The Estimated Cost of Maintenance of Certification.

BACKGROUND: Maintenance of Certification (MOC) is a controversial topic in medicine for many different reasons. Studies have suggested that there may be associations between fewer negative outcomes and participation in MOC. However, MOC still remains controversial because of its cost. We sought to determine the estimated cost of MOC to the average orthopaedic surgeon, including fees and time cost, defined as the market value of the physician's time. METHODS: We calculated the total cost of MOC to be the sum of the fees required for applications, examinations, and other miscellaneous fees as well as the time cost to the physician and staff. Costs were calculated for the oral, written, and American Board of Orthopaedic Surgery Web-based Longitudinal Assessment (ABOS WLA) MOC pathways based on the responses of 33 orthopaedic surgeons to a survey sent to a state orthopaedic society. RESULTS: We calculated the average orthopaedic surgeon's total cost in time and fees over the decade-long period to be $71,440.61 ($7,144.06 per year) for the oral examination MOC pathway and $80,391.55 ($8,039.16 per year) for the written examination pathway. We calculated the cost of the American Board of Orthopaedic Surgery web-based examination pathway to be $69,721.04 ($6,972.10 per year). CONCLUSIONS: The actual cost of MOC is much higher than just the fees paid to organizations providing services. The majority of the cost comes in the form of time cost to the physician. The ABOS WLA was implemented to alleviate the anxiety of a high-stakes examination and to encourage efficient longitudinal learning. We found that the ABOS WLA pathway does save time and money when compared with the written examination pathway when review courses and study periods are taken. We believe that future policy changes should focus on decreasing physician time spent completing MOC requirements, and decreasing the cost of these requirements, while preserving the model of continued evidence-based medical education.

Federal requirements for nursing homes to include certified nursing assistants in resident care planning and interdisciplinary teams: A policy analysis.

Starting in 2016, Centers for Medicare and Medicaid Services implemented the first phase of a 3-year multi-phase plan revising the manner in which nursing homes are regulated. In this revision, attention was placed on the importance of certified nursing assistants (CNAs) to resident care and the need to empower these frontline workers. Phase II mandates that CNAs be included as members of the nursing home interdisciplinary team that develops care plans for the resident that are person-centered and comprehensive and reviews and revises these care plans after each resident assessment. While these efforts are laudable, there are no direct guidelines for how to integrate CNAs in the interdisciplinary team. We recommend the inclusion of direct guidelines, in which this policy revision clarifies the expected contributions from CNAs, their responsibilities, their role as members of the interdisciplinary team, and the expected patterns of communication between CNAs and other members of the interdisciplinary team.

Pearls and Pitfalls of the Virtual Interview: Perspectives From Both Sides of the Camera.

As the SARS-COV-2 pandemic created the need for social distancing and the implementation of nonessential travel bans, residency and fellowship programs have moved toward a web-based virtual process for applicant interviews. As part of the Society of Asian Academic Surgeons 5th Annual Meeting, an expert panel was convened to provide guidance for prospective applicants who are new to the process. This article provides perspectives from applicants who have successfully navigated the surgical subspecialty fellowship process, as well as program leadership who have held virtual interviews.

The impact of patient-centered medical home certification on quality of care for patients with diabetes.

OBJECTIVE: To identify the impact of changes surrounding certification as a patient-centered medical home (PCMH) on outcomes for patients with diabetes. STUDY SETTING: Minnesota legislation established mandatory quality reporting for patients with diabetes and statewide standards for certification as a PCMH. Patient-level quality reporting data (2008-2018) were used to study the impact of transition to a PCMH. STUDY DESIGN: Achievement of Minnesota's optimal diabetes care standard-in aggregate and by component-was modeled for adult patients with Type 1 or Type 2 diabetes as a function of time relative to the year the patient's primary care practice achieved PCMH certification. Patients from uncertified practices were used to control for general trend. Practice-level random effects captured time-invariant characteristics of practices and the practices' average patient. DATA COLLECTION: Electronic health record data were submitted by 695 Minnesota practices capturing components of the quality standard: blood sugar control, cholesterol control, blood pressure control, nonsmoking status, and use of aspirin. PRINCIPAL FINDINGS: The first cohort of practices achieving PCMH certification (July 2010-June 2014) showed statistically insignificant changes in optimal care. The next cohort of practices (July 2014-June 2018) achieved larger, clinically meaningful increases in quality of care during the time prior to and following certification. Specifically, this second cohort of practices was estimated to achieve a 12.8 percentage-point improvement (P < .001) in the predicted probability of providing optimal diabetes care over the period spanning 3 years before to 3 years after certification. CONCLUSIONS: Our results suggest that the initial cohort of certified practices was already performing at a high level before certification, perhaps requiring little change in their operations to achieve PCMH certification. The second cohort, on the other hand, made meaningful, quality-improving changes in the years surrounding certification. Differences by cohort may partially explain the inconsistent PCMH impacts found in the literature.

Roles, Training, and Qualifications of a Case Manager in the Canadian Health Care Industry: A Narrative Review.

PURPOSE: The purpose of this article is to explore primary roles, training, competencies, and qualifications of a case manager in the Canadian health care industry and how to improve case management practice in Canada. PRIMARY PRACTICE SETTING: Case managers' primary practice setting investigated in this article is the Canadian health care industry, which includes clinics, hospitals, continuing care, short-term and long-term care facilities, as well as palliative and end-of-life care settings. CONCLUSION: The main role of case managers is to help clients meet their goals. Assessment, monitoring, interpersonal communication, and collaboration are essential roles and competencies of case managers. Many case managers come from regulated health care professions and have prior years of professional experience, and many of them come from a nursing profession. This article is a narrative review based on the current literature about case managers' roles, training, and competencies in the Canadian health care industry and how to improve Canadian case management practice. Certification and standardization of case managers in Canada are needed to better understand the roles, training, and qualifications of case managers in the Canadian health care industry. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Case managers require skills in assessment, monitoring, cultural competency, interpersonal communication, collaboration, coordinating, and advocating for resources and services to meet clients' goals in the health care industry. Case managers must also consider how to combat and address other social determinants of health such as a client's social economic status, literacy, income, employment, and working conditions that influence client's health. Ongoing professional development for case managers is fundamental in achieving effective case management practice. Finally, it is important to have case management certification in Canada in order to better understand case manager's roles and qualifications in the Canadian health care industry.

Influence of Sex and Age on Ratings of Confidence and Relevance in Continuing Certification Longitudinal Assessment: A Pilot Study.

OBJECTIVE: Longitudinal assessments use spaced repetition of items to facilitate learning. Algorithms selecting repetition items can prioritize various properties for future presentation. The purpose of this pilot study was to evaluate the relationship between participant ratings of item-specific confidence and/or practice relevance and participant age, sex, and response correctness. DESIGN: This is a prospective quality improvement study of 403 American Board of Physical Medicine and Rehabilitation diplomates with time-limited certificates. Participants answered 20 items quarterly over four quarters, rating each item on its relevance to their practice and their confidence in their response. RESULTS: The relationship between sex and ratings of response confidence was significant, with women less likely than men to be confident in their responses, regardless of correctness. Younger physicians were significantly more confident in their responses and rated items as more practice relevant. CONCLUSIONS: Women physicians were less confident than men in their item-specific confidence ratings, regardless of correctness, on the American Board of Physical Medicine and Rehabilitation continuing certification longitudinal knowledge assessment. Older physicians were less confident in their responses than younger physicians. The findings supported the American Board of Physical Medicine and Rehabilitation prioritization of response correctness and practice relevance, rather than response confidence, to select items for spaced repetition in American Board of Physical Medicine and Rehabilitation's continuing certification longitudinal assessment.

Proposal of Standard for Medical Science Liaison (MSL) Profession in Japan: A Viewpoint from the Japanese Association of Pharmaceutical Medicine (JAPhMed).

Medical science liaisons (MSLs) are field-based professionals sited in medical affairs (MA) departments who contribute to the generation of medical evidence and exchange advanced medical and scientific information with healthcare professionals to standardize treatments and maximize the value of medical products for patient outcomes. As such, it is essential for companies to have MSL training programs that cover areas such as advanced scientific expertise, pharmaceutical regulations, and medical communication proficiency and to certify the knowledge and skills that enable MSLs to perform their tasks effectively. The lack of a standardized training curriculum, assessment of MSL capabilities, and key performance indicators (KPIs) in Japan has made it difficult for MSLs to carry out these tasks. It is important to clarify the status of MSLs in MA divisions within the Japanese pharmaceutical industry. The mission of the Japanese Association of Pharmaceutical Medicine (JAPhMed) is to promote pharmaceutical medicine by enhancing the knowledge, expertise, and skills of pharmaceutical professionals. JAPhMed established an accreditation system for the MSL certification programs of individual companies in early 2015 and then embarked on defining the individual MSL qualifications from late 2015 to mid-2017. Here, we describe the MSL recommendation that covers (1) MA in Japan, (2) definition of MSL, (3) roles and activities of MSLs, (4) regulation and compliance for MSLs, (5) qualification requirements for MSLs, (6) KPIs for MSLs, and (7) a training curriculum for MSLs. In the training curriculum, JAPhMed considered the relevance of each part of the training curriculum in terms of the fixed roles and activities of MSLs.

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).

Clinical informatics subspecialists: characterizing a novel evolving workforce.

BACKGROUND: The growing complexity of data systems in health care has precipitated increasing demand for clinical informatics subspecialists. The first board certification exam for the clinical informatics subspecialty was offered in 2013. Characterizing trends in this novel workforce is important to inform its development. METHODS: We conducted an exploratory analysis of American Board of Medical Specialties data on individuals certified in clinical informatics from 2013 to 2019 to review trends and demographic characteristics of current subspecialists. RESULTS: 2018 physicians were certified in clinical informatics from 2013 to 2019. The annual number of awarded certifications declined after 2016. The majority of primary certifications held by clinical informaticians were in broad-based medical specialties relative to primarily procedural specialties. CONCLUSIONS: Disparities may exist within the clinical informatics physician workforce with respect to primary specialty certifications and geographic distribution. There remains a need for the creation of fellowship programs to sustain the growth of this workforce.

Establishing voluntary certification of community health workers in Arizona: a policy case study of building a unified workforce.

BACKGROUND: Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort. CASE PRESENTATION: In this article, we describe the process of unifying the two major CHW workforces in Arizona, promotoras de salud in US-Mexico border communities and community health representatives (CHRs) serving American Indian communities. Differences in the origins, financing, and even language of the population-served contributed to historically divergent interests between CHRs and promotoras. In order to move forward as a collective workforce, it was imperative to integrate the perspectives of CHRs, who have a regular funding stream and work closely through the Indian Health Services, with those of promotoras, who are more likely to be grant-funded in community-based efforts. As a unified workforce, CHWs were better positioned to gain advocacy support from key health care providers and health insurance companies with policy influence. We seek to elucidate the lessons learned in our process that may be relevant to CHWs representing diverse communities across the US and internationally. CONCLUSIONS: Legislated voluntary certification provides a pathway for further professionalization of the CHW workforce by establishing a standard definition and set of core competencies. Voluntary certification also provides guidance to organizations in developing appropriate training and job activities, as well as ongoing professional development opportunities. In developing certification with CHWs representing different populations, and in particular Tribal Nations, it is essential to assure that the CHW definition is in alignment with all groups and that the scope of practice reflects CHW roles in both clinic and community-based settings. The Arizona experience underscores the benefits of a flexible approach that leverages existing strengths in organizations and the population served.

An Examination of Self-Reported Assessment Activities Documented by Specialist Physicians for Maintenance of Certification.

INTRODUCTION: Specialists in a Maintenance of Certification program are required to participate in assessment activities, such as chart audit, simulation, knowledge assessment, and multisource feedback. This study examined data from five different specialties to identify variation in participation in assessment activities, examine differences in the learning stimulated by assessment, assess the frequency and type of planned changes, and assess the association between learning, discussion, and planned changes. METHODS: E-portfolio data were categorized and analyzed descriptively. Chi-squared tests examined associations. RESULTS: A total of 2854 anatomical pathologists, cardiologists, gastroenterologists, ophthalmologists, and orthopedic surgeons provided data about 6063 assessment activities. Although there were differences in the role that learning played by discipline and assessment type, the most common activities documented across all specialties were self-assessment programs (n = 2122), feedback on teaching (n = 1078), personal practice assessments which the physician did themselves (n = 751), annual reviews (n = 682), and reviews by third parties (n = 661). Learning occurred for 93% of the activities and was associated with change. For 2126 activities, there were planned changes. Activities in which there was a discussion with a peer or supervisor were more likely to result in a change. CONCLUSIONS AND DISCUSSION: Although specialists engaged in many types of assessment activities to meet the Maintenance of Certification program requirements, there was variability in how assessment stimulated learning and planned changes. It seems that peer discussion may be an important component in fostering practice change and forming plans for improvement which bears further study.

Theoretical and practical knowledge curriculum for European Breast Surgeons.

The Breast Surgery theoretical and practical knowledge curriculum comprehensively describes the knowledge and skills expected of a fully trained breast surgeon practicing in the European Union and European Economic Area (EEA). It forms part of a range of factors that contribute to the delivery of high quality cancer care. It has been developed by a panel of experts from across Europe and has been validated by professional breast surgery societies in Europe. The curriculum maps closely to the syllabus of the Union of European Medical Specialists (UEMS) Breast Surgery Exam, the UK FRCS (breast specialist interest) curriculum and other professional standards across Europe and globally (USA Society of Surgical Oncology, SSO). It is envisioned that this will serve as the basis for breast surgery training, examination and accreditation across Europe to harmonise and raise standards as breast surgery develops as a separate discipline from its parent specialties (general surgery, gynaecology, surgical oncology and plastic surgery). The curriculum is not static but will be revised and updated by the curriculum development group of the European Breast Surgical Oncology Certification group (BRESO) every 2 years.

What Is Stroke Certification and Does It Matter?

Many academic and community hospitals have obtained, or are considering obtaining, stroke center certification. Participation in structured quality improvement programs that also incorporate an objective assessment has been shown to improve outcomes and foster team building. Although obtaining certification can be challenging and costly, it can provide a framework to ensure hospitals deliver high- level, evidence-based stroke care. For the intensive care unit nurse, awareness and participation in the certification programs process is an important part of professional nursing practice.

Pain Medicine Board Certification Status Among Physicians Performing Interventional Pain Procedures in the State of Florida Between 2010 and 2016.

BACKGROUND: The US Department of Health and Human Services has recommended that physicians performing interventional pain procedures be credentialed based on criteria based guidelines and minimum training requirements. OBJECTIVES: To quantitatively assess gaps in certification related to pain medicine fellowship requirements, we studied the distribution of such procedures in Florida between 2010 and 2016. STUDY DESIGN: This research involved a retrospective analysis with a sample size of n = 1,885,442 interventional pain procedures. SETTING: Data describing interventional pain procedures performed in Florida between January 2010 and December 2016 were obtained from the Florida Department of Health. The National Provider Identifier file and board certification lists from the American Board of Medical Specialties (ABMS), the American Board of Pain Medicine (ABPM), and the American Board of Interventional Pain Physicians (ABIPP) corresponding to this time frame were also obtained. METHODS: The datasets were linked to determine the specialty of physicians performing interventional pain procedures, and whether or not they were pain medicine diplomates of the ABMS, the ABPM, or the ABIPP. The similarity index theta was calculated for the distribution of interventional pain procedure codes among medical specialty groups, and with respect to the practitioners' pain medicine board certification status. RESULTS: Of the interventional pain procedures, anesthesiologists performed 63.5%, physiatrists 19.1%, neurologists or psychiatrists 5.2%, and other practitioners 12.3%. Among procedures performed by anesthesiologists, physiatrists, and psychiatrists or neurologists, 66.2%, 50.3%, and 50.4% were by ABMS pain board-certified practitioners, respectively. Practitioners without ABMS pain medicine boards performed 45.8% of interventional pain procedures. Practitioners without such boards from either the ABMS, ABPM, or ABIPP performed 37.7%. There was very large similarity (theta > 0.9) in the distribution of procedures comparing ABMS pain medicine board-certified practitioners to non-ABMS pain medicine board-certified anesthesiologists, physiatrists, or all other specialties. LIMITATIONS: In countries other than the United States, where pain medicine board certification is relatively recent, there may be a higher percentage of interventional pain procedures performed by individuals without certification than we report. In "opt-out" states, where nurse anesthetists can independently perform interventional pain procedures, the percentage of interventional pain procedures performed by individuals without physician pain medicine board certification may also be higher. The datasets we used do not contain information to allow assessment of outcomes or effectiveness resulting from pain medicine board certification. CONCLUSIONS: Approximately one-third of interventional pain procedures were performed by physicians without at least 1 of the 3 pain medicine board certifications. In addition, the practitioners performed very similar distributions of procedures (i.e., those without pain medicine board certification, overall, have not restricted their practice). These results suggest the need for additional accredited pain medicine fellowship training positions for newly graduated residents. The results also show that, for the recommendations of the Department of Health and Human Services to be satisfied, physicians without board certification performing intervention procedures would need to obtain ABPM or ABIPP certification, or ABMS certification after completion of a full-time Accreditation Council of Graduate Medical Education pain medicine fellowship. KEY WORDS: Chronic pain, education, medical, graduate, specialty boards.

Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality.

Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

Association of Medical Certification Factors with All-Cause Mortality in U.S. Aviators.

INTRODUCTION: The value of aeromedical certification in reducing adverse medical outcomes is an especially important question for this era of increasing flight operations that do not require an FAA medical certificate. The study of this question has previously been thwarted by a lack of information about pilots when their medical certificates are not renewed.METHODS: We matched airmen in the FAA medical certification database to the U.S. Social Security Death Index to identify date of death for deceased pilots. Logistic regression models were used to explore associations of certification data with odds of death while holding a medical certificate and within 4 yr of expiration of a medical certificate.RESULTS: FAA aeromedical waivers were associated with 33% lower odds of death while holding a medical certificate and 35% increased odds of death within 4 yr after expiration of a medical certificate. Denial was associated with 21% increased odds of death in the next 4 yr. Only 13 of 47 medical conditions having significant associations were associated with increased odds of death during certification.DISCUSSION: We found that FAA aeromedical certification reduces the odds of death while holding a medical certificate compared to the 4 yr after certificate expiration. We believe this helps provide a positive answer to the question of whether medical certification reduces medically related events.Mills WD, Greenhaw RM. Association of medical certification factors with all-cause mortality in U.S. aviators. Aerosp Med Hum Perform. 2019; 90(11):938-944.