American Board of Internal Medicine Updates Exams Using Condition Frequency Data and Physician Input

Philadelphia, June 13, 2017 – The American Board of Internal Medicine (ABIM) is continuing to update Maintenance of Certification (MOC) exam content to focus on more of the conditions doctors treat frequently and find important to diagnose.

In 2015, ABIM began inviting physicians to review the Internal Medicine MOC exam blueprint, an outline of exam content. Thousands of physicians participated in the blueprint review process and rated exam topic areas by relative frequency and importance in practice. This process continues to expand. The JAMA study results, in conjunction with the blueprint review process, informed updates to MOC exams. (Study results were published this week in JAMA.)

"Physicians asked ABIM to look for ways to make MOC more reflective of clinical practice, so we are studying our program to determine what works well and where we can improve," study co-author and ABIM Board member Marianne Green, MD, said. "ABIM is using real-world data and feedback from a large group of internists to align exam content with conditions seen frequently and the importance of these conditions for patient mortality and morbidity."

About the JAMA study

ABIM researchers used data from National Ambulatory Medical Care and National Hospital Discharge surveys, comprising more than 120,000 patient contacts, to determine conditions frequently seen in practice by general internists. They then compared these conditions with the frequency of questions related to those conditions appearing on MOC exams from 2010 to 2013.

"We found that the medical conditions related to a majority of exam questions, 69 percent, were aligned with conditions seen by practicing internists in terms of frequencies of patient contacts versus frequency of exam questions," said lead author Bradley M. Gray, PhD, ABIM Senior Health Services Researcher. "These results are promising because they show that the exam content was reflective of what internists see in practice – even before changes to the blueprint were implemented."

Though researchers found some discordance based on frequency of some conditions seen on the exam, Dr. Green noted that the study did not consider importance of conditions to patient care.

"Most of the discordant conditions where the frequency of questions on the exam was greater than the frequency of conditions seen were conditions that may be uncommon but were rated as extremely important to patient care by internists responding to a survey involving review of exam blueprints. An example of this is diagnosis and management of vasculitis, a rare but painful condition that can slow vital blood supply to tissues and organs. Based on physicians' input, these conditions continue to be included on the exam," Dr. Green said.

Authors also noted that future research is needed to gauge whether this process increased the relevance of Internal Medicine MOC exam content and to evaluate other forms of content validity, including the degree to which exam performance predicts outcomes that are important to patients.

Read more

View the research article in JAMA.

Read more research from ABIM and other organizations about board certification, MOC and physician assessment.

Learn more about the ABIM MOC program, which includes independent assessment and continuous learning activities that doctors can complete to stay current with medical knowledge.

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Internists and subspecialists who earn and maintain board certification from the American Board of Internal Medicine (ABIM) differentiate themselves every day through their specialized knowledge and commitment to continual learning in service of their patients. Established as an independent nonprofit more than 80 years ago, ABIM continues to be driven by doctors who want to achieve higher standards for better care in a rapidly changing world. Visit ABIM's blog to learn more and follow ABIM on Facebook and Twitter. ABIM is a member of the American Board of Medical Specialties.