christine k. cassel, m.d. president and ceo abim-at-a-glance
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Christine K. Cassel, M.D. President and CEO ABIM-At-A-Glance. American Board of Internal Medicine. Established 1936 as a not-for-profit, independent organization All revenues come from certification fees 29 Directors, voluntary/staff model - PowerPoint PPT PresentationTRANSCRIPT
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Christine K. Cassel, M.D.President and CEO
ABIM-At-A-Glance
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American Board of Internal Medicine
• Established 1936 as a not-for-profit, independent organization
• All revenues come from certification fees
• 29 Directors, voluntary/staff model
• Examines 30,000 candidates each year for certification and recertification
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ABIM Mission Statement“To enhance the quality of health care available to the American public by continuously improving the process and maintaining high standards for certifying internists and subspecialists who possess the knowledge, skills and attitudes essential for the provision of excellent care.”
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ABIM’s Core Values• Assuring the public of the highest quality
patient care• Professionalism and excellence in the
practice of medicine• Science-based medicine and intellectual
rigor• Leadership in evaluation and standard
setting• Maintaining autonomy to preserve these
values
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Specialty Board Certification• Time-limited certification is offered by
twenty-four officially recognized specialty boards.
• Specialty boards are private, non-profit certifying organizations with many stakeholders but no true constituency.
• Certification is voluntary but 87% of all U.S. doctors possess this credential.
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Requirements for IM Certification
• complete the required pre-doctoral medical education
• meet the post-doctoral training requirements
• demonstrate clinical competence in the care of patients
• meet the licensure requirements• pass the secure examination
Candidates must:
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Annual Program Director Ratings
• Clinical judgment• Medical knowledge• Clinical skills• Medical care• Humanistic qualities• Professionalism• Moral-ethical behavior
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Internal Medicine Training
408 Internal Medicine training programs1,400 Subspecialty training programs
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ABIM Certification Examination
• Objective, reproducible, and valid method for assessing medical knowledge and clinical judgment.
• Indispensable to board certification in internal medicine and the medical subspecialties.
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2002 ABIM Internal Medicine Certification Examination: Group Size & Pass Rates
Total Exam Group 7,074% Passing 87
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Subspecialty Internal Medicine
• Rapid growth beginning about 1970
• 16 areas now recognized
• Effect of market forces on subspecialization
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Requirements for Certification in a Subspecialty or Added Qualification
• be previously certified in Internal Medicine by the ABIM
• complete the requisite training• demonstrate clinical competence in
the care of patients• meet the licensure requirements• pass the secure examination in a
subspecialty or area of added qualifications
Candidates must:
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IM Subspecialty Certificates• Allergy and Immunology• Cardiovascular Disease• Endocrinology, Diabetes, and Metabolism• Gastroenterology• Hematology• Infectious Disease• Medical Oncology• Nephrology• Pulmonary Disease• Rheumatology
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IM Certificates of Added Qualifications
• Adolescent Medicine• Clinical Cardiac Electrophysiology• Critical Care Medicine• Geriatric Medicine• Interventional Cardiology• Sports Medicine
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ABIM Subspecialty Examinations
First-time Taker Pass RatesCardiology 701 83%CCEP 89 78%Critical Care Medicine 393 86%Endocrinology 227 88%Gastroenterology 339 84%Geriatrics 311 86%
Year 2002 N % Pass
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ABIM Subspecialty Examinations
First-time Taker Pass RatesHematology 260 75%Infectious Diseases 274 83%Interventional Cardiology570 63%Medical Oncology 458 77%Nephrology 367 89%Pulmonary Disease 427 83%Rheumatology 171 87%
Year 2002 N % Pass
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Changing Environment
• Public expectation• Payer pressures• Government concerns
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Challenges of Recertification
• Clinical relevance• Quality improvement• Practice environments• Advancing science• Computer-based testing
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ABIM Foundation
• Physician quality• Professionalism
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Lynn O. Langdon, MSSenior Vice President, SubspecialtyMedicine and Chief Program Officer
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Educational SupportSome of our Collaborators
American Association for the Study of Liver Disease
American College of CardiologyAmerican College of Chest PhysiciansAmerican College of Rheumatology
American Gastroenterological AssociationAmerican Geriatrics Society
American Society of NephrologyNational Kidney Foundation
Society of Critical Care Medicine
American College of Physicians
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CollaborationsEducational Hyperlinks
SEP-Based Learning Sessions
CPD Credit for Self-Assessment Programs
Practice Improvement Module Links
Other Creative Ideas
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Educational HyperlinkEducational Material
ASA LinkWhich of the following is part of the face?
(A) nose(B) foot(C) hand(D) heart
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ASA’s Website
The face is comprised of several physical features: two eyes, a nose, a mouth, two ears, two eyebrows…
The Face
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SEP-Based Learning Sessions
Educational courses at annual or region meetings organized around group completion of an SEP for CPD credit, facilitated by ABIM.
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CPD Credit forSelf-Assessment Programs
Credit for up to 2 modules (120 questions) for questions that are part of a society educational program.
Questions must meet ABIM standards of content and performance; pretest data is required to assess performance.
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Practice Improvement Module (PIM) Links
PIMs use chart review, review of practice systems, patient surveys and quality improvement to assess performance.
Creates opportunities for educational links and data collection for complementary programs. Diplomates will need resources to help with their quality improvement activities.
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CPD At-A-GlanceSummer 2003
Continuous Professional Development
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The Context for CPD1974 Voluntary ABIM Recertification Program1990 ABIM Certificates Limited to 10 years1999 “To Err is Human” - Institute of
Medicine2001“The Quality Chasm” –
Institute of Medicine2002 American Board of Medical Specialties
Maintenance of Certification Report
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• Continuous self-improvement—cornerstone of professional excellence
• Certification of knowledge alone not sufficient
• Evaluation of clinical skills and practice performance essential to assure quality, public accountability
• Goal: relevant, useful process for diplomates and healthcare systems
Why CPD?
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• Self-evaluation• Secure examination• Credentials review
What Are the Components of CPD?
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•Medical Knowledge•Clinical Skills•Patient and Peer Assessment•Practice Improvement
Four Types of Self-Evaluation Modules
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• Multiple choice questions• Up-to-date knowledge• At home, open-book• Some have electronic links to society
educational resources• CME credits• Pass/fail module; repeat as needed• Feedback = incorrect responses• Available in paper, CD, or web-based
formats
Self-Evaluation of Medical Knowledge
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Medical KnowledgeUnmarkedA 28 year-old black woman (gravida 3, para 2) is referred to you
because of an abnormal glucose tolerance test. Her previous pregnancies were uncomplicated, and the babies were healthy and of normal size at birth. A standard 50-gram glucose challenge was done in the 24th week of pregnancy; one-hour plasma glucose level was 155 mg/dL. She is not obese and has been in good health otherwise. Her mother has type 2 diabetes mellitus. A followup 100-gram, three-hour glucose tolerance test yields the following results:
Basal 110 mg/dLOne hour 190 mg/dL
Two hours 160 mg/dLThree hours 155 mg/dL
You advise exercise, appropriate diet, and home blood glucose monitoring. During the first week, results of home monitoring show fasting blood glucose levels between 100 and 115 mg/dL and postprandial levels between 140 and 160 mg/dL.
Educational Material
Society 1 Link
Which of the following measures is most appropriate now?(A) No further measures(B) Repeat glucose tolerance test in four weeks(C) Begin insulin therapy(D) Begin metformin therapy
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• Interactive CD-ROM technology• Multiple choice questions in physical
exam and communications• At home, choice of resources/colleagues• CME credits• Pass/fail module; repeat as needed• Feedback = incorrect responses
Self-Evaluation of Clinical Skills
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Physical Examination Skills
UnmarkedA 22-year-old male college student comes to your office following a syncopal episode that occurred during wrestling practice. He was unconscious for less than one minute, according to a coach. During the past year, he has had several episodes of lightheadedness with exertion. A heart murmur was detected when he was 10, and his younger brother also has a murmur. Pulse rate is 60 per minute, and blood pressure is 120/80mm Hg in both arms. Jugular venous pulses are normal. The apical impulse is in the fifth intercostal space at the midclavicular line; it is 3cm in diameter and has a presystolic component. Auscultatory findings at the upper left sternal edge are demonstrated in the model
The murmur is loudest at the mid-left sternal edge. Auscultatory findings are demonstrated
You perform the diagnostic maneuver shown
Which of the following is the most likely diagnosis?
(A) Mitral regurgitation
(B) Tricuspid regurgitation
(C) Atrial septal defect
(D) Ventricular septal defect
(E) Hypertrophic obstructive cardiomyopathy(F) Valvular aortic stenosis
(click here for video).
(click here for video).
(click here for video).
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Communication SkillsUnmarked
Which of the following will be the most likely patient outcome of the physician’s counseling tactic?
(A)
(B)
(C)
(D)
Better understanding of the risks associated with smoking
Willingness to seek additional information
Less defensiveness when discussing his habit
More motivation to quit smoking
A 28 year-old man is evaluated by his general internist for an acute respiratory tract infection. The infection is the third of its kind in the last year. The patient has smoked at least one pack of cigarettes daily since high school.
After completing the physical examination, the physician prescribes treatment for bronchitis. Believing that the patient’s recurrent infections are related to his continued smoking, the physician decides to address the issue.
Click here for video
AAPPClick Here
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QualityQualityImprovementImprovement
PlanPlan
Summary ReportSummary Report40 Patients 1040 Patients 10 20 Peers 25 20 Peers 25Self-AssessmentSelf-Assessment
Interactive Interactive Voice Response Voice Response System Asks the System Asks the
QuestionsQuestions
Self- Evaluation of Patient and Peer Feedback
Distribute SurveysDistribute Surveys40 Patients40 Patients
20 Peer20 Peer
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Patient Feedback Component
• is truthful, frank• treats me
respectfully, never talks down
• is interested in me as a person
• discusses optionswith me
• encourages my questions
• uses words I can understand
“My Doctor ...”
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• Medical knowledge• Management of
multiple complex problems
• Management of hospitalized patients
• Overall clinical skills
• Respect• Integrity• Approach to
psychosocialaspects of illness
• Problem-solving
How do you rate this physician’s …
Physician Feedback Component
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Self-Evaluation of Practice Improvement
Practice ReportPractice Reportandand
Improvement Improvement PlanPlan
Impact Impact ReportReport
Chart Review Chart Review Patient SurveyPatient SurveyPractice ReviewPractice Review
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• Collect data on prevention of CHD• Patient characteristics• BP, Lipids• ASA, Beta-block, ACE-ARB prescribing• Patient satisfaction and involvement
in care• Review practice systems• Analyze practice report and make a
plan• Study the impact of the change
Preventive Cardiology PIM
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Practice Improvement Modules
Under DevelopmentAcute Myocardial InfarctionAsthma
Care of Vulnerable ElderlyCommunity-Acquired PneumoniaDepressionHeart FailureHypertensionOsteoarthritisOsteoporosis
Clinical Preventive ServicesDiabetesPreventive Cardiology
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• 60 MCQs/module• 3 modules• High relevance ratings• Absolute pass/fail standard• Offered twice a year • Multiple test centers• Paper exam• Transition to computer exam by 2006
CPD Examination
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• Between 2004-2006 ABIM will move all exams to a computer format
• Certification exams will be phased in 2005-2006
• Recertification exams will be phased in 2004-2006
Coming Soon: Computer-Based Testing
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• Greater number of centers; more conveniently located and comfortable
• Individual workstations; more professional and private
• Enhanced graphics; better quality reproduction and multi-media capability
Advantages of Computer-Based Testing
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Overall Recertificatio
n ExaminationPass Rate:
95%
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Credentials VerificationCredentials Verification
Current StaffAppointment
UnrestrictedUnrestrictedMedical LicenseMedical License
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ID
Examination
Credentials
CPD For Multiple CertificatesIM
1st through 10th year after Certification
IM
Examination
Credentials
ID
Self-Evaluation
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• Enroll in CPDwww.abim.orgClick on “online services”1-800-441-2246 Ext 3593
• Complete 5 self-evaluation modules by 12/31 of year certificate expires
1 Medical Knowledge in certificate area4 Electives
• Register for May or November examination• Submit credentials verification forms
What to do if your What to do if your certificate expires sooncertificate expires soon
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To apply, order modules, register for
an exam,or check your CPD
statusclick online services at
www.abim.org
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Medical Knowledge
Professional Behavior
Professional Behavior
Competent Patient Care
Medical Knowledge
Performance in Practice
Formal Training
Life-long Learning
Faculty Evaluation Self-EvaluationCertification Maintenance
ABIM Certification Elements
Examination
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ABIM’s Self-Evaluation ModulesABIM’s Self-Evaluation Modules
Medical Knowledge
Clinical Skills
Practice Improvement
Peer & Patient FeedbackProfessional Behavior
Performance in Practice
Life-long Learning
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Self-Evaluation ProcessSelf-Evaluation ProcessGives physicians ownership in
quality improvementExposes a gap between current and
ideal performanceStimulates practice-based learning
and improvementChanges part of certification from
quality assessment to quality Improvement
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Measure current practice compared to established guidelines
Change practice to improve care Demonstrate competence in systems-based practice and
practice-based learning and improvement
Objectives of Practice Improvement Modules
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Automatic practice analysis
Practice improvement plan
Test of Change
Chart review Practice surveyPatient survey
PD
S
A
Data Collection
Plan for Improvement
Practice Improvement Module
Impact