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College and ABIM outline ongoing evolution in recertification

From the September ACP Observer, copyright 2004 by the American College of Physicians.

Recent discussions between ACP and the American Board of Internal Medicine (ABIM) are leading to new options being created for recertifying physicians—as well as a rapid evolution in the recertification (now called maintenance of certification) process.

According to Steven E. Weinberger, FACP, the College's Senior Vice President for Medical Knowledge and Education, ABIM's board of directors has agreed to allow recertifying physicians to complete MKSAP as a way to fulfill one of the major components of the maintenance of certification process.

However, Dr. Weinberger pointed out that those process components are changing and that the use of MKSAP is being tied to a redefinition of component requirements that will take effect within a year. Currently, recertifying physicians must complete five ABIM modules, chosen from available ones that target knowledge self-assessment, external patient-peer evaluation, or practice evaluation and improvement.

That five-module requirement is now evolving into two separate components that will be aligned with a program established by the American Board of Medical Specialties. Those two components will include: up to three modules for self-assessment of knowledge, and the remainder for practice performance evaluation. Within this new maintenance of certification framework, MKSAP can fulfill up to three knowledge modules, if recertifying physicians will also evaluate their practice performance.

In their 2002 Memorandum of Understanding on recertification, the College and the ABIM agreed to postpone requiring the completion of any practice evaluation modules as part of recertification until 2010. However, College leadership and the ABIM now agree that including an evaluation of practice performance should no longer be postponed.

"That is being driven by the fact that nationally, there is a great deal of movement toward having physicians assess and improve their performance," Dr. Weinberger said. "Because physicians are being asked to do more practice assessment anyway, we want to provide them with multiple options to improve their practice, as well as to fulfill the practice evaluation component of recertification."

With a target date sometime in 2005, ABIM will ask recertifying physicians to demonstrate an evaluation of their performance in practice, accompanied by a plan for improvement. At the same time, recertifying physicians will complete up to three knowledge self-assessment process modules—instead of the five that are now required—and they will be able to use MKSAP to fulfill that knowledge requirement.

According to Dr. Weinberger, both the College and the ABIM are beginning to actively assess other practice evaluation methods that, in addition to the ABIM's practice improvement modules, recertifying physicians will be able to use to fulfill the practice evaluation component of the program.

At the same time, a joint ABIM-ACP work group is now examining options for improving another component of the recertification process: the secure, closed-book exam. As with substituting MKSAP for the self-evaluation modules, the work group's goal will be, Dr. Weinberger said, "to make this process as user-friendly and effective as possible for recertifying physicians."

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