Author + information
- Mariell Jessup, MD, FACC, FAHA∗ (, )
- ABIM Cardiovascular Specialty Board
- ↵∗Address correspondence to:
Dr. Mariell Jessup, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, Pennsylvania 19104.
As communicated in these pages previously, the American Board of Internal Medicine (ABIM) began a change in governance in mid-2013, establishing the council and specialty boards separate from their board of directors (1–3). The role of the board of directors is to focus on governance issues, and the council, which is primarily composed of the chairs of each specialty board, determines requirements for certification and maintenance of certification (MOC) for internal medicine (IM) and across all specialties, while harmonizing ABIM standards with those of other recognized physician education and assessment initiatives. The critical role of the specialty boards is to build partnerships with societies and other organizational participants so that their broad input can ensure ABIM policies and standards reflect the communities’ needs, ultimately targeting the common goal of improving patient outcomes. The specialty boards also have the essential role of deciding discipline-specific training requirements for initial certification eligibility. Specifically, the Cardiovascular Board (our name change from the Cardiology Board as of July 1, 2015, in response to the suggestion of many cardiologists) is charged with establishing a strong, bidirectional communication between the ABIM and many cardiac societies, including the American College of Cardiology (ACC), Heart Rhythm Society, Heart Failure Society of America, Society for Cardiac Angiography and Interventions, American Heart Association, and the Adult Congenital Heart Association, to name a few.
The Cardiovascular Board (shown in Table 1 and reported previously ) met for the first time on March 27, 2015, and had 1.5 days to assimilate the details of the ABIM structure, the current processes of developing and grading certification and MOC written examinations, and the path that ABIM diplomates must currently negotiate to maintain their cardiovascular certification. Most importantly, we had time to understand what the ABIM now views as missteps in their revision of the MOC program (5); our Board members reported back the responses from the cardiovascular community, ranging from disgruntled and angry expressions of disagreement to an irate call for an alternative credentialing organization (6). Here are some of our observations as well our first step toward improving the MOC process as it relates to cardiovascular physicians.
What We Have Learned and Want to Report to the Cardiovascular Community
1. IM and IM specialties fall under the aegis of the ABIM. The ABIM, in turn, is part of a larger confederation, the American Board of Medical Specialties (ABMS). The ABMS works in collaboration with 24 specialty member boards (e.g., orthopedics, pediatrics, dermatology, and so on) to maintain the standards for physician certification. The ABMS originated the obligation for their member boards to require the practice assessment, patient safety, and the patient voice programs (known collectively as Part IV) to be an important part of MOC. Thus, physicians outside of IM are likewise struggling with the increased complexity of maintaining their respective certificates.
2. The members of the ABIM’s board of directors, council, and staff have proceeded through a series of measures to ensure that their next steps in the MOC program are created in tandem with all relevant stakeholders in the community. A number of larger meetings in this respect have already occurred. In addition, the cardiovascular societies have been particularly vocal in their commitment to lifelong learning, a value that cardiologists have long cherished, while outlining their strong recommendations to make the ABIM relevant to the cardiovascular constituency. The ACC has reported this to its members in multiple venues (1,4).
3. We spent a considerable time discussing the values that the larger IM community might share with respect to a physician’s initial certification and ongoing ability to stay current and competent. What is the value of CME courses or online learning: a repeat examination every 10 years or the role of an individual physician in maintaining proficiency? Moreover, we speculated on the role of the ABIM beyond administering the initial certification examination. These issues are important areas for which we hope to receive regular feedback from our cardiovascular colleagues.
4. The ABIM has received many complaints that the 10-year MOC examinations, obligatory since 1990, are testing obscure, clinically irrelevant facts designed by academics from elite universities who are remote from the daily practice of cardiology. The ABIM has already taken measures to improve the relevancy of the examinations, beginning with the IM examination itself. One of the jobs of the Cardiovascular Board is to supervise the blueprint of the cardiovascular examination, along with that of the secondary specialties of interventional, electrophysiology, adult congenital, and advanced heart failure. It is possible that, in the future, the MOC examination in cardiology and the secondary specialties will be different from the initial certification examination. The council has already approved this concept. This reflects the often observed fact that physicians taking the initial certification examination are entirely different from the experienced physicians taking the MOC examination. In addition, the blueprint of each examination will be vetted by a large group of ABIM diplomates to grade areas on the blueprint as clinically relevant, critical knowledge, or both.
5. Many members of our board thought the rules and regulations of the ABIM are too complex, and there was a strong voice to simplify everything. For example, we learned that there are 3 types of certificates:
• “Lifetime” certificates (“grandfathers”)
○ Issued before 1990
○ Valid indefinitely
• Time-limited certificates
○ Issued from 1990 to 2013
○ Valid for 10 years from date of issue
• “Must-be-maintained” certificates
○ Issued for diplomates who took the examination for initial certification in 2013 and after, and for MOC certificates in 2014 and after
○ Ongoing validity is contingent upon “participating in MOC”
6. It took Board members some time to understand the current MOC requirements since they were modified in February 2015. We reproduce a simplified explanation here:
• ABIM reports “participating in MOC” at the level of the physician and not at the certificate level. Thus, any MOC activity in any area of IM qualifies as participation.
• To be “participating in MOC,” diplomates must:
○ Maintain a valid, unrestricted medical license
○ Complete an MOC activity every 2 years
○ Earn 100 MOC points every 5 years
▪ Points may be in self-assessment of medical knowledge or practice assessment
○ Pass an MOC examination every 10 years
Many cardiac societies have developed modules for self-assessment of medical knowledge that are often free to members. For example, the ACC releases new modules every few months covering general cardiology, new guidelines, and more specific specialty areas (7). The ABIM creates new self-assessment of medical knowledge modules for general cardiology and for each of the cardiology specialties every 2 to 3 years; they are available at no additional charge to diplomates participating in MOC.
Our First Step to Improve Cardiovascular MOC
Currently, cardiologists who choose to maintain their certification in their secondary subspecialty (interventional, electrophysiology, adult congenital, and advanced heart failure) must also maintain an underlying MOC in cardiovascular medicine; this affects about 30% of cardiologists. Our Cardiovascular Board voted to explore this issue further. We are currently partnering with multiple cardiac societies to poll their membership regarding this ABIM policy. If we hear that cardiologists would rather choose which certification to maintain rather than be mandated a route, it is expected that we can facilitate this policy change.
These are challenging times for our cardiovascular community. The path of changes that the ABIM has created for MOC is now vitally dependent on IM diplomates’ constructive input into the process. The Cardiovascular Specialty Board, in partnership with the ACC and other cardiac societies, is poised to listen to your views.
- American College of Cardiology Foundation
- O’Gara P.T.,
- Oetgen W.J.
- Ting H.H.,
- Bates E.R.,
- Beliveau M.E.,
- et al.
- American Board of Internal Medicine. ABIM governance overview. Available at: https://www.abim.org/pdf/specialty-boards/governance-fact-sheet.pdf. Accessed May 12, 2015.
- O’Gara P.T.,
- Oetgen W.J.
- ↵American Board of Internal Medicine. ABIM announces immediate changes to MOC program. Available at: http://www.abim.org/news/abim-announces-immediate-changes-to-moc-program.aspx. Accessed May 12, 2015.
- ↵American College of Cardiology. Online learning catalog. Available at: http://www.acc.org/education-and-meetings/education-catalog. Accessed May 12, 2015.