With the first board certification exam in hospital medicine less than a year away, the long-awaited program has grown in scope following the decision by the American Board of Family Medicine to allow family physicians to join internists in pursuing the new credential.
Starting in May 2010, internists and family physicians can sign up with their respective boards to take the exam that will be one of the requirements for certification with a Focused Practice in Hospital Medicine. The first exam will be on Oct. 25, 2010.
Internists seeking hospitalist certification already can start working on the required self-evaluation and practice improvement modules developed by the American Board of Internal Medicine (ABIM). The American Board of Family Medicine hopes to make its modules available starting in January, said Robert Catoi, a spokesperson for the ABFM.
The new credential will be offered through the maintenance of certification (MOC) framework, explained Dr. Jeffrey Wiese, president-elect of the Society for Hospital Medicine and chair of the ABIM internal medicine question-writing committee. The new certification process is “really a separate pathway,” he said. For example, “an internist [doing his required MOC] would choose to go down the hospital medicine process rather than the standard MOC process. But the framework is going to be the same.”
Candidates will have to complete requirements in four areas: citizenship (including evidence of state licensure), self-evaluation, practice improvement, and secure exam. These requirements can be met in lieu of the standard MOC process, but newly trained internists seeking the new credential must first be certified in internal medicine and have at least 3 years of practice focused on hospital medicine.
“One wrinkle for hospitalists is that they would be required to have Advanced Cardiac Life Support certification,” Dr. Wiese noted. A minimum number of inpatient medicine contacts also would be required.
The self-evaluation module in the hospital medicine pathway is “not going to differ appreciably [from those used in the existing MOC process], but the vision going forward is [to have] more hospital-focused sets, on things like patient safety and transition of care,” said Dr. Wiese, who is a professor of medicine at Tulane University in New Orleans.
The practice improvement module “will focus on the ability to interact well with a team,” he said. “The candidate would sign up, would identify some practice area, collect data on the practice, design an intervention, and collect data again after a few months to show an improvement in practice delivery.”
The secure exam will differ from the standard internal medicine exam “in that it has much greater hospital medicine–focused content, but also questions on quality, patient safety, and transitions,” he continued. “Individuals that pass this exam can hold themselves out to patients and say, 'I have competence understanding systems of care, transitions of care, and quality.' Our part is to design an exam that reflects all those virtues.”
Dr. Eric Holmboe, the ABIM's senior vice president and chief medical officer, noted that the idea for certification with a Focused Practice in Hospital Medicine came from hospitalists themselves. “They came to the board over 5 years ago saying they believed their field had matured to the point that it needed to have a specific program, and their primary driver was quality and defining the discipline,” he said. “They were interested in the [physician's] role in patient safety and quality and transitions at the hospital.”
In addition, the hospitalists felt that taking MOC exams that emphasized outpatient care was not a good fit for their practice, Dr. Holmboe said.
Dr. Holmboe noted that in addition to hospital medicine certification, an option for certification in ambulatory care (originally called comprehensive care/internal medicine) was under consideration in recent years. “There was a lot of concern about moving that forward, mostly because of the beleaguered state of primary care,” he said. “That's been put on hold—not that it [won't] necessarily come back, but we are not pursuing this MOC pathway right now.”
In a statement on its Web site, the ABIM noted that “the rapid growth and development of this field is evidenced by the fact that there are currently about 20,000 hospitalists in the United States; approximately 85% are internists.”
The ABIM did not go the subspecialty route with hospital medicine because “subspecialty practice involves applying internal medicine as well as specialized knowledge and procedures to a subset of internal medicine patients,” the statement explains. “In contrast, hospital medicine is the practice of internal medicine for patients during hospitalization.
The new certification process is considered a pilot program by the American Board of Medical Specialties, Dr. Holmboe noted. The ABIM “will be doing pretty extensive research … to find out what value and impact this [pathway] has for hospitalists and patients.”