SAN DIEGO -- If they get their way, internists seeking to maintain their board certification may soon have a third option beyond the often-dreaded 10-year American Board of Internal Medicine exam or the board's two-year that starts next year.
In a nutshell, officials with the American College of Physicians say their home educational learning tool, called , or Medical Knowledge Self Assessment Program, is a great foundation for a better way, and could become an acceptable alternative to what the ABIM now requires for maintenance of certification (MOC), said , immediate past chair of the ACP's Board of Regents.
"The ABIM would deem the ACP's pathway as meeting its requirements," Tape said. Despite rumors and hallway talk circulating during last week's annual ACP meeting, it is not the ACP's plan to have the ACP determine if the doctor meets criteria, he emphasized.
With the ABIM process today, "you have to go somewhere else [besides the ABIM] to learn the material. Whether it's journals or conferences, board review courses, or use the ACP's MKSAP, you're on your own to figure out how to learn. And then the ABIM tells you whether you've learned enough. The ACP's conceptualization is to bring the learning and assessment together into one piece."
Updated for some 50 years, the MKSAP is used by about 66,000 physicians, according to the ACP.
From Study Guide to Standalone
It consists of modules for 11 -- such as cardiovascular or infectious diseases -- offering a total of 1,200 to 1,800 questions, depending on whether online or in book format. The purpose is to help doctors pass the ABIM exam, but also to help internists and their subspecialties "diagnose disease states that are less common and sometimes overlooked or confusing" and help them "determine when to refer patients for surgery or care by subspecialists."
The answers and key points are listed in the back of the books or digital modules. Currently, physicians submit their scores online or by mail to the ACP for continuing medical education credit and to test their skills at their own pace and setting.
Tape said the MKSAP is already helping doctors stay on top of the latest in evidence-based care.
He offered this analogy: A high school student applying to college might take an advanced placement exam for, say, calculus. "If the student passes that exam, they don't take the course. They're certified as having learned the material."
But he cautioned that getting ABIM to accept the MKSAP for certification is far from a sure thing.
"We're at the 50,000 foot level, and we need to bring it down to a more practical level, and that hasn't happened yet," he said in an interview during the ACP's annual meeting here. At least one meeting between ACP and the ABIM is scheduled in the next few weeks, he said.
"We're hoping we'll come to an agreement with ABIM where they say, 'That's a really important and useful way of combining learning and assessment ... and we'll deem that an alternative to the two other pathways, the 10-year pathway and the every two-year Knowledge Check-In.'"
The idea may also serve to greatly lessen the hostility some internal medicine physicians harbor toward the ABIM for what they say are overly burdensome and expensive requirements that are irrelevant to their practices.
In response to a question during a session held during the ACP's annual meeting here Friday, ABIM president , confirmed that the ACP's MKSAP idea has legs and that talks are underway
"We all recognize that the MKSAP is a spectacular educational resource. And that people who are authentically engaged in MKSAP... that's a great way to keep up," he said.
What's on the table is the idea that if someone completes MKSAP, "that should count for our maintenance [of certification] pathway," he said.
Details to Work Out
But several questions remain, Baron cautioned. For starters, the ABIM will have to define what is required to "complete" the MKSAP, and define a successful completion.
The ABIM also would have to assure security for the testing process, and have confidence that the person completing the MKSAP is the same person as the one seeking to complete MOC requirements, Baron said.
"How do we know it's that person? Because when you move from it being a purely educational informative program, and start putting any consequence on it, behavior changes," he said.
Also unclear is how the money would flow. Would internists continue to pay the ABIM fees that can top $200 per year per board, even if MKSAP is their chosen way of proving knowledge -- while also paying the ACP to take the MKSAP?
But the idea that the ABIM is willing to consider further options in what it requires for doctors to become re-certified is significant.
Three years ago, many specialty groups covered by the ABIM's criteria expressed extreme frustration and outrage, with some even threatening mutiny at the ABIM's new requirement that they would have to complete "continuous learning" segments, in addition to the traditional 10-year exam.
One doctor, , of San Diego, leads an effort to set up an alternative certification board.
New rules say that physicians certified prior to 1990 are still certified for life. But doctors who do not complete continuous learning exercises or tests at required intervals for maintenance of certification points will show up on the ABIM website as "certified, not participating in MOC."
According to an ABIM spokeswoman, in order to be shown on the website as "'participating in MOC,' any physician — grandfathered or time-limited — currently needs to take the following steps, which include earning some points every two years, earning 100 points every five years, and taking the exam every 10 years." But doctors first certified before 1990 who do not complete these steps will not lose certification.
The ABIM has since taken numerous steps to modify its requirements and Baron, in several statements, acknowledged both he and the board have reconsidered some of their stances.
For example, in response to several physician surveys, the ABIM last year removed about 700 questions from the exam, said ABIM board member .
The new Knowledge Check-In sets learning requirements every two years, has fewer questions than the long form 10-year exam, can be taken in a doctor's home or office or in a testing center, and the physician will learn results immediately. Unless a physician fails two years in a row, taking the check-in every two years eliminates the need to take the 10-year exam.
Similar discussions are underway between ABIM and the American Society of Clinical Oncology and the American College of Cardiology, because they also have "well-developed self-assessment programs," said , ACP senior vice president of medical education.
"It's important to note that none of these three societies will be the ones to certify their physicians as board certified," Alguire said. "[Societies] will simply tell the ABIM that a physician successfully completed the program. We think we can offer enhancements that the ABIM cannot because we're an educational organization."