Fellow Orientation Medical School Residency & Fellowship Examination & Certification Professional Development & MOC Outcomes: Healthy Children

About the American Board of Pediatrics Sole mission is to the public. One of the 24 specialty boards of the American Board of Medical Specialties (ABMS) Certifies physicians with specialized education and clinical expertise in the care of children (general and subspecialties) Standards of certification set by practicing pediatricians The public can view the certification status of all pediatricians on ABP’s website. Every discipline of medicine has their own board, certifying exams, and standards. You do not join the ABP as a member; nor do you pay dues to belong. You become an ABP diplomate when you pass the boards. 250 practicing pediatricians (community and academic based) volunteer their time to the ABP to set standards. (Includes subspecialists as well) Established 1933

Purpose of Certification ABP Mission The ABP certifies general pediatricians and pediatric subspecialists based on standards of excellence that lead to high quality health care. Certification provides assurance to the public that a general pediatrician or pediatric subspecialist has successfully completed accredited training and fulfills continuous evaluation requirements that encompass the six core competencies. Purpose of Certification Improve care of children Assure standardized training and promote evidence-based care Provide accountability to the public that the general pediatrician and subspecialist has unique skills to provide routine and complex care and that they maintain those skills over time ”The ABP certification provides assurance to the public that a general pediatrician or pediatric subspecialist has successfully completed accredited training and fulfills the continuous evaluation requirements that encompass the six core competencies: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.  From ABP’s Mission Statement: “The ABP's quest for excellence is evident in its rigorous evaluation process and in new initiatives undertaken that not only continually improve the standards of its certification but also advance the science, education, study, and practice of pediatrics.” The ABP engages in innovation and the use of data to improve education and training. Emphasize that training in an ACGME accredited program is required to sit for ABP boards. This topic will be revisited on the ACGME v. ABP slide #5.

AAP & ABP American Academy of Pediatrics (AAP) American Board of Pediatrics (ABP) Advocates for children & pediatricians Source of continuing medical education in pediatrics Members pay dues Certifies pediatricians, known as diplomates Develops & administers In-Training, Certifying, & Maintenance of Certification (MOC) examinations Creates & manages process of MOC to ensure ongoing mastery of the six core competencies initially assessed during training AAP also has strong presence in local, state and national affairs relating to children. It has a Department of Federal Affairs in Washington DC; AAP is the largest national source of continuing medical education. You may become a “resident member” of the AAP and your dues may be paid by your program. You will become a “fellow” of the AAP (FAAP) when you pass your ABP General Pediatrics Certifying exam. This is different than being a “fellow” in a training program.

ACGME & ABP Accreditation Council for Graduate Medical Education (ACGME) American Board of Pediatrics (ABP) Accredits training programs Develops the accreditation requirements for training programs Evaluates programs through site visits and data collection Certifies individual pediatricians Sets the standards residents must meet during training to be admitted to the initial certification examination and for fellows to be admitted to the subspecialty certifying examination Works closely with ACGME to ensure that requirements for program accreditation & standards for certification of individuals are aligned Milestones are being reported to ACGME but not yet to ABP. Emphasize that one accredits PROGRAMS (ACGME), and the other certifies INDIVIDUALS (ABP). It's critical that you graduate from an ACGME accredited fellowship program. Without this, you are not eligible (will not be able) to sit for the ABP subspecialty board exam. The ACGME uses subspecialty examination board pass rates of our graduates when it evaluates our program.

Data Reported Annually to the ABP Program Directors provide end-of-year evaluations for each fellow in two areas: clinical competence & professionalism. Clinical competence may be evaluated as either satisfactory, marginal, or unsatisfactory. Clinical Competence Satisfactory Marginal Unsatisfactory Professionalism Professionalism may be evaluated as either satisfactory or unsatisfactory. “Pediatric Residents: A Guide to Evaluating Your Clinical Competence” explains the ABP training and evaluation program and how your competence is evaluated during training and reported to the ABP. It is the same for residents and fellows. Unsatisfactory evaluation requires a repeat year of training. A marginal evaluation may allow for advancement to the next year along with a remediation plan. When a fellow receives an unsatisfactory in professionalism only, then at the ABP’s discretion and PDs recommendation, a period of observation in lieu of a repeat year may be allowed. A Guide to Board Certification – Booklet of Information: provides additional details about the certification process. Receiving a less than satisfactory performance evaluation does have ramifications.

Milestones & Competencies The ABP and the ACGME have developed descriptions of observable behaviors, called Milestones, to be used in assessing the development of competence in the six core domains. Practicing Pediatrician Knowledge Medical Patient Care Interpersonal & Communication Skills Practice-Based Learning & Improvement Systems-Based Practice Professionalism Fellow Resident Glossary of terms: Milestones: descriptions of behaviors Competencies: essential domains of physician practice The arrow demonstrates the development of competence from novice to master across a continuum. Note the progression chart on the first slide (medical school -> residency & fellowship -> examination & certification -> professional development & MOC -> OUTCOME: healthy children) Medical Student Your progress through these developmental milestones will be assessed in a variety of ways throughout your training.

Milestones Milestones are reported twice a year to ACGME and your performance reflects on both you and your training program. ABP expects programs to use milestones to inform their annual assessment of fellows’ clinical competence and professionalism. Milestones are reported to ACGME but NOT to ABP at the present time. Distinguish what is being reported to ACGME (milestones data that is used in aggregate to assess the program) and what is reported to ABP (individual’s evaluation).

Subspecialty In-Training Examination (SITE) Purpose: Designed as an abbreviated version of the subspecialty certifying exam To enable fellows to assess strengths and weaknesses in knowledge at the time of the exam To assess progress from year-to-year To compare performance with national peer groups Inform your fellows about the SITE and when it will be administered, if applicable. The first examination will assess knowledge early in fellowship. SITE scores may help to predict performance on the subspecialty certifying exam but the data are not yet as robust as that with the ITE you took during residency. Using the exam scores other than for self-assessment constitutes a misuse of the scores and compromises the validity and meaningfulness of the results.

Subspecialty Certifying Examination One half-day exam given every two years Cost ~$2900 Must successfully complete training with verification by fellowship program director Eligibility to take and pass the exam is 7 years after completion of fellowship Must also have an unrestricted medical license and be certified in general pediatrics Results reported to fellowship program director Note that to sit for the Subspecialty Certifying examination, you first need to pass the General Pediatrics Certifying Examination. There is a time limit to do so (see below). Emphasize the cost and highlight that this fee MUST be paid via credit card. The subspecialty exam costs more than the General Pediatrics Exam because there are fewer test takers in which to distribute the fee. Also, if you don’t have one already, you will need to obtain a state medical license and this will incur additional cost. Must pass exam within 7 years of graduating from an accredited training program. Eligibility to take the exam expires after 7 years following training. (https://www.abp.org/content/policies#TimeLimited). Note that most subspecialty certifying exams are generally given every TWO years. Certification is public information and will be displayed on ABP website. Additional details about ramifications of not passing--insurance requirements, certain positions require it; maintaining employment; hospital credentialing. A Guide for Board Certification – A Booklet of Information is available online (https://www.abp.org/sites/abp/files/pdf/certboi.pdf). Review A Guide for Board Certification - A Booklet of Information for details

SITE & Certification Exam Security Exam material is confidential and protected by federal copyright law Sharing of exam content is a violation of honor code Honor code signed during application and exam administration The board takes this extremely seriously. Discuss the ramifications of a security breach which can include revocation of certification, banned from future testing, legal action, etc. For SITE exam, cheating could alter a trainee's professionalism evaluation.

Scholarly Activity Fellows MUST engage in projects in which they develop hypotheses or in projects of substantive scholarly exploration and analysis Scholarship Oversight Committee (SOC) is responsible for monitoring progress and deciding whether the ABP requirements have been met Before the end of fellowship, a work product and a personal statement must be submitted to the ABP Potential areas of study include basic, clinical or translational biomedicine, health services, quality improvement, bioethics, education and public policy. Examples include biomedical research, critical meta-analysis of literature, systematic review of clinical practice like a Cochrane review, critical analysis of public policy and curriculum development project with an assessment component. Other activities may also qualify but abstracts, case reports and review articles do not qualify. SOC comprised of at least 3 individuals of whom one must be from outside the trainee’s subspecialty. The Fellowship Program Director can serve as a mentor and participate in the activities of the SOC but is NOT considered a formal member of the SOC. Examples of work product include a peer-reviewed publication, in-depth manuscript, thesis written in pursuit of an advanced degree, some extramural grant applications and progress report for projects of exceptional complexity. The personal statement should describe why the fellow chose that area for study, the project and his/her role in it and how the furthers the fellow’s career path. Both the work product and the personal statement must be approved by all members of the SOC. More information can be found at: https://www.abp.org/apply-exam/subspecialty-certifying-examinations/subspecialty-certifications-and-admission

What is MOC? Maintenance of Certification (MOC) is: 4-part program that you begin once you have passed your initial general pediatrics certification examination Evaluates the same 6 core competencies measured throughout training Competencies are assessed in 5-year cycles, as defined by Maintenance of Certification MOC provides ongoing assessment of the 6 core competencies evaluated during training as shown on this graphic. Each part of MOC addresses multiple competencies with the exception of Part 3 the secure examination. MOC begins once you have passed your general pediatrics certifying exam. MOC for your subspecialty begins once you pass your subspecialty certifying exam. They are different but some MOC activities provide points for both. Part 1 (professionalism) requires physicians to hold a valid, unrestricted medical license (applies to all licenses held). The ABP feels that this licensure requirement is a very low bar to satisfy assessment of professionalism. Work will soon begin to examine professionalism and discussions will take place about the possible need for this component to become more rigorous.

MOC Credit During Fellowship MOC credit depends on a fellow’s certification status (Have they passed the GP exam?) Fellows who have not yet passed their general pediatrics examination may earn MOC credit for ABP approved QI Projects and apply credit to their first MOC cycle. Fellows already certified in general pediatrics get credit in 2 ways: 20 points of MOC credit automatically awarded per year for fellowship ABP Approved QI activities earn additional MOC credit For more information, please visit: Points awarded depend upon whether the fellow is certified in General Pediatrics. If yes, points are automatically awarded. If no, eligible to get Part 4 points (but not Part 2) by participating in an approved ABP QI activity. These points are then banked until the fellow passes the General Peds Exam. For fellows who are certified, points are given via an automated process based on tracking and evaluation forms submitted by Fellowship Program Director. Fellow receives electronic notification when credit is posted to his/her online portfolio. Fellow may receive additional credit if submits an approved QI project. As a resident, you should have already registered on the ABP website for your ABP Portfolio after the first ITE. As part of the MOC for Residents program, you may have earned bankable credit for Part 4 activities. This will become available once you pass your General Pediatrics Certifying Exam. Remember, fellows cannot get part 2 credit until they pass their certifying exam in General Pediatrics!! More information can be found at: https://www.abp.org/content/moc-for-residents https://www.abp.org/content/moc-for-residents-and-fellows

The ABP website is a valuable resource for information www.abp.org The ABP website is a valuable resource for information Eligibility and training requirements How to become certified How to maintain certification Subspecialty Exam Content Outline Please visit: https://www.abp.org/apply-exam/subspecialty- certifying-examinations/subspecialty-certifications-and- admission If I’m a fellow – what do I want to know? Where do I go? ABP website has information on how to become certified, exam preparation, and resources: https://www.abp.org/content/policies Link to the examination content specs/outline: https://www.abp.org/content/content-outlines Nonstandard pathways including research pathways "The ABP has a number of non-standard pathways. They are available on the website: https://www.abp.org/content/non-standard-pathways-and-combined-programs.