Maintenance Of Certification For Family Physicians Research Articles

What Family Physicians Really Think of Maintenance of Certification Part II Activities.

This study examines how improving curricular content and technical interface issues could make maintenance of certification activities more meaningful to American Board of Family Medicine diplomates completing Maintenance of Certification for Family Physicians (MC-FP) Program self-assessment modules (SAMs). We used a sequential exploratory design to analyze quantitative and qualitative data from 320,500 surveys of family physicians who completed a SAM between January 2004 and April 2013. This included numeric rating scales and free text comments. Basic statistical rankings, template-based automated coding, and emergent coding were used to analyze SAM experience and identify thematic content. Across SAMs, numeric ratings were universally high and positive free text comments outnumbered negative comments two to one. When comparing feedback on the knowledge assessment and clinical simulation (CS) activities, SAMs were rated less favorably when the frequency of ideas identified by participants as most prevalent in one activity mismatched those identified as most prevalent in the companion activity. Participants were also critical of navigation issues, technical issues, and a lack of realness in the CS activity. Whether analyzed through quantitative data, qualitative data, or mixed methods, a large majority of participants rated their experience with SAMs highly. When individual SAMs were rated poorly, it seemed to be due to discordance in ideas emphasized between the knowledge assessment and CS components, or an opinion regarding the SAM topic that existed independent of the SAM process.

The Predictive Validity of the National Board of Osteopathic Medical Examiners' COMLEX-USA Examinations With Regard to Outcomes on American Board of Family Medicine Examinations.

To examine the predictive validity of the National Board of Osteopathic Medical Examiners' Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) series with regard to the American Board of Family Medicine's (ABFM's) In-Training Examination (ITE) and Maintenance of Certification for Family Physicians (MC-FP) Examination. A repeated-measures design was employed, using test scores across seven levels of training for 1,023 DOs who took the MC-FP for the first time between April 2012 and November 2014 and for whom the ABFM had ITE scores for each of their residency years. Pearson and disattenuated correlations were calculated; Fisher r to z transformation was performed; and sensitivity, specificity, and positive and negative predictive values for the COMLEX-USA Level 2-Cognitive Evaluation (CE) with regard to the MC-FP were computed. The Pearson and disattenuated correlations ranged from 0.55 to 0.69 and from 0.61 to 0.80, respectively. For MC-FP scores, only the correlation increase from the COMLEX-USA Level 2-CE to Level 3 was statistically significant (for Pearson correlations: z = 2.41, P = .008; for disattenuated correlations: z = 3.16, P < .001). The sensitivity, specificity, and positive and negative predictive values of the COMLEX-USA Level 2-CE with the MC-FP were 0.90, 0.39, 0.96, and 0.19, respectively. Evidence was found that the COMLEX-USA can assist family medicine residency program directors in predicting later resident performance on the ABFM's ITE and MC-FP, which is becoming increasingly important as graduate medical education accreditation moves toward a single aligned model.

More Comprehensive Care Among Family Physicians is Associated with Lower Costs and Fewer Hospitalizations.

Comprehensiveness is lauded as 1 of the 5 core virtues of primary care, but its relationship with outcomes is unclear. We measured associations between variations in comprehensiveness of practice among family physicians and healthcare utilization and costs for their Medicare beneficiaries. We merged data from 2011 Medicare Part A and B claims files for a complex random sample of family physicians engaged in direct patient care, including 100% of their claimed care of Medicare beneficiaries, with data reported by the same physicians during their participation in Maintenance of Certification for Family Physicians (MC-FP) between the years 2007 and 2011. We created a measure of comprehensiveness from mandatory self-reported survey items as part of MC-FP examination registration. We compared this measure to another derived from Medicare's Berenson-Eggers Type of Service (BETOS) codes. We then examined the association between the 2 measures of comprehensiveness and hospitalizations, Part B payments, and combined Part A and B payments. Our full family physician sample consists of 3,652 physicians providing the plurality of care to 555,165 Medicare beneficiaries. Of these, 1,133 recertified between 2007 and 2011 and cared for 185,044 beneficiaries. There was a modest correlation (0.30) between the BETOS and self-reported comprehensiveness measures. After adjusting for beneficiary and physician characteristics, increasing comprehensiveness was associated with lower total Medicare Part A and B costs and Part B costs alone, but not with hospitalizations; the association with spending was stronger for the BETOS measure than for the self-reported measure; higher BETOS scores significantly reduced the likelihood of a hospitalization. Increasing family physician comprehensiveness of care, especially as measured by claims measures, is associated with decreasing Medicare costs and hospitalizations. Payment and practice policies that enhance primary care comprehensiveness may help "bend the cost curve."

Family physicians' scope of practice and American Board of Family Medicine recertification examination performance.

Previous research indicated that rural family physicians were more likely to pass the American Board of Family Medicine (ABFM) Maintenance of Certification for Family Physicians (MC-FP) examination. One possible explanation is that rural family physicians may have a broader scope of practice. This was a cross-sectional study of family physicians taking the ABFM MC-FP examination in 2013. Examination results were linked with the Scope of Practice for Primary Care (SP4PC) scale. Linear and logistic regression models, with and without SP4PC score, determined associations between scope of practice and examination results. Among 10,978 examinees, rural physicians had a higher passing rate (90.7% vs 86.8%, P < .05) and higher SP4PC score (16.1 vs 14.3 P < .05) compared with urban physicians. Regression models without SP4PC score confirmed that urban physicians were less likely to pass (OR = 0.73; 95% CI, 0.62-0.87) and scored lower, -15.6 points, compared with rural physicians. Including SP4PC score completely attenuated the relationship between practice location and passing (OR = 0.86; 95% CI, 0.73-1.02) and decreased the relationship between score and practice location (-5.8 points). Each point increase on the SP4PC score was associated with 9% higher odds of passing (OR = 1.09; 95% CI, 1.07-1.11) and 4.9 more points. A broader scope of practice rather than rural or urban practice location, was associated with increased likelihood of passing the MC-FP examination. If higher board scores are associated with providing higher quality of care, then maintaining a broad scope of practice may enable the delivery of higher quality primary care.

Performance on the Maintenance of Certification for Family Physicians (MC-FP) examination: comparison of initial certfiers with experienced physicians.

The perception that state-of-the-art clinical knowledge declines as a physician moves further away from formal training is prevalent.[1][1] This perception is reinforced by a significant body of research.[2][2][⇓][3][⇓][4][⇓][5][⇓][6][⇓][7]–[8][8] As a result, seasoned family physicians

The Evolution of Maintenance of Certification for Family Physicians (MC-FP) Part IV, Performance in Practice

With the first recertification examination offered by the American Board of Family Medicine (ABFM) in 1976, the board required a patient record review to assess performance in practice. The initial records reviews required physicians to assess 4 patient records in each of 5 disease categories; these

THE CONSEQUENTIAL VALIDITY OF ABFM EXAMINATIONS

THE CONSEQUENTIAL VALIDITY OF ABFM EXAMINATIONS

Improving quality of care and guideline adherence for asthma through a group self-assessment module.

The quality of care for asthma remains suboptimal. Compliance with guidelines remains low, but improved adherence to guidelines may increase the quality of care. but. We conducted a trial to determine whether group Self-Assessment Module (SAM) activities led by a facilitator and conducted as part of Maintenance of Certification for Family Physicians (MC-FP) would increase knowledge of and adherence to asthma guidelines. Participating physicians completed audits of the charts of patients with asthma before and 6 months after a group SAM. Surveys of physicians' knowledge of asthma guidelines were administered immediately before, immediately after, and 6 months after the group SAM. We tested for differences in knowledge of and adherence to guidelines before and after the SAM using χ(2) and t tests. Thirty-eight physicians in Virginia completed the SAM and had complete data. Participants completed more MC-FP activities than other physicians but were comparable in other characteristics. Except for prescribing controller medications for persistent asthma, all other quality measures significantly improved 6 months after the group SAM. Diagnosis by severity improved from 48.3% to 80.2%, and the use of action plans increased from 8.1% to 54.1%. Physicians' knowledge of guidelines improved immediately after the SAM and was sustained at 6 months. Increased knowledge translated into clinical skills: 30% of participants reported comfort with assessing control after the SAM, which increased to 97.5% 6 months after the SAM. Group SAMs may be an effective method to increase physicians' knowledge of and adherence to clinical guidelines.

Improving Quality of Care for Diabetes Through a Maintenance of Certification Activity: Family Physicians' Use of the Chronic Care Model

Improving the care of patients with diabetes is a health care priority. Through Part 4 of Maintenance of Certification for Family Physicians (MC-FP), American Board of Family Medicine (ABFM) diplomates participate in quality improvement (QI) modules for diabetes. Our objective was to determine associations between physician characteristics and actions taken during Part 4 diabetes modules with quality of care outcomes. The study sample was all Part 4 modules completed by family physicians from 2005 to 2012. Descriptive statistics were used to characterize the physicians and their behavior in the module. We used linear regression to test for associations between choice of intervention, mode of intervention, and chronic care model domain with improvement in quality measures. There were 7924 modules completed by family physicians, whose mean age was 48.2 years; 61.9% were male, and 76.9% lived in urban areas. All physician and patient quality measures improved over the course of the Part 4 module. Regression models found that only baseline performance was consistently associated with quality outcomes. No other consistent association was seen between intervention type, mode, or chronic care model domain and greater likelihood of improvements; however, every quality measure improved. Through MC-FP, family physicians improved the quality of care they delivered to diabetic patients. Improvement of care across nearly all measures, despite no consistent associations between processes of care or physician characteristics with improvement, suggests that participation in QI itself may lead to higher quality health care and this may be achieved through MC-FP.

Do family physicians choose self-assessment activities based on what they know or don't know?

Maintenance of Certification (MOC) for Family Physicians (MC-FP) includes clinical Self-Assessment Modules (SAMs). Whether family physicians choose SAMs that reflect their aptitudes or knowledge gaps has not been studied. Secondary analysis of demographic data, 2009 certification examination scores, and 2009-2012 SAM participation data. We computed disease-specific scores for asthma, diabetes, and hypertension from the examination. We ran unadjusted logistic and adjusted conditional logistic regression models of score quintiles, matched on the number of SAMs completed and controlling for physician demographics and area-level social deprivation. In 2009, 9,610 physicians passed the exam. Mean scores were 591.4 (SD ± 308.5) for asthma, 558.6 (SD ± 216.1) for diabetes, and 533.3 (± 226.7) for hypertension. Average scores on hypertension and diabetes were higher for physicians who subsequently completed related SAMs but not for those who completed the asthma SAM. The percentage of physicians in each quintile of scaled score who completed each SAM increased for diabetes (32.3%-40.9%) and hypertension (33.0%-36.9%). For asthma, logistic regression analyses found no statistically significant associations. For diabetes, there was a consistent association in both models between higher score quintile and likelihood of taking the SAM. For hypertension, an association of higher score and higher likelihood of taking the SAM was significant only in the third quintile (OR = 1.20 (1.03, 1.39)). We found inconsistent relationships between physician knowledge and SAM selection. For MOC to better impact quality, boards should consider directing physicians toward MOC activities that fill knowledge gaps rather than areas of strength.

Family Physicians' Quality Interventions and Performance Improvement Through the ABFM Diabetes Performance in Practice Module

Practice performance assessment is the fourth requirement of Maintenance of Certification for Family Physicians (MC-FP). American Board of Family Medicine (ABFM) diplomates have many options for completing Part 4 requirements, including Web-based Performance in Practice Modules (PPMs) developed by the ABFM. Our objective was to describe the actions and outcomes of family physicians who completed the ABFM diabetes PPM. We undertook a descriptive study of all diabetes PPMs completed by physicians in the 50 United States and Washington, DC, from 2005 to October 2012. Successful completion required quality measure abstraction from 10 patient charts before and after a plan-do-study-act cycle improvement effort. We used descriptive statistics to assess physician demographics and quality outcomes. Family physicians completed 7,924 diabetes qualitative improvement modules. Their mean age was 48.2 years, they had practiced a mean of 13.8 years, and three-fourths lived in urban areas (76.9%). Nearly one-half selected diabetic foot examination or eye examination as their quality improvement measure. Performance on all quality measures improved. Significant improvement was seen in rates of hemoglobin A1c control (<7.0%; 57.4% to 61.3%), blood pressure control (<130/90 mm Hg; 53.3% to 56.3%), foot examinations (68.0% to 85.8%); and retina examinations (55.5% to 71.1%). The most common interventions were standing orders (51.6%) and patient education (37.1%). Family physicians participating in MC-FP implemented improvement projects and showed quality improvements in caring for patients with diabetes. Emphasis on quality of care by payers will increasingly require physicians to embrace quality measurement and improvement.

A CLOSER LOOK AT RECERTIFICATION CANDIDATE PASS RATES

We continue to receive a number of inquiries from physicians regarding the low pass rate statistics for recertification candidates for the reporting periods from 2010 to 2012. Many physicians fear the examination has changed in some way, putting those attempting to maintain their certification at a distinct disadvantage. Others worry that the passing score criteria for recertifiers are greater than those of initial certifiers. We appreciate the active interest in ongoing assessment results and welcome the opportunity to clarify the source of these statistical changes. In short, the Maintenance of Certification for Family Physicians (MC-FP) examination has not changed. Passing score criteria for those attempting to maintain their certificates are no more stringent now than in recent years. The apparent pass rate discrepancy for this group in 2010, 2011, and 2012 is a sample bias among recertification candidates created by a policy change that extended certification from 7 years to 10 years. We will attempt to explain this statistical artifact in simple terms and address the concerns expressed by many family physicians.

DIMENSIONALITY OF THE MAINTENANCE OF CERTIFICATION FOR FAMILY PHYSICIANS EXAMINATION: EVIDENCE OF CONSTRUCT VALIDITY

The American Board of Family Medicine (ABFM) Maintenance of Certification for Family Physicians (MC-FP) examination is designed to measure a single construct: clinical decision-making abilities within the scope of practice of family medicine. Implied in the construct of clinical decision-making

Dimensionality of the Maintenance of Certification for Family Physicians Examination: Evidence of Construct Validity

The American Board of Family Medicine (ABFM) Maintenance of Certification for Family Physicians (MC-FP) examination is designed to measure a single construct: clinical decision-making abilities within the scope of practice of family medicine. Implied in the construct of clinical decision-making

ABFM'S HEART FAILURE SELF-ASSESSMENT MODULE SIMULATION ACTIONS VIS-A-VIS GUIDELINE RECOMMENDATIONS

The American Board of Family Medicine (ABFM) introduced Maintenance of Certification for Family Physicians (MC-FP) in 2004 in response to policy adopted by the American Board of Medical Specialties (ABMS.)1 ABFM reported in 2006 the initial Diplomate experiences with MC-FP.2 At that time, ABFM had Self-Assessment Modules (SAMs), consisting of a 60-item knowledge assessment followed by a virtual patient clinical simulation available only for hypertension, type 2 diabetes mellitus, asthma, and depression. Since that time, ABFM has deployed modules for coronary artery disease, chronic heart failure, well child care, maternity care, preventive care, care of the vulnerable elderly, pain management, early childhood illness, cerebrovascular disease, and health behavior. Each of the SAMs includes a Diplomate assessment of both the knowledge assessment and the simulation components. In addition to the Diplomates’ subjective assessments of the SAMs, ABFM captures the actions taken during each simulation, including the action itself, the simulated date and time of the action, and the simulated patient’s current health state. This information is captured in an action log, which serves as a persistent record of the Diplomate’s traversal through the simulation scenario. ABFM introduced the chronic heart failure (CHF) SAM and associated simulation in 2006. We present in Figure 1 a graphical summary of simulation actions taken in the CHF SAM, as extracted from the simulation action logs from 2006 to 2011. We present the results as percentage of simulations in which given actions occurred. Figure 1 Chronic heart failure Self-Assessment Module simulations including indicated actions. The results indicate overall high use of angiotensin converting inhibitors (ACEInhibitors), ACE inhibitors and/or angiotensin receptor blockers (ACEInhibitor-sARBS), but surprisingly low use of beta-adrenergic blocking agents (BetaBlockers.) Digitalis preparations (DigitalisPrep) demonstrated very low use. The majority of Diplomates also did a formal assessment of left ventricular function (Echocardiogram.) The CHF simulations generally present scenarios representing patients with stage C heart failure, as defined in the 2009 ACCF/AHA heart failure guideline.3 According to that guideline, ACE inhibitors and beta-adrenergic blockers should routinely be used in these patients.3 This discrepancy between recommended therapy and the low percentage of beta-adrenergic blocker prescriptions in the simulations suggests that the knowledge assessments should perhaps place greater emphasis on the use of these agents in class C .heart failure. The current CHF knowledge assessment contains only 7 items that reference beta-blockers, and nearly all of these present a beta-adrenergic agent only as historical information in the clinical stem of the item, rather than as a focus of decision-making in the item. These results suggest that the simulations, although clearly presenting a virtual patient environment, can serve as a useful probe for identifying possible management gaps that should be emphasized in the SAM knowledge assessments.

American Board of Family Medicine Introduces Important Enhancements to Maintenance of Certification for Family Physicians

The American Board of Family Medicine (ABFM) has always affirmed that it would listen carefully to feedback and concerns from Diplomates, and would continuously make improvements to the Maintenance of Certification for Family Physicians (MC-FP), simplifying and streamlining the process, targeting it

ABFM Introduces Important Enhancements to MC-FP

The American Board of Family Medicine (ABFM) has always maintained that it would listen carefully to feedback and concerns from Diplomates and would continuously make improvements to Maintenance of Certification for Family Physicians (MC-FP) to simplify and streamline the process, target it to

American Board of Family Medicine (ABFM) Announces Further Enhancements to Maintenance of Certification for Family Physicians (MC-FP)

The beginning of 2010 officially completed the staged, 7-year transition of every single American Board of Family Medicine (ABFM) Diplomate into the new recertification paradigm: Maintenance of Certification for Family Physicians (MC-FP). At its inception in 2003, the MC-FP was designed to assist

ABFM Announces Further Enhancements to MC-FP

The beginning of 2010 officially completed the staged, 7-year transition of every American Board of Family Medicine (ABFM) Diplomate into the new recertification paradigm, Maintenance of Certification for Family Physicians (MC-FP). At its inception in 2003, MC-FP was designed to assist with

First Cohort of Physicians in Maintenance of Certification for Family Physicians (MC-FP) Completes Second Stage in Strong Numbers

The American Board of Family Medicine (ABFM) is pleased to announce that, as of March 1, 2010, almost 8500 of the Diplomates who were certified or recertified in 2003 successfully met the deadline of completing their stage one and stage two requirements for Maintenance of Certification for Family