Recertification Now Requires a Secure Examination!

The announcement by the American Board of Pediatrics (ABP) that recertification in the pediatric subspecialties will no longer be satisfied by an open-book examination has caused concern among those holding subspecialty boards, including some of the 785 individuals with time-limited certificates in pediatric gastroenterology. Since the spring of 2003, those re-certifying in general pediatrics or a pediatric subspecialty have been required to demonstrate cognitive expertise by taking a secure examination. The examination is a half-day, closed-book test administered at computer testing centers throughout the United States, Canada, and abroad. The examinations are available 6 days per week for 2 months each year (mid-March to mid-April and mid-October to mid-November). The examinations focus on content related to the daily practice of the subspecialty and not on issues typically requiring the use of reference materials. Recertification is required every 7 years if an individual wishes to maintain active certification status. The ABP issues certificates of special qualifications in adolescent medicine, pediatric cardiology, pediatric critical care medicine, developmental–behavioral pediatrics, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology–oncology, pediatric infectious diseases, neonatal–perinatal medicine, pediatric nephrology, pediatric pulmonology, and pediatric rheumatology. Certificates of added qualifications are given in medical toxicology, neurodevelopmental disabilities, and sports medicine. The ABP does not review or accredit pediatric subspecialty fellowship programs. This activity is undertaken by the Residency Review Committee under the auspices of the Accreditation Council for Graduate Medical Education. The reason the ABP made the change to a secure examination is straightforward. A secure examination assures that the individual being recertified is the individual who has participated in this aspect of the recertification process. The 24 member boards of the American Board of Medical Specialties (ABMS) believe that if recertification is to be recognized as a valid instrument in the assessment of knowledge of a specialty or subspecialty, they must be able to demonstrate to the public that the individual being recertified is indeed the individual who has been tested. The “public” in this situation includes patients, families, state licensing boards, insurers, hospitals, and others. The ABP believes these entities should have the reasonable expectation that physicians remain knowledgeable about the practice elements of their field. Understanding the mission of the ABP will make the rationale for this change more apparent. The ABP was established to advance the science, study and practice of pediatrics by evaluating the credentials of physicians applying for certification as pediatricians, by examining applicants, and by certifying those who qualify. Certification includes initial specialty and subspecialty certification and maintenance of certification throughout one’s professional career. As stated in the purpose statement of the ABP, “The intent of certification is to provide assurance to the public and the medical profession that a certified pediatrician has successfully completed an accredited educational program and various evaluations, including an examination, and that the individual possesses the knowledge, skills, and experience requisite to the provision of the high-quality care in pediatrics.” The ABP is a member of the ABMS, which is the umbrella organization for the medical subspecialty boards. The ABMS has mandated the shift from the previous method of recertification. A task force of the ABMS created a framework of essential competencies, from which it developed a four-part model of maintenance of certification that all certifying boards will eventually employ. The four parts of the model are: 1) evidence of professional standing; 2) evidence of life-long learning and periodic self-assessment; 3) evidence of cognitive expertise; and 4) evidence of satisfactory performance in practice. Part 4 of the Program for Maintenance of Certification in Pediatrics (PMCP) will include quality improvement activities in our subspecialty that are being developed in collaboration with the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Dr. James Stockman, President of the ABP, addressed concerns about PMCP in a letter to the editor of AAP News in June 2003. He agreed that, given the choice, few would prefer a secure examination to an open-book self-assessment. He noted, however, that health care providers, hospitals, managed care organizations, private insurers, state licensing bodies and other US government agencies had expressed increasing interest in the methods used to certify and recertify physicians. For example, some states waive the requirement for a state-administered examination for physicians relocating to the state only if the applicant has been recertified by a process that has included a secure examination. The open-book self-assessment examination previously used does not meet this criterion. Member boards of the Federation of State Medical Boards (FSMB) that previously permitted licensure on the basis of recertification no longer do so unless the recertification process includes a secure examination. Several states (Nevada and Texas are examples) are now considering a requirement for periodic cognitive assessment for relicensure. Participation in a recertification program that includes a secure examination will suffice for this purpose; otherwise, a state-administered examination will be given. If this FSMB activity progresses, pediatric gastroenterologists who do not maintain their subspecialty certification will face the possibility of taking a nonspecialty state-administered examination to be relicensed. The maintenance of certification program allows standards of competence to be set from within our discipline, rather than having standards imposed by state legislatures. The move to a secure examination by the ABP was thought to be its only responsible course of action. It is worth noting that all 24 certifying boards of the ABMS have or soon will have secure examinations as part of their maintenance of certification programs. The change to maintenance of certification that includes a secure examination allows the ABP to fulfill its mission, which is to certify pediatricians who are qualified to take care of children in their subspecialty.

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