Development and Results of the First Certification Examination in the American Board of Medical Specialties Neurocritical Care Subspecialty.

This article reviews the development of the American Board of Medical Specialties subspecialty in neurocritical care (NCC) and describes the requirements for certification and the results of the first certification examination administered in October 2021. The American Board of Psychiatry and Neurology (ABPN) is the administrative board, and the sponsoring boards are the American Board of Anesthesiology (ABA), American Board of Emergency Medicine (ABEM), American Board of Internal Medicine (ABIM), and American Board of Neurological Surgery. The American Board of Medical Specialties approved the subspecialty in 2018, and the Accreditation Council for Graduate Medical Education developed and approved the training requirements in 2021. The fellowship programs are either 12 or 24 months in length and may become available in Academic Year 2022-2023. The first NCC examination was developed by a multispecialty group of subject matter experts following established test development procedures and was successfully administered to 1,011 candidates in October 2021. There were 406 (40.2%) ABIM candidates, 356 (35.2%) ABPN candidates, 208 (20.6%) ABA candidates, and 41 (4.1%) ABEM candidates. The end-of-test survey indicated that most examinees were satisfied with their test taking experience, and the .92 reliability index indicated that the test scores were reliable. An established process was also followed to set the criterion-referenced passing standard, and the resulting pass rate of 72.7% was judged to be reasonable. In summary, the combined efforts of representatives from the ABPN, ABA, ABEM, ABIM, and American Board of Neurological Surgery yielded a quality assessment instrument to identify physicians who possess the expertise required to be certified in NCC. The test development committee will continue to expand and improve the pool of test questions for the next examination, which is scheduled for October 2022.

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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Primary Care and Neurology in Psychiatry Residency Training: a Survey of Early Career Psychiatrists.

OBJECTIVE: A survey of recently certified psychiatrists was conducted to obtain their feedback about the contribution of the primary care and neurology components of residency training to their professional development and to their current needs as practitioners. METHODS: A 22-item survey was developed based on issues discussed at a forum on residency competence requirements and administered electronically to four cohorts of recently certified psychiatrists. RESULTS: The response rate was 17% (1049/6083). Overall, the respondents described both their primary care and neurology experiences as helping them accomplish several goals for their professional development. The majority were satisfied with their primary care training and felt well-prepared to enter practice. The most common suggestions for improving the primary care component were better integration with psychiatry and providing longitudinal experiences and more outpatient experience. They were somewhat less satisfied with their neurology training, and only about half felt well-prepared for the neurologic aspects of psychiatry practice. The most common suggestions for improving neurology training were to provide more time in neurology with experiences that were more relevant to psychiatry such as outpatient and consultation experiences. Some also thought longitudinal experiences would be useful. CONCLUSIONS: These psychiatrists were generally satisfied with the primary care and neurology components of residency training and felt that they had contributed to their professional development. Their suggestions for improvement contribute to the rich discussion among training directors and other psychiatry educators about these components of residency training.

Subspecialty Training and Certification in Geriatric Psychiatry: A 25-Year Overview.

The Institute of Medicine estimated that by 2030, from 10.1 to 14.4 million Americans aged 65 years or older will have mental health or substance use disorders. This article reviews the history and current status of training, certification, and practice in geriatric psychiatry against the backdrop of this "silver tsunami." The American Board of Psychiatry and Neurology (ABPN) administered the first subspecialty examination in geriatric psychiatry in 1991, and through 2015 3,329 certificates were awarded. The Accreditation Council for Graduate Medical Education approved the training requirements in 1993. After a surge in programs and fellows, the numbers appear to have stabilized at about 57 programs and 60-65 trainees per year with fewer than half of the positions filled each year. The majority of graduates seeks and obtains ABPN certification, and the majority of those who were fellowship trained have maintained certification. Despite the unprecedented demand for mental health services for older adults, it must be acknowledged that not enough geriatric psychiatrists can be prepared to meet the needs of an aging U.S. POPULATION: Strategies for addressing the shortage are discussed, including undertaking subspecialty training in the fourth year of psychiatry training, increasing the time devoted to the care of older adults in undergraduate and graduate medical education, and developing alternative training pathways such as mini-fellowships. It is not clear whether more favorable Medicare reimbursement rates for those certified in geriatric psychiatry would increase the numbers seeking fellowship training.

Headache Education in Adult Neurology Residency: A Survey of Program Directors and Chief Residents.

OBJECTIVE: This cross-sectional study reassesses the status of headache didactics and clinical training in adult neurology residency programs in the United States to determine if program directors and chief residents feel that current training in headache is adequate. BACKGROUND: Headache is among the most common new complaints to both the neurology and primary care clinic and represents a significant economic burden. However, headache remains both under-diagnosed and under-treated. Of those who seek treatment only 28% report they are very satisfied with their management. One possible cause for dissatisfaction is inadequate education of treating physicians. Two studies in 2002 and 2005 that collectively surveyed all 125 adult neurology residency programs concluded that more evidence was needed to evaluate the adequacy of headache education in these programs. A survey of neurology residency department chairs and program directors in 2005 also evaluated the status of headache education in adult neurology training programs and concluded the same. METHODS: We surveyed 133 neurology residency program directors and 213 chief residents. Program directors and chief residents were asked about the amount of headache didactics, amount of clinical exposure to headache, perceived adequacy of current training and if plans existed to increase headache education through didactics or clinical exposure. RESULTS: Seventy-two program directors (54%) and 117 chief residents (55%) responded. Twenty-six percent of programs reported a mandatory headache clinic. Of these, 35% of programs reported <2 weeks of clinic, 54% of programs reported 2-4 weeks, and 12% of programs reported > 4 weeks of clinic. Fifty-one percent of program directors felt more than 4 weeks of clinical exposure to headache was needed to adequately prepare neurology residents. Ninety-six percent of program directors surveyed believed their residents were adequately prepared to diagnose and treat headache disorders. Twenty-one percent had plans to increase didactic time and 26% planned to incorporate more clinical exposure. CONCLUSIONS: Despite a modest increase in headache didactics in neurology residency programs over the last decade, many program directors and chief residents report that their programs do not include what they believe to be adequate educational experiences in headache. Although the overwhelming majority of neurology residency programs reported that residents were adequately prepared to diagnose and treat headache disorders, about a fourth of programs still felt the need to increase the amount of didactic and clinical exposure dedicated toward the management of headache disorders.

Allen Joseph Bard (1933-2024).

Father of contemporary electrochemistry.

An Article-Based Format for Medical Specialty and Subspecialty Maintenance of Certification.

INTRODUCTION: This article describes an article-based alternative for maintenance of certification that the American Board of Psychiatry and Neurology developed and began pilot testing in 2019. The rationale for and components of the pilot program are presented along with data on participant performance and feedback from the first year of implementation in three primary specialties (neurology, child neurology, and psychiatry) and one subspecialty (child and adolescent psychiatry). METHODS: Evaluation of the pilot program was guided by a widely used validity framework. Data were collected that addressed the five categories of validity evidence: content, response process, internal structure, relation to other variables, and consequences. RESULTS: Enrollment ranged from 66.7% for psychiatrists to 75.3% for child neurologists. For the 2019 cohort, the pass rates ranged from 92.6% for child and adolescent psychiatry to 98.7% for neurology, and very small numbers of diplomates failed or did not complete the process. For psychiatrists, there was a modest, but significant, relationship between performance on previous and subsequent maintenance of certification examinations. Ninety percent or more agreed that: the articles were easy to access and helpful to their practices; the mini-tests were a fair assessment of their understanding of the articles; and their test-taking experience was satisfactory. DISCUSSION: Most eligible diplomates participated in the article-based pilot project, and they strongly preferred this format to the traditional multiple-choice examinations. Most important, the pilot was perceived to be a meaningful and relevant learning activity that had a positive effect on patient care.

Recent trends in american board of psychiatry and neurology psychiatric subspecialties.

OBJECTIVE: this article reviews the current status and recent trends in the American Board of Psychiatry and Neurology (ABPN) psychiatric subspecialties and discusses the implications of those trends as well as several key questions whose answers may well determine subspecialty viability. METHODS: data are presented on specialty and subspecialty programs; graduates; and ABPN certification candidates and diplomates drawn from several sources, including the records of the ABPN, the websites of the Accreditation Council for Graduate Medical Education and the American Medical Association, and the annual medical education issues of JAMA. RESULTS: fewer than half of psychiatry graduates pursue subspecialty training. While most recent specialty graduates attempt to become certified by the ABPN, many subspecialists elect not to do so. There have been recent decreases in the number of fellowship programs and trainees in geriatric psychiatry and addiction psychiatry. The pass rates for fellowship graduates are superior to those for the "grandfathers" in all of the newer psychiatric subspecialties. Lower percentages of subspecialists than specialists participate in maintenance of certification, and maintenance of certification pass rates are high. CONCLUSION: the initial interest in training and certification in some of the ABPN subspecialties appears to have slowed, and the long-term viability of those subspecialties may well depend on the answers to a number of complicated social, economic, and political questions in the new health care era.

Training in Neurology: Feedback from Graduates About the Psychiatry Component of Residency Training.

OBJECTIVE: To obtain feedback from early career adult and pediatric neurologists about the psychiatry component of residency training. METHODS: A survey was developed and administered electronically to 4 cohorts of recently certified American Board of Psychiatry and Neurology diplomates. RESULTS: The response rate was 16% (431/2,677) and included 330 adult neurologists and 101 pediatric neurologists. Fewer than half of the respondents described themselves as extremely or quite satisfied with their psychiatry training whereas 26% of the adult neurologists and 33% of the pediatric neurologists felt slightly or not at all prepared for this component of practice. Four themes were identified in the respondents' suggestions for improving psychiatry training: provide more outpatient experience; provide more time/teaching in psychiatry; provide more experience with both pharmacologic and nonpharmacologic psychiatric treatments; and provide more exposure to patients with conditions likely to be encountered in neurology/child neurology practice. CONCLUSION: These recent graduates of adult and pediatric neurology residency programs felt underprepared for the psychiatric issues they encountered in their patients. They suggested a number of strategies for better alignment of psychiatry training with the likely demands of practice. A model curriculum recently developed by the American Academy of Neurology's Consortium of Neurology Program Directors and the American Association of Directors of Psychiatric Residency Training also provides guidance for both neurology and psychiatry program directors.

State hospital-university collaborations: a 25-year follow-up.

OBJECTIVE: A formative survey of psychiatry departments 25 years ago showed strong and valued relationships between these departments and state hospitals. The authors sought to evaluate the extent of present-day collaborative relationships. METHODS: A repeat of a similar survey was sent in 2005 to 119 chairs of departments of psychiatry. RESULTS: Fifty-eight of 119 chairs (49% response rate) participated. A sustained high level of programmatic partnership was still observed, with 75% of respondents reporting ongoing administrative relationships. Seventy-four percent of respondents reported ongoing residency training relationships. CONCLUSION: These findings suggest that strong state-university collaborations have prevailed over the past 25 years despite major changes for academic health care and psychiatry residency training during this period.

Subspecialization in clinical neurophysiology: Development and current status.

OBJECTIVE: To describe the development and current status of training and certification in clinical neurophysiology (CNP); to explore the impact of the newer subspecialties in sleep medicine, neuromuscular medicine, and epilepsy; and to obtain information about aspects of practice in the subspecialty. METHODS: Information about training programs and certification was obtained from the records of the Accreditation Council for Graduate Medical Education and the American Board of Psychiatry and Neurology, and diplomates were surveyed about their CNP practice activities and attitudes toward certification/recertification. RESULTS: In the years since the first examination was administered, a robust number of CNP training programs developed, but recently, there has been a decrease in the number of programs and fellows, although the number of programs and fellows in the subspecialties of epilepsy, neuromuscular medicine, and sleep medicine has increased. A diplomate survey indicated that most respondents devoted significant practice time to CNP procedures, especially to EEGs and EMGs. Although more diplomates performed EEGs than EMGs, a substantial portion performed both. Most diplomates were planning to or had maintained certification in CNP. CONCLUSION: Over 3,000 neurologists, child neurologists, and psychiatrists have obtained certification in CNP, and the majority are participating in recertification. Although the newer and overlapping subspecialties of epilepsy, neuromuscular medicine, and sleep medicine may be having a negative impact on CNP, it continues to have a relatively large number of programs and attracts a relatively large number of fellows.

Clinical Skills Evaluation in Neurology, Child Neurology and Psychiatry: Program Directors' Perspective and Future Opportunities.

BACKGROUND: When the American Board of Psychiatry and Neurology (ABPN) eliminated the oral segment of the board-certification examination, it began requiring in-training assessments termed Clinical Skill Evaluations (CSEs). OBJECTIVE: This study describes the experience of residency program directors (PDs) with CSEs and identifies opportunities for improvement. METHODS: A 23-question survey was administered electronically to neurology, child neurology, and psychiatry PDs assessing their CSE testing procedures in April 2019. Data from the ABPN preCERT® Credentialing System CSE was analyzed to corroborate the survey results. RESULTS: A total of 439 PDs were surveyed. The overall response rate was approximately 40% with a similar response across the 3 specialties. Overall, there was a strong enthusiasm for CSEs as they captured the essence of the physician-patient relationship. Most PDs encouraged trainees to attempt CSEs early in their training though the completion time frame varied by specialty. Approximately 57% of psychiatry residencies offered formal, in-person faculty training while less than one-fourth of neurology and child neurology programs offered such a program. Most PDs are interested in a faculty development course to ensure a standardized CSE testing process at their institution. CONCLUSIONS: This survey confirmed earlier findings that CSEs are usually implemented early in the course of residency training and that most PDs think it captures the essence of the physician-patient relationship. While few residencies offer a CSE training course, there is widespread support for a formal approach to faculty development and this offers a specific opportunity for CSE improvement in the future.

Relationship between Resident-In-Training Examination in psychiatry and subsequent certification examination performances.

OBJECTIVE: This study analyzed the relationship between performance on The American College of Psychiatrists' Psychiatry Resident-In-Training Examination (PRITE) and the ABPN Part 1 examination. METHODS: Pearson correlation coefficients were used to examine the relationship between performance on the 2002 PRITE and the 2003 Part 1 examination for 297 examinees. RESULTS: The correlation between the PRITE global psychiatry and the Part 1 psychiatry scores was 0.59, and the correlation between the PRITE global neurology and the Part 1 neurology scores was 0.39. CONCLUSION: Although the PRITE and the Part 1 examination have different purposes and are developed independently, the significant correlations between scores on the two tests support the use of PRITE results to guide preparation for the Part 1 examination. Guidelines for PRITE scores associated with poor performance on the Part 1 examination are provided.

Performance of Certification and Recertification Examinees on Multiple Choice Test Items: Does Physician Age Have an Impact?

INTRODUCTION: The development of recertification programs (now referred to as Maintenance of Certification or MOC) by the members of the American Board of Medical Specialties provides the opportunity to study knowledge base across the professional lifespan of physicians. Research results to date are mixed with some studies finding negative associations between age and various measures of competency and others finding no or minimal relationships. METHODS: Four groups of multiple choice test items that were independently developed for certification and MOC examinations in psychiatry and neurology were administered to certification and MOC examinees within each specialty. Percent correct scores were calculated for each examinee. Differences between certification and MOC examinees were compared using unpaired t tests, and logistic regression was used to compare MOC and certification examinee performance on the common test items. RESULTS: Except for the neurology certification test items that addressed basic neurology concepts, the performance of the certification and MOC examinees was similar. The differences in performance on individual test items did not consistently favor one group or the other and could not be attributed to any distinguishable content or format characteristics of those items. DISCUSSION: The findings of this study are encouraging in that physicians who had recently completed residency training possessed clinical knowledge that was comparable to that of experienced physicians, and the experienced physicians' clinical knowledge was equivalent to that of recent residency graduates. The role testing can play in enhancing expertise is described.

Comparison of Certification and Recertification Examinee Performance on Multiple-Choice Items in Forensic Psychiatry.

Research on the association between age and performance on tests of medical knowledge has generally shown an inverse relationship, which is of concern because of the positive association between measures of knowledge and measures of clinical performance. Because the certification and maintenance of certification (MOC) examinations in the subspecialty of forensic psychiatry draw on a common item bank, performance of the two groups of examinees on the same items could be compared. In addition, the relationship between age and test performance was analyzed. Performance on items administered to certification and MOC examinees did not differ significantly, and the mean amount of time spent on each item was similar for the two groups. Although the majority (five of eight) of the correlations between age and test score on the certification and MOC examinations were negative, only three were significant, and the amount of variance explained by age was small. In addition, examination performance for those younger than 50 was similar to those 60 and older, and diplomates recertifying for the second time outperformed those doing so for the first time. These results indicate that in this subspecialty, there is no clear evidence of an age-related decline in knowledge as assessed by multiple-choice items.

The American Psychiatric Association's resource document on guidelines for psychiatric fitness-for-duty evaluations of physicians.

The psychiatric evaluation of a physician's fitness for duty is an undertaking that is both important to patients' well-being and to the physician-subject of the evaluation. It is necessary that psychiatrists who agree to perform such evaluations proceed in a careful and thorough manner. This document was developed to provide general guidance to the psychiatric evaluators in these situations. It was prepared by the American Psychiatric Association (APA) Council on Psychiatry and Law and Corresponding Committee on Physician Health, Illness, and Impairment, of which the authors are members. The Resource Document was approved by the APA Joint Reference Committee in June 2004. APA Resource Documents do not represent official policy of the American Psychiatric Association. This Resource Document was edited to conform to Journal style and has therefore been modified slightly from the original document approved by the APA.

Association between performance on Neurology In-Training and Certification Examinations.

OBJECTIVE: This study analyzed the relationship between performance on the American Academy of Neurology Residency In-Service Training Examination (RITE) and subsequent performance on the American Board of Psychiatry and Neurology (ABPN) Certification Examination. METHODS: Pearson correlation coefficients were used to examine the relationship between performance on the RITE and the Certification Examination for 2 cohorts of adult neurologists and 2 cohorts of child neurologists. The 2 cohorts represented test takers for 2008 and 2009. RESULTS: For adult neurologists, the correlation between the total RITE and the Certification Examination scores was 0.77 (p < 0.01) in 2008 and 0.65 (p < 0.01) in 2009. For child neurologists, it was 0.74 (p < 0.01) in 2008 and 0.56 (p < 0.01) in 2009. DISCUSSION: For 2 consecutive years, there was a significant correlation between performance on the RITE and performance on the ABPN Certification Examination for both adult and child neurologists. The RITE is a self-assessment examination, and performance on the test is a positive predictor of future performance on the ABPN Certification Examination.

Relationship between performance on child and adolescent psychiatry in-training and certification examinations.

BACKGROUND: Studies across a range of specialties have consistently yielded positive associations between performance on in-training examinations and board certification examinations, supporting the use of the in-training examination as a valuable formative feedback tool for residents and residency programs. That association to date, however, has not been tested in child and adolescent psychiatry residents. OBJECTIVE: This is the first study to explore the relationship between performance on the American College of Psychiatrists' Child Psychiatry Resident In-Training Examination (CHILD PRITE) and subsequent performance on the American Board of Psychiatry and Neurology's (ABPN) subspecialty multiple-choice examination (Part I) in child and adolescent psychiatry (CAP). METHODS: Pearson correlation coefficients were used to examine the relationship between performance on the CHILD PRITE and the CAP Part I examination for 342 fellows. RESULTS: Second-year CAP fellows performed significantly better on the CHILD PRITE than did the first-year fellows. The correlation between the CHILD PRITE total score and the CAP Part I examination total score was .41 (P  =  .01) for first-year CAP fellows; it was .52 (P  =  .01) for second-year CAP fellows. CONCLUSIONS: The significant correlations between scores on the 2 tests show they assess the same achievement domain. This supports the use of the CHILD PRITE as a valid measure of medical knowledge and formative feedback tool in child and adolescent psychiatry.