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Opinion |
1 Department of Radiology, Emory University Hospital, 1364 Clifton Rd., N.E., Ste. E118, Atlanta, GA 30322.
Received November 21, 2001;
accepted after revision December 27, 2001.
Summation statement of the annual summer conference of the Intersociety
Commission of the American College of Radiology, July 2001.
Introduction
The American Medical Accreditation Program was formed in 1996 to provide a mechanism for professional accreditation. However, in early 2000, the program was discontinued because of a lack of physician support and high costs.
In response to this program, the Quadri-Specialty Leadership Consortium, consisting of representatives from four primary care specialty societies, was formed. This group formulated a set of principles to guide the operation of a program for accreditation of individual physicians. Although the consortium is no longer functioning, the principles have continued to guide the ABMS as it develops the maintenance of certification program.
The 24 member boards of the ABMS are committed to the concept of maintenance of certification and have approved a statement emphasizing that they agree to transition their programs of recertification to programs of maintenance of certification. The transition for some boards will require time, flexibility, and assistance from the ABMS or other member boards.
Maintenance of certification contains the following four components for maintaining physician certification: evidence of satisfactory professional standing (an unrestricted medical license and demonstration of ethical behavior), evidence of commitment to lifelong learning and involvement in periodic self-assessment, evidence of cognitive expertise, and evaluation of practice performance.
Additionally, the ABMS, the Council of Medical Specialty Societies, and the Accreditation Council for Graduate Medical Education have adopted six general competencies that will be assessed by the boards. These competencies are patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.
In July 2000, the ABMS adopted a program for the evaluation of practice performance. They recommended establishing a framework for assessing physician practice performance by addressing individual physician performance and practice site factors that influence physician performance.
Kay H. Vydareny, a member of the Board of Trustees of the American Board of Radiology (ABR), gave conference attendees an overview of the accomplishments of the diagnostic trustees of the ABR in planning for maintenance of certification. The board comprises 24 trustees, of whom 15 are diagnostic radiologists, six are radiation oncologists, and three are physicists. The following eight participating societies nominate members to the ABR Board of Trustees: ACR, American Medical Association, American Roentgen Ray Society (ARRS), Radiological Society of North America (RSNA), Association of University Radiologists, American Society for Therapeutic Radiology and Oncology, American Radium Society, and American Association of Physicists in Medicine. Once elected to the board of trustees of the ABR, the trustee is expected to function independently of the nominating society and to make decisions that benefit all of radiology.
The ABR has developed a strategic plan for establishing maintenance of certification programs in diagnostic radiology, radiation oncology, and medical physics. The plan includes looking at how the six general competencies will be evaluated; developing a public relations plan to build a consensus among diplomats for the concept of maintenance of certification; and working with other societies to develop an effective mechanism of cognitive evaluation (defining the core material, developing a pool of questions, preparing multiple versions of an examination, and piloting and validating the examination). Various components will be carefully weighed when developing appropriate measures for maintenance of certification.
The first 10-year time-limited ABR certificates will be awarded in 2002 with recertification examinations to be given in 2012. The Certificate of Qualification recertification examinations will begin in 2004, because these certificates were limited to 10 years when they were issued beginning in 1994. The examination will be computerized, preceded by take-home self-assessment modules. Multiple versions of the examination will be tailored to each practice type, with a common core component. The examinations will be held in at least four examination centers, which are presently located in Chicago, Tucson, Dallas, and Tampa.
Some of the potential issues to be considered in implementing maintenance of certification include convenience of the examination, relevance of the examination, preparation time for the examination, and pass rates and cost of the examination. The ABR plans to address all these issues when developing maintenance of certification.
Although the process for developing the maintenance of certification program is just beginning, the ABR is committed to improving the quality of patient care and patient care systems. The ABR is responsible for all aspects of maintenance of certification and will provide guidelines for lifelong learning programs and for programs to assess physician and practice performance.
E. Stephen Amis, Jr., vice-chairman of the ACR Board of Chancellors, reported on the collaborative efforts of the ACR and the ABR in developing the maintenance of certification program. In his presentation, Amis reiterated the four basic components and six general competencies of maintenance of certification. He noted that the definition of a competent physician is one who possesses the medical knowledge, judgment, professionalism, and clinical and communication skills to provide high-quality patient care.
In March 2001, a model agreement for specialty societies and boards was developed by the ABMS and the Council of Medical Specialty Societies. The agreement contains the following items: the board will retain responsibility for certification, recertification, and maintenance of certification; education programs, including content and curriculum, will be determined under guidelines developed jointly by specialty societies and boards; specialty societies will be responsible for preparing and delivering the educational content to physicians; self-assessment programs, as part of the educational process, will continue to be developed by specialty societies; and practice assessment programs will be developed by specialty societies and incorporated into maintenance of certification as determined by the boards.
In January 1999, the ACR formed an ad hoc committee on radiology performance measures to discuss the ACR role in developing individual physician performance measures. Additionally, the ACR and the ABR formed a joint committee to discuss the ways that radiology can coordinate efforts in maintenance of certification. Discussion has included a review of the current recertification plans, antitrust issues, licensure, recertification, secondary certification, inservice examinations, recertification intervals, and ABMS and Council of Medical Specialty Societies initiatives. The joint committee has also examined how other specialties are coping with maintenance of certification; external forces pushing the concept of maintenance of certification; the relationship of existing ACR programs (such as accreditation, continuous professional improvement, Committee on Mammography Interpretation Skills Assessment, the noninterpretive skills program of the ACR and Association of Program Directors in Radiology, the ACR syllabi) to maintenance of certification; the establishment of an oversight body for maintenance of certification initiatives; and incorporation of measurable competencies into maintenance of certification programs.
Specialty societies are invited to develop programs in lifelong learning to determine patterns of practice in radiology, to assess current continuing medical education (CME) programs and practice patterns, and to strengthen the self-assessment portion of learning programs.
Members of the ACR Task Force on Patient Safety and the Subcommittee on Model Peer Review and Self-Evaluation have developed a new physician performance measurement program called RADPEER. This program will create a system that allows images and prior interpretation to be collected and structured in a reviewable format. The process will show trends that could help radiologists to focus their CME. Efforts to optimize interpretive skills should result in improved patient care.
The ACR has spearheaded action to develop a national CME database to track lifelong learning requirements for maintenance of certification. The ACR is also evaluating current ACR educational programs to ensure that they meet lifelong learning guidelines. The ACR will continue to develop and administer programs to meet the ABR guidelines.
Lawrence W. Davis, assistant director of the ABR, discussed time-limited certificates for radiation oncologists. In 1995, the first 10-year time-limited certification was offered in radiation oncology. Recertification will thus be required in 2005 for those certified in 1995. This maintenance of certification cognitive examination includes a general written examination consisting of approximately 250 questions. The examination is also practice-oriented and clinically relevant and includes applicable questions pertaining to physics and biology. The development process of the cognitive examination is similar to that of the certification examination. The recertification examination committee comprises clinical members, the chair of the radiobiology examination subcommittee, and the chair of the physics examination subcommittee. Examination results are provided in a pass-or-fail format with no breakdown of performance on topics. Plans for the future include a computerized interactive examination.
Bernice M. Capusten, chair of the Canadian Association of Radiologists Committee for Continuing Professional Development, outlined the framework of education options for continuing professional development and educational activities planned by specialists and directed toward meeting professional and practice needs in Canada. Capusten reported that physicians are required to earn 400 credits during 5 years of active practice by participating in educational activities of their choice. These programs include educational sessions sponsored by accredited providers of continuing professional development activities; learning activities that are not necessarily affiliated with an accredited provider; programs designed to assist the specialist in identifying his or her educational needs; structured learning projects; practice review and appraisal studies; and activities involving standards setting, educational development, teaching, and research.
Education sessions developed by accredited providers of continuing professional development activities include accredited clinical rounds, journal clubs, workshops, courses, conferences, and distance education programs. Other learning activities not necessarily affiliated with an accredited provider include participating in nonaccredited rounds and meetings, reading journals and texts, conducting information searches, listening to audiotapes, viewing videotapes, and participating in computer or Internet CME. Programs designed to assist the specialist in identifying his or her educational needs include self-assessment programs developed or sponsored by the facilities and colleges of the national speciality society and training or virtual reality simulators used for self-assessment. Additional structured learning projects include traineeships, preceptored courses, and master's degree and doctoral programs. Activities that assist specialists in reviewing their practice, such as practice audits and patient surveys, institution audits, incident reports, and utilization studies, also grant credit. Reviewing manuscripts, preparing presentations, teaching courses, taking examinations, conducting research, and participating in standards setting are also considered educational activities that earn credit.
Capusten reported that in Canada a didactic examination is not part of maintenance of certification, and that Canadians believe it is important for a physician to provide evidence of lifelong learning.
Jonathan Levy, the ACR's private practice representative to the Intersociety Commission, presented his opinion about the maintenance of certification program. He discussed who should be involved in writing a certification or competency test and the steps that the ABR and ACR should take in this process. Levy stressed the importance of maintenance of certification and stated that the ABR should be responsible for implementing this program. He also cautioned the ABR to proceed carefully, to understand the legal implications for practicing radiologists involved in maintenance of certification, and to be prepared to educate everyone involved in maintaining competency.
After the Friday morning general session, the conference participants gathered into small groups facilitated by the faculty and members of the executive committee. Each group was presented with the following questions pertaining to the role of specialty societies in the maintenance of certification:
The following recommendations were made:
Using the Web for Competency and Education
The survey results indicated that 24% of the Web sites offer CME, 50% charge for CME, and 41% offer educational materials other than CME. In addition, 12% of the Web sites offer a literature search, and 29% provide information about obtaining grants. The survey also found that 44% of society Web sites are designed by staff, 21% hire a professional Web designer, 18% hire a Web designer affiliated with the RSNA, and 38% hire other contractors.
The initial cost for Web design ranged from $860 to $114,000, and the annual maintenance cost for the sites ranged from $35 per hour to $59,000 a year.
Other statistics presented during the session included technical issues relating to links, number of pages on a Web site, the process of tracking hits on a Web site, graphics, updates, public relations, meeting registration, membership renewal, abstract submissions, and sale of programs and products.
Andre Duerinckx conducted an online demonstration of society Web sites, highlighting activities and services offered via the Web. Representatives from the ACR, RSNA, and the American Association of Physicists in Medicine presented features of their Web sites. A list of Web site addresses for the member societies of the Intersociety Commission is provided in Appendix 1.
After the presentations, representatives assembled into groups led by the faculty and executive committee. Discussion included the following:
The following recommendations were made:
Resolution on Radiation Dose and CT
Several new task forces have been formed in the past year. The Task Force on Human Resources was formed as an outcome of a resolution submitted by the Intersociety Commission and adopted by the council in 2000. This task force is cochaired by E. Stephen Amis, Jr., and C. Douglas Maynard and consists of 17 other representatives from private practice; academic, small, or rural practices; and other societies. The task force is studying workforce issues in radiology and allied professional fields.
The Task Force on Fellowship Training was formed as a result of the resolution submitted by the Intersociety Commission in 1999. This task force is chaired by Neil Messinger and is charged with investigating appropriate ways to advertise, market, and support fellowships in radiology subspecialties in both the private practice and the academic communities and to maintain the standards of excellence in subspecialty training programs.
The Task Force on the Internet is chaired by Michael Pentecost and is investigating ways to increase, expand, and improve electronic communication.
The Task Force on Screening Technologies is chaired by Neal Templeton and includes academic and private practice radiologists. This task force is charged with studying issues related to screening for occult disease using existing or evolving imaging technologies, including helical CT for lung cancer, virtual colonography for colorectal cancer, CT coronary artery calcification scoring, and Doppler sonography for carotid artery occlusion. The task force will also address guidelines for new screening technologies, randomized clinical trials, the reimbursement process, and the role of the radiologist with respect to the patient and the referring physician.
The Task Force on Patient Safety is chaired by James Borgstede. Six working committees have been formed under this task force to address preventable errors, to model peer review and self-evaluation, to study state and federal regulations, to evaluate national credentialing standards, to disseminate safety information, and to perform research and validation of patient safety information. This task force is also working on the peer-review program, RAD-PEER, as previously discussed.
The Task Force on Corporate Relations was formed to improve relations with industry; to look at ways to increase revenue; to establish liaisons for the advancement of the profession and the science of radiology; and to formalize a conduit to share information regarding technology, market research, new product offerings, and strategic direction.
The ACR Strategic Plan Update Committee was formed to reevaluate the 1997 ACR strategic plan.
Harvey L. Neiman reported on the ACR's efforts to increase alliances with other societies and to coordinate activities of mutual concern. In the past year, the ACR leadership met with the leadership from the Society of Chairmen of Academic Radiology Departments, the Association of Program Directors in Radiology, the Association of University Radiologists, the American Society for Therapeutic Radiology and Oncology, RSNA, ARRS, the Society of Cardiovascular & Interventional Radiology, the American Institute of Ultrasound in Medicine, the Society of Nuclear Medicine, the American Medical Association, and the American College of Emergency Physicians.
Neiman also stated that the Intersociety Commission would become the Intersociety Committee, chaired by N. Reed Dunnick. He informed the attendees that the change from a commission to a committee would not change any of the Intersociety activities including the summer conference.
Neiman informed the attendees that he would be forming a new commission on molecular imaging within the next year (James Thrall has been appointed as chair of this commission). Molecular imaging is a new field that is now experiencing large-scale and rapid development in the research setting and that could play a major role in clinical imaging in the future. The commission will develop a strategy to incorporate molecular imaging into the training of radiologists, will look at ways to make molecular imaging available to practicing radiologists, and will ensure that the radiology profession has the lead role in molecular imaging when it becomes an established part of clinical practice.
American Association of Physicists in Medicine
Association of Program Directors in Radiology
Task Force on Fellowship Training
2002 Intersociety Summer Conference
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
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Introduction
Maintenance of Certification