ABEM CERTIFICATION.

ABEM CERTIFICATION

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.

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

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

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 In 2003, the American Board of Internal Medicine commissioned the Gallup organization to poll the general public about their views on physician certification and maintenance of certification. The findings of this poll were published in a September 2004 peer-reviewed article in the Journal of the American Medical Association. In the article the authors summarize the relationship of board certification to patient care, and based on the results of the poll, report that the public sees certification as an essential designation of physician quality. Three of four adults surveyed reported that they would change or select physicians on the basis of board certification and that they would place board certification status over the recommendation of trusted family and friends. The survey also revealed that certification and maintenance of certification are highly valued by the public. Slide #10

ABEM EM Certification Journey
Residency Training Initial Certification Continuous Certification In-training Examination Credentialing Written & Oral Examinations Professional Standing Lifelong Learning & Self Assessment ConCert Examination Assessment of Practice Performance Like some other ABMS member boards, ABEM develops and administers an in-training examination; and, like all ABMS member boards, ABEM requires the successful completion of residency training before an emergency physician can sit for the certification examination. This requirement means that the process of continuous certification in Emergency Medicine really begins at the onset of approved Emergency Medicine residency training. Maintenance of Certification© was conceived by the American Board of Medical Specialties to extend the peak of formal learning over the entire career of a specialist physician. Through maintenance of certification, emergency physicians will be challenged to continue their learning for their entire career and be afforded regular opportunities to test their knowledge and demonstrate their mastery of skills. The ABEM program to help diplomates maintain certification is called “Emergency Medicine Continuous Certification” or “EMCC.” © American Board of Medical Specialties, Maintenance of Certification Slide #6

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.

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 The EM Model is a state-of–the-art document that describes the current clinical practice of Emergency Medicine. It was developed through a lengthy scientific process that was based on the collaboration of six Emergency Medicine organizations: ABEM, the American College of Emergency Physicians, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents Association, the Residency Review Committee for Emergency Medicine, and the Society for Academic Emergency Medicine. The EM Model serves as the common-source document for all EM organizations as they work to develop school and residency program curricula, training program accreditation standards, board certification test specifications, and organizational agendas for post-graduate education, research, and patient advocacy for the specialty. The EM Model can be located on the ABEM website, Slide #8

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).

Applying to Take ABEM Exam
April April 15 – June 30 July July 1 – August 31 Applications sent to EM residency directors for distribution to graduating residents Annual application cycle ABEM verifies successful completion of EM program requirements with each program director Late application cycle Acceptance letters and registration materials sent to candidates on a rolling approval basis In April, ABEM sends applications to the Emergency Medicine program directors for distribution to graduating residents. If the graduating resident plans to take the fall written certification examination, the application must be completed and returned with the application fee to the ABEM office postmarked by June 30. During July, ABEM requests written verification from the program directors that the EM residency graduates successfully completed the requirements of the program. If the June 30 deadline is missed, there is a late application cycle that extends through August 31. There is an additional fee added to the application fee if the application is submitted during this late cycle. When ABEM receives verification of successful completion of the training program, acceptance letters and examination registration materials are sent to the candidate. This process occurs on a rolling approval basis beginning in late July. Slide #10

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 The written certification examination is a one-day, 6.5 hour examination, given annually in the fall at several sites across the country. It consists of approximately 335 multiple-choice questions. All questions require only one best answer. About one-third of the questions are field-test questions that are not scored. Neither the written nor the oral examination have any scorable questions that have not been previously field-tested. This assures that they have met clinical and statistical criteria for entry into the active question databank. A score of 75% is required to pass the written examination and move on to the oral examination. Slide #11

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%

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

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

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.

ABEM Oral Exam Content (red= area of emphasis)
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 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

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

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

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 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.

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 The written examination tests the breadth and depth of the candidate’s knowledge base, as defined by a proportional sampling of questions based on The Model of the Clinical Practice of Emergency Medicine. The oral examination tests certain clinical skills that are difficult to assess in a written format. In particular, the oral examination focuses on data acquisition, problem-solving, clinical judgment, interpersonal skills, management of multiple patients, and integration of all relevant information into a clinically appropriate diagnostic and treatment plan. Slide #20

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.

The Components of Continuous Certification Programs
Professional Standing Lifelong Learning and Self Assessment Assessment of Cognitive Expertise Assessment of Practice Performance The EMCC program will include four components, as required by the American Board of Medical Specialties, for all MoC programs. Professional Standing Lifelong Learning and Self Assessment Assessment of Cognitive Expertise Assessment of Practice Performance We will cover each of these components on the slides that follow. Slide #22

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”

Self Assessment (LLSA)
Lifelong Learning and Self Assessment (LLSA) Online annual open book self-assessment test Based on annual reading list multiple-choice questions 90% correct passing score 3 opportunities to pass before repaying fee Began April 5, 2004 Each test available for three years The Lifelong Learning and Self-Assessment (LLSA) tests will be available online to diplomates beginning on April 5, 2004. LLSA will include an annual list of readings based on The Model of the Clinical Practice of Emergency Medicine. The list of readings is available on the ABEM website. The readings are designed as study tools and should be read critically. They are not intended to be all-inclusive and are not meant to define the standard of care for the clinical practice of EM. Each year, LLSA focuses on a specific designated content area of the EM Model. Approximately half of the readings selected annually relate to the designated content area. The other readings relate to the remaining content areas of the EM Model. Diplomates have access to annual online self-assessment tests based on the list of readings for that year. Each test has a passing standard of 90% correct and will remain available online for three years. Diplomates may access each test as often as they prefer and have three opportunities to pass each test without having to re-register. Slide #24

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

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 ABEM implemented the cognitive expertise examination (ConCert) in the fall of 2004. This component includes a secure, proctored examination administered over the course of six days at approximately 200 computer-based testing centers nationwide. The content will be based on The Model of the Clinical Practice of Emergency Medicine, with up to 40% of items eventually based on Lifelong Learning and Self-Assessment readings. The Continuous Certification (ConCert) examination will be a five hour examination with approximately 205 questions. Like all ABEM examinations, it will include field-test questions. Slide #26

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%

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

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

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

Difference Between LLSA & ConCert Exam
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

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 ABEM’s Assessment of Practice Performance will be focused on practice improvement and will accommodate diplomates in a variety of practice settings. The component will offer diplomates a choice of ways to meet ABEM requirements. The implementation timeframe for this component is still being determined. Research and development work related to the component will continue over the next few years. Slide #32

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

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

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.

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%

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%

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

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

Author credit – ABEM Certifications David Cheng MD
Questions

Postresidency Tools of the Trade CD
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 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

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