American Board Of Preventive Medicine Research Articles

Structure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors.

In 2011, the American Board of Medical Specialties established clinical informatics (CI) as a subspecialty in medicine, jointly administered by the American Board of Pathology and the American Board of Preventive Medicine. Subsequently, many institutions created CI fellowship training programs to meet the growing need for informaticists. Although many programs share similar features, there is considerable variation in program funding and administrative structures. The aim of our study was to characterize CI fellowship program features, including governance structures, funding sources, and expenses. We created a cross-sectional online REDCap survey with 44 items requesting information on program administration, fellows, administrative support, funding sources, and expenses. We surveyed program directors of programs accredited by the Accreditation Council for Graduate Medical Education between 2014 and 2021. We invited 54 program directors, of which 41 (76%) completed the survey. The average administrative support received was $27,732/year. Most programs (85.4%) were accredited to have two or more fellows per year. Programs were administratively housed under six departments: Internal Medicine (17; 41.5%), Pediatrics (7; 17.1%), Pathology (6; 14.6%), Family Medicine (6; 14.6%), Emergency Medicine (4; 9.8%), and Anesthesiology (1; 2.4%). Funding sources for CI fellowship program directors included: hospital or health systems (28.3%), clinical departments (28.3%), graduate medical education office (13.2%), biomedical informatics department (9.4%), hospital information technology (9.4%), research and grants (7.5%), and other sources (3.8%) that included philanthropy and external entities. CI fellowships have been established in leading academic and community health care systems across the country. Due to their unique training requirements, these programs require significant resources for education, administration, and recruitment. There continues to be considerable heterogeneity in funding models between programs. Our survey findings reinforce the need for reformed federal funding models for informatics practice and training.

Congratulations, American Board of Preventive Medicine: 75th Anniversary!

Congratulations, American Board of Preventive Medicine: 75th Anniversary!

Influence of Preventive Medicine Residency Programs and Combined Master of Public Health Programs on Specialty Selection

To determine medical school characteristics that may result in graduates entering the specialty of public health and general preventive medicine (PH&GPM), the authors conducted an analysis comparing the presence of affiliated preventive medicine residency programs and combined Master of Public Health degree programs with the likelihood of graduates entering the specialty of PH&GPM. Using data from the American Board of Preventive Medicine and publicly available information on medical schools and residencies, in spring 2022, the authors compared medical schools that produced PH&GPM physicians with the presence of a PH&GPM residency program, the presence of any preventive medicine residency (public health and general preventive medicine or occupational medicine or aerospace medicine), and the presence of a combined Doctor of Medicine‒Master of Public Health or Doctor of Osteopathic Medicine‒Master of Public Health program. Between 2017 and 2021, there were 385 physicians newly board certified in PH&GPM, 210 medical schools, and 75 preventive medicine residencies. The 385 physicians graduated from 110 of the 210 medical schools. Analyses showed statistically significant associations between medical schools that graduated PH&GPM physicians and the presence of PH&GPM residencies (OR=3.74; 95% CI=1.61, 8.69), all preventive medicine residencies (OR=2.75; 95% CI=1.37, 5.51), and combined degree programs (OR=4.37; 95% CI=2.45, 7.79). Because PH&GPM residency programs affiliated with medical schools are a significant factor associated with PH&GPM physicians obtaining board certification, such analyses may provide critical guidance in the utilization of resources intended to produce more physicians certified in this specialty.

A Model Curriculum for an Emergency Medicine Residency Rotation in Clinical Informatics.

This curriculum is designed for emergency medicine residents at all levels of training. The curriculum covers basic foundations in clinical informatics for improving patient care and outcomes, utilizing data, and leading improvements in emergency medicine. The curriculum is designed for a four-week rotation. The American College of Graduate Medical Education (ACGME) mandated that all Emergency Medicine (EM) residents receive specific training in the use of information technology.1,2 To our knowledge, a clinical informatics curriculum for EM residents does not exist. We propose the following standardized and reproducible educational curriculum for EM residents. The aim of this curriculum is to teach informatics skills to emergency physicians to improve patient care and outcomes, utilize data, and develop projects to lead change.3 These goals will be achieved by providing a foundational informatics elective for EM residents that follows the delineation of practice for Clinical Informatics outlined by the American Medical Informatics Association (AMIA) and the American Board of Preventive Medicine (ABPM).4-6. The educational strategies used in this curriculum include asynchronous learning via books, papers, videos, and websites. Residents attend administrative sessions (meetings), develop a project proposal, and participate in small group discussions.The rotation emphasizes the basic concepts surrounding clinical informatics with an emphasis on improving care delivery and outcomes, information systems, data governance and analytics, as well as leadership and professionalism. The course focuses on the practical application of these concepts, including implementation, clinical decision support, workflow analysis, privacy and security, information technology across the patient care continuum, health information exchange, data analytics, and leading change through stakeholder engagement. An initial version of the curriculum was introduced to two separate institutions and was completed by three rotating resident physicians and one rotating resident pharmacist. A brief course evaluation as well as qualitative feedback was solicited from elective participants by the course director, via email following the completion of the course, regarding the effectiveness of the course content. Learner feedback was used to influence the development of this complete curriculum. The curriculum was graded by learners on a 5-point Likert scale (1=strongly disagree, 5 = strongly agree). The mean response to, "This course was a valuable use of my elective time," was 5 (sd=0). The mean response to, "I achieved the learning objectives," and "This rotation helped me understand Clinical Informatics," were both 4.75 (sd=0.5). Overall, participants reported that the content was effective for achieving the learning objectives. During initial implementation, we found that the preliminary asynchronous learning component worked less effectively than we anticipated due to a lower volume of content. In response to this, as well as resident feedback, we added significantly more educational content.In conclusion, this model curriculum provides a structured process for an informatics rotation for the emergency medicine resident that utilizes the core competencies established by the governing bodies of the clinical informatics specialty and ACGME. Clinical informatics key concepts, including definitions, fundamental terminology, history, policy and regulations, ethical considerations, clinical decision support, health information systems, data governance and analytics, process improvement, stakeholder engagement and change management.

ASAM calls for addiction medicine physicians in insurance networks

The proposed Patient Protection and Affordable Care Act rule by the Center for Medicare & Medicaid Services (CMS) should include a requirement that addiction medicine physicians be included in health care networks, according to the American Society of Addiction Medicine (ASAM). In submitting a comment letter to the proposed rule Jan. 23, ASAM wrote that there should be a separate, individual provider specialty type specific to “Addiction Specialist Physicians” to be included as part of network adequacy. These specialists need to be available to patients in terms of specific time and distance standards, and should include physicians who receive subspecialty board certification in addiction medicine by the American Board of Preventive Medicine, subspecialty board certification in addiction psychiatry by the American Board of Psychiatry and Neurology, subspecialty board certification in addiction medicine by the American Osteopathic Association or certification by the American Board of Addiction Medicine. Along the same lines, on Jan. 27, ASAM released a new public policy statement that describes the role of addiction specialist physicians in U.S. health care. For the Jan. 23 letter to the CMS, go to https://sitefinitystorage.blob.core.windows.net/sitefinity‐production‐blobs/docs/default‐source/advocacy/letters‐and‐comments/22.01.23‐asam‐comments‐re‐2023‐notice‐of‐benefit‐and‐payment‐parameters‐rule.pdf. For the Jan. 27 public policy statement, go to https://www.asam.org/advocacy/public‐policy‐statements/details/public‐policy‐statements/2022/01/28/public‐policy‐statement‐on‐the‐recognition‐and‐role‐of‐addiction‐specialist‐physicians‐in‐health‐care‐in‐the‐united‐states.

The Development and Current Status of Subspecialty Training and Certification in Addiction Psychiatry.

This article describes the evolution of subspecialty training and certification in addiction psychiatry. The impact of the newer subspecialty in addiction medicine is also addressed. Information about programs and trainees was obtained from records of the Accreditation Council for Graduate Medical Education. Information about addiction psychiatry certification was obtained from the records of the American Board of Psychiatry and Neurology (ABPN). Information about the addiction medicine subspecialty was obtained from the American Board of Preventive Medicine. In AY 2020-2021, there were 53 addiction psychiatry programs with 92 fellows, and the numbers of each have increased over the past 5 academic years. The total number of addiction psychiatry certificates awarded through 2020 was 2806. Three years after addiction medicine programs were first accredited, there were 83 programs with 149 fellows. Thus far, 3282 addiction medicine certificates have been awarded, 1275 (38.8%) of them to ABPN diplomates. In the 30 years since addiction psychiatry received subspecialty recognition, the numbers of training programs and fellows have grown steadily and are continuing to increase. Recently, the numbers of training programs and fellows in the newer subspecialty of addiction medicine have grown rapidly with substantial psychiatry involvement in addiction medicine training and certification programs. Nonetheless, it is apparent that the need for specialists with expertise in substance use disorders will far exceed the supply for the foreseeable future.

The Supply and Distribution of the Preventive Medicine Physician Workforce.

Preventive medicine physicians work at the intersection of clinical medicine and public health. A previous report on the state of the preventive medicine workforce in 2000 revealed an ongoing decline in preventive medicine physicians and residents, but there have been few updates since. The purpose of this study was to describe trends in both the number of board-certified preventive medicine physicians and those physicians who self-designate preventive medicine as a primary or secondary specialty and examine the age, gender distribution, and geographic distribution of this workforce. Analysis of the supply of preventive medicine physicians using data derived from board certification files of the American Board of Preventive Medicine and self-designation data from the American Medical Association Masterfile. The 50 US states and District of Columbia. Board-certified and self-designated preventive medicine physicians in the United States. Number, demographics, and location of preventive medicine physicians in United States. From 1999 to 2018, the total number of physicians board certified in preventive medicine increased from 6091 to 9270; the number of self-identified preventive medicine physicians has generally decreased since 2000, with a leveling off in the past 4 years matching the trend of preventive medicine physicians per 100 000 population; there is a recent increase in women in the specialty; the practice locations of preventive medicine physicians do not match the US population in rural or micropolitan areas; and the average age of preventive medicine physicians is increasing. The number of preventive medicine physicians is not likely to match population needs in the United States in the near term and beyond. Assessing the preventive medicine physician workforce in the United States is complicated by difficulties in defining the specialty and because less than half of self-designated preventive medicine physicians hold a board certification in the specialty.

Addiction Medicine After COVID-19: The Imperative of a Trained Workforce

Addiction Medicine After COVID-19: The Imperative of a Trained Workforce

Addiction Psychiatry and Addiction Medicine: The Evolution of Addiction Physician Specialists.

Addiction Psychiatry and Addiction Medicine are two physician subspecialities recognized by the American Board of Medical Specialties (ABMS) that focus on providing care for patients with substance use disorders. Their shared and distinct historical roots are reviewed, and their respective ABMS board examination content areas and Accreditation Council on Graduate Medical Education (ACGME) fellowship training program requirements are compared. Addiction Psychiatry, a subspecialty under the American Board of Psychiatry and Neurology, began certifying diplomates in 1993, currently has 1202 active diplomates, and certifies around 150 diplomates every 2 years through 50 ACGME-accredited fellowships. Addiction Medicine, a subspecialty under the American Board of Preventive Medicine, began certifying diplomates in 2018, has 2604 diplomates with more expected before the practice pathway closes (anticipated in 2021), after which a fellowship training becomes required. Currently there are 78 accredited Addiction Medicine fellowships and more under development. The fields display substantial overlap between their respective examination content areas and fellowship training requirements, covering similar knowledge and skills for evaluation and treatment of substance use disorders and psychiatric and medical comorbidities across the full range of clinical settings, from general medical to addiction specialty settings. Key differences include that Addiction Psychiatry is open only to Board-certified psychiatrists and places extra emphasis on psychotherapeutic and psychopharmacological management strategies. Addiction Medicine is open to any ABMS primary specialty, including psychiatry. Opportunities for collaboration are discussed as both fields pursue the common goal of providing a well-trained workforce of physicians to meet the public health challenge presented by addiction. (Am J Addict 2020;00:00-00).

A Clinical Informatics Program Directors' Proposal to the American Board of Preventive Medicine

In 2013, the American Board of Preventive Medicine (ABPM) and the American Board of Pathology (ABPath) offered the first board certification examination in Clinical Informatics to eligible physicians in the United States. In 2022, the Practice Pathway will expire and in 2023 only candidates eligible through the Fellowship Pathway will be eligible for the board certification. To date, Clinical Informatics as a specialty has not had a regular match process and used a controlled offer-acceptance process that does not meet candidates' or programs' needs. Fellows may not be offered a position with their top choice program initially, and they may accept offers from other programs to avoid risk by ensuring that they have a fellowship position. Programs have to consider losing an applicant in the first round in the ranking of applicants. The process is open to manipulation including early agreements between program directors and candidates. In this open letter to the ABPM, program directors make the case for a third-party match and are calling on the ABPM to leverage its status as the Clinical Informatics certifying body and its existing infrastructure to implement a Clinical Informatics match.

Early experiences with combined fellowship training in clinical informatics.

Given the ubiquitous nature of information systems in modern health care, interest in the pursuit of formal training in clinical informatics is increasing. This interest is not restricted to generalists-informatics training is increasingly being sought by future subspecialists. The traditional structure of Accreditation Council on Graduate Medical Education subspecialty training requires completion of both clinical and clinical informatics fellowship programs, and understandably lacks appeal due to the time commitment required. One approach to encourage clinical informatics training is to integrate it with clinical fellowships in order to confer dual-board eligibility. In this perspective, we describe 3 successful petitions for combined training in clinical informatics in order to support other programs and the American Board of Preventive Medicine in establishing pathways for training subspecialists in clinical informatics.

AMA Delegates Act on Opioid Epidemic, Widening Legalization of Cannabis

Back to table of contents Previous article ProfessionalFull AccessAMA Delegates Act on Opioid Epidemic, Widening Legalization of CannabisMark MoranMark MoranSearch for more papers by this authorPublished Online:12 Dec 2019https://doi.org/10.1176/appi.pn.2019.12b34Below is a list of some of the reports and resolutions adopted by the AMA House of Delegates at its Interim Meeting in November in San Diego:AMA Board of Trustees Report titled “Enabling Methadone Treatment of Opioid Use Disorder in Primary Care Settings.” The report calls for further research on how primary care physicians can incorporate medication treatment for addiction into their practices and asks the AMA Opioid Task Force to increase its evidence-based educational resources focused on methadone maintenance therapy and publicize those findings.AMA Board of Trustees Report titled “Opioid Mitigation.” The report calls for evaluation of outcomes and best practices by grantees of awards from the Substance Abuse and Mental Health Services Administration for the creation of local strategies to address the opioid epidemic. The report expands policy to include encouraging drug courts to use evidence-based models of care for those who the court determines would benefit from intervention rather than incarceration. It also urges state and federal policymakers to enforce applicable mental health/substance use parity laws.Resolution on Support for Veterans Courts. This resolution supports use of veterans courts as an intervention for veterans who commit criminal offenses that may be related to a neurological or psychiatric disorder.Council on Medical Education Report titled “Board Certification Changes Impact Access to Addiction Medicine Specialists.” The AMA recognizes the American Board of Preventive Medicine, as well as the American Osteopathic Association (AOA) and the AOA Bureau of Osteopathic Specialists, for developing and providing pathways for physicians to obtain certification in the subspecialty of addiction medicine, in order to improve access to care for patients with substance use disorders.Resolution on Expediting Entry of Qualified IMG Physicians to U.S. Medical Practice. This resolution asks the AMA to study and make recommendations for the best means of expediting the evaluation and credentialing of competently trained international medical graduates into medical practice in the United States.Resolution on Raising Awareness of the Public Health Impact of Cannabis. This resolution calls for the AMA to work with interested organizations to collate existing worldwide data on the public health and societal impacts and unintended consequences of legalization and/or decriminalization of cannabis for recreational and medicinal use; encourage research on the unintended consequences of legalization and decriminalization of cannabis; disseminate information on the public health impacts of legalization and decriminalization of cannabis, including possibly making links to that information available on the AMA website; and work with interested organizations to lobby Congress to allow more sites to conduct research on the risks and benefits of cannabinoid products.Resolution on Gun Violence and Mental Illness Stigma in the Media. This resolution encourages the Centers for Disease Control and Prevention, in collaboration with other public and private organizations, to develop recommendations and/or best practices for media coverage of mass shootings. This would include informed discussion of the limited data on the relationship between mental illness and gun violence and recognition of the potential for exacerbating stigma against individuals with mental illness.Resolution on Ban on Electronic Nicotine Delivery System (ENDS) Products. This resolution calls for the AMA to advocate for regulatory, legislative, and/or legal action at the federal and/or state levels to ban the sale and distribution of all e-cigarette and vaping products, with the exception of those that may be approved by the FDA for tobacco cessation purposes and made available by prescription only. The resolution also calls for the AMA to advocate for research funding to sufficiently study the safety and effectiveness of e-cigarette and vaping products for tobacco cessation purposes. ■A complete list of annotated reports and resolutions of the AMA House of Delegates Interim Meeting is posted here. ISSUES NewArchived

Domains, tasks, and knowledge for clinical informatics subspecialty practice: results of a practice analysis.

The study sought to develop a comprehensive and current description of what Clinical Informatics Subspecialty (CIS) physician diplomates do and what they need to know. Three independent subject matter expert panels drawn from and representative of the 1695 CIS diplomates certified by the American Board of Preventive Medicine contributed to the development of a draft CIS delineation of practice (DoP). An online survey was distributed to all CIS diplomates in July 2018 to validate the draft DoP. A total of 316 (18.8%) diplomates completed the survey. Survey respondents provided domain, task, and knowledge and skill (KS) ratings; qualitative feedback on the completeness of the DoP; and detailed professional background and demographic information. This practice analysis resulted in a validated, comprehensive, and contemporary DoP comprising 5 domains, 42 tasks, and 139 KS statements. The DoP that emerged from this study differs from the 2009 CIS Core Content in 2 respects. First, the DoP reflects the growth in amount, types, and utilization of health data through the addition of a practice domain, tasks, and KS statements focused on data analytics and governance. Second, the final DoP describes CIS practice in terms of tasks in addition to identifying knowledge required for competent practice. This study (1) articulates CIS diplomate tasks and knowledge used in practice, (2) provides data that will enable the American Board of Preventive Medicine CIS examination to align with current practice, (3) informs clinical informatics fellowship program requirements, and (4) provides insight into maintenance of certification requirements.

Characteristics and Outcomes of an Innovative Train-in-Place Residency Program.

Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable outcomes, created to train midcareer physicians who desire formal training in occupational medicine. We evaluated educational outcomes from a novel residency program for midcareer physicians seeking formal training and board certification in occupational medicine. Physicians train in place at selected clinical training sites where they practice, and participate in 18 visits to the primary training site over a 2-year period. Program components include competency-based training structured around rotations, mentored projects, and periodic auditing visits to train-in-site locations by program faculty. Main outcome measures are achievement of Accreditation Council for Graduate Medical Education Occupational Medicine Milestones, American College of Occupational and Environmental Medicine competencies, performance on the American College of Preventive Medicine examinations, diversity in selection, placement of graduates, and the number of graduates who remain in the field. Since inception of this program in 1997, there have been 109 graduates who comprise 7.2% of new American Board of Preventive Medicine diplomates over the past decade. Graduates scored competitively on the certifying examination, achieved all milestones, expressed satisfaction with training, and are geographically dispersed, representing every US region. Most practice outside the 25 largest standard metropolitan statistical areas. More than 95% have remained in the field. Training in place is an effective approach to provide midcareer physicians seeking comprehensive skills and board certification in occupational medicine formal training, and may be adaptable to other specialties.

Addiction Medicine: Current Status of Certification, Maintenance of Certification, Training, and Practice.

Addiction medicine (ADM) is an emerging medical field. It will soon be recognized by the American Board of Medical Specialties as a multispecialty subspecialty, sponsored by the American Board of Preventive Medicine. Certification and maintenance of certification in ADM are available currently through the American Board of Addiction Medicine (ABAM). There is an urgent need for trained and certified ADM physicians to serve the needs of patients and society. Thirty-seven addiction medicine fellowships of 12months duration are now available, and their number is increasing. Physicians specializing in medical toxicology have educational, training, and practice overlap with addiction medicine. Medical toxicology physicians usually meet ADM examination eligibility requirements, based on clinical practice experience and continuing medical education activities. Those with fellowship training or in a fellowship bring training experience which has commonalities to ADM fellowship training, and therefore are particularly prepared for examination and practice in ADM. There are opportunities for partnerships in training, practice, and leadership between addiction medicine and medical toxicology.

Editorial introductions

Editorial introductions

American College of Occupational and Environmental Medicine's Occupational and Environmental Medicine Competencies-2014: ACOEM OEM Competencies Task Force*.

The preventive medicine foundation of occupational medicine impacts all the different practice areas of OEM, whether it involves preventing illness related to a hazardous exposure, treating injury due to an employee health condition, or addressing unnecessary work disability after an occupational injury. The OEM physicians are required to effectivelyinteractwithawiderangeofother professionals and provide guidance not only to patients but also to other clinicians and occupational health nurses, employers, safety and industrial hygiene professionals, human resource managers, attorneys, labor unions, and public health care professionals. In these interactions,OEMphysiciansshouldfollowa strict code of ethics related to matters of confidentiality and potential conflicts of interest. Detailed guidance in this area is provided in ACOEM Code of Ethics. 16 Effective communication in OEM includes risk communication, patient education, workforce education, development of policy and guidance documents, and medical/legal document preparation. Physicians practicing OEM typically

Certification for Physicians in Biomedical Informatics

Certification for Physicians in Biomedical Informatics

More Boards Reporting on Certification Maintenance

Eleven new medical boards have begun publicly reporting whether physicians are up to date on their maintenance of certification requirements. The trend toward disclosing maintenance of certification (MOC) status started in August 2011 when seven medical specialty boards, including the American Board of Family Medicine, began making the information publicly available at www.certificationmatters.org – the consumer-focused website of the American Board of Medical Specialties (ABMS). Now only six ABMS member boards do not publicly post the MOC status of their diplomates. That list includes the American Board of Internal Medicine. However, all ABMS member boards are expected to publicly report MOC status by early 2014, according to Dr. Lois Nora, ABMS president and CEO. The move to make MOC information readily available to the public is an important part of medical professionalism, Dr. Nora said in an interview. “We have a covenant with the public that we will act in their best interest.” Since the launch of the certificationmatters.org site in February 2011, more than 1.1 million people have visited the site, according to ABMS. The site allows individuals to search for board certification and MOC status by physician name, location, or specialty. If the physician's certifying board is one of the 18 that publicly discloses its members' MOC status, consumers will also see “Yes,” “No,” or “Not Required” displayed next to a doctor's MOC status. The “Not Required” response relates to physicians who have a lifetime certification. The 18 boards now reporting MOC: ▸American Board of Allergy and Immunology▸American Board of Colon and Rectal Surgery▸American Board of Dermatology▸American Board of Emergency Medicine▸American Board of Family Medicine▸American Board of Medical Genetics▸American Board of Neurological Surgery▸American Board of Nuclear Medicine▸American Board of Obstetrics and Gynecology▸American Board of Ophthalmology▸American Board of Otolaryngology▸ American Board of Physical Medicine and Rehabilitation▸American Board of Plastic Surgery▸American Board of Preventive Medicine▸American Board of Psychiatry and Neurology▸American Board of Surgery▸American Board of Thoracic Surgery▸American Board of Urology

Board certification for pathologists in clinical informatics: Are you a lumper or a splitter?

This issue's article entitled “Clinical fellowship training in pathology informatics: A program description” is a first critical look at how pathology informatics fellowships will measure up to the task of preparing fellows for the clinical informatics subspecialty board examination.[1] Recently approved by the American Board of Medical Specialties, clinical informatics is unique among subspecialty board examinations because it is open to applicants who have primary certification in any medical specialty, including pathology.[2] The practice of pathology is quite different than other medical specialties, and this has led to opposing concerns about the contents of the exam. On the one hand, the board examination might either focus too much on non-pathology informatics issues such as electronic prescription writing, thereby reducing the likelihood that pathologists could pass the test. Conversely, the exam may lack sufficient depth for those areas of informatics which are critically important to pathologists, such as automation. The controversy has stimulated this commentary. The article compares a relatively new but very large pathology informatics fellowship program against the program requirements proposed by the Clinical Informatics Training Program Requirements team within the American Medical Informatics Association.[3] Many of the program requirements are similar to those found in other American College of Graduate Medical Education (ACGME)-certified programs. As with all such programs, the mechanisms by which such requirements are met have different flavors and nuances that may ultimately achieve the same goal. However, this paper brings to light specific uncertainties associated with an untested new subspecialty program. It points out that the program requirements may not be amenable to some of the peculiar flexibilities already built in to some existing pathology core training programs. At the authors’ institution, one such flexibility allows a trainee to do a fellowship before completing core pathology training. Pathology residents often do two or more fellowships, so the burden of a 2-year program requirement for pathologists who want to train in clinical informatics is discussed. Despite these differences, the author of this commentary was surprised by the number of similarities between the proposed program requirements and the existing requirements of the described pathology informatics fellowship. Therefore, the overall assessment of the similarities between pathology and non-pathology informatics may be more subjective than realized in the conclusions of the article. While pathology practice is unique in medicine, the informatics principles that pathology informaticists use to improve data acquisition, storage, management, and retrieval are the same as those used in non-pathology practices. This begs the question as to how training programs for pathologists in clinical informatics should be structured. If you are the proverbial “lumper,” then clinical informatics fellows of any primary specialty would train in the same program with the same administrative structure and overhead. “Splitters” would then argue for completely separate pathology informatics training programs that have little to no interaction with non-pathology informatics programs. The answer to this dilemma will be highly dependent on the institution and the distribution of potential informatics faculty within it. Institutions with an abundance of informatics faculty within one department will likely gravitate toward a specialty-specific training program. However, given the broad audience of the board examination and the fact that pathology informaticists are often called upon to help resolve data management issues between non-pathologists and the laboratory, a better model may be a hybrid of general and specialty-specific training. Much of this will certainly depend on the final structure and content of the board examination. The Association of Pathology Informatics is working with the American Board of Pathology and the American Board of Preventive Medicine to assist in the construction and execution of the board examination, anticipated at this moment to be first available in the fall of 2012. Criteria for the by-experience pathway for those of us who are already practicing informaticists are also being set. This involvement will assist in providing clear guidance to pathology departments on how to align the program requirements[3] and core content[4] with those of clinical informatics fellowships, regardless of whether they are completely or partially housed within a department of pathology.