Fellowship-trained physicians who let their geriatric medicine certification lapse: A national survey.

Background: Only 62.6% of fellowship-trained and American Board of Internal Medicine (ABIM)-certified geriatricians maintain their specialty certification in geriatric medicine, the lowest rate among all internal medicine subspecialties and the only subspecialty in which physicians maintain their internal medicine certification at higher rates than their specialty certification. This study aims to better understand underlying issues related to the low rate of maintaining geriatric medicine certification in order to inform geriatric workforce development strategies.

Changes in Stress and Workplace Shortages Reported by U.S. Critical Care Physicians Treating Coronavirus Disease 2019 Patients.

Objectives: Eleven months into the coronavirus disease 2019 pandemic, the country faces accelerating rates of infections, hospitalizations, and deaths. Little is known about the experiences of critical care physicians caring for the sickest coronavirus disease 2019 patients. Our goal is to understand how high stress levels and shortages faced by these physicians during Spring 2020 have evolved.

Opportunities for Maintenance of Certification to Better Reflect Scope of Practice Among Medical Oncologists.

Purpose: Critics argue that the American Board of Internal Medicine's medical oncology Maintenance of Certification examination requires medical oncologists with a narrow scope of practice to spend time studying material that is no longer relevant to their practice. However, no data are available describing the scope of practice for medical oncologists.

Methods: Using Medicare claims, we examined the scope of practice for 9,985 medical oncologists who saw 8.

"That Was Pretty Powerful": a Qualitative Study of What Physicians Learn When Preparing for Their Maintenance-of-Certification Exams.

Background: A key component of Maintenance of Certification (MOC) for family and internal medicine physicians is the requirement to pass a periodic examination of medical knowledge. Little is known about the effects of preparing for MOC exams on knowledge and practice.

Objective: To understand how MOC exam preparation can affect knowledge and practice.

Tiny Moments Matter: Promoting Professionalism in Everyday Practice.

Introduction: Professionalism rests upon a number of individual, environmental, and societal level factors, leading to specific professional behavior in specific situations. Focusing on professional lapses to identify and remediate unprofessional physicians is incomplete. We explored professionalism in practicing internal medicine physicians in the context of everyday practice, to highlight how typical experiences contribute to positive, yet often unnoticed, professional behavior.

Co-creation by the ABIM Geriatric Medicine Board and the AGS - Helping Move Geriatrics Forward.

The American board of internal medicine (ABIM) establishes standards for physicians. The American geriatrics society (AGS) is a not-for-profit membership organization of nearly 6,000 health professionals devoted to improving the health, independence, and quality of life of all older people. Beginning in 2013, ABIM redesigned its governance structure, including the role of the specialty boards.

How hospitalists work to pull healthcare teams together.

Purpose: The purpose of this paper is to document everyday practices by which hospitalist physicians negotiate barriers to effective teamwork.

Design/methodology/approach: Ethnographic observation with a sample of hospitalists chosen to represent a range of hospital and practice types.

Findings: Hospitals rely on effective, interprofessional teamwork but typically do not support it.

Assessing the Quality of Osteoporosis Care in Practice.

Background: Patients with osteoporosis can sustain fractures following falls or other minimal trauma. This risk of fracture can be reduced through appropriate diagnostic testing, pharmacologic therapy, and other readily measured standards of care.

Objectives: Our aim was to develop a credible clinical performance assessment to measure physicians' quality of osteoporosis care, and determine reasonable performance standards for both competent and excellent care.

Assessing interprofessional teamwork: pilot test of a new assessment module for practicing physicians.

Introduction: Teamwork is a basic component of all health care, and substantial research links the quality of teamwork to safety and quality of care. The TEAM (Teamwork Effectiveness Assessment Module) is a new Web-based teamwork assessment module for practicing hospital physicians. The module combines self-assessment, multisource feedback from members of other professions and specialties with whom the physician exercises teamwork, and a structured review of those data with a peer to develop an improvement plan.

Association between imposition of a Maintenance of Certification requirement and ambulatory care-sensitive hospitalizations and health care costs.

Importance: In 1990, the American Board of Internal Medicine (ABIM) ended lifelong certification by initiating a 10-year Maintenance of Certification (MOC) program that first took effect in 2000. Despite the importance of this change, there has been limited research examining associations between the MOC requirement and patient outcomes.

Objective: To measure associations between the original ABIM MOC requirement and outcomes of care.

Development of an instrument to evaluate residents' confidence in quality improvement.

Background: Practice-based learning and improvement is a core competency that all medical residents must demonstrate. Because confidence is important in translating competence into action, effective quality improvement (QI) curricula should evaluate trainees' knowledge and confidence to perform QI. Past efforts to assess educational outcomes in QI have not adequately evaluated trainees' confidence from a multidimensional perspective.

Variability in obtaining institutional review board approval for quality improvement activities in residency programs.

Introduction: Quality improvement (QI) activities are an important part of residency training. National studies are needed to inform best practices in QI training and experience for residents. The impact of the Institutional Review Board (IRB) process on such studies is not well described.

A new tool to give hospitalists feedback to improve interprofessional teamwork and advance patient care.

Teamwork is a vital skill for health care professionals, but the fragmented systems within which they work frequently do not recognize or support good teamwork. The American Board of Internal Medicine has developed and is testing the Teamwork Effectiveness Assessment Module (TEAM), a tool for physicians to evaluate how they perform as part of an interprofessional patient care team. The assessment provides hospitalist physicians with feedback data drawn from their own work of caring for patients, in a way that is intended to support immediate, concrete change efforts to improve the quality of patient care.

Comparative trial of a web-based tool to improve the quality of care provided to older adults in residency clinics: modest success and a tough road ahead.

Purpose: To determine whether residency programs can use a multicomponent, Web-based quality improvement tool to improve the care of older adults.

Method: The authors conducted an exploratory, cluster-randomized, comparative before-after trial of the Care of the Vulnerable Elderly Practice Improvement Module in the ambulatory clinics of 46 internal medicine and family medicine residency programs, 2006-2008. The main outcomes were the deltas between pre- and post-performance on the Assessing Care of the Vulnerable Elderly (ACOVE) quality measures.

Gaps in quality of diabetes care in internal medicine residency clinics suggest the need for better ambulatory care training.

To ensure that medical residents will be prepared to deliver consistently high-quality care, they should be trained in settings that provide such care. Residents in internal medicine, particularly, need to learn good care habits in order to meet the needs of patients with diabetes and other common chronic and high-impact illnesses. To assess the strength of such training, we compared the quality of medical care provided in sixty-seven US internal medicine residency ambulatory clinics with the quality of care provided by 703 practicing general internists.

Listening to older adults: elderly patients' experience of care in residency and practicing physician outpatient clinics.

The population of people aged 65 and older is rapidly growing. Research has demonstrated significant quality gaps in the clinical care of older patients in the United States, especially in training programs. Little is known about how older patients' experience with care delivered in residency clinics compares with that delivered by practicing physicians.

Setting a fair performance standard for physicians' quality of patient care.

Background: Assessing physicians' clinical performance using statistically sound, evidence-based measures is challenging. Little research has focused on methodological approaches to setting performance standards to which physicians are being held accountable.

Objective: Determine if a rigorous approach for setting an objective, credible standard of minimally-acceptable performance could be used for practicing physicians caring for diabetic patients.

Measuring physicians' performance in clinical practice: reliability, classification accuracy, and validity.

Much research has been devoted to addressing challenges in achieving reliable assessments of physicians' clinical performance but less work has focused on whether valid and accurate classification decisions are feasible. This study used 957 physicians certified in internal medicine (IM) or a subspecialty, who completed the American Board of Internal Medicine (ABIM) Diabetes Practice Improvement Module (PIM). Ten clinical and two patient-experience measures were aggregated into a composite measure.

Toward better care coordination through improved communication with referring physicians.

Background: Effective care coordination requires good physician-to-physician communication. The authors evaluated a new tool called the Communication with Referring Physicians Practice Improvement Module (CRP-PIM), which assesses and encourages improved communication among physician consultants and referring physicians.

Method: Eight-hundred three consultants (internists and subspecialists) completed a practice system survey and were rated by 12,212 referring physicians on 13 communication processes using a six-point scale.

Clinic systems and the quality of care for older adults in residency clinics and in physician practices.

Purpose: The U.S. health care system is not prepared to meet the needs of the increasing population of older adults.

Variation in internal medicine residency clinic practices: assessing practice environments and quality of care.

Background: Few studies have systematically and rigorously examined the quality of care provided in educational practice sites.

Objective: The objectives of this study were to (1) describe the patient population cared for by trainees in internal medicine residency clinics; (2) assess the quality of preventive cardiology care provided to these patients; (3) characterize the practice-based systems that currently exist in internal medicine residency clinics; and (4) examine the relationships between quality, practice-based systems, and features of the program: size, type of program, and presence of an electronic medical record.

Design: This is a cross-sectional observational study.

Self-assessment of practice performance: development of the ABIM Practice Improvement Module (PIM).

Background: Quality measurement and improvement in practice are requirements for Maintenance of Certification by the American Board of Medical Specialties boards and a component of many pay for performance programs.

Objective: To describe the development of the American Board of Internal Medicine (ABIM) Practice Improvement Module (PIM) and the average performance of ABIM diplomates who have completed the Preventive Cardiology PIM.

Design: Observational study of self-administered practice quality improvement.

Improving the quality of care via maintenance of certification and the Web: an early status report.

Few question the need for continuous professional development throughout a physician's career, but rapid changes in health care are creating demand for physicians to acquire new knowledge, skills, and attitudes to implement quality improvement in clinical practice. The Internet and World Wide Web are technologies that have the potential to facilitate deep change in physician practice and lifelong learning. This paper describes how the American Board of Internal Medicine (ABIM) has utilized the Web and the Internet to engage physicians in the competencies of practice-based learning and improvement and systems-based practice.