abem certification. society for academic emergency medicine american board of emergency medicine...

ABEM CERTIFICATION

Society for Academic Emergency Medicine

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


ABEM EM Certification Journey

• In-training Examination

ResidencyTraining

• Credentialing• Written & Oral Examinations

InitialCertification

1. Professional Standing2. Lifelong Learning & Self Assessment3. ConCert Examination4. Assessment of Practice

Performance

ContinuousCertification


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


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

July

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


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


ABEM Qualifying Exam Content

Question Percentage Listing of Conditions & Components1.0 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)

1) Signs, Symptoms and Presentations

2) Abdominal & Gastrointestinal Disorders

3) Cardiovascular Disorders 4) Cutaneous Disorders5) Endocrine, Metabolic &

Nutritional Disorders6) Environmental Disorders7) Head, Ear, Eye, Nose & Throat

Disorders8) Hematologic Disorders9) Immune System Disorders

10) Systemic Infectious Disorders

11) Musculoskeletal Disorders (Non-traumatic)

12) Nervous System Disorders13) Obstetrics and Gynecology14) Psychobehavioral Disorders15) Renal and Urogenital

Disorders16) Thoracic-Respiratory

Disorders17) Toxicologic Disorders18) Traumatic Disorders


ABEM Oral Board Exam

Physician Tasks 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 5.75. 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

1. Data acquisition2. Problem solving3. Clinical judgment4. Interpersonal relations

5. Management of multiple patients


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

1. Professional Standing

2. Lifelong Learning and Self Assessment

3. Assessment of Cognitive Expertise

4. Assessment of Practice Performance


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”


Lifelong Learning andSelf Assessment (LLSA)

Online annual open book self-assessment test

Based on annual reading list

32 - 40 multiple-choice questions

90% correct passing score

3 opportunities to pass before repaying fee

Began April 5, 2004

Each test available for three years


LLSA Content (cycle repeat in 2013)

2004: Thoracic-Respiratory DisordersImmune System DisordersMuskuloskeletal Disorders

2005: Nervous System Disorders

Toxicologic Disorders

2006: Traumatic DisordersCutaneous Disorders

2007: Signs, Symptoms, and PresentationsPsychobehavioral Disorders

2008: Procedures & Skills Integral to the Practice of EM

Environmental Disorders

2009: Cardiovascular DisordersHematologic Disorders

2010: Abdominal & Gastrointestinal Dz Other Components of Practice of EM

2011: Head, Ear, Eye, Nose, Throat DzEndocrine, Metabolic & Nutritional DzRenal & Urogenital Disorders

2012: Systemic Infectious DisordersObstetrics & 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


ConCert Exam Content

Question Percentage Listing of Conditions & Components1.0 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

LLSA 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


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 remindersPersonal educationChange in systems or processClinical pathway

2. Must access and review one of the following sources of patient data from 10 to 25 patients:Patient clinical dataFeedback from patients that relates to clinical care givenPatient 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 boardDepartment chairChief of staffMedical directorPractice 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 2004--92% (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


WWW.ABEM.ORG


Author credit – ABEM CertificationsDavid Cheng MD

Questions


Postresidency Tools of the Trade CD

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

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

abem certification. society for academic emergency medicine american board of emergency medicine...

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oral certification examination

successful abem certification

initial certification

andcontinuous certification

approved abem subspecialties

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