ABFM Annual Update Including COVID-19 Impacts on ......5/1/2020 12 Resident Graduate Survey •Thank...

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ABFM Annual Update Including COVID-19 Impacts on

Certification Activities

April 30, 2020

A Family Medicine Residency Community Forum & Discussion

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The American Board of Family Medicine

The 2020 ABFM Update: Residencies Now and in the Future

Warren P. Newton, MD, MPH

Thomas O’Neill, PhD

Libby Baxley, MD

American Board of Family Medicine

April 30, 2020

©2020 American Board of Family Medicine

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Schedule for Tonight

• Overview and Update (Dr. Newton)

• ABFM Measurement Services: A Common Currency: (Dr. O’Neill)

• Board Eligibility & Parental Leave (Dr. Baxley)

• Questions after each section via chat function. Thank you to AAFP staff for helping to moderate!


Objectives

• Environmental Scan: • COVID and its implications • The Rest of Family Medicine Education…

• ABFM Strategic Plan 2019-2025

• ABFM Residency Ongoing Activities

• Major Revision of Residency Guidelines

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Main Takeaways

• We live in a time of transformation of

healthcare, with great challenges—including

COVID—and major opportunities

• We are committed to supporting personal

physicians over their careers, starting in

residency

• We will work with you to support excellence

in education and improve residencies

• Thank you for all you do: we are optimistic…


COVID implications for residencies

• What will happen to ACGME accreditation and ABFM Board Eligibility?

• Our Commitment: Residents will not lose board eligibility on the basis of what happens during the last four months of this academic year.

• You are making the choices of what residents do, balancing patient needs, resident safety and education. We trust you.

• We rely on you/your CCCs to judge “readiness for autonomous practice”.

• We will not require extension of residency for less than 1650 visits or rotation shifts.

• We will work with you about 2021 as information becomes available.

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What You Will Document…

• Usual time (June 15 or later); limited to one screen (as before)

• Do you and your CCC believe this resident is ready for autonomous practice?

• Document number of visits, including televisits, as you will for ACGME

• Tell us briefly major changes for overall residency in spring 2020—eg FPC went virtual 3/15, no nursing home visits after 4/1, etc…

Examination Reschedule

• New summer examination block—July 7-August 4, 2021, with physical distancing among test takers

• Sign up now—76% have!• If finish residency by 10/31/20, ok to take in July; if by

4/30/2021, can take in November 9-14 block• Must finish KSA, PI in advance; can take before getting

license, but full license necessary for Board certification.

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ABFM Strategic Plan 2019-2025

• Key questions for our planning:• What will health and health care look like in 2040?

• What will the personal physician of the future look like?

• How can ABFM support the personal physician, now and in 15 years?

• We are committed to renewal of continuity, comprehensiveness, broad scope and leading change in health and health care.

• We plan change in both what we do and how we do it…


ABFM Strategic Plan 2019-2025

© 2020 American Board of Family Medicine 12

2019 2020 2021 2022 2023 2024 2025

May 2019

STRA

TEGIC

P

LAN

A

PP

RO

VED

April. 2020

SPR

ING

BO

AR

DM

EETING

July 2021

MID

PLA

NR

EVIEW

Phase 1

Phase 2

KSA UpdatesPerformance Improvement UpdateJournal Based Activity Pilot

FMCLA LaunchOutreach / Engagement

Innovation Professionalism Assessment

Improve Quality Improvement New Certification Dimensions

Phase 3

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Family Medicine Certification Longitudinal Assessment (FMCLA)

• Both Summative and Formative Roles

• 25 questions/3 months, anytime, anywhere, with flexibility

• 300 completed questions required for scoring; up to 4 yrs to complete

• Popular: 71% selected in 2019; 98.4% moved into year 2

• Feedback outstanding:

• 95-98% satisfaction with IT system, format, tracking

• #1 feedback comment – I am learning as I go

• 75% looked up something after the exam!

• Pilot extended to 2020 cohort; 81% signed up; likely will become permanent

• NOTE: Initial certification exam will still be one-day in secure test center


FMCLA Summative Validity

• Item hierarchy preserved…

• But performance on items with and without open book essentially the same

• Comparable function with 1 day exam (3/21); cognitive Expertise Stability (3/21 and later)


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Updates Underway as Part of Strategic Plan

• KSA revision: Single best answer, revision of topics, updated critiques and references

• PI Update: PI locator, Self Directed PI, COVID PI, Organizational PI (ResPip)

• New Blueprint


Coming in 2021: A Journal Article-Based Self-Assessment Activity

• 100 articles identified each year: relevant to FP, robust methodology, and change practice

• Participants choose 20, read full text on line, answer 4 questions, get ABFM credit

• Optional alternative to KSA/CKSA

• National Advisory Committee just named

• Pilot in 2021: Would love to work with residencies to pilot parallel educational activities!

©2020 American Board of Family Medicine 16

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Residency Tools: In-Training Exam (ITE)

• 200 multiple choice questions, taken annually

• Content identical to ABFM certification exam

• Answers and critiques, references can be

downloaded after completion

• Bayesian Score Predictor gives probability of

passing; go to Physician Portfolio to download


Residency Tools: Knowledge Self Assessments (KSA)

• Free, highly evaluated, new IT platform

• Topics follow IOM list of problems most important for health and cost

• Just under 15,000 total KSAs completed by residents in 2019

1960

1078

879 914839

10721001

915

11531213

1584

2186

0

500

1000

1500

2000

2500

Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19

Number of KSA Activities Completed by Residents in 2019


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Residency Tools:Continuous Knowledge Self Assessment (CKSA)

• Continued growth in resident participation over time; note Bayesian score predictor applies to CKSA also

• Getting ready for FMCLA! 361

747817

930

1085

1377

1915

2132

2527

2777

2247

0

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1000

1500

2000

2500

3000

2017 Q3 2017 Q4 2018 Q1 2018 Q2 2018 Q3 2018 Q4 2019 Q1 2019 Q2 2019 Q3 2019 Q4 2020 Q1

Nu

mb

er o

f R

esid

ents

Quarter

Number of Residents Completing KSA


Residency Tools: PI Activities

A mix of ABFM and activities sponsored by others

Newly updated

• Improved ABFM Platform

• ABFM Module options – far more broad in scope to choose from

• Self-Directed + Organizational option for groups

2872

2517

2913 2876

2245

2017

2372

1976 2013

2264

0

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1000

1500

2000

2500

3000

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2015 2016 2017 2018 2019

Resident PI Activity CompletionsABFM Developed vs Approved Alternatives

ABFM PI Other PI


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Residency Tools: Performance Improvement/ResPip

• To know and do!

• QI training and experience required curriculum

• ResPip allows for one submission for all faculty and residents

• Align with your practice’s clinical goals

• Ann Williamson ([email protected]) can help with Respip application

2017 2018 2019 2020

Total # of Sponsors (cumulative)

17 36 57 (65)

Total # of Activities Submitted (net new)

29 87 137 (0)

Total # of Completed Submissions (net new)

155 404 450 (95)

ResPip By The Numbers


Ongoing Innovation in Residencies

• Length of Training Trial—emerging findings

• Applications

• Impact on knowledge, scope

• FM-NICCE trial

• Can we improve continuity with schedule flexibility

• AFMRD Running, Evaluation Funded by ABFM-F?

• A Superiority Trial


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Resident Graduate Survey

• Thank you!

• 2019, based on 2016 graduates

• 3500 graduates, 66% response rate

• Only specialty doing this…

• Can we use to improve outcomes of residencies?

0 10 20 30 40 50 60 70 80 90 100

Behavioral Health CareBuprenorphine treatment

Musculoskeletal ultrasoundIntegrative Health Care

Management of Hepatitis COsteopathic Manipulative Treatment

Pediatric Outpatient CareJoint aspiration and injection

Management of HIV/AIDSPregnancy Termination

Uterine aspiration / D&CVasectomy

CastingCardiac Stress Testing

End of Life CareImplantable long-acting reversible contraception

IUD insertion and removalEndometrial Biopsy

Basic OB ultrasoundColposcopy

Intensive care / ICU-CCUPediatric Hospital CareNeonatal Circumcision

Newborn Hospital CareMaternity Care

Currently Practicing Residency Prepared


Osteopathic ABFM Certification Pathway

• Support residents whose programs may not receive ACGME Accreditation expeditiously

• Five-Year window: 2018-2022

• Completion of three years training in an AOA accredited program, ACGME pre-accredited program, or ACGME accredited program

• Meet ABFM Family Medicine Certification entry requirements prior to examination approval

• For current DO residents, if you want to use KSA/CKSA, sign up with Kathy Botner at [email protected]. This does not obligate ABFM certification.


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The Broader Educational Environment

• ACGME Program Director/Core Faculty requirement: Progress!

• From RC: SAS working well, common citations: role models, 1650 visits

• Family Medicine Residency Slots + 3.5% per year; FP salaries increasing

• Family Medicine Match

• 2019: Reduction in US Grads

• 2020: Further reduction of US allopathic graduates

• NBME: Part I—pass/fail!


Major Revision of FM Residency Guidelines

• Why important: major revisions every 12-15 years + imprinting

• What does society need us to do?

• The Starfield 4 Cs: continuity, comprehensiveness, coordination, community

• Address specific clinical problems:• Opioid Abuse and Co-epidemics

• Multimorbidity

• Transitions of Care

• Social Drivers of Health, Disparities

• Emerging Infectious Diseases


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The Future of Residency EducationA Dialogue across the Specialty…

• What should our scope of practice be? – in residency and beyond?

• Hospital Care? Women’s Health? Office Procedures? Change over lifetime?

• What new curricula should we mandate for all residencies?

• MAT? Ultrasound? Advocacy? Population Health?

• Should we change how we teach?

• How implement competency-based education?

• Active Learning? Longitudinal Curricula?

• Should length of training change--3 vs 4 years?

• Innovation vs Regulation?


Questions?

• Join Us for AFMRD Focus Group Meetings on Family Leave and the Major Revision of Guidelines—TBA!

• National Summit on the Future of Family Medicine Residency Education—Mid-Late Fall, COVID-19 Permitting…


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Updates from the ABFM’s Psychometrics Department

Thomas R. O’Neill, Ph.D.Vice President of Psychometric Services


Overview of Products


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Board CertifiedFamily Practice

ResidencyMedical School

USMLE Step 1

USMLE Step 3

USMLE Step 2

ITE PGY 1

ITE PGY 3

ITE PGY 2

FMCECert Exam

Bayesian Score Predictor

Continuous Knowledge Self-Assessment

FMCLALongitudinal Assessment

FMCECert Exam

FMCECert Exam

FMCECert Exam

COMLEX Level 1

COMLEX Level 3

COMLEX Level 2

The FMCE Scale: A Common Scale

Review of the Passing Standard


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Passing Standard

• In January 2020, the Board of Directors reviewed the results of a passing standard setting exercise that was based upon ratings of 68 ABFM Diplomates.

• The Board decided to retain the current standard of 380 for another 3 years. It will be reviewed again before the 2023 examination.


Developing a New Blueprint


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Current Blueprint: Body System

Cardiovascular 12%

Endocrine 8%

Gastrointestinal 7%

Hematologic/Immune 3%

Integumentary 6%

Musculoskeletal 12%

Nephrologic 3%

Neurologic 3%

Nonspecific 9%

Psychogenic 7%

Reproductive—Female 4%

Reproductive—Male 1%

Respiratory 13%

Special Sensory 2%

Population-based Care 5%

Patient-based Systems 5%


Patient Age plus Knowledge

These percentages are what was in one of the exam forms in 2017.

It is not necessarily what will in the new blueprint.


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Urgency & Duration

These percentages are what was in one of the 2017 exam forms.

It is not the new blueprint.


ITE 2020 Update


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How many questions were answered correctly, EXCLUDINGdeleted items.



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Table 4 permits physicians to label the questions by content category for review purposes.


Bayesian Score Predictor


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• The scores in these tables are SCORES, not NUMBER CORRECT.

• Use a Score Report (ITE, COMLEX-USA, or USMLE)


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Continuous Knowledge Self-Assessment


2018-Q1 Question 20


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Thomas O’Neill, Ph.D. Ting Wang, Ph.D.

VP of Psychometric Services Senior Psychometrician

(859) 687-2538

Kathy Botner

Resident Education/RTM Coordinator

(859) 429-7360


If you have questions about the scoring of the ITE or the certification exam, please call us. We are eager to help.

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Thomas O’Neill, Ph.D.

Thomas R. O’Neill, Ph.D.

Vice President of Psychometric Services,




Resident Eligibility for ABFM Certification: What’s New?

Libby Baxley, MD

Executive Vice President



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Objectives for This Portion

• Review ABFM Policies• Transfer/A-P Credit

• Absence from Training

• Resident Eligibility Requirements

• ABFM Guidelines for Professionalism, Licensure, and Personal Conduct

• Discuss new considerations related to Parental/Family Leave policy

• Discuss plans for provision of enhanced resources for PDs, Coordinators and Residents (aka Residency Toolkit)


Achieving Diplomate statusResident MC-FP Entry Process

ABFM Certification is awarded upon completion of the following:

1. Successful performance on the initial ABFM certification exam

2. Completion of 50 FMC points • Participation in Knowledge Self-

Assessment and Performance Improvement Activities

3. Possession of a currently valid, full and unrestricted license to practice medicine in the U.S. or Canada

4. Compliance with the Guidelines on Professionalism, Licensure and Personal Conduct

5. Completion of training with verification from the program director that the resident has satisfactorily met all ACGME requirements

• Includes being scheduled to see patients in continuity clinic a minimum of 40 weeks per year having 1650 or more patient visits


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Achieving Diplomate status:Resident MC-FP Entry Process

Board eligibility lasts 7-years from the date of successful

completion of an ACGME-accredited Family Medicine

residency training program

Three years to successfully complete exam using

residency-completed pre-requisite activities

If >3 years after residency training completed• Must satisfy the Certification Entry Process in order to

take the examination and gain initial certification status.

• Requirements found on website and in Physician Portfolio


Common Application Deficiencies

• Having not completed requirements for KSA and PI activities

• Length of training < 36 months

• PGY2/PGY3 years not continuous

• Irregularities in advanced placement credit reporting

• Failure to enter permanent medical license – not necessary for exam application, but is for certification


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Transfer/Advanced Level Entry

• Program must advise, through RTM system, of any advance placement or transfer credits prior to, or within 90 days of, resident starting the program.

• If no AP training recorded in this timeframe, resident is expected to complete the full 36 months, regardless of the amount of prior training or their performance in the program (no retrospective decisions)


Maximum Amount of Transfer Credit:12 months total

Adult Medicine 12 months Care of Neonates, Children & Adolescents 5 months

Ambulatory Medicine/Subspecialty

6 months Ambulatory 4 months

Geriatrics 1 month Inpatient 2 months

ICU 1 month Community Medicine & Population Health 1 month

Inpatient 8 months Dermatology 1 month

Maternity Care & Gynecologic Care 3 months Diagnostic Imaging & Nuclear Medicine 1 month

Gynecologic Care 1 month Emergency Medicine 3 months

Maternity Care 2 months Human Behavior & Mental Health 3 months

Surgery 3 months Musculoskeletal & Sports Medicine 2 months

General Surgery 1 month Electives 3 months

Surgical Subspecialties 2 months


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Time Away from Residency

• When an LOA is granted for any reason, the Program Director is expected to inform ABFM promptly in RTM system of the dates of departure and expected return

• Current maximum excused absence (vacation, illness, personal business, leave, etc.) = 21 working days or 30 calendar days per academic year

• No two may be concurrent, i.e. no cross over years of training

• Residents may take vacation time immediately prior to or subsequent to a LOA

• If maximum allowable time exceeded, additional time must be made up before resident advances to next training level and must be added to the required 36 months of education to determine the projected date of completion.


Continuity Requirement and Absence >3 Months:

• Requirement for final two years of training to be in same program to maintain continuity of care with a panel of patients

• If a hardship exists, a waiver of the requirement may be obtained

• Absence >3 months prompts a review and decision by the Professionalism Committee of the ABFM Board of Directors


Hardship Examples

• Complications during pregnancy

• Post delivery problems with the infant and/or mother

• Prolonged illness

• Injury/Accident

• The closing of a residency

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Let’s Talk About Leave Time…

Re-Frame the Discussion

• Culture and stigma around childbearing during residency is long ingrained (“I am pregnant and I am sorry”)

• Desire not to extend training is single greatest determinant in women limiting their own leave

• Lack of leave for fathers/non-birth parents perpetuates division of labor for parenting, creating an “asymmetric” parent

• Frame shift – let’s talk about investing in the offspring of our residents!

• What about payback? • “We need to help each other out when others need it!” (Tom Nasca, President,

ACGME)


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What is Reality Today?

• In 2019, there were 355 LOAs specified as parental, medical and family leave (note: as many not specified)

• 67% maternity leave• 13% PGY-1, 36% PGY-2, 51% PGY-3/4

• 5% paternity leave• 15% PGY-1, 40% PGY-2, 45% PGY-3

• 22% personal medical leave • 59% women; 41% men

• 27% PGY-1, 36% PGY-2, 37% PGY-3

• 5% family medical leave • 82% women, 18% men

• 18% PGY-1, 53% PGY-2, 29% PGY-3

• 19 (5%) had > 1 LOA

Residency Extensions

• Avg # days = 54.5

• range 4-233

• 169 (48%) used vacation time

• Avg # of days = 13

• range 1-30


Guiding Principles for ABFM BOD

1. Support residents as they add to their families and as they attend to major personal and family health events.

2. Residency experiences in continuity patient care and core family medicine rotations should be priorities.

If at all possible, time that residents take for Family Leave should be assigned to elective and/or selected specialty rotations.

3. Allow cross over from one PGY year to the next. Decisions about advancement from one year to the next to be determined by the Program Director and the Sponsoring institution.

4. Vacation time may be used but should not to be exhausted for Family Leave.

Minimum of one week of vacation per year to be separated from Family Leave time away. This is essential to support resident well-being.

5. ABFM exam will continue to be offered twice a year, so as to not materially delay certification for residents who require extension of training.


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New Family Leave Policy - ABFM

Includes:• Birth and care of a newborn, adopted, or foster child, including both birth- and non-birth parents

of a newborn.

• Care of a family member with a serious health condition.

• A resident’s own serious health condition

Does not include:

• Other personal leave and/or interruptions from a residency • e.g., prolonged vacation/travel, unaccredited research experience, unaccredited clinical experience, military or

government assignment outside the scope of the specialty, etc.

• Periods of time for which a resident does not qualify for credit by reason of resident’s failure to meet academic, clinical, or professional performance standards.

New Family Leave Policy - ABFM

Family Leave Within a Training Year

• Up to 8 weeks (42 working days or 60 calendar days) per academic year, in addition to Vacation Leave.

• Family Leave and Vacation Leave may be combined for up to 12 weeks away from the program in a given year to accommodate parental leave, personal medical leave, care of immediate family.

• Allows programs to maintain 40 week requirement for continuity experience in each PGY year, including any academic year in which they take Family Leave.

• Programs encouraged to preserve at least one week of vacation outside of the Family Leave period for the resident to have for

time off in same year as Family Leave.

Total Family Leave Across Training

• Maximum of 20 weeks of leave over duration of residency (104 working days or 149 calendar days), inclusive of Family Leave (up to 8 weeks total) and Vacation Leave (up to 4 weeks per year, as allowed by the program).

• If >12 weeks away from the program in a given year, and/or a maximum of 20 weeks total (e.g. second pregnancy, extended or recurrent personal or family leave) training extension necessary to cover the duration of time in excess of 20 weeks

• Must still achieve 1650 continuity visits by end of residency.

ABFM approval not required as long as within these parameters and resident is on schedule to meet other training requirements. However, ABFM still requests that residencies report in RTM any Family Leave or other LOA, even when extension of training is not required, to allow for data tracking that supports ongoing evaluation of this policy change.

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Comparison Across [Some] Boards

Board Max Weeks/Year Max Weeks/ProgramIncludes all Leave:

vacation, sick, medical, parental

Notes

ABFM Current 30 days (-4 weeks) 90 days (-12 weeks) Yes Cannot carry over

ABFM Proposed 8 weeks 20 weeks Annual No / Total Yes Carry over allowed

ABOG 12 week 24 weeks Yes

ABA 12 weeks YesCan add up to 8 additional

upon request without extension of training

ABIM 5 weeks 105 days (15 weeks) Yes

ABS4+2 (Yr 1-3) 4+4 (4-

5)

(Max 34 weeks if used all vacation plus additional

leave)Hybrid

ABP 1 mo per year 3 months (12 weeks) YesPD can request waiver for 2 additional months for family

or medical leave

Training Extensions Relative to Exam


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Residency Toolkit

• Enhanced resources for PDs, Coordinators and Residents related to ABFM Certification

• Support for resident education about certification as well as step-by-step understanding of requirements and timelines

• Updated centrally and made available as you need

• Welcoming graduates into certification

• Other ways to support training programs… we want to hear from you!


Thank You!

Questions Today?

Questions in the future:Call or email Kathy Botner at ABFM: [email protected]


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Elizabeth Baxley, MD

Elizabeth Baxley, MD, MPH

Executive Vice President,



Plus /Delta

Plus Delta

What worked? What would have made it

better?

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Upcoming Events

May –

Watch your inbox for announcement about the new PDW RPS On Demand product – an online library of 22 recorded workshops.

June – July –

Submit proposals for the 2021 PDW and RPS Symposium.

March 5-9, 2021 –

Attend the 2021 PDW and RPS Symposium - a month early.

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ABFM Annual Update Including COVID-19 Impacts on ......5/1/2020 12 Resident Graduate Survey •Thank...

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