Delegates to the 2019 Congress of Delegates here addressed a number of education-related issues, including the pros and cons of the American Board of Family Medicine's Family Medicine Certification Longitudinal Assessment; the desire for more CME on health care systems, economics and policy; and how to best approach issues with family medicine residencies.
Elizabeth Baxley, M.D., executive vice president for the American Board of Family Medicine, testifies before the Reference Committee on Education in response to a resolution that said the ABFM's Family Medicine Certification Longitudinal Assessment was inconsistent with the final report of the American Board of Medical Specialties' Continuing Board Certification: Vision for the Future Commission.
FMCLA Inconsistent With ABMS Vision Report
Family physicians who participated in the Reference Committee on Education hearing on Sept. 23 discussed a resolution that said the ABFM FMCLA was inconsistent with the American Board of Medical Specialties' Continuing Board Certification: Vision for the Future Commission's Final Report.(www.abms.org)
Based on testimony from the hearing, the reference committee had recommended not adopting the measure, but it was extracted and amended during the business session Sept. 24, and delegates ultimately adopted it as amended.
The amended version called on the AAFP to express its concern that the ABFM's FMCLA is the only alternative to the one-day certification exam and asked that the Academy urge the ABFM to offer a longitudinal self-assessment process (similar to that used by the American Board of Obstetrics and Gynecology) and that this process satisfy the cognitive component of ABFM's continuing certification requirement.
- Family physicians who participated in the 2019 Congress of Delegates Reference Committee on Education hearing on Sept. 23 discussed a resolution about the American Board of Family Medicine's Family Medicine Certification Longitudinal Assessment.
- Delegates also debated two resolutions that addressed family medicine residency closures and shortages, respectively; both were ultimately referred to the Board.
- Another pair of resolutions submitted by the Colorado, New York and Utah chapters that were referred to the Board suggested adding a CME category for "health care systems, economics and policy."
Speaking in support of the original resolution that her chapter had submitted, Florida AFP President Michelle Brandhorst, M.D., of Pensacola, asked, "If you were to explain these alternatives to your patients, in which would they prefer you to participate? And given that the ABMS Vision Report recommends that ABMS and ABMS boards must have consistent processes and requirements, do you feel those two alternatives are consistent?
"On which alternative do you want your ability to serve your patients and provide for yourself and family to depend?" Brandhorst continued. "And finally, is FMCLA really a valuable MOC alternative, or is it just better than what we had before?"
During discussion at the business session, new physician constituency delegate Lt. Cmdr. Kevin Bernstein, M.D., of Jacksonville, Fla., said new physicians appreciate having alternative ways to recertify available, including those that accommodate various learning methods and styles.
"Given that the ABFM is open to evaluating this process, without reason, this is a really good window of opportunity to take a look at additional alternatives for new physicians who will eventually recertify, as well as for the rest of you," he said.
During the reference committee hearing, Elizabeth Baxley, M.D., executive vice president for the ABFM, testified in response to discussion about this resolution, saying the Board appreciates the interest in the Vision Commission and report but adding that the original resolution didn't offer a complete understanding of the Board's intent.
"FMCLA is done on your own time, in your own location, you can do one question -- or 25 questions -- a day, you can use references -- it is substantially different from the one-day exam," she said.
Baxley said the most consistent type of exam format across the 24 medical member boards mirrors that of the FMCLA.
"With respect to whether we are consistent on the formative/summative, the most frequent feedback we are getting from people participating is that 'I am learning while I am doing it,'" she said. "I like this format, it is less stressful, and I'm learning."
Baxley further noted that while she was attending this conference, a delegate told her that FMCLA had changed his practice.
"While he is using FMCLA, he is able to do something different the next day in practice because he can see the critiques not available on the one-day exam and he's learning from them."
Baxley concluded by stating that the ABFM thinks the FMCLA is highly formative and complements the Board's other formative mechanisms.
"We believe we are consistent with the Vision Commission," she said. "And the commission believes that summative decisions of whether diplomates demonstrate ongoing competency in their specialties (are) necessary for ABMS boards to fulfill their responsibility to the public.
"We continue to work with the Academy around issues with remediation and give people more opportunities for formative learning." Baxley continued. "Remember, this is the first year of a two-year pilot, and remember that there are committees in place through the Vision Commission that are going to take the commission's report and actualize them into standards."
Family Medicine Residency Closures, Shortages
Two resolutions that delegates referred to the Board addressed family medicine residency closures and shortages, respectively.
Colorado AFP delegate Brian Bacak, M.D., of Highlands Ranch, discusses a resolution his chapter introduced that asked the ABFM to create a new hardship category for residents whose residency program is heading for closure but has not yet made a formal announcement.
First, a resolution submitted by the Colorado chapter charged the AAFP with, among other things, requesting that the ABFM expand and alter its definition of "hardship" to create a new hardship category that defines a residency program hardship as the period of time before closure is formally announced during which a program experiences significant decrements in financial, faculty or educational support, requiring advanced planning for residents in their second or third year of training.
Additionally, the resolution asked the Academy to work with the ABFM to allow a waiver of continuity requirement for residents under the newly created hardship category and create a resource within the AAFP or ABFM to assist residents who find themselves involved in a program closure.
Colorado AFP delegate Brian Bacak, M.D., of Highlands Ranch, testified that while he was serving on the Colorado AFP's Education Committee, the group dealt with a residency closure in the state.
"This resolution is trying to address the period of time before a residency closure is actually announced," he said. "In residency programs where the resources are being slowly strangled through the gradual withdrawal of community preceptorships, educational funding and poor teaching elements, residents often have no recourse. You can see this happening usually long before the institution or sponsor organization announces a closure."
Bacak testified that residents he spoke with about this issue said they wanted an opportunity to discuss their future. "They want to be able to network with programs that might be able to assist them," he explained. "But for peace of mind, they need to fall under some sort of ABFM waiver that would allow them to transfer programs."
ABFM President and CEO Warren Newton, M.D., M.P.H., testified that the organization is typically involved in one to three residency closure cases a year.
"We are committed to working with individual residents," he said. "From year to year, we typically extend hardships in these cases. And we have a full-time employee who is available to help with these residents along with Elizabeth Baxley and myself.
Utah AFP delegate Kirsten Stoesser, M.D., of Salt Lake City, testifies about a resolution her chapter introduced that suggested financial incentives should be offered to encourage graduating medical students to choose residencies in family medicine and remain in primary care practice.
"We believe the spirit of this resolution is already being met," Newton continued. "But it is absolutely critical that we know well in advance and as it is happening about these situations. The faster we know, the better."
Finally, AAFP Director James Ellzy, M.D., of Washington, D.C., spoke on behalf of the Board, stating that the Academy has good relationships with the ABFM and the Accreditation Council for Graduate Medical Education and has worked closely with these organizations as residencies have closed during the past three or four years.
"The Board believes that this is a big issue that needs more study and broader solutions than the specific asks in the resolve clauses," he said.
Another resolution the Utah chapter submitted that delegates referred to the Board suggested financial incentives might encourage graduating medical students to choose residencies in family medicine and remain in primary care practice.
Utah AFP delegate Kirsten Stoesser, M.D., of Salt Lake City, pointed to the severe shortage of primary care physicians in the United States, especially in rural areas.
In response to that, she said, the AAFP has taken a leading role in an initiative that has the ambitious goal of having 25% of U.S. medical school graduates join family medicine residencies by 2030; an aligned goal is to expand the number of family residency positions to 10,000.
"Within 10 years, we're calling to more than double the number of U.S. medical school graduates going into family medicine and more than double the current number of family medicine residency slots, while at the same time facing a decline in the number of M.D. seniors" who matched into family medicine residencies last year, Stoesser said.
To better incentivize graduating medical students to choose family medicine, she said the chapter's resolution suggested more dramatic measures.
"Our resolution focuses on providing financial incentives to ease student debt for those who go into primary care and family medicine and further reward those who go into practice in rural and underserved areas," Stoesser said, including through tax incentives.
LaTasha Seliby Perkins, M.D., of Arlington, Va., who was finishing her term as the AAFP's new physician Board member, testified that the Board thinks the issues raised in the resolution are important and need further study given the local complexities involved.
Heath Care Systems, Economics and Policy CME Category
A final pair of resolutions delegates referred to the Board were submitted by the Colorado, New York and Utah chapters and addressed adding an explicit CME category for "health care systems, economics and policy."
The resolutions' authors argued that the intent was to help facilitate the development of online educational materials, CME lectures at AAFP conferences and other educational platforms to cover these undertaught subjects.
Ellzy, again speaking for the Board, testified that the Board agreed that it didn't see these topics fitting into current CME categories.
"The AAFP is currently revising our CME categories as the ABFM is reviewing its blueprint, as well," he said.
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