Change Board Recertification is a national movement of physicians committed to reforming the Board Recertification process so we are better able to serve the needs of our patients.

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The Need for Physician Assessment and Evaluation:

Clinical Judgment & Diagnostic Errors

  • Clinical judgment and the ability to deal with uncertainty are especially critical with respect to misuse and overuse of processes of care.[1]
  • Misuse and overuse of processes of care (e.g., overprescribing antibiotics and unnecessary imaging and procedures) put patients at greater risk for unnecessary complications.[2]
  • Physician knowledge and clinical judgment are central to making correct diagnoses.[3]
  • Diagnostic errors are prevalent and consequential among physicians and may not simply resolve with more practice experience.[4, 5]
  • One study found that premature closure, i.e., the failure to continue considering reasonable alternatives after an initial diagnosis was reached, was the single most common cause of diagnostic error. Other common causes included faulty context generation, misjudging the salience of findings, faulty perception, and errors arising from the use of heuristics.[6]

Physician Skills Deteriorate Over Time

  • On average, clinical skills tend to decline over time.[5]
  • Amount of clinical experience does not necessarily lead to better outcomes or improvement of skills.[5]
  • Fewer than 30% of physicians examine their own performance data.[7]
  • A physician’s ability to independently and accurately self-assess and self-evaluate is limited.[8]

The Role of Certification and Maintenance of Certification

Testing Clinical Knowledge and Judgment

  • Secure examinations of medical knowledge and clinical judgment can provide an effective means to assess whether physicians have incorporated new knowledge and have synthesized the knowledge over time.[9]
  • The ABIM Certification and Maintenance of Certification examinations in internal medicine and its subspecialties are designed to evaluate the extent of the candidate’s knowledge and clinical judgment in the areas in which an internist or subspecialist should demonstrate a high level of competence.[10]
  • These exams assess expertise in the broad domain of internal medicine or in the particular subspecialty and the diagnosis and treatment of both common and rare conditions that have important consequences for patient.[10]
  • The majority of questions on the ABIM exams require integration of information, prioritization of alternatives, and/or utilization of clinical judgment in reaching a correct conclusion.[11]
  • ABIM exam questions test “efficiency” or conservative management in health care. [12]
  • High performance on the ABIM Certification examination predicted decreased risk for future disciplinary action for American or Canadian medical school graduates.[13]

Certification is Associated with Better Care

  • Mortality was lower for patients with acute myocardial infarction cared for by certified physicians.[14]
  • Certified cardiologists saved more lives than certified primary care doctors than doctors who are not board certified.[14]
  • Certification in surgery was a significant predictor of lower mortality and complication rates for colorectal surgery.[15]
  • Higher scores on the ABIM internal medicine Maintenance of Certification examination are associated with better performance on Medicare quality indicators for diabetes and mammography screening.[16]
  • There is a positive association between the rate at which preventive care services were delivered for Medicare patients and certification status in internal medicine or family medicine.[17]
  • Time since physician's last board certification correlates with decline in quality of care for patients being treated for high blood pressure.[18]

The Public Expects It

  • The public expects, in return for the privilege of self-regulation, that physicians undergo a rigorous, periodic examination of knowledge.[19]
  • A recent ABMS consumer survey found 91 percent of respondents said that board certification is “very important” or “important” in choosing a doctor.[20] Physicians Value It
  • In general, physicians seem to value the Maintenance of Certification process for its effort to improve quality of care and patient safety. [21]
  • Physicians find the ABIM Maintenance of Certification program personally (61%) and professionally (71%) valuable. [22]
  • 78% of physicians who completed an ABIM self-assessment of knowledge module agree that it helped them identify further areas of study, and 70% agree that it raised their awareness of how to improve patient care. [23]
  • 82% of physicians would recommend the ABIM practice improvement modules to a colleague. 73% indicated that they changed their practice as a result of the module. [24]

Notes:

  1. 1. Fisher, E.S., Medical care--is more always better? The New England Journal Of Medicine, 2003. 349(17): p. 1665-1667.
  2. 2. Mold, J.W. and H.F. Stein, The cascade effect in the clinical care of patients. The New England Journal Of Medicine, 1986. 314(8): p. 512-514.
  3. 3. Gruppen, L.D. and A.Z. Frohna, Clinical reasoning, in International Handbook of Research in Medical Education. 2002, Kluwer Academic Publishers: Great Britain. p. 205-230.
  4. 4. Bordage, G., Why did I miss the diagnosis? Some cognitive explanations and educational implications. Academic Medicine: Journal Of The Association Of American Medical Colleges, 1999. 74(10 Suppl): p. S138-43. 5. Choudhry, N.K., R.H. Fletcher, and S.B. Soumerai, Systematic Review: The
  5. Relationship between Clinical Experience and Quality of Health Care. Annals of Internal Medicine, 2005. 142(4): p. 260-W-30.
  6. 6. Graber, M.L., N. Franklin, and R. Gordon, Diagnostic Error in Internal Medicine. Archives of Internal Medicine, 2005. 165(13): p. 1493-1499.
  7. 7. Audet, A.-M.J., et al., Measure, Learn, And Improve: Physicians' Involvement In Quality Improvement. Health Affairs, 2005. 24(3): p. 843-853.
  8. 8. Davis, D.A., et al., Accuracy of Physician Self-assessment Compared With Observed Measures of Competence. JAMA: Journal of the American Medical Association, 2006. 296(9): p. 1094-1102.
  9. 9. Downing, S. and T. Haladyna, Handbook of Test Development. 2006, Mahwah, NJ: Lawrence Erlbaum Associates.
  10. 10. http://www.abim.org/exam/exams.aspx.
  11. 11. Holmboe, E.S., R. Lipner, and A. Greiner, Assessing Quality of Care. Journal of the American Medical Association, 2008. 299(3): p. 338-340.
  12. 12. Sirovich, B., et al. When less is more: A new measure of appropriately conservative management based on the internal medicine certifying exam. in SGIM Meeting. 2008.
  13. 13. Papadakis, M.A., et al., Performance during Internal Medicine Residency Training and Subsequent Disciplinary Action by State Licensing Boards. Annals of Internal Medicine, 2008. 148(11): p. 869-876.
  14. 14. Norcini, J.J., H.R. Kimball, and R.S. Lipner, Certification and specialization: do they matter in the outcome of acute myocardial infarction? Academic Medicine: Journal Of The Association Of American Medical Colleges, 2000. 75(12): p. 1193-1198.
  15. 15. Prystowsky, J.B., G. Bordage, and J.M. Feinglass, Patient outcomes for segmental colon resection according to surgeon's training, certification, and experience. Surgery, 2002. 132(4): p. 663. 16. Holmboe, E.S., et al., Association Between Maintenance of Certification Examination Scores and Quality of Care for Medicare Beneficiaries. Archives of Internal Medicine, 2008. 168(13): p. 1396-1403.
  16. 17. Pham, H.H., et al., Delivery of Preventive Services to Older Adults by Primary Care Physicians. JAMA: Journal of the American Medical Association, 2005. 294(4): p. 473-481.
  17. 18. Turchin, A., et al., Effect of board certification on antihypertensive treatment intensification in patients with diabetes mellitus. Circulation, 2008. 117(5): p. 623-628.
  18. 19. Brennan, T.A., et al., The Role of Physician Specialty Board Certification Status in the Quality Movement. JAMA: Journal of the American Medical Association, 2004. 292(9): p. 1038-1043.
  19. 20. http://www.abms.org/News_and_Events/Media_Newsroom/pdf/ABMS_Survey_Fact_Sheet.pdf.
  20. 21. Lipner, R.S., et al., Who Is Maintaining Certification in Internal Medicine--and Why? A National Survey 10 Years after Initial Certification. Annals of Internal Medicine, 2006. 144(1): p. 29-37.
  21. 22. ABIM MOC Program survey results, May 2000-Nov. 2007.
  22. 23. ABIM SEP Modules survey results, April 2007-Sept. 2008.
  23. 24. ABIM PIM survey results Dec. 2008