1. REPRINT
ACP Observer
American College of Physicians News for Internists www.acponline.org
Vol. 24 No. 3 April 2004 Pages 2-3
The forces driving recertification in
internal medicine
By Christine K. Cassel, MACP
holders, we do not have “members,” marking sistent with other ABMS boards, we began
I t has been eight years since, as President of
ACP, I wrote an article for ACP Observer.
I appreciate the opportunity to return to
a key difference between the ABIM and
ACP.
Like the College, however, the ABIM is
issuing 10-year certificates. Time-limited cer-
tification asserts a philosophical view that
physicians have a professional responsibility
these pages in my role as president of the committed to promoting professional com- to demonstrate maintenance of knowledge
American Board of Internal Medicine petence and improving quality. Our mission and skills.
(ABIM). statement spells out this goal clearly: “To Many other specialties already required
Consistent with my new role, I took the assure patients and the profession that certi- diplomates to renew their certificates. The
exam that is part of the Continuous Pro- fied internists are competent to provide high- American Board of Family Practice, for
fessional Development (CPD) process in quality medical care in a compassionate, instance, has issued seven-year certificates
geriatric medicine last November, and humanistic, and ethical manner.” since its inception in 1974, while surgery has
thankfully, I passed. After completing one had 10-year limited certificates since 1969.
more self-evaluation module, I will have Certification defined
renewed my geriatrics certificate. This Board certification has always been a The role of the ABMS
process has given me first-hand knowledge of voluntary but highly respected credential The ABMS is the self-governing feder-
internists’ experience with the ABIM. recognized throughout the world. Certi- ation of recognized certifying boards that sets
Aside from shoring up my knowledge fication demonstrates that a physician has consistent standards. The ABMS plays sig-
of geriatrics, I’ve also learned in my initial completed intensive study, undertaken self- nificant roles in both certification and main-
months at ABIM that internists don’t always assessment and received good evaluations for tenance of certification (the phrase we now
fully understand the role of the Board. practice performance. Although substantial use for recertification).
Perhaps a little history might shed some data support the view that certification is a A good example of the ABMS’ unifying
light. marker of physician quality, it is just one step role is reflected in the framework it adopted
in physicians’ lifelong process of evaluation. in 1999 with the Accreditation Council for
The ABIM’s roots Certification used to be considered an Graduate Medical Education (ACGME).
The ABIM was established in 1936 by honorific credential. With changes in health After working through a five-year process
ACP and the AMA. It is the only internal care financing and delivery, however, certifi- involving many stakeholders, both groups
medicine board recognized by the American cation is becoming expected—and even endorsed six general competencies for all spe-
Board of Medical Specialties (ABMS), and required—by some health plans, medical cialties. That joint endorsement means that
only one of 24 specialty boards to be recog- groups and hospitals. Currently, 87% of physicians will be expected to demonstrate
nized by the ABMS. U.S. physicians are certified. these competencies in both training and cer-
Like all boards that belong to the For most of the ABIM’s history, certifi- tification.
ABMS, the ABIM is a private, not-for-prof- cation was a once-in-a-lifetime event that Those six competencies are in the fol-
it standard-setting organization that refers to was connected to completing residency lowing areas:
the physicians we certify as “diplomates.” training. But in 1974, the ABIM introduced Ⅺ patient care;
While certifying boards have many stake- voluntary recertification. In 1990, con- Ⅺ medical knowledge;
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2. Commentary
Ⅺ practice-based learning and im- ducible test. A national network of practic- how CPD functions—and how Board re-
provement; ing internists reviews all potential questions, quirements affect practicing internists.
Ⅺ interpersonal and communications and only questions that receive very high rat- From the beginning, the ABIM has been
skills; ings for relevance to clinical practice appear committed to a process that is efficient and
Ⅺ professionalism; and on exams. congruent with internists’ other quality
Ⅺ systems-based practice. Currently, most ABIM exams are improvement efforts. We realize that CPD
administered on paper at approximately 50 must be credible and rigorous, yet easy to
The ABMS framework for sites, but the Board is converting to comput- understand, relevant and flexible enough to
recertification er-based testing. By 2005, all CPD exams will apply to the entire range of internists’ inter-
The ABMS has used these competencies be administered at more than 200 profes- ests and careers.
as the basis for a “maintenance of certifica- sional centers throughout the United States, To help meet these commitments, the
tion” framework that consists of four compo- saving diplomates travel time and offering Board has sought collaborations with ACP
nents and is relevant to all the boards. In more flexibility. and other specialty societies. We also ini-
adopting this framework, each board agreed Ⅺ Part 4: Evaluation of performance tiated discussions with national organiza-
to promulgate a program suited to its spe- in practice. This ABMS requirement for tions, including the Joint Commission on
cialty with all components present. (See CPD represents the first time we are asking Accreditation of Healthcare Organizations
“How CPD recertification meets the ABMS physicians to participate in a quality im- and the National Committee on Quality
requirements” on this page.) provement project, an increasing expecta- Assurance.
Here is a closer look at how the CPD tion in health care. New ABIM tools will We hear diplomates’ concerns from in-
program addresses each of the four ABMS guide diplomates through the study of their ternists directly or through their professional
components. own practice. society representatives. I encourage you to
Ⅺ Part 1: Professional standing. The The first of these tools, practice im- talk to ABIM representatives at society
ABIM verifies diplomates’ credentials by provement modules, are now available for meetings, visit our Web site (www.abim.org),
assuring a clean license in the state or states preventive cardiology, asthma and diabetes, or contact us by e-mail (request@abim.org) or
where they practice. We also confirm good and other modules are being developed. phone (800-441-2246).
standing with local credentialing bodies. Because this is a new area, the modules
Ⅺ Part 2: Lifelong learning and self- are optional, although they count toward ABIM and medical societies
assessment. Traditional ABIM self-evalua- self-evaluation credit. To facilitate communication with
tion modules consist of 60 multiple-choice Diplomates may also select a module that medical societies, the ABIM and ACP estab-
questions focused on medical knowledge and
judgment. New types of modules have been
introduced to allow diplomates to evaluate
their clinical skills or focus on recent ad-
How CPD recertification meets the ABMS requirements
vances by specialty. We continue to work ABMS maintenance of certification ABIM’s CPD component
with professional societies to find new and
innovative ways to help diplomates complete Professional standing Credentials verification
self-evaluation.
Life-long learning and self-assessment Self-evaluation modules
Ⅺ Part 3: Cognitive expertise. The
secure, proctored exam is sometimes per- Cognitive expertise Secure exam
ceived as the biggest hurdle in the CPD Evaluation of performance in practice Practice improvement or patient-peer
process. All ABIM examinations are scored feedback modules
using an absolute standard, which means that
anyone who answers enough questions cor-
rectly will pass. In other words, there is no solicits feedback from patients and peers. This lished the Liaison Committee on Recer-
grading curve. module includes materials that are similar to tification (LCR) in 2002. This group
While I can attest that the exam requires the patient satisfaction surveys that practice includes representatives from many of the
preparation, our data suggest that the vast groups and Medicare regularly use. professional societies that collaborate on the
majority of diplomates are well-prepared. CPD process.
Between 1996 and 2003, 91% of diplomates Efforts to improve CPD We’re also working together to create
passed the CPD exam on their first attempt, To improve the CPD process, we at the concrete programs and resources. For
and 98% succeeded on repeated attempts. ABIM are investing considerable time and instance, five societies last fall offered work-
CPD exams are based on the same psy- effort in the process. To serve on the Board, shops at their annual meetings, with expert
chometric standards as ABIM certifying all directors and committee members must panels leading participants through a self-
exams, and all meet the highest industry enroll in CPD and work to renew their cer- evaluation module.
standards for an objective, reliable repro- tificates. This ensures that we understand Diplomates were able to attend an edu-
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3. Commentary
cational session with CME credit and then ticipate in a formal practice improvement Achieving and maintaining certification
submit their answers to the ABIM for CPD activity. sends a respectful message to our patients
credit. Because those sessions were so well- We’re also enthusiastic about an ACP about how the profession sets standards and
received, they are being expanded in number proposal to substitute MKSAP modules for upholds public expectations.
and frequency. ABIM-developed self-evaluation modules. As a standard-setting organization, the
Medical societies are now providing We’re making good progress on developing a ABIM takes its role in advancing physician
educational resources to help diplomates process and standards that will enable quality very seriously. At the same time, we
complete self-evaluation modules at home, MKSAP to count for up to two CPD knowl- recognize that the Board is just one element
through printed syllabi or electronic edge modules. That credit should be avail- in a wide network of individuals and organi-
resources. (ACP provides CME credit to able by the end of this year. zations, all working toward the same goal of
diplomates who complete modules on their improving quality. My hope is that our col-
own, as well as to those who pass the exam.) Why maintain certification? lective efforts will help us realize that goal
The ABIM and ACP recently received joint Historically, achieving certification has much more effectively than any one of us can
approval to use the Board’s new practice signaled that a physician has demonstrated a achieve alone. ■
improvement modules in an AMA pilot high level of competence.
study to assess a new type of CME credit. Demonstrating quality is a critical part Christine K. Cassel, MACP, is president
That credit will reward physicians who par- of our profession’s societal obligation. of the American Board of Internal Medicine.
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