College leaders give update on recertification
Editor's note: In the following letter, College leadership addresses the issue of recertification.
As you probably know, the first time-limited certificates in internal medicine and its subspecialties awarded by the American Board of Internal Medicine (ABIM) expired in 2000. Therefore, recertification is much on the minds of some ACP-ASIM members. We want to bring you up to date on the College's involvement in responding to the concerns many of you have expressed.
First, we must make an important disclaimer. The ABIM and ACP-ASIM are entirely separate organizations, and the College neither appoints members to the Board nor has any say about policies developed by the ABIM. Although there has been communication between the leaders of the two organizations over the years, the concerns that arose from College membership about recertification called for a more specific dialogue, focused on this one important issue.
As you may know, the current ABIM recertification program (introduced in 1995) currently requires passing a number of self-evaluation modules of multiple-choice questions, followed by passing a secured examination. We have heard from you that the questions in the self-evaluation modules have been at times ambiguous, not clinically relevant, and not of the quality of the multiple-choice questions in the certifying examination. Some of you have also been greatly inconvenienced by the necessity to travel a considerable distance to reach a test center for the final examination.
The Board has assured ACP-ASIM that it continually reviews the questions in the self-evaluation modules and eliminates unsatisfactory ones, replacing them with questions that are clear, unambiguous and highly clinically relevant. The Board plans to offer the secure final examination at local computerized testing centers, so travel will no longer be an issue. However, because of the inadequacies of current testing centers, this will take some time to accomplish.
Many of you will have read the article in the Aug. 1, 2000, issue of Annals of Internal Medicine announcing the revised recertification process called the program for Continuous Professional Development (CPD), to be fully implemented by the ABIM in 2004. CPD will take place during the decade following certification or recertification and, like the original program, consists of five self-evaluation modules and a secure examination, which is no longer a final step but can be taken anytime during the five years before a certificate expires. One self-evaluation module will focus on new medical knowledge, one on clinical skills, one on patient and physician peer feedback concerning professionalism and communication, and two on practice performance.
It is in response to the ABIM CPD plan that the College has received the largest number of communications from members, sharing with us their serious concerns and seeking the College's intercession with the ABIM. In response, the Board of Regents of the College appointed us to serve on a Joint Committee, with equal representation from the ABIM, to communicate and try to be responsive to the important concerns of the College and its members and to try to persuade the ABIM to modify its planned launching of CPD.
The three broad goals of the College as it entered this dialogue with the ABIM were as follows:
The recertification process should be clinically relevant, cost- and time-effective, and not redundant of the quality measures that are already being done well in the practice environment of many physicians (such as patient and peer feedback and practice performance improvement.) The world of practice has changed greatly during the past 10 years. Many quality improvement measures and initiatives are now required by hospitals and health care systems, which wasn't the case a decade ago.
The responsibility of the ABIM in recertification should be limited to evaluation; the education that is a necessary part of every physician's maintenance of competence should be left to those organizations that are skilled in educational program development and delivery.
There should be requirements for continuing medical education to assure maintenance of competence. However, there must be flexibility in how this requirement can be met, recognizing that physicians, as adult learners, may have varying but equally effective learning styles.
The Joint Committee on Recertification has met several times, and the organizations' staffs have done considerable work. The current status is as follows:
With respect to the issues of relevance and redundancy, there has been expressed a "willingness on the part of ABIM to ensure that, responsive to the reasonable concerns that have been voiced broadly by the membership of the College, the recertification process is modified to address these concerns within the goals set for CPD by the ABIM." To make further progress, a joint staff group will be meeting shortly to address the details underlying this commitment.
With respect to the separation of responsibility for evaluation and education, the ACP-ASIM believes the ABIM should set the standards for evaluation and administer the examination and other entities, such as ACP-ASIM, should be responsible for education. The ABIM has said it will "develop a plan whereby evaluation and self-assessment required for CPD and education, reflective of the mission and expertise of the College, are integrated into an effective program for demonstration of maintained competence."
With respect to the continuing medical education necessary for continued competence, a joint staff group will develop a proposal for review by the Joint Committee.
At the January meeting of the College's Board of Regents, there was extensive discussion of the dialogue with ABIM and the results achieved so far. We all recognize that, although the initial results are encouraging, the devil will be in the details. The Joint Committee is working hard to bring more concrete outcomes to the Board of Regents meeting that will be held in Atlanta in March before Annual Session.
We will keep you, our members, informed of our progress on an ongoing basis through reports in ACP-ASIM Observer and on the ACP-ASIM Web site. We welcome any comments you might wish to bring to our attention. They can be sent to Herbert S. Waxman, FACP, by mail to College headquarters, by fax to 215-351-2594, or by e-mail to firstname.lastname@example.org. We strongly believe that two-way communication will ensure that the College continues to represent your best interests.
Bernard Rosof, FACP, Joint Committee on Recertification Co-chair and Chair-elect of the Board of Regents
Barbara Schuster, MACP, Regent
Barbara McGuire, FACP, Governor for New Mexico
Herbert S. Waxman, FACP, ACP-ASIM staff to Joint Committee on Recertification
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