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How ABIM is changing recertification for internists

Physicians can now get CME credit for their efforts and forget about burdensome life-support requirements

From the March 2000 ACP–ASIM Observer, copyright © 2000 by the American College of Physicians–American Society of Internal Medicine.

By Phyllis Maguire

After years of heated debate, mandatory recertification in internal medicine has finally arrived. This is the first year that internists who passed their boards in 1990 must either recertify or lose their board certification, and the clock is ticking.

When the American Board of Internal Medicine (ABIM) first announced plans for mandatory recertification, some internists bristled at the idea of having to prepare for a second round of boards while they were busy building a career. The recertification process, which is more than just a final examination, involves three steps: a self-evaluation process (SEP), which is a series of take-home tests; a clinical competence assessment; and a final exam. (For more details on the recertification process, see www.abim.org.) Many internists who originally complained about recertification have gone through the process and, by ABIM's account, most have done well. Nonetheless, ABIM has been refining its recertification program, both to streamline the process and to make changes based on feedback from those who have already completed the process. ACP­ASIM Observer talked to ABIM president Harry R. Kimball, MACP, about those changes and what they mean for internists facing recertification.

Q: How many internists have gone through recertification, and how have they fared?

A: The ABIM has recertified more than 7,000 physicians in internal medicine and its subspecialties since 1995; 94% of diplomates have been successful on their first attempt to recertify. According to our surveys, 80% of physicians who complete the process feel it has significant personal and professional value.

Q: How have you changed the process because of suggestions from internists?

A: First, the program has a new name, Continuous Professional Development (CPD), which better reflects the true purpose of recertification.

Second, given the CPD program's educational function, ABIM is now giving up to 120 category 1 CME credits through ACP­ASIM to physicians who recertify. That was a direct response to physician requests.

Third, the board decided to give physicians the full 10-year value of their previous certificate if they recertify during year eight or nine of that certification. The new certificate takes effect the year that their previous certificate expires.

The board also has dropped the requirement for certification in BLS/ACLS [Basic Life Support/Advanced Cardiac Life Support] because maintaining active status proved to be a major hassle for many physicians. The BLS/ACLS certificates have very short life spans, and many diplomates asked us to accept the word of their hospitals about their competency.

Q: Are there any suggestions that you have rejected?

A: One thing the board has not done is make the SEPs any less rigorous, despite some criticism that they are too difficult and take too much time to complete. The SEPs are designed to require references because they serve a prime educational function. On average, each module takes 15 hours to complete (physicians must complete a total of five to recertify), but many diplomates tell us that they learned a lot from doing them.

Q: Has the final exam changed at all?

A: This year is the first time the examination is being offered twice, in May and in November. For the May exam, the SEP modules must be completed by Feb. 1 and an application for the examination submitted by March 1. For the November exam, those deadlines are Aug. 1 and Sept. 1. The examination is being offered at 20 sites in the spring and 45 in the fall.

Q: What else is on the horizon for recertification?

A: The new CPD program is exciting because it is designed to expand self-assessment beyond medical knowledge to measure clinical skills and practice performance. This change gives physicians more flexibility in the kind of SEPs they choose. While the program won't be fully implemented until 2004, there already are two new SEP modules available--one on clinical preventive services and another which provides confidential feedback from patients and physician colleagues about a diplomate's practice skills. A new module on physical examination skills is expected this July, and others on communication skills and clinical reasoning/critical appraisal of the literature are under development.

Q: Should physicians be anxious about recertification?

A: I don't think so. Diplomates have already been certified once, and the CPD program is fair and doable. The board believes it is of substantive value to diplomates and to those who use the credential.

For more information or recertification application forms, call ABIM at 800-441-2246 or send an e-mail to request@abim.org.


Recertification: how the College can help

The College has several tools to help internists get through recertification.

At Annual Session next month in Philadelphia, internists will find a number of courses and sessions. On April 11-12, the College will hold a pre-Session course, "The Core of Internal Medicine: A Recertification Preparation Course," designed to help internists pinpoint areas where they need further study. The College will also offer an orientation session on recertification on April 13, the day Annual Session begins. (For more information, see the Annual Session Final Program.)

Herbert S. Waxman, FACP, the College's Senior Vice President for Education, recommended that test-takers capitalize on the College's Medical Knowledge Self-Assessment Program (MKSAP), a longtime favorite of internists preparing for the high-stakes ABIM examinations. Dr. Waxman also pointed out that MKSAP 12, scheduled for a September release, will offer a completely redesigned format to make it more user-friendly. MKSAP 12 will also include a supplementary preparation package for board exams with additional multiple choice questions and critiques, a collection of images (ECGs, X-rays, etc.), and a guide to test-taking strategies, all designed with certification and recertification candidates in mind.

The College is also identifying sites around the country where it can offer recertification candidates the chance to take the In-Training Examination each fall. The College hopes to begin offering its In-Training Examination as a recertification tool in the next year or two.

Finally, you can purchase audio and videotape versions of College board review materials on the Web at www.cmeunlimited.com/ACP-ASIM or by calling 800-776-5454.

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