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

• Examines 30,000 candidates each year for certification and recertification

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.”

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

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.

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:

Annual Program Director Ratings

• Clinical judgment• Medical knowledge• Clinical skills• Medical care• Humanistic qualities• Professionalism• Moral-ethical behavior

Internal Medicine Training

408 Internal Medicine training programs1,400 Subspecialty training programs

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.

2002 ABIM Internal Medicine Certification Examination: Group Size & Pass Rates

Total Exam Group 7,074% Passing 87

Subspecialty Internal Medicine

• Rapid growth beginning about 1970

• 16 areas now recognized

• Effect of market forces on subspecialization

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:

IM Subspecialty Certificates• Allergy and Immunology• Cardiovascular Disease• Endocrinology, Diabetes, and Metabolism• Gastroenterology• Hematology• Infectious Disease• Medical Oncology• Nephrology• Pulmonary Disease• Rheumatology

IM Certificates of Added Qualifications

• Adolescent Medicine• Clinical Cardiac Electrophysiology• Critical Care Medicine• Geriatric Medicine• Interventional Cardiology• Sports Medicine

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

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

Changing Environment

• Public expectation• Payer pressures• Government concerns

Challenges of Recertification

• Clinical relevance• Quality improvement• Practice environments• Advancing science• Computer-based testing

ABIM Foundation

• Physician quality• Professionalism

Lynn O. Langdon, MSSenior Vice President, SubspecialtyMedicine and Chief Program Officer

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

CollaborationsEducational Hyperlinks

SEP-Based Learning Sessions

CPD Credit for Self-Assessment Programs

Practice Improvement Module Links

Other Creative Ideas

Educational HyperlinkEducational Material

ASA LinkWhich of the following is part of the face?

(A) nose(B) foot(C) hand(D) heart

ASA’s Website

The face is comprised of several physical features: two eyes, a nose, a mouth, two ears, two eyebrows…

The Face

SEP-Based Learning Sessions

Educational courses at annual or region meetings organized around group completion of an SEP for CPD credit, facilitated by ABIM.

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.

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.

CPD At-A-GlanceSummer 2003

Continuous Professional Development

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

• 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?

• Self-evaluation• Secure examination• Credentials review

What Are the Components of CPD?

•Medical Knowledge•Clinical Skills•Patient and Peer Assessment•Practice Improvement

Four Types of Self-Evaluation Modules

• 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

• 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

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

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 ...”

• 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

Self-Evaluation of Practice Improvement

Practice ReportPractice Reportandand

Improvement Improvement PlanPlan

Impact Impact ReportReport

Chart Review Chart Review Patient SurveyPatient SurveyPractice ReviewPractice Review

• 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

Practice Improvement Modules

Under DevelopmentAcute Myocardial InfarctionAsthma

Care of Vulnerable ElderlyCommunity-Acquired PneumoniaDepressionHeart FailureHypertensionOsteoarthritisOsteoporosis

Clinical Preventive ServicesDiabetesPreventive Cardiology

• 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

• 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

• 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

Overall Recertificatio

n ExaminationPass Rate:

95%

Credentials VerificationCredentials Verification

Current StaffAppointment

UnrestrictedUnrestrictedMedical LicenseMedical License

ID

Examination

Credentials

CPD For Multiple CertificatesIM

1st through 10th year after Certification

IM

Examination

Credentials

ID

Self-Evaluation

• 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

To apply, order modules, register for

an exam,or check your CPD

statusclick online services at

www.abim.org

CPD Questions:www.abim.org

request@abim.org(800) 441-2246

ext. 3593

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

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

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

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

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