Life Science Compliance Update

February 15, 2017

ABIM Increases Physician Choice with New Assessment Option

ABIM

The American Board of Internal Medicine (ABIM) is providing more choice to physicians who are working to maintain their board certification. ABIM has decided to take this step after physicians asked for more flexible options that affirm to themselves, their patients, and their peers that they are staying current in medical knowledge.

As ABIM has been re-thinking the process for continuous certification, the organization invited all 200,000 ABIM Board Certified physicians and twenty-seven medical societies to share input. This first phase of dialogue guided the ABIM Council, a body of practicing physicians from several internal medicine subspecialties, to update the assessment process.

The option that emerged as the one that provided the most choice, relevance and convenience was short assessments every two years emerged. This will help physicians to maintain their certification and confidence that they are staying current in their education.

Physicians will able to choose to take assessments every two years or every 10 years. 

Details about the two-year assessment

  • You can choose to take the two-year assessment on your personal or work computer – or at a testing center.
  • You do not need a passing score on every two-year assessment. However, if you are unsuccessful twice in a row or if there is a longer gap between assessments, you will need to take additional steps to maintain certification.
  • You will have more dates from which to choose when scheduling the two-year assessment.
  • This “knowledge check-in” offers more continuous learning, feedback and improvement. Results will be available immediately after the assessment. More feedback will follow.

General Details

  • Beginning in 2018, physicians certified in Internal Medicine can choose to take shorter “knowledge check-ins”—at the location they choose—every two years.
  • To assist physicians with adjusting to changes—and for ABIM to learn from the process— there will be no consequences for unsuccessful performance on the two-year assessment in 2018.
  • ABIM will share updates on availability of these options for subspecialties in the coming months.
  • Physicians can still choose to take an assessment every 10 years in a testing center. ABIM is continuing to collaborate with physicians to make this option more reflective of practice.
  • ABIM is also working to make the 10-year assessment open book.

Dr. Richard J. Baron, President and CEO of ABIM, created a video message about these changes, which can be found here.

Industry Reaction

 “ABIM is changing because physicians are changing it. We are very proud to be collaborating with the many doctors who are constructively helping us update the assessment process,” said Richard J. Baron, MD, ABIM’s President and CEO and a board certified internist who practiced for 30 years in his Philadelphia community.

“Doctors want a certification program that integrates into their daily routine, while affirming to their patients and peers that they have up-to-date medical knowledge. That is exactly why ABIM is introducing assessment options.”

“By involving physicians in every step of the process, ABIM has been able to simplify its programs to focus on meaningful activities that increase knowledge, provide doctors confidence in their practice, and allow doctors more time to devote to patient care,” said Jeanne M. Marrazzo, MD, Chair of ABIM Council. “This work is constantly evolving as we move forward, and we’re proud that the steps we’re taking are informed by physicians who are dedicated to improving patient care.”

“The number of activities is just unprecedented in terms of ways we've been partnering with the physician community. Again, not abandoning the core principle of saying board certification means something,” said Clarence H. Braddock, III, MD, Chair of the ABIM Board of Directors. “It’s a badge of honor to have mastered a body of clinical knowledge and skills that you want to be able to proudly display, but at the same time, we want to make sure that it’s realistic and relevant through the eyes of the practicing physician.”

January 30, 2017

Education at ACC Chapter Meetings Positively Impacts Management of Severe or Resistant Hypercholesterolemia: Preliminary Results

Medical-education

Despite guideline-directed statin therapy, the majority of patients with severe hypercholesterolemia and other high-risk populations continue to have a substantial residual risk of cardiovascular disease (CVD). In patients with severe or resistant hypercholesterolemia, new and emerging treatments to reduce low-density lipoprotein cholesterol (LDL-C) offer additional options to control CVD risk.

To address the gap in care of patients with severe or resistant hypercholesterolemia and enhance awareness about emerging agents, an educational series comprised of five 1-hour lectures was developed by a steering committee of two expert faculty. The content was developed to provide guideline-driven information and clinical trial data on reducing LDL-C levels in patients with severe or resistant hypercholesterolemia who are at high risk for CVD. The activities were held in conjunction with regional chapter meetings of the American College of Cardiology (ACC).

To date, three lectures have taken place, with a total of 186 participants attending. Nearly three-quarters of attendees were MDs/DOs, 62% of whom specialized in cardiology. The majority of participants (60%) reported seeing more than 60 patients with hypercholesterolemia each month. The activity content was found to be highly relevant to the participating clinicians, with 99% agreeing it prepared them to better care for patients and gave them tools/knowledge to change practices to improve care. Interestingly, even in this highly-experienced group of cardiologists, as many as 69% of participants indicated that at least half of the content was new to them.

Preliminary outcome findings demonstrate that participation increased attendee confidence regarding their management of patients with severe/resistant hypercholesterolemia who are at risk for major adverse cardiovascular events. At baseline, 60% of participants felt “confident,” “very confident,” or “expert,” which rose to 90% post activity. After the activity, 78% of participants reported that they will increase monitoring of patient LDL-C levels to assess compliance and response to therapy after participating in this activity, indicating that the education has the potential to positively impact the care of patients with severe or resistant hypercholesterolemia who are at risk of CVD.

Early results also suggested improved knowledge regarding the degree of reduction in the risk of major adverse CVD events with LDL-C reduction to 50 mg/dL (pre-test, 25%; post-test, 73%; P<0.005); the impact of statins on CVD risk (pre-test, 23%; post-test, 56%; P<0.005); and the beneficial impact of LDL-C reduction on the rates of adverse clinical events (pre-test, 42%; post-test, 71%; P<0.005). Improved post-test knowledge was also observed regarding agents for lipid reduction, including CTEP inhibitors, which are still in development (pre-test, 20%; post-test, 80%; P<0.005); identifying the drug class for PCSK9 inhibitors (pre-test, 77%; post-test, 97%; P<0.005); and the indication of a microsomal triglyceride transfer protein inhibitor and an oligonucleotide inhibitor of apo B-100 synthesis (pre-test, 48%; post-test, 90%; P<0.005).

Based on the calculation of the effect size, it is estimated that the cardiologists who attended the activity are 55.4% more likely to deliver evidence-based care to the 83,000 patients seen each year with severe/resistant hypercholesterolemia who are at risk for major adverse cardiovascular events.

In conclusion, while additional data are needed, these preliminary observations support the concept that this regional lecture series has a positive impact on cardiologists’ knowledge, confidence, and practice in managing patients with severe or resistant hypercholesterolemia. In addition to collecting more data from participants at the remaining two venues, we will collect insights into their practice changes during a follow-up survey sent approximately 6 weeks after each live activity.

The initiative, “Managing Severe or Resistant Hypercholesterolemia: The Next Generation of LDL-C Lowering Agents,” is jointly provided by the Potomac Center for Medical Education and Rockpointe and supported by an educational grant from Amgen. The Potomac Center for Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Authors

Carole Drexel, PhD, CHCP, Rockpointe Corporation and Potomac Center for Medical Education, Columbia, MD

Kathy Merlo, CHCP, Rockpointe Corporation and Potomac Center for Medical Education, Columbia, MD

Leanne Berger, Rockpointe Corporation and Potomac Center for Medical Education, Columbia, MD

Thomas Sullivan, Rockpointe Corporation and Potomac Center for Medical Education, Columbia, MD

December 09, 2016

AMA Calls for End to Manditory Secured Exam for MOC

THR_Sept_2007_pp12_01

In June 2016, at the AMA House of Delegates meeting in Chicago, one of the topics discussed was Maintenance of Certification. However, what was not mentioned in the AMA press (or really, any other press) was the fact that the AMA officially opposes mandatory ABMS recertification exams.

Interestingly, the position took place with little fanfare: it wasn’t listed in the Top 10 Stories from the AMA 2016 Meeting, nor was it listed in the coverage of the MOC resolutions that passed. It was only mentioned in tweets by attendees. AMA only focused on publicizing the following MOC resolutions:

  • Examining the activities that medical specialty organizations have underway to review alternative pathways for board recertification
  • Determining whether there is a need to establish criteria and construct a tool to evaluate whether alternative methods for board recertification are equivalent to established pathways
  • Asking the American Board of Medical Specialties to encourage its member boards to review their MOC policies regarding the requirements for maintaining underlying primary or initial specialty board certification in addition to subspecialty board certification to allow physicians the option to focus on MOC activities most relevant to their practice.

While the AMA House of Delegates Reference Committee C did try to amend the resolution that called for an “immediate end of any mandatory, recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process,” the HOD rejected modifications made by the committee, extracted it to a full vote on the house floor, and restored the language of the resolution. The resolution language, as passed, reads:

RESOLVED, That our American Medical Association call for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination.

There were several delegates that opposed the house action, saying that it shouldn’t try to do away with secure exams. Donna Sweet, MD, stated, “Secure simply means that it guarantees that you or the person are the person who is taking the test.”

ABMS, of course, opposes the AMA resolution. In a statement released by the Association, they stated:

Consumers, patients, hospitals and other users of the Board Certification credential expect board certified physicians to be up-to-date with the knowledge, judgment and skills of their specialty—both at the point of initial certification and along the physician’s career path – and to verify it through an external assessment. The privilege to self-regulate which physicians enjoy demands that we meet that expectation with more than just continuing medical education.

Continuing medical education is an important component of a physician’s continuous learning and an important part of Maintenance of Certification (MOC), but by itself is not sufficient to verify that a physician is up to date. The other components of MOC—professionalism, external assessment of knowledge, judgment and skills, and improvement in medical practice—are also important.

The AMA also approved a resolution to continue working with ABMS to “encourage the development by and sharing between specialty boards” of alternate ways to assess medical knowledge, other than by a secure exam. The AMA HOD also bolstered its support of using appropriate continuing medical education (CME) courses to maintain quality assessments of physicians.

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