ABFM Extends 2004 SAM Deadline

For many Americans, April 15 isn't exactly a date to look forward to. But for FPs enrolled in the American Board of Family Medicine's Maintenance of Certification Program for Family Physicians, or MC-FP, that date might now take on a positive slant. April 15 is the new deadline for completing the required 2004 self-assessment module, or SAM, of the board's MC-FP process.

Why the extension from Dec. 31? The board had multiple reasons for allowing additional time to complete the SAM requirement this year, according to ABFM Deputy Executive Director Joseph Tollison, M.D. Perhaps foremost among them: "This is an educational initiative, not a test," Tollison stressed in an interview Jan. 4. "With all the challenges faced by family physicians and with all the start-up conditions, this was deemed appropriate by the board."

With many FPs having entered the ABFM's SAM Web site late in the year, one factor may be as simple as demand overwhelming supply.

"We had a lot of our Diplomates who were committed to doing the right thing; they were trying to get in, and the system just got really loaded," said Tollison. "And that last Christmas week, we knew our Help Desk would not be at (full) staff."

Melissa Duxbury, M.D., of Hudson, N.H., an at-large member of the New Hampshire AFP Board of Directors, knows firsthand some of the Web-based SAM's limitations.

"During the year, I had tried several times to access the site, which was 'busy' or 'down' many times," said Duxbury in a Jan. 11 interview. "I had spent several hours trying to work on this myself when I realized there were 18 -- yes, 18 -- references that we were required to read to answer the 60 questions posed. I asked a few other physicians, some of whom told me it took over 40 hours to complete.

"I think the best idea would be to have three to four brief review articles in a POEMs (patient-oriented evidence that matters) format and be questioned on those. Or the board could request more CME credit -- maybe up to 50 CME credits -- as I would expect it to take about 50 hours to critically read 18 articles."

Based on information provided by the ABFM, the entire SAM exercise was approved for 15 Prescribed credits. And Duxbury said she hasn't even yet begun the second part of the SAM, a physician-patient clinical encounter simulation.

Throughout the process, Duxbury said she corresponded frequently with Web site support staff at the ABFM, apprising them of her progress and of problems she encountered with the system.

"After multiple complaints about the site and the enormity of the process, I was told on Dec. 23 that an extension was being made available until April 15."

What bearing Duxbury's appeal may have had on the ABFM's decision is unclear, but the ABFM board, meeting in late December, decided to cut Diplomates some slack -- this year, at least. The board remains committed, Tollison said, to requiring completion of one SAM each year of the six-year recertification cycle. So Diplomates would still need to complete a SAM during calendar year 2005 to fulfill the 2005 requirement.

"I must be honest," Duxbury said, "I have learned nothing (from this process) except how to become frustrated. I have not yet spoken to anyone who felt this was a poor idea, just that it was poorly executed. Obviously, the people who are working on this exam are trying to work with the system, but there are still a lot of issues.

So just how many Diplomates are likely to take the board up on its extension offer? Of 11,259 Diplomates eligible to complete this part of the recertification process, said Tollison, 4,350 had completed the diabetes module as of Jan. 4, and another 355 were in the process of doing so. For the hypertension module, 2,181 Diplomates had completed it, with another 172 in progress.

"We're delighted with this number," said Tollison. "We obviously have seen a lot of concerns, and a lot of them were appropriate concerns. We're very open about that. That's the reason we solicited user feedback."

The board has made good use of that feedback, Tollison added, instituting 16 modifications secondary to Diplomates' input.

"Technologically, we've really made some major, major improvements," Tollison noted. "So the person who took it in February or March (2004) and completed it then would have had a very different electronic experience than that person would have had in November or December. And we continue to improve it."

The end goal, according to Tollison, is to make the computer-based SAM process -- and indeed the entire MC-FP process -- as user-friendly as possible.

"Ultimately, the computer needs to be a tool, a vehicle," he said. "It should be like getting in your car. When you got in your car this morning and drove to work, you didn't worry about whether the alternator was doing its thing or whether the carburetor was doing its thing -- you were thinking about work or family or whatever. You were thinking about your life. And that's what we're working toward with this. Ultimately, the computer is just a tool -- a very good tool -- that a person can use to accomplish an educational endeavor."

For now, Duxbury offers the following advice on tackling the SAMs: "Start sooner and e-mail about every issue -- as it happens -- to the ABFM and your local AAFP chapter, so there is strict documentation of problems with the process. This would include days the site is down, difficulty with the questions, the amount of reading required, the simulation, whether you feel the information presented is useful in everyday practice, and so forth."

To take advantage of the extension, e-mail mcfpextension@theabfm.org. Include the words extension request in the subject line and body of your e-mail.

In response to a directive from the 2004 Congress of Delegates, the AAFP last November sent a letter to the board, discussing concerns about the SAM process and offering suggestions for addressing those concerns. AAFP leaders hope the SAM process will be among topics to be discussed at a meeting of the two organizations' executive committees and asked the board to respond by March 1.