SAEM Vanderbilt Emergency Medicine PowerPoint Presentation

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ABEM CERTIFICATION

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American Board of Emergency Medicine (ABEM) Mission To protect the public by promoting and sustaining the integrity, quality, and standards of training in and practice of Emergency Medicine.

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ABEM Purposes To improve the quality of emergency medical care To establish and maintain high standards of excellence in the specialty of Emergency Medicine and its approved subspecialties To improve medical education and facilities for training emergency physicians, and subspecialists in approved ABEM subspecialties To evaluate specialists in Emergency Medicine who apply for initial certification and continuous certification and subspecialists in approved subspecialties who apply for subcertification, and continuous certification  To grant and issue to qualified physicians certificates or other recognition of special knowledge and skills in Emergency Medicine and approved ABEM subspecialties and to suspend or revoke same To serve the public, physicians, hospitals, and medical schools by furnishing lists of those diplomates certified by the American Board of Emergency Medicine

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Importance of Board Certification Recognition as a specialist Protecting the public Integrity Quality

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General Public & Board Certification Gallup poll commissioned by ABIM in 2003 83% of responders felt physicians should be evaluated by an independent board of physicians 90% felt physicians should be re-evaluated periodically

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ABEM EM Certification Journey In-training Examination Residency Training Credentialing Written & Oral Examinations Initial Certification Professional Standing Lifelong Learning & Self Assessment ConCert Examination Assessment of Practice Performance Continuous Certification

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ABEM In-Service Exam 225 questions 4.5 hour exam Annual testing date -- last Wednesday of February Questions are drawn from The Model of the Clinical Practice of Emergency Medicine It is a standardized examination used to judge an individual resident’s progress toward successful ABEM certification. There is a strong relationship between in-training and qualifying examination scores. Physicians with higher in-training scores have a higher likelihood of passing the qualifying examination and those with lower scores have a lower likelihood of passing the qualifying examination.

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The Model of the Clinical Practice of Emergency Medicine *Developed by six EM organizations *Based on an analysis of the clinical practice of EM *Composed of 1) listing of conditions and components 2) physician tasks 3) patient acuity *Basis for ABEM examinations

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ABEM Certification There are three steps to achieve Emergency Medicine certification: 1) applying and credentialing, 2) taking and passing a qualifying examination, formerly known as the written certification examination, and 3) taking and passing an oral certification examination. Physicians who successfully complete each of these steps are certified as diplomates of the American Board of Emergency Medicine (ABEM). Certification is for a period of ten years. To maintain certification, diplomates must participate in the Emergency Medicine Continuous Certification program (EMCC).

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Applying to Take ABEM Exam

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Initial ABEM Qualifying Written Exam *One-day examination *Criterion Referenced exam *Given at 200 PearsonVUE centers across US in the fall *6.5 hours, 335 multiple-choice questions (no penalty for guessing) *10-15% Exam have a pictorial stimulus *The examination is divided into two portions, one administered in the morning and the second administered in the afternoon ^The morning portion of the examination typically consists of standard single best-answer multiple-choice questions ^The afternoon portion of the examination typically contains pictorial single best-answer multiple-choice questions, in addition to standard single best-answer multiple-choice questions *Candidates must score at least 75% to take the oral examination

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ABEM Qualifying Exam Content Question Percentage Listing of Conditions & Components 1.0 Signs, Symptoms and Presentations 9% 2.0 Abdominal & Gastrointestinal Disorders 9% 3.0 Cardiovascular Disorders 10% 4.0 Cutaneous Disorders 2% 5.0 Endocrine, Metabolic & Nutritional Disorders 3% 6.0 Environmental Disorders 3% 7.0 Head, Ear, Eye, Nose & Throat Disorders 5% 8.0 Hematologic Disorders 2% 9.0 Immune System Disorders 2% 10.0 Systemic Infectious Disorders 5% 11.0 Musculoskeletal Disorders (Non-traumatic) 3% 12.0 Nervous System Disorders 5% 13.0 Obstetrics and Gynecology 4% 14.0 Psychobehavioral Disorders 3% 15.0 Renal and Urogenital Disorders 3% 16.0 Thoracic-Respiratory Disorders 8% 17.0 Toxicologic Disorders 4% 18.0 Traumatic Disorders 11%  Appendix I: Procedures & Skills 6%  Appendix II: Other Components 3%

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ABEM Qualifying Exam Content Acuity Frames Target (± 5%) *Critical 27% *Emergent 37% *Lower Acuity 27% *None 9% Physician Tasks *For this dimension, the Board has assigned the following specific percentage weights to the Modifying Factor of age: Pediatrics: 8% minimum Geriatrics: 4% minimum

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Qualifying Exam Preparation Old In-service Exam Results Use your old in-service exams results to determine your weakness and strengths (ie what section did you have the most of incorrect answers—was cardio or trauma or tox ,etc). Then Concentrate more on your weakness to improve your score Most Common Review Courses (EMRA Survey) NEMBR & Ohio ACEP Most Common Review Book Used (EMRA Survey) --- Carol Rivers Written Board Book Best Questions Book --- PEER VII (ACEP) --- Older PEER (ie Peer VI, Peer V, Peer IV) Best thing to bring to the test --- Stopwatch to pace yourself during the exam

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ABEM Oral Board Exam A standardized oral examination that tests the application of Emergency Medicine knowledge using scenarios based on actual clinical cases 5 hours, given in the spring and fall  Seven simulated patient encounters: five involve single patients; two involve multiple patients; each encounter is given by a separate examiner & one case is a field test case.

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ABEM Oral Exam Content (red= area of emphasis) 1) Signs, Symptoms and Presentations 2) Abdominal & Gastrointestinal Disorders 3) Cardiovascular Disorders 4) Cutaneous Disorders 5) Endocrine, Metabolic & Nutritional Disorders 6) Environmental Disorders 7) Head, Ear, Eye, Nose & Throat Disorders 8) Hematologic Disorders 9) Immune System Disorders 10) Systemic Infectious Disorders 11) Musculoskeletal Disorders (Non-traumatic) 12) Nervous System Disorders 13) Obstetrics and Gynecology 14) Psychobehavioral Disorders 15) Renal and Urogenital Disorders 16) Thoracic-Respiratory Disorders 17) Toxicologic Disorders 18) Traumatic Disorders

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ABEM Oral Board Exam Physician Tasks Modifying Factor of Pediatrics is emphasized Acuity Frames Critical: approximately 2/3 of total cases Emergent: approximately 1/3 of total cases

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ABEM Oral Exam Each case is scored from 1 to 8 based on 8 performance criteria: Data acquisition Problem solving Patient management Resource use Health care provided Interpersonal relations Comprehension of pathophysiology Overall clinical competence

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ABEM Oral Board Passing Criteria Passing oral exam by meeting either of two pass/fail criteria First, the average of the candidate’s scores on the eight performance criteria for each case that is not a field-test case is computed. This average is then compared to ABEM’s criterion of 5.75. The candidate passes if the rating average is 5.75 or greater. Second, the candidate’s scores on the eight performance criteria for each case which is not a field-test case are averaged to create six individual case scores. The highest and lowest case scores are averaged, and the candidate passes if this score and the remaining four case scores are 5.0 or above.

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Why Both Qualifying and Oral Exams? Qualifying examination tests the breadth/depth of your knowledge base   Oral examination tests your clinical skills Data acquisition Problem solving Clinical judgment Interpersonal relations Management of multiple patients

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EM Continuous Certification Mandated for all specialties by the American Board of Medical Specialties Recertification programs into a four-component Maintenance of Certification (MOC) program that is based in six defined competencies. The six competencies are (1) Patient Care (2) Medical Knowledge (3) Practice-Based Learning and Improvement (4) Interpersonal and Communication Skills (5) Professionalism (6) Systems-Based Practices.

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The Components of Continuous Certification Programs Professional Standing Lifelong Learning and Self Assessment Assessment of Cognitive Expertise Assessment of Practice Performance

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Professional Standing Began January 1, 2004 Diplomates must hold at least one medical license in the United States, its territories, or Canada that is active, current, valid, unrestricted, and unqualified throughout the time that they are certified All licenses must comply with the ABEM “Policy on Medical Licensure”

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Lifelong Learning and Self Assessment (LLSA) Online annual open book self-assessment test Based on annual reading list 32 - 40 multiple-choice questions 90% correct passing score 3 opportunities to pass before repaying fee Began April 5, 2004 Each test available for three years

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LLSA Content (cycle repeat in 2013) 2004: Thoracic-Respiratory Disorders Immune System Disorders Muskuloskeletal Disorders  2005: Nervous System Disorders Toxicologic Disorders 2006: Traumatic Disorders Cutaneous Disorders 2007: Signs, Symptoms, and Presentations Psychobehavioral Disorders 2008: Procedures & Skills Integral to the Practice of EM Environmental Disorders 2009: Cardiovascular Disorders Hematologic Disorders 2010: Abdominal & Gastrointestinal Dz Other Components of Practice of EM 2011: Head, Ear, Eye, Nose, Throat Dz Endocrine, Metabolic & Nutritional Dz Renal & Urogenital Disorders 2012: Systemic Infectious Disorders Obstetrics & Gynecology

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Assessment of Cognitive Expertise ConCert Examination First administered in 2004 Required every 10 years Secure, proctored examination at approximately 200 computer-based testing centers nationwide Content based on The Model of the Clinical Practice of Emergency Medicine Link between previous LLSA readings and the ConCert examination no longer exists 205 question, 5 hour criterion examination 75% correct to pass

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ConCert Exam Content Question Percentage Listing of Conditions & Components 1.0 Signs, Symptoms and Presentations 9% 2.0 Abdominal & Gastrointestinal Disorders 9% 3.0 Cardiovascular Disorders 10% 4.0 Cutaneous Disorders 2% 5.0 Endocrine, Metabolic & Nutritional Disorders 3% 6.0 Environmental Disorders 3% 7.0 Head, Ear, Eye, Nose & Throat Disorders 5% 8.0 Hematologic Disorders 2% 9.0 Immune System Disorders 2% 10.0 Systemic Infectious Disorders 5% 11.0 Musculoskeletal Disorders (Non-traumatic) 3% 12.0 Nervous System Disorders 5% 13.0 Obstetrics and Gynecology 4% 14.0 Psychobehavioral Disorders 3% 15.0 Renal and Urogenital Disorders 3% 16.0 Thoracic-Respiratory Disorders 8% 17.0 Toxicologic Disorders 4% 18.0 Traumatic Disorders 11%  Appendix I: Procedures & Skills 6%  Appendix II: Other Components 3%

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Concert Exam Content Acuity Frames Target (± 5%) *Critical 27% *Emergent 37% *Lower Acuity 27% *None 9% Physician Tasks *For this dimension, the Board has assigned the following specific percentage weights to the Modifying Factor of age: Pediatrics: 8% minimum Geriatrics: 4% minimum

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ConCert Exam Eligibility Medical License Eligibility Have a current, active, valid, unrestricted, and unqualified license to practice medicine in at least one jurisdiction in the United States, its territories, or Canada and the licenses must comply with ABEM’s Policy on Medical Licensure LLSA Completion Eligibility must complete the number of LLSA test equivalents required for a specific ConCert examination otherwise cannot take the concert exam

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Failure of LLSA Eligibility Missed one required LLSA test equivalent prior to the expiration of his or her certification, he or she must take and pass the initial qualifying written certification examination by the end of the third year after his or her certification expires.  Within those three years, the physician is required to take and pass an LLSA test in each of the years that he or she does not take the qualifying examination Missed two or more required LLSA test equivalents prior to his or her certification expiration, he or she must take and pass both the qualifying written examination and the oral certification examination to regain certification

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Difference Between LLSA & ConCert Exam LLSA Open Book Promote Learning More specific detailed knowledge questions Concert Closed Book Test working knowledge More general concepts & facts of EM Shorter version of initial written exam

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Assessment of Practice Performance Designed for clinically active diplomates Will be focused on practice improvement Will begin in 2011 Will require Patient care practice improvement—year 4 & year 8 of certification, diplomates will attest to completing practice improvement (PI) program by completing a ABEM online checklist and providing name of a verifier Communications/Professionalism—once in every ten year, diplomates will attest to participating in a communications and professionalism feedback program by completing an ABEM online checklist and providing name of verifier

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Practice Improvement: Patient Care Clinically active diplomates will be required to complete a four-step PI program: 1.  Must develop and implement a PI plan in one of four areas: Clinical reminders Personal education Change in systems or process Clinical pathway 2.  Must access and review one of the following sources of patient data from 10 to 25 patients: Patient clinical data Feedback from patients that relates to clinical care given Patient safety module 3.  Your patient data must be compared to accepted practice standards: Evidence-based guidelines, where available Explicit expert consensus, where available, or Peer data, if available 4.  You must re-measure to determine if performance lower than the standard is improved or if performance higher than the standard is at least maintained

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Practice Performance: Communications & Professionalism Feedback Diplomates must get feedback addressing the areas listed below: Clear communications Showing respect to the patient Asking about medical history and prescription drug use Making the patient feel comfortable Understanding the patient’s main concern Providing information about tests and procedures Providing adequate pain relief Giving the patient options where appropriate

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Practice Performance: Verification Your verifier must be someone with oversight or knowledge of your APP activities The verifier must be appropriate for your circumstances. Hospital board chair or other member of the board Department chair Chief of staff Medical director Practice administrator in non-hospital settings The verifier must be able to verify that your APP program met all of ABEM’s requirements and that you have completed all required components of your PI program. 10% of diplomates submitting complete APP activity information will be randomly selected annually for verification.

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Recent ABEM Exam Scores Written Exam (First Time Taker) Pass Rate 2005—90% 2004—88% 2003—93% 2002—90% 2001—89% 2000—91% 1999—89% 1998—91% 1997—89% 1996—90% 1995—88%

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Recent ABEM Exam Scores

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Recent ABEM Exam Scores Oral Boards (First Time Takers) Pass Rate 2005—95% 2004—95% 2003—91% 2002—91% 2001—94% 2000—92% 1999—86% 1998—91% 1997—89% 1996—94% 1995—92%

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Recent ABEM Exam Scores Written Recertification Pass Rate 2004--92% (First year of ConCert Exam) 2003—92% 2002—87% 2001—90% 2000—92% 1999—91% 1998—95% 1997—93% 1996—92% 1995—94%

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“Genius is 99 perspiration and 1 percent inspiration”---Thomas Edison Start Early Study Hard

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WWW.ABEM.ORG

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Author credit – ABEM Certifications David Cheng MD Questions

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Postresidency Tools of the Trade CD 1) Career Planning – Garmel 2) Careers in Academic EM – Sokolove 3) Private Practice Career Options - Holliman 4) Fellowship/EM Organizations – Coates/Cheng 5) CV – Garmel 6) Interviewing – Garmel 7) Contracts for Emergency Physicians – Franks 8) Salary & Benefits – Hevia 9) Malpractice – Derse/Cheng 10) Clinical Teaching in the ED – Wald 11) Teaching Tips – Ankel 12) Mentoring - Ramundo 13) Negotiation – Ramundo 14) ABEM Certifications – Cheng 15) Patient Satisfaction – Cheng 16) Billing, Coding & Documenting – Cheng/Hall 17) Financial Planning – Hevia 18) Time Management – Promes 19) Balancing Work & Family – Promes & Datner 20) Physician Wellness & Burnout – Conrad /Wadman 21) Professionalism – Fredrick 22) Cases for professionalism & ethics – SAEM 23) Medical Directorship – Proctor 24) Academic Career Guide Chapter 1-8 – Nottingham 25) Academic career Guide Chapter 9-16 – Noeller