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Recertification questions? Annual Session can help

From the March 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

Officials from the American Board of Internal Medicine (ABIM) will be on hand at an Annual Session course to help internists better understand its new recertification process.

The panel, which will be moderated by ABIM President Harry R. Kimball, MACP, will explain the key components of the Continuous Professional Development (CPD) recertification program. The new program has generated much discussion since its launch last summer.

Panelist Heather E. Gantzer, FACP, a general internist with Park Nicollet Clinic in Minneapolis and a member of the ABIM's recertification committee, said that some internists are having a hard time grasping the new format. "It seems daunting,” she said, “but when you consider the ‘continuous’ nature of CPD, the program requires only about 10 hours of medical education every year."

Her co-panelist, James L. Naughton, ACP-ASIM Member, an internist with Alliance Medical Group in Pinole, Calif., and the ABIM's secretary-treasurer, said he believes that once physicians understand the program's details, they'll see it as a more valuable route to recertification than the previous format.

"The program’s main strengths are flexibility and relevance," Dr. Naughton said. "You can adapt recertification to your practice, rather than working with a one-size-fits-all approach. And it is a much better measure of how physicians actually practice."

Here’s a look at the points that will be covered at the Annual Session presentation.

The basics

Under the new CPD program, recertifying physicians will still have to complete five self-evaluation modules. However, these will include only one of the traditional medical knowledge modules, which consist of 60 take-home, open-book multiple-choice questions, plus other modules that focus on practice quality, clinical skills and communication. These new components include:

  • Clinical and communication skills. Internists will use a CD-ROM with audio and video components to answer questions that test their clinical and communication skills.

  • Patient and peer assessment. Each diplomate will invite 25 patients and 10 peers to complete a short, anonymous automated telephone survey. Diplomates will also be asked to design a self-improvement plan based on the confidential feedback.

  • Practice improvement. Diplomates will need to complete at least two practice improvement modules, which feature clinical vignettes and disease-related questions. They will also have to submit information about how they manage patients with the specific condition (diabetes, asthma, etc.) covered in that module. Upon completion, internists will have to develop a quality improvement plan based on feedback.

The ABIM estimates that diplomates will have to spend approximately 100 hours over 10 years to complete the CPD program.

Other new features

In addition to the new CPD program, the ABIM has added some other features to recertification. To help diplomates avoid cramming all the components of the process into the 10th year, the ABIM requires internists to begin some element of the process by year four of the CPD cycle. According to Dr. Naughton, this requirement should make recertification less disruptive.

Furthermore, the recertification exam no longer has to be the final component of the process. Diplomates can take the six-hour exam any time after year six, giving internists plenty of time to repeat the test if they don't pass the first time. (The exam is pass-fail and can be repeated as often as necessary.)

In addition, the ABIM this year will begin sending annual letters to physicians informing them of their status in the recertification process and listing the modules they need to complete.

Examining quality

With its CPD program, the ABIM is dramatically broadening the competencies it will assess and moving beyond medical knowledge into quality improvement measures. According to Dr. Naughton, CPD will now make recertification an even more realistic assessment of the practicing internist’s clinical, interviewing and patient management skills.

More importantly, he said that measuring physicians' practice performance and communication skills responds to growing public demand for quality assessments. While managed care has been validly criticized, Dr. Naughton said, its emphasis on quality improvement has been valuable. Yet many of the quality measures being used by managed care reveal what Dr. Naughton called "the disconnection" between what physicians know and how they practice.

"We really wanted to deal with that disconnection," Dr. Naughton said, explaining ABIM’s reason for assessing quality. "We think it is best handled through a continuing quality improvement module in which you actually measure and try to fix shortcomings."

It is true, Dr. Naughton continued, that many physicians who contract with managed care companies already submit quality assessment measures. But many physicians are not affected by managed care measurement tools, he pointed out. And because the future of managed care as an economic model is uncertain, the ABIM felt it needed to incorporate quality improvement in the recertification process.

"We would like to see a universally recognized standard," said Dr. Naughton, addressing criticism that some CPD elements force internists to duplicate some efforts. "We're working with managed care organizations to eliminate duplication so that a component would be acceptable to the ABIM as well as to an independent provider organization or HMO."

A diverse group

Co-panelist Dr. Gantzer pointed out that CPD addresses another major trend among internists: diversity. "We're a much more diverse group as we go through recertification than when we first came out of residency," she said. "The ABIM recognized that physicians need a variety of modules to choose from that relate to their areas of practice and expertise."

For instance, an academic physician may not have patients with cardiovascular problems. Instead of selecting a preventive cardiology practice improvement module, Dr. Gantzer said, that physician could choose the critical review of the literature module that is now being developed.

And Dr. Gantzer noted that the practice improvement module is not an external audit. "It's not a pass-fail component," she said. "It's supposed to spur physicians to self-reflection and examination."

ABIM officials emphasize that CPD is still very much a work in progress. While the structure of the new program is set, many modules are still being developed, and the program itself is being phased in.

This year, diplomates can opt to complete clinical skills, as well as patient and peer assessment modules, in lieu of Self-evaluation modules. Three practice improvement modules are being beta-tested this year. The ABIM estimates that by 2005—when the CPD program should be fully in place—internists will be able to choose from 30 to 35 different practice improvement modules.

This year, recertification exams will be held in approximately 50 different centers across the country on May 1 and Nov. 7. (See www.abim.org for more information.) For more information on CPD, see the Aug. 1, 2000, Annals of Internal Medicine on the Web at www.annals.org/issues/v133n3/toc.html.

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