GSACEP and military medical legend Dr. Dave Barry shares an update on ABEM's activities at GSS 2022.
GSACEP was deeply saddened to hear about the passing of Dr. Barry earlier this week. We treasure this opportunity to hear his voice once again and learn from this incredible physician, educator, and leader.
I know a lot of people here, I'm happy to say but for those of you that don't know me, my name is Dave Berry. I am a longtime a BIM or GSA CEP member. And five years ago transitioned to the civilian world but maintained as a member of GSA CEP, I was lucky enough to be selected to be on the board of a BIM. And wanted to give you guys an update of what's going on, on the bigger picture of a BIM, especially over the last two years that we've made a lot of changes at a BIM, there's been a lot of changes from the pandemic. And I would say that some of the, I guess I should stand up here. So that could be in the picture. Some of the decisions we've made today, BIM haven't been super popular with some people. So I wanted to give you guys an update of what we did and why we did it. And really focus on your questions and your interests, I have a slide deck that we can use or not use, and I assume this is how to forward the slides,Unknown:
and will really play it by ear. And we can spend all the time talking about what you want to talk about, or we can go through some of these slides as well. So this is what I have prepared to talk about sort of notable notable transitions over the last few years, I will say that I was selected to be on the board two years ago, because I'm sort of finishing my second year. So I stepped into the board at a BIM during a era of high transition, and lots of changes. So I've been super busy, and it's been a whirlwind of of learning on my part. If you have questions, or topics you want to talk about that aren't on this slide, we can go ahead and scrap the slide deck and talk about those. If you want to hear about sort of the things that I thought might be highlighted over the last two years, we can go ahead and and do that as well. Okay. Just as background, I did want to give you guys sort of the demographics hmm, right now, we right now we have a little over 41,000 42,000, emergency medicine boarded physicians, I did a Google search. And at least some statistical says that there's what 58,000 practicing emergency physicians in the US. So of those 50 8000s, about about 42,000 Are our board certified in a BIM. The other ones are either not em specialists are board certified in another certifying community and not a BIM. age wise, this is what a BIM, the emergency medicine community of a BIM looks like. This used to be, they always talk about a bimodal distribution of of Emergency Physicians and, and as you can see, that's not really pairing anymore. The The other mode, the the bump in the slide used to be over there where the yellow bump is, and that's the people that certified through the practice pathway. Before the first 10 years that a BIM was in existence, there was an ability to become a BIM certified without residency training. And that expired about 10 years after a bems was started. And that's that bump, there are the people that certified through practice only. And you can see they're gradually retiring, and the rest of the population is residency trained. And you can see it's more of just a single mode. We have a lot of young physicians, and then as we taper on and get older, we either retire or move on to other things. This is what emergency medicine looks like across the nation. What's not shown here are the GSA set members who are spread throughout all these states. This is based on where people put their address and not what state there were, you know, GSA said, what they're lined up to be. GSA Sep, in and of itself has I want to say I think they told me 1100 members, which puts us as like the ninth largest chapter, compared to all the other state chapters, and we're sort of speckled in between there. And then, worldwide, we have somewhere around 60 or 80 people that are deployed with apps outside the US. If you look at sub specialties, you can see EMS has the most subspecialty trainees, amongst all emergency physicians followed by med talks. If you add up all of the critical care pathways between emergency medicine and anesthesia and general surgery, critical care is right about the same as medical toxicology and then the other subspecialties have less trainees. Going back to the update. As I mentioned, the last two years has been pretty dramatic for everybody and certainly has been dramatic for specialty training and certification. Some of these were affected by the pandemic and others we had already sort of plan to do pay pandemic wise, of course, we had a challenge in trying to maintain certification, both initial certification and continuing certification for emergency physicians, because of the pandemic and, and lock downs and things. So we rapidly converted the continuing certification exam to online. And you can see that up there. I'll talk a little bit later about how we're going to sunset that. And that's been something that's been planned for a little bit longer. We also had a challenge in initial certification in the final phase of initial certification, which is the oral boards. The oral boards traditionally has been an in person exam. And we rapidly converted that in person exam to a virtual exam. It took us about a year to do that. And in that year, we had a backlog of about a year and a half of emergency physician candidates, which weren't able to board certify, certainly the military sort of group was important, because just like some of the civilians, your pay is based on whether you're board certified or not. So we really made an effort and a priority at a ban to refocus our and realign our sort of priorities and make fixing that backlog of physicians that were candidates but not board certified, and make getting them through the process to be able to be board certified. i It wasn't a huge undertaking, I'm proud to say that the board made it a priority. And we fixed a backlog of like you can see 5000 candidates, that's about a year and a half of people, as well as taking care of the people that were continuing to come and now we have a backlog of zero. So over the course of last year, we instead of doing two oral exams a year, we did eight oral exams last year, fix the backlog of all those people. And now we're back up to you know, training and doing board certification for people that are just coming out of training. I'm pretty proud to say that. The other thing is on the slide in black I have slides for so I can sort of talk through those quickly. The only other two things that I don't have slides for down the bottom, focus practice designation in advanced emergency medicine, ultrasound is something that's new, we just had our first ATM us exam last month, those scores are being finalized and the people should get their scores and whether they passed or not here pretty quickly if any of you took that exam, did you take the exam? Have you gotten your score back? Okay, well, the scores are being finalized, you know, they they have to be, you know, sorted out. But once that sorting is done, you should get your score pretty quick. Anytime we develop a new exam, that's one of the challenges in getting the scores back is making sure those questions sort of ferret out from a statistical standpoint, and making sure it's a fair exam. And then setting a passing rate is always a challenge and takes a little time. And then, as as you heard the specialty leaders, John and all the other ones, talk about hospital administration, leadership and management, emergency medicine is a major player in that. And the American Board of Emergency Medicine applied to our our sort of parent group, the American Board of Medical Specialties, to see if we can sponsor a specialty and hospital administration leadership management. That application won't be approved or disapproved for a while. But the board felt like this is a strong and common practice pathways and probably going to become a more common practice pathway for emergency physicians in the future. So we're looking to be the sort of the sort of sponsoring board for that new specialty. That doesn't mean that only emergency physicians will be able to apply for that specialty, it'll, it'll just be that a ban will be the sponsoring board. And that's better than other specialties can apply. But we'll be the ones to give out their certificate. I do think it's a it's a benefit for emergency medicine as a whole though. Going through the slide deck, I sort of mentioned, you know, we focused a little bit during the pandemic on initial certification and really put most of our resources towards the oral board exam and transitioning from an in person exam to a virtual exam and then getting rid of our backlog. But one of the things that we've also done during the pandemic is focused on continuing certification and sort of updating and hopefully preparing to stay nimble in the future as far as maintaining certification, and making sure that our physicians maintain the quality of Emergency Medicine to our patients. And that's really a bems mission. Many ways we've done that, but probably the most significant way is through a transition from the high stakes continuing certification exam that you just take once every 10 years and trust As it transitioning away from that to something called my answer which I can go over. In doing that, we converted to a five year certification cycle and an annual fee. And I think the five year certification cycle is where a lot of people had a lot of heartache. So I'm happy to answer questions and discuss sort of why we made those decisions. I don't know if anybody wants to chime in and ask questions now. But we are transitioning depending on when your certification expires, your next certification will be a five year certification instead of a 10. Year. We did that for a number of reasons. One is because we got rid of the continuing certification exam that was a 10 year cycle. And the rest of the cycles that your continuing certification relies on was a five year cycle already. The other reason we did it is because the public expects physicians to update and maintain their knowledge, skills and attributes in their practice more than every 10 years. I think a BIM was smart in recognizing this, and and sort of transitioning early towards a shorter certification cycle. As it turns out, our parent body, the American Board of Medical Specialties, just sort of announced their future plans. And now every specialty is going to have to shorten their certification cycle towards something shorter, primarily, because it's something that as you know, we're trying to govern ourselves. We think public is going to benefit from specialists making sure they're, they maintain their knowledge, skills and attributes over a shorter time period than every 10 years. And it makes sense, you know, from a public's point of view, do you really want your emergency physician to update their skills every 10 years? That seems like a long time, especially in today's world where things happen so quickly? Yes, sure. Yeah. Yes, yeah. No, and it was it was a it was a tough pill to swallow. Initially, three modules for storage. Yes. Yep. Eight, I'll go into it. Yeah, I'll go into Yeah. Surgeon at what point? Do I research? My research department? Yep. Yep, I looked at you, your recertification. You know, it's probably at the end of December or one year or something. But when you when you initially start your five year certification study cycle, you can start taking my insert. I guess my question was all the research I'll show you. Let me let me go to the next slide. I'm just going to whip through these slides. If I can. We transition to an annual fee. So instead of paying these big lump sums, and having, you know dropping giant amounts of your pay of your pocketbook, every, you know, five years or 10 years or something, we just transitioned to a an annual certification fee, the costs remain the same, you're just doing it sort of every year as opposed to in lump sums every five or 10 years. If you want to know your requirements, you can go to the website and punch in the year that your certification ends. And then you can find out what your requirements are. And this is a little QR code. If you really want to look it up, you can do that. I'm gonna let him take a picture, then I'll move on and then this will answer your question. Okay, so let's talk about my answer. It's an open book test. The idea is you take it alone as opposed to the LLC, which we sort of, you know, encourage people to take as a group, it's a four hour time limit, it's done on your computer at home. It's open book in you get immediate feedback. The big difference from my point of view is that it is focused more on a formative type of learning, which is more educational than a summative type of test, which is more evaluative. So certainly there is an evaluation component and you do get a pass fail. But the questions and the test itself are developed. ABMS focus is more on a learning and reinforcement type test than it is a you know, test your knowledge of the Krebs cycle, which only two or three people in the room that are toxicologists are really interested in. I think this is good where your questions can be answered. So there's eight modules, all of those eight modules throughout those eight modules. It covers the the whole of the emergency medicine as far as the emergency medicine model, which is sort of you know, the Bible for what emergency medicine covers. There are you take four modules every five years. So you'll take for those modules in the next five yours when whenever your certification expires, and you start a new cycle in that five years, so in that five years, you'll take for em, sort of my insert modules, and then the next five years will take the other four. Does that answer your question? Okay. Okay. I certainly. Okay. Yep. My question for ya, so it's a little bit of semantics. From my point of view, you haven't started, you haven't recertified until your certification ends. So your certification ends in December, in January, you can start taking my answers. Does that make sense? So there was a lot of confusion, a lot of people felt like when they took the continuing certification exam, then they were recertified, and your recertification from an a BIM point of view starts on the day that your certification ends. So you could take four modules in January if you wanted to. But your certification wouldn't end until 2027. Does that make sense? Okay, three sections, there's core questions, there's questions sets, which are just, you know, a group of questions on the same type of patient or something. And then there's key advances, which I think are is one of the most sort of exciting things, and what's going to propel our specialty in the future. Those key advances are about 1/5 of the of the test. And those key advances are just key elements of emergency physician, which are new updates, which we believe every emergency physician should know. And they we get those from practice advances in the specialty, we get those from clinical policy, sort of updates from other specialties, including our own, and then suggestions from the literature. And we have a body of volunteers, which are all practicing emergency physicians, that will have developed those, and then even publishes a brief summary or synopsis on those that we put on the website, there's always, there's also videos, all kinds of stuff. And those are available for you, as you take your modules. The idea is that that's going to sort of translate this new knowledge to the whole specialty, little bit emergency medicine, and to our patients faster than we have historically done. You guys know, historically, there's rapid adopters, people that are up on the literature that are adopting things super quick, sometimes there can be a downside to that, because some of the new things we do, don't always last that long. There's the rest of sort of a bulk of emergency medicine or whatever specialty, adopts it later, and then they're slow adopters. And our vision is to take some of these key advances that are already accepted as important in our specialty, and translate those to the whole of Emergency Medicine faster. And so these key advances will be incorporated into those eight modules, and allow us to improve emergency medicine across the board faster than we have in the future. And I I'm excited about it. I hope you are too, but I think it accelerates learning, and it accelerates our ability to improve care for our patients. Yeah. Your first time here. Now? Yeah, yes. So I may have to backup to get to that. But that's, I don't know, if you're still in, you might still be in your first 10 years of certification. Right. So you're, you're gonna, you're gonna maintain that you have the ability to do really whatever you want. You can take the concert, if you want to take it before the end of this year, the continuing certification exam, the one time high stakes exam, or you can take my insert, modules, and a mixture of llsa and miam cert and the way to figure out what MCs, what options you have is to go to this website, which is the APM website and you can log on yourself, you punch in the year that your certification ends, and it'll give you a list of what your options are and how you can do it. So for people that are still on that initial 10 year certification, you have the option to sort of, you know, take a smorgasbord of options and now however you want to play it out, you can once you finish that initial 10 year certification and jump into those five year certification modules you'll be required to do for my insert modules every five years. I did want to talk about a couple other things. You know a BIM publishes a lot of public statements that we think are important for the specialty. We've published a statement on the value of of board certification. Obviously, we published statements that about how we believe the delivery of emergency medicine care is best done by, or at least best led by, by emergency medicine trained physicians. We just recently published a public statement, sort of providing support for state medical boards, and their ability to discipline physicians if they feel like the additional physicians have done things that aren't, that are unprofessional. And along those veins, we published and enacted a code of professionalism in April, that all of you will have to attest to, when you go on a BIM to take those miam cert exams, or, or any of the other business you do on a BIM, you're going to have to attest to a statement of professionalism. Just to back that up in August, we published a specific statement about medical misinformation. We are not trying to stifle you know, debate or or, or, you know, real discussion about medical evidence. But if you're using your ABM certification to forward ideas that can potentially harm patients, we didn't feel like that was going to serve the specialty or the value of your board certification well. And so if you do break that code of professionalism, there is the option that you may it could lead to denial of your even certification if you're not certified yet. And withdrawal of it if you are, certainly there's a due process and appeals process and things. But I have gotten a lot of pushback from that. And I'm happy to discuss what our thoughts are, and why we're doing it and and not why we're doing it. Like I said, we're not trying to stifle true scientific discussion. We're trying to keep people from using the weight of their ABM certification to to push ideas that may harm patients. I am proud to say that a ban was probably was one of the first specialties to come out with a professionalism and misinformation statement. And since then, other large bodies such as the AMA, the American Board of Medical Specialties, our parent group, the federal, state medical boards have all come out with similar statements. But I am proud to say that a Ben was one of the first to come out ahead of the bunch to say that we're going to stand up for sort of, against medical misinformation. Just other things we've done, we did sort of develop a strategic framework, it's going to allow us to stay sort of nimble, and adapt and improve in the future, which is what I think is going to become more and more difficult to do. As you know, things change so much more rapidly with the development of, of online information and things like that we're gonna need to be staying nimble. We also sort of started an initiative of diversity, equity and inclusion. Making sure that we understand the diversity of thought, equity and medical services, inclusion. And the trust that you build with inclusion is something that we Amen board believe is going to be important for us to move forward in the future. And and stay up to date and serve our patients best. You can see listed a number of ways that we're initiating this dei process into our tests, as well as our staff and everything else we do today. Then. The last thing I want to mention, you know, we put a lot of effort into continuing certification, revamping it and starting my insert and all that stuff. Now, it was sort of planned, but it's sort of timely with the discussions of the workforce, that we're starting an initiative looking at the front phase of ABM, which is the initial certification process. We started initiative called becoming certified initiative. We've held it we sort of stood up a becoming certified Task Force. And right now we're in the process of gaining ideas from a number of stakeholders. You can see we develop a stakeholder advisory group, which is emergency physicians from all kinds of different areas from all kinds of different levels from leadership, including residents, including patient advocates. There's a, you know, basically a whole rainbow of people on this stakeholder advisory group that we're trying to get input from. We have sent out surveys to program directors, to leaders of emergency to varmints to IBM Certified physicians. To get feedback, I had focus groups, and then just finally, in March just finished a summit of about 50 or 60 people that we gathered to develop ideas, and hopefully we'll be coming up with some good ideas to revamp and update the way that we initially certify candidates. That's all I got. I know I'm a little bit late, but I tried to catch up on questions. I thought this honestly, I thought you were gonna be a tougher crowd, and I thought I was gonna get a lot more, I was gonna get a lot beat up a lot more. So I am open to taking some some difficult questions. Don't Don't? Don't be shy. Yeah. Yeah, so the oral board exam will stay virtual for candidates. You know, the oral board exam is a tough bird, primarily due to the, the security of the test. And so transitioning to an oral format was a really big challenge from a security standpoint, to make sure that, you know, it's secure, and people don't cheat and, and stay fair. We are committed to maintaining that virtual portion for the candidates. But the, the administrate the people administrating it, the people administering the test, I'm not sure that's gonna stay virtual. And right now what the goal is to make it probably hybrid, it's easier to have the people, it's easier to be sort of standardized and consistent. If you have all the people administering the test in the same place, you can, you can standardize it and make sure that you're teaching the same things and testing the same knowledge that way easier. But we recognize that it's going to be difficult. So it's probably going to be a hybrid for the people administering the test and virtual for the test takers. Yes. Yes, no. But we are, you know, those those modules are continually updating. And as you can probably attest from taking the ultrasound test, they're working progress. And when you tested the the initial versions, I'm sure there were some horrible questions. And we're continuing to edit and update and improve those. And as time goes on, we'll go through those tests get out old knowledge, or, or bad tests, based on stats and in putting new ones. tough question to answer. The intent is to only keep it at eight. We are looking at incorporating a one more module, which would be a resuscitation module, how that's going to be incorporated. Whether it's going to be a requirement or optional, is something that's still under debate. But I guess I'm a major proponent of adding a ninth module, which would be a resuscitation module because I think that's sort of you know, sort of what we do but that's it's still up in the air right now. We've endocrine till the end is what you're saying. Yeah, so that's, that's one of the that's one of the Intents is to, you know, get rid of some of the merit badge type stuff that people do you know that Abraham has already a sort of a statement that says, hey, you shouldn't need those merit badges it's not shouldn't as an easy thing to say but. Be happy, happy. Not only that your service and instruction match, totally respect to your neighbor. Ha. But my argument would be that, you know, a TLS all of those BLS those are made for the masses and not for emergency physicians. So if we, if we do incorporate a resuscitation module, it'll probably be focused more on emergency physician level care, as opposed to more of a, you know, ACLs, a TLS, BLS, you know, for the masses type care. So hopefully it'd be a little bit more advanced. That's all I got. Thank you. Yes, please, please. Wait. She had a question. Yeah. Yeah, I think the triples are probably a sort of a beast of the past because it's too difficult to get the triples sort of organized into a virtual format. So we have transitioned to a different one has anybody? Yeah, so you're talking about so a structured interview, was our way to try to incorporate some of the skills and attributes, you know, troubleshooting, and things like that, that we tested with the triple now is a structured interview, and we're actually starting to do to to structured interview cases now to All right, thank you.