5
|
Hawkins RE, Irons MB, Welcher CM, Pouwels MV, Holmboe ES, Reisdorff EJ, Cohen JM, Dentzer S, Nichols DG, Lien CA, Horn TD, Noone RB, Lipner RS, Eva KW, Norcini JJ, Nora LM, Gold JP. The ABMS MOC Part III Examination: Value, Concerns, and Alternative Formats. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1509-1515. [PMID: 27355778 DOI: 10.1097/acm.0000000000001291] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article describes the presentations and discussions at a conference co-convened by the Council on Medical Education of the American Medical Association (AMA) and by the American Board of Medical Specialties (ABMS). The conference focused on the ABMS Maintenance of Certification (MOC) Part III Examination. This article, reflecting the conference agenda, covers the value of and evidence supporting the examination, as well as concerns about the cost of the examination, and-given the current format-its relevance. In addition, the article outlines alternative formats for the examination that four ABMS member boards are currently developing or implementing. Lastly, the article presents contrasting views on the approach to professional self-regulation. One view operationalizes MOC as a high-stakes, pass-fail process while the other perspective holds MOC as an organized approach to support continuing professional development and improvement. The authors hope to begin a conversation among the AMA, the ABMS, and other professional stakeholders about how knowledge assessment in MOC might align with the MOC program's educational and quality improvement elements and best meet the future needs of both the public and the physician community.
Collapse
Affiliation(s)
- Richard E Hawkins
- R.E. Hawkins is vice president, Medical Education Outcomes, American Medical Association, Chicago, Illinois. M.B. Irons is senior vice president, Academic Affairs, American Board of Medical Specialties, Chicago, Illinois. C.M. Welcher is senior policy analyst, Medical Education Outcomes, American Medical Association, Chicago, Illinois. M.V. Pouwels is director, Medical Education Collaborations, American Medical Association, Chicago, Illinois. E.S. Holmboe is senior vice president, Milestone Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. E.J. Reisdorff is executive director, American Board of Emergency Medicine, East Lansing, Michigan. J.M. Cohen is director, Education, Department of Neurology, Mount Sinai Continuum; Headache Fellowship program director, Headache Institute and Adolescent Headache Center, Mount Sinai Roosevelt Hospital; and assistant professor of neurology, Icahn School of Medicine at Mount Sinai, New York, New York. S. Dentzer is senior policy adviser, Robert Wood Johnson Foundation, Washington, DC. D.G. Nichols is president and chief executive officer, American Board of Pediatrics, Chapel Hill, North Carolina. C.A. Lien is professor and vice chair for academic affairs, Department of Anesthesiology, Weill Cornell Medical Center, New York, New York. T.D. Horn is executive director, American Board of Dermatology, Newton, Massachusetts. R.B. Noone is executive director, American Board of Plastic Surgery, Philadelphia, Pennsylvania. R.S. Lipner is senior vice president, Evaluation, Research and Development, American Board of Internal Medicine, Philadelphia, Pennsylvania. K.W. Eva is associate director and senior scientist, Centre for Health Education Scholarship, and professor and director of education research and scholarship, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. J.J. Norcini is president and chief executive officer, Foundation for Advancement of International Medical Education and Research, Philadelphia, Pennsylvania. L.M. Nora is president and chief executive officer, American Board of Medical Specialties, Chicago, Illinois. J.P. Gold is chancellor, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Fiorilli PN, Minges KE, Herrin J, Messenger JC, Ting HH, Nallamothu BK, Lipner RS, Hess BJ, Holmboe ES, Brennan JJ, Curtis JP. Association of Physician Certification in Interventional Cardiology With In-Hospital Outcomes of Percutaneous Coronary Intervention. Circulation 2015; 132:1816-24. [PMID: 26384518 DOI: 10.1161/circulationaha.115.017523] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/14/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The value of American Board of Internal Medicine certification has been questioned. We evaluated the Association of Interventional Cardiology certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010. METHODS AND RESULTS We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined interventional cardiology (ICARD) certification status using American Board of Internal Medicine data. We compared in-hospital outcomes of patients treated by certified and noncertified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary end points were all-cause in-hospital mortality and bleeding complications. Secondary end points included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510,708 PCI procedures performed by 5175 physicians, case mix and unadjusted outcomes were similar among certified and noncertified physicians. The adjusted risks of in-hospital mortality (odds ratio, 1.10; 95% confidence interval, 1.02-1.19) and emergency coronary artery bypass grafting (odds ratio, 1.32; 95% confidence interval, 1.12-1.56) were higher in the non-ICARD-certified group, but the risks of bleeding and vascular complications and the composite end point were not statistically significantly different between groups. CONCLUSIONS We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency coronary artery bypass grafting in patients treated by non-ICARD-certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes and indicate a need to enhance the value of subspecialty certification.
Collapse
Affiliation(s)
- Paul N Fiorilli
- From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.)
| | - Karl E Minges
- From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.)
| | - Jeph Herrin
- From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.)
| | - John C Messenger
- From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.)
| | - Henry H Ting
- From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.)
| | - Brahmajee K Nallamothu
- From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.)
| | - Rebecca S Lipner
- From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.)
| | - Brian J Hess
- From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.)
| | - Eric S Holmboe
- From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.)
| | - Joseph J Brennan
- From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.)
| | - Jeptha P Curtis
- From Section of Cardiovascular Medicine, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia (P.N.F.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (K.E.M., J.J.B., J.P.C.); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (J.H., J.P.C.); Health Research & Educational Trust, Chicago, IL (J.H.); Department of Medicine, Division of Cardiology, University of Colorado, Denver, Aurora (J.C.M.); University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, New York (H.H.T.); University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor (B.K.N.); American Board of Internal Medicine, Philadelphia, PA (R.S.L., B.J.H.); Hess Consulting, St. Nicolas, QC, Canada (B.J.H.); and Accreditation Council for Graduate Medical Education, Chicago, IL (E.S.H.).
| |
Collapse
|