association American Geriatrics Society American Society of Nephrology National Kidney Foundation Society of Critical Care Medicine

22. Collaborations Educational Hyperlinks SEP-Based Learning Sessions CPD Credit for Self-Assessment Programs Practice Improvement Module Links Other Creative Ideas

23. Which of the following is part of the face? (A) nose (B) foot (C) hand (D) heart Educational Material ASA Link Educational Hyperlink

24. ASA’s Website The Face The face is comprised of several physical features: two eyes, a nose, a mouth, two ears, two eyebrows…

25. SEP-Based Learning Sessions Educational courses at annual or region meetings organized around group completion of an SEP for CPD credit, facilitated by ABIM.

26. CPD Credit forSelf-Assessment Programs Credit for up to 2 modules (120 questions) for questions that are part of a society educational program. Questions must meet ABIM standards of content and performance; pretest data is required to assess performance.

27. Practice Improvement Module (PIM) Links PIMs use chart review, review of practice systems, patient surveys and quality improvement to assess performance. Creates opportunities for educational links and data collection for complementary programs. Diplomates will need resources to help with their quality improvement activities.

28. Continuous Professional Development CPD At-A-Glance Summer 2003

29. The Context for CPD 1974 Voluntary ABIM Recertification Program 1990 ABIM Certificates Limited to 10 years 1999 “To Err is Human” - Institute of Medicine • “The Quality Chasm” – Institute of Medicine 2002 American Board of Medical Specialties Maintenance of Certification Report

30. Why CPD? • Continuous self-improvement—cornerstone of professional excellence • Certification of knowledge alone not sufficient • Evaluation of clinical skills and practice performance essential to assure quality, public accountability • Goal: relevant, useful process for diplomates and healthcare systems

31. What Are the Components of CPD? • Self-evaluation • Secure examination • Credentials review

32. Four Types of Self-Evaluation Modules • Medical Knowledge • Clinical Skills • Patient and Peer Assessment • Practice Improvement

33. Self-Evaluation of Medical Knowledge • Multiple choice questions • Up-to-date knowledge • At home, open-book • Some have electronic links to society educational resources • CME credits • Pass/fail module; repeat as needed • Feedback = incorrect responses • Available in paper, CD, or web-based formats

34. Medical Knowledge Unmarked A 28 year-old black woman (gravida 3, para 2) is referred to you because of an abnormal glucose tolerance test. Her previous pregnancies were uncomplicated, and the babies were healthy and of normal size at birth. A standard 50-gram glucose challenge was done in the 24th week of pregnancy; one-hour plasma glucose level was 155 mg/dL. She is not obese and has been in good health otherwise. Her mother has type 2 diabetes mellitus. A followup 100-gram, three-hour glucose tolerance test yields the following results: Basal 110 mg/dL One hour 190 mg/dL Two hours 160 mg/dL Three hours 155 mg/dL You advise exercise, appropriate diet, and home blood glucose monitoring. During the first week, results of home monitoring show fasting blood glucose levels between 100 and 115 mg/dL and postprandial levels between 140 and 160 mg/dL. Previous Next References Review Help Which of the following measures is most appropriate now? Educational Material (A) No further measures Society 1 Link (B) Repeat glucose tolerance test in four weeks (C) Begin insulin therapy (D) Begin metformin therapy

35. Self-Evaluation of Clinical Skills • Interactive CD-ROM technology • Multiple choice questions in physical exam and communications • At home, choice of resources/colleagues • CME credits • Pass/fail module; repeat as needed • Feedback = incorrect responses

36. Physical Examination Skills A 22-year-old male college student comes to your office following a syncopal episode that occurred during wrestling practice. He was unconscious for less than one minute, according to a coach. During the past year, he has had several episodes of lightheadedness with exertion. A heart murmur was detected when he was 10, and his younger brother also has a murmur. Pulse rate is 60 per minute, and blood pressure is 120/80mm Hg in both arms. Jugular venous pulses are normal. The apical impulse is in the fifth intercostal space at the midclavicular line; it is 3cm in diameter and has a presystolic component. Auscultatory findings at the upper left sternal edge are demonstrated in the model The murmur is loudest at the mid-left sternal edge. Auscultatory findings are demonstrated You perform the diagnostic maneuver shown Unmarked Previous Next References (click here for video). Review (click here for video). Help (click here for video). Which of the following is the most likely diagnosis? Exit (A) Mitral regurgitation (B) Tricuspid regurgitation (C) Atrial septal defect (D) Ventricular septal defect (E) Hypertrophic obstructive cardiomyopathy (F) Valvular aortic stenosis

37. Communication Skills Unmarked A 28 year-old man is evaluated by his general internist for an acute respiratory tract infection. The infection is the third of its kind in the last year. The patient has smoked at least one pack of cigarettes daily since high school. After completing the physical examination, the physician prescribes treatment for bronchitis. Believing that the patient’s recurrent infections are related to his continued smoking, the physician decides to address the issue. Previous Next References Review Click here for video Help Which of the following will be the most likely patient outcome of the physician’s counseling tactic? Exit (A) Better understanding of the risks associated with smoking AAPP Click Here (B) Willingness to seek additional information (C) Less defensiveness when discussing his habit (D) More motivation to quit smoking

38. Self- Evaluation of Patient and Peer Feedback Distribute Surveys40 Patients20 Peer Interactive Voice Response System Asks the Questions Summary Report40 Patients 10 20 Peers 25Self-Assessment QualityImprovementPlan

39. is truthful, frank treats me respectfully, never talks down is interested in me as a person discusses optionswith me encourages my questions uses words I can understand Patient Feedback Component “My Doctor ...”

40. Medical knowledge Management of multiple complex problems Management of hospitalized patients Overall clinical skills Respect Integrity Approach to psychosocialaspects of illness Problem-solving Physician Feedback Component How do you rate this physician’s …

41. Self-Evaluation of Practice Improvement Chart Review Patient Survey Practice Review Practice ReportandImprovement Plan Impact Report

42. Preventive Cardiology PIM • Collect data on prevention of CHD • Patient characteristics • BP, Lipids • ASA, Beta-block, ACE-ARB prescribing • Patient satisfaction and involvement in care • Review practice systems • Analyze practice report and make a plan • Study the impact of the change

43. Practice Improvement Modules Clinical Preventive ServicesDiabetes Preventive Cardiology Under Development Acute Myocardial InfarctionAsthma Care of Vulnerable Elderly Community-Acquired Pneumonia Depression Heart Failure Hypertension Osteoarthritis Osteoporosis

44. CPD Examination • 60 MCQs/module • 3 modules • High relevance ratings • Absolute pass/fail standard • Offered twice a year • Multiple test centers • Paper exam • Transition to computer exam by 2006

45. Coming Soon: Computer-Based Testing • Between 2004-2006 ABIM will move all exams to a computer format • Certification exams will be phased in 2005-2006 • Recertification exams will be phased in 2004-2006

46. Advantages of Computer-Based Testing • Greater number of centers; more conveniently located and comfortable • Individual workstations; more professional and private • Enhanced graphics; better quality reproduction and multi-media capability

47. Overall Recertification ExaminationPass Rate:95%

48. Credentials Verification UnrestrictedMedical License Current StaffAppointment

49. CPD For Multiple Certificates IM ID IM ID Self-Evaluation Examination Examination Credentials Credentials 1st through 10th year after Certification

50. What to do if your certificate expires soon • Enroll in CPD www.abim.org Click on “online services” 1-800-441-2246 Ext 3593 • Complete 5 self-evaluation modules by 12/31 of year certificate expires 1 Medical Knowledge in certificate area 4 Electives • Register for May or November examination • Submit credentials verification forms