September 4, 2022 • 33 mins
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.
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Episode Transcript
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Dave Barry (00:02):
I know a lot of people here, I'm happy to say
but for those of you that don'tknow me, my name is Dave Berry.
I am a longtime a BIM or GSA CEPmember. And five years ago
transitioned to the civilianworld but maintained as a member
of GSA CEP, I was lucky enoughto be selected to be on the
(00:23):
board of a BIM. And wanted togive you guys an update of
what's going on, on the biggerpicture of a BIM, especially
over the last two years thatwe've made a lot of changes at a
BIM, there's been a lot ofchanges from the pandemic. And I
would say that some of the, Iguess I should stand up here. So
that could be in the picture.
(00:43):
Some of the decisions we've madetoday, BIM haven't been super
popular with some people. So Iwanted to give you guys an
update of what we did and why wedid it. And really focus on your
questions and your interests, Ihave a slide deck that we can
use or not use, and I assumethis is how to forward the
slides,
Unknown (01:02):
and will really play it by ear. And we can spend all the
time talking about what you wantto talk about, or we can go
through some of these slides aswell. So this is what I have
prepared to talk about sort ofnotable notable transitions over
the last few years, I will saythat I was selected to be on the
board two years ago, because I'msort of finishing my second
year. So I stepped into theboard at a BIM during a era of
(01:26):
high transition, and lots ofchanges. So I've been super
busy, and it's been a whirlwindof of learning on my part.
If you have questions, or topicsyou want to talk about that
aren't on this slide, we can goahead and scrap the slide deck
and talk about those. If youwant to hear about sort of the
(01:47):
things that I thought might behighlighted over the last two
years, we can go ahead and anddo that as well.
Okay.
Just as background, I did wantto give you guys sort of the
demographics hmm, right now, weright now we have a little over
41,000 42,000, emergencymedicine boarded physicians, I
(02:10):
did a Google search. And atleast some statistical says that
there's what 58,000 practicingemergency physicians in the US.
So of those 50 8000s, aboutabout 42,000 Are our board
certified in a BIM. The otherones are either not em
specialists are board certifiedin another certifying community
(02:31):
and not a BIM.
age wise, this is what a BIM,the emergency medicine community
of a BIM looks like. This usedto be, they always talk about a
bimodal distribution of ofEmergency Physicians and, and as
you can see, that's not reallypairing anymore. The The other
mode, the the bump in the slideused to be over there where the
(02:54):
yellow bump is, and that's thepeople that certified through
the practice pathway. Before thefirst 10 years that a BIM was in
existence, there was an abilityto become a BIM certified
without residency training. Andthat expired about 10 years
after a bems was started. Andthat's that bump, there are the
(03:16):
people that certified throughpractice only. And you can see
they're gradually retiring, andthe rest of the population is
residency trained. And you cansee it's more of just a single
mode. We have a lot of youngphysicians, and then as we taper
on and get older, we eitherretire or move on to other
things.
This is what emergency medicinelooks like across the nation.
(03:38):
What's not shown here are theGSA set members who are spread
throughout all these states.
This is based on where peopleput their address and not what
state there were, you know, GSAsaid, what they're lined up to
be.
GSA Sep, in and of itself has Iwant to say I think they told me
(03:59):
1100 members, which puts us aslike the ninth largest chapter,
compared to all the other statechapters, and we're sort of
speckled in between there. Andthen, worldwide, we have
somewhere around 60 or 80 peoplethat are deployed with apps
outside the US.
If you look at sub specialties,you can see EMS has the most
(04:20):
subspecialty trainees, amongstall emergency physicians
followed by med talks. If youadd up all of the critical care
pathways between emergencymedicine and anesthesia and
general surgery, critical careis right about the same as
medical toxicology and then theother subspecialties have less
trainees.
Going back to the update.
(04:44):
As I mentioned, the last twoyears has been pretty dramatic
for everybody and certainly hasbeen dramatic for specialty
training and certification.
Some of these were affected bythe pandemic and others we had
already sort of plan to do paypandemic wise, of course, we had
a challenge in trying tomaintain certification, both
(05:04):
initial certification andcontinuing certification for
emergency physicians, because ofthe pandemic and, and lock downs
and things. So we rapidlyconverted the continuing
certification exam to online.
And you can see that up there.
I'll talk a little bit laterabout how we're going to sunset
that. And that's been somethingthat's been planned for a little
bit longer. We also had achallenge in
(05:28):
initial certification in thefinal phase of initial
certification, which is the oralboards.
The oral boards traditionallyhas been an in person exam. And
we rapidly converted that inperson exam to a virtual exam.
It took us about a year to dothat. And in that year, we had a
backlog of about a year and ahalf of emergency physician
(05:49):
candidates, which weren't ableto board certify, certainly the
military sort of group wasimportant, because just like
some of the civilians, your payis based on whether you're board
certified or not. So we reallymade an effort and a priority at
a ban to refocus our and realignour sort of priorities and make
(06:13):
fixing that backlog ofphysicians that were candidates
but not board certified, andmake getting them through the
process to be able to be boardcertified.
i It wasn't a huge undertaking,I'm proud to say that the board
made it a priority. And we fixeda backlog of like you can see
5000 candidates, that's about ayear and a half of people, as
(06:35):
well as taking care of thepeople that were continuing to
come and now we have a backlogof zero. So over the course of
last year, we instead of doingtwo oral exams a year, we did
eight oral exams last year, fixthe backlog of all those people.
And now we're back up to youknow, training and doing board
certification for people thatare just coming out of training.
(06:56):
I'm pretty proud to say that.
The other thing is on the slidein black I have slides for so I
can sort of talk through thosequickly. The only other two
things that I don't have slidesfor down the bottom, focus
practice designation in advancedemergency medicine, ultrasound
is something that's new, we justhad our first ATM us
(07:16):
exam last month, those scoresare being finalized and the
people should get their scoresand whether they passed or not
here pretty quickly if any ofyou took that exam, did you take
the exam?
Have you gotten your score back?
Okay, well, the scores are beingfinalized, you know, they they
have to be, you know, sortedout. But once that sorting is
(07:39):
done, you should get your scorepretty quick.
Anytime we develop a new exam,that's one of the challenges in
getting the scores back ismaking sure those questions sort
of ferret out from a statisticalstandpoint, and making sure it's
a fair exam. And then setting apassing rate is always a
(07:59):
challenge and takes a littletime.
And then, as as you heard thespecialty leaders, John and all
the other ones, talk abouthospital administration,
leadership and management,emergency medicine is a major
player in that. And the AmericanBoard of Emergency Medicine
applied to our our sort ofparent group, the American Board
(08:20):
of Medical Specialties, to seeif we can sponsor a specialty
and hospital administrationleadership management. That
application won't be approved ordisapproved for a while. But the
board felt like this is a strongand common practice pathways and
probably going to become a morecommon practice pathway for
(08:41):
emergency physicians in thefuture. So we're looking to be
the sort of the sort ofsponsoring board for that new
specialty. That doesn't meanthat only emergency physicians
will be able to apply for thatspecialty, it'll, it'll just be
that a ban will be thesponsoring board. And that's
better than other specialtiescan apply. But we'll be the ones
to give out their certificate.
(09:02):
I do think it's a it's a benefitfor emergency medicine as a
whole though.
Going through the slide deck, Isort of mentioned,
you know, we focused a littlebit during the pandemic on
initial certification and reallyput most of our resources
towards the oral board exam andtransitioning from an in person
exam to a virtual exam and thengetting rid of our backlog. But
(09:25):
one of the things that we'vealso done during the pandemic is
focused on continuingcertification and sort of
updating and hopefully preparingto stay nimble in the future as
far as maintainingcertification, and making sure
that our physicians maintain thequality of Emergency Medicine to
our patients. And that's reallya bems mission.
(09:49):
Many ways we've done that, butprobably the most significant
way is through a transition fromthe high stakes continuing
certification exam that you justtake once every 10 years and
trustAs it transitioning away from
that to something called myanswer which I can go over. In
doing that, we converted to afive year certification cycle
and an annual fee. And I thinkthe five year certification
cycle is where a lot of peoplehad a lot of heartache. So I'm
(10:10):
happy to answer questions anddiscuss sort of why we made
those decisions.
I don't know if anybody wants tochime in and ask questions now.
Butwe are transitioning depending
on when your certificationexpires, your next certification
will be a five yearcertification instead of a 10.
Year. We did that for a numberof reasons. One is because we
(10:33):
got rid of the continuingcertification exam that was a 10
year cycle. And the rest of thecycles that your continuing
certification relies on was afive year cycle already. The
other reason we did it isbecause the public expects
physicians to update andmaintain their
(10:57):
knowledge, skills and attributesin their practice more than
every 10 years.
I think a BIM was smart inrecognizing this, and and sort
of transitioning early towards ashorter certification cycle. As
it turns out, our parent body,the American Board of Medical
Specialties, just sort ofannounced their future plans.
(11:22):
And now every specialty is goingto have to shorten their
certification cycle towardssomething shorter, primarily,
because it's something that asyou know, we're trying to govern
ourselves. We think public isgoing to benefit from
specialists making sure they're,they maintain their knowledge,
skills and attributes over ashorter time period than every
(11:44):
10 years. And it makes sense,you know, from a public's point
of view, do you really want youremergency 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 toughpill to swallow.
(12:06):
Initially, three modulesfor storage. Yes.
Yep. Eight, I'll go into it.
Yeah, I'll go into Yeah.
Surgeon at what point? Do Iresearch? My research
department?
Yep.
(12:31):
Yep, I looked at you, yourrecertification. You know, it's
probably at the end of Decemberor one year or something. But
when you when you initiallystart your five year
certification study cycle, youcan start taking my insert.
I guess my question wasall the research
(13:00):
I'll show you. Let me let me goto the next slide. I'm just
going to whip through theseslides. If I can.
We transition to an annual fee.
So instead of paying these biglump sums, and having, you know
dropping giant amounts of yourpay of your pocketbook, every,
you know, five years or 10 yearsor something, we just
transitioned to a an annualcertification fee, the costs
(13:21):
remain the same, you're justdoing it sort of every year as
opposed to in lump sums everyfive or 10 years.
If you want to know yourrequirements, you can go to the
website and punch in the yearthat your certification ends.
And then you can find out whatyour requirements are. And this
is a little QR code. If youreally want to look it up, you
can do that.
(13:42):
I'm gonna let him take apicture, then I'll move on and
then this will answer yourquestion.
Okay, so let's talk about myanswer. It's an open book test.
The idea is you take it alone asopposed to the LLC, which we
sort of, you know, encouragepeople to take as a group, it's
a four hour time limit, it'sdone on your computer at home.
It's open book in you getimmediate feedback. The big
(14:02):
difference from my point of viewis that it is focused more on a
formative type of learning,which is more educational than a
summative type of test, which ismore evaluative. So certainly
there is an evaluation componentand you do get a pass fail. But
the questions and the testitself are developed. ABMS focus
(14:23):
is more on a learning andreinforcement type test than it
is a you know, test yourknowledge of the Krebs cycle,
which only two or three peoplein the room that are
toxicologists are reallyinterested in.
I think this is good where yourquestions can be answered. So
there's eight modules, all ofthose eight modules throughout
those eight modules. It coversthe the whole of the emergency
(14:45):
medicine as far as the emergencymedicine model, which is sort of
you know, the Bible for whatemergency medicine covers. There
are you take four modules everyfive years. So you'll take for
those modules in the next fiveyours when whenever your
certification expires, and youstart a new cycle in that five
years, so in that five years,you'll take for em, sort of my
insert modules, and then thenext five years will take the
(15:09):
other four. Does that answeryour question?
Okay.
Okay.
I certainly.
Okay. Yep.
My question forya, so it's a little bit of
(15:31):
semantics. From my point ofview, you haven't started, you
haven't recertified until yourcertification ends. So your
certification ends in December,in January, you can start taking
my answers.
Does that make sense? So therewas a lot of confusion, a lot of
people felt like when they tookthe continuing certification
(15:52):
exam, then they wererecertified, and your
recertification from an a BIMpoint of view starts on the day
that your certification ends. Soyou could take four modules in
January if you wanted to. Butyour certification wouldn't end
until 2027. Does that makesense? Okay, three sections,
(16:13):
there's core questions, there'squestions sets, which are just,
you know, a group of questionson the same type of patient or
something. And then there's keyadvances, which I think are is
one of the most sort of excitingthings, and what's going to
propel our specialty in thefuture. Those key advances are
about 1/5 of the of the test.
And those key advances are justkey elements of emergency
physician, which are newupdates, which we believe every
(16:36):
emergency physician should know.
And they we get those frompractice advances in the
specialty, we get those fromclinical policy, sort of updates
from other specialties,including our own, and then
suggestions from the literature.
And we have a body ofvolunteers, which are all
practicing emergency physicians,that will have developed those,
(16:57):
and then even publishes a briefsummary or synopsis on those
that we put on the website,there's always, there's also
videos, all kinds of stuff. Andthose are available for you, as
you take your modules. The ideais that that's going to sort of
(17:17):
translate this new knowledge tothe whole specialty, little bit
emergency medicine, and to ourpatients faster than we have
historically done. You guysknow, historically, there's
rapid adopters, people that areup on the literature that are
adopting things super quick,sometimes there can be a
downside to that, because someof the new things we do, don't
always last that long. There'sthe rest of sort of a bulk of
(17:40):
emergency medicine or whateverspecialty, adopts it later, and
then they're slow adopters. Andour vision is to take some of
these key advances that arealready accepted as important in
our specialty, and translatethose to the whole of Emergency
Medicine faster. And so thesekey advances will be
incorporated into those eightmodules, and allow us to improve
(18:04):
emergency medicine across theboard faster than we have in the
future. And I I'm excited aboutit. I hope you are too, but I
think it accelerates learning,and it accelerates our ability
to improve care for ourpatients.
Yeah.
(18:25):
Your first time here.
Now?
Yeah, yes. SoI 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 yourfirst 10 years of certification.
(18:47):
Right. So you're, you're gonna,you're gonna maintain that you
have the ability to do reallywhatever you want. You can take
the concert, if you want to takeit before the end of this year,
the continuing certificationexam, the one time high stakes
exam, or you can take my insert,modules, and a mixture of llsa
(19:07):
and miam cert and the way tofigure out what MCs, what
options you have is to go tothis website, which is the APM
website and you can log onyourself, you punch in the year
that your certification ends,and it'll give you a list of
what your options are and howyou can do it. So for people
that are still on that initial10 year certification, you have
the option to sort of, you know,take a smorgasbord of options
(19:28):
and now however you want to playit out, you can once you finish
that initial 10 yearcertification and jump into
those five year certificationmodules you'll be required to do
for my insert modules every fiveyears.
I did want to talk about acouple other things. You know a
(19:50):
BIM publishes a lot of publicstatements that we think are
important for the specialty.
We've published a statement onthe value of
of board certification.
Obviously,we published statements that
about how we believe thedelivery of emergency medicine
care is best done by, or atleast best led by, by emergency
(20:12):
medicine trained physicians.
We just recently published apublic statement, sort of
providing support for statemedical boards, and their
ability to discipline physiciansif they feel like the additional
physicians have done things thataren't, that are unprofessional.
(20:34):
And along those veins, wepublished and enacted a code of
professionalism in April, thatall of you will have to attest
to, when you go on a BIM to takethose miam cert exams, or, or
any of the other business you doon a BIM, you're going to have
to attest to astatement of professionalism.
Just to back that up in August,we published a specific
(20:58):
statement about medicalmisinformation.
We are not trying to stifle youknow, debate or or, or, you
know, real discussion aboutmedical evidence. But if you're
using your ABM certification toforward
(21:21):
ideas that can potentially harmpatients, we didn't feel like
that was going to serve thespecialty or the value of your
board certification well. And soif you do break that code of
professionalism, there is theoption that you may it could
lead to denial of your evencertification if you're not
certified yet. And withdrawal ofit if you are, certainly there's
(21:44):
a due process and appealsprocess and things. But I have
gotten a lot of pushback fromthat. And I'm happy to discuss
what our thoughts are, and whywe're doing it and and not why
we're doing it. Like I said,we're not trying to stifle true
scientific discussion. We'retrying to keep people from using
the weight of their ABMcertification to to
(22:06):
push ideas that may harmpatients.
I am proud to say that a ban wasprobably was one of the first
specialties to come out with aprofessionalism and
misinformation statement. Andsince then, other large bodies
such as the AMA, the AmericanBoard of Medical Specialties,
(22:27):
our parent group,the federal, state medical
boards have all come out withsimilar statements. But I am
proud to say that a Ben was oneof the first to come out ahead
of the bunch to say that we'regoing to stand up for sort of,
against medical misinformation.
Just other things we've done, wedid sort of develop a strategic
(22:50):
framework, it's going to allowus to stay sort of nimble, and
adapt and improve in the future,which is what I think is going
to become more and moredifficult to do. As you know,
things change so much morerapidly with the development of,
of online information and thingslike that we're gonna need to be
staying nimble.
We also sort of started aninitiative of diversity, equity
(23:14):
and inclusion.
Making sure that we understandthe diversity of thought,
equity and medical services,inclusion. And the trust that
you build with inclusion issomething that we Amen board
believe is going to be importantfor us to move forward in the
future. And and stay up to dateand serve our patients best. You
(23:39):
can see listed a number of waysthat we're initiating this dei
process into our tests, as wellas our staff and everything else
we do today. Then.
The last thing I want tomention,
you know, we put a lot of effortinto continuing certification,
(24:00):
revamping it and starting myinsert and all that stuff. Now,
it was sort of planned, but it'ssort of timely with the
discussions of the workforce,that we're starting an
initiative looking at the frontphase of ABM, which is the
initial certification process.
We started initiative calledbecoming certified initiative.
We've held it we sort of stoodup a becoming certified Task
(24:22):
Force. And right now we're inthe process of gaining ideas
from a number of stakeholders.
You can see we develop astakeholder advisory group,
which is emergency physiciansfrom all kinds of different
areas from all kinds ofdifferent levels from
leadership, including residents,including
(24:44):
patient advocates. There's a,you know, basically a whole
rainbow of people on thisstakeholder advisory group that
we're trying to get input from.
We have sent out surveys toprogram directors, to leaders of
emergency tovarmints to IBM Certified
physicians.
(25:04):
To get feedback, I had focusgroups, and then just finally,
in March just finished a summitof about 50 or 60 people that we
gathered to develop ideas, andhopefully we'll be coming up
with some good ideas to revampand update the way that we
initially certify candidates.
(25:27):
That's all I got. I know I'm alittle bit late, but I tried to
catch up onquestions. I thought this
honestly, I thought you weregonna be a tougher crowd, and I
thought I was gonna get a lotmore, I was gonna get a lot beat
up a lot more. SoI am open to taking some some
difficult questions. Don'tDon't? Don't be shy.
Yeah.
(25:50):
Yeah, so the oral board examwill stay virtual for
candidates.
You know, the oral board exam isa tough bird, primarily due to
the, the security of the test.
And so transitioning to an oralformat was a really big
challenge from a securitystandpoint,
(26:10):
to make sure that, you know,it's secure, and people don't
cheat and, and stay fair. We arecommitted to maintaining that
virtual portion for thecandidates. But the, the
administrate the peopleadministrating it, the people
administering the test, I'm notsure that's gonna stay virtual.
(26:31):
And right now what the goal isto make it probably hybrid, it's
easier to have the people, it'seasier to be sort of
standardized and consistent. Ifyou have all the people
administering the test in thesame place, you can, you can
standardize it and make surethat you're teaching the same
things and testing the sameknowledge that way easier. But
(26:52):
we recognize that it's going tobe difficult. So it's probably
going to be a hybrid for thepeople administering the test
and virtual for the test takers.
Yes.
(27:15):
Yes,no. But we are, you know, those
those modules are continuallyupdating. And as you can
probably attest from taking theultrasound test, they're working
progress. And when you testedthe the initial versions, I'm
sure there were some horriblequestions. And we're continuing
to edit and update and improvethose. And as time goes on,
(27:40):
we'll go through those tests getout old knowledge, or, or bad
tests, based on stats and inputting new ones.
tough question to answer. Theintent is to only keep it at
(28:00):
eight.
We are looking at incorporatinga one more module, which would
be a resuscitation module, howthat's going to be incorporated.
Whether it's going to be arequirement or optional, is
something that's still underdebate. But I guess I'm a major
proponent of adding a ninthmodule, which would be a
(28:22):
resuscitation module because Ithink that's sort of you know,
sort of what we dobut that's it's still up in the
air right now.
We've endocrine till the end iswhat you're saying.
(28:43):
Yeah, so that's, that's one ofthe that's one of the Intents is
to, you know, get rid of some ofthe merit badge type stuff that
people do you know that Abrahamhas already a sort of a
statement that says, hey, youshouldn't need those merit
badges it's not shouldn't as aneasy thing to say but.
(29:16):
Be happy, happy.
Not only that your service andinstruction match, totally
respect to your neighbor.
(29:37):
Ha.
But my argument would be that,you know, a TLS all of those BLS
(29:57):
those are made for the massesand not for emergency
physicians.
So if we, if we do incorporate aresuscitation module, it'll
probably be focused more onemergency physician level care,
as opposed to more of a, youknow, ACLs, a TLS, BLS, you
know, for the masses type care.
So hopefully it'd be a littlebit more advanced.
(30:19):
That's all I got.
Thank you. Yes, please, please.
Wait. She had a question.
Yeah.
Yeah, I think the triples areprobably a sort of a beast of
the past because it's toodifficult to get the triples
sort of organized into a virtualformat. So we have transitioned
(30:42):
to a different one has anybody?
Yeah, so you're talking about soa structured interview,
was our way to try toincorporate some of the skills
and attributes, you know,troubleshooting, and things like
that, that we tested with thetriple now is a structured
interview, and we're actuallystarting to do to to structured
(31:05):
interview cases now toAll right, thank you.
I know a lot of people here, I'm happy to say
but for those of you that don'tknow me, my name is Dave Berry.
I am a longtime a BIM or GSA CEPmember. And five years ago
transitioned to the civilianworld but maintained as a member
of GSA CEP, I was lucky enoughto be selected to be on the
(00:23):
board of a BIM. And wanted togive you guys an update of
what's going on, on the biggerpicture of a BIM, especially
over the last two years thatwe've made a lot of changes at a
BIM, there's been a lot ofchanges from the pandemic. And I
would say that some of the, Iguess I should stand up here. So
that could be in the picture.
(00:43):
Some of the decisions we've madetoday, BIM haven't been super
popular with some people. So Iwanted to give you guys an
update of what we did and why wedid it. And really focus on your
questions and your interests, Ihave a slide deck that we can
use or not use, and I assumethis is how to forward the
slides,
Unknown (01:02):
and will really play it by ear. And we can spend all the
time talking about what you wantto talk about, or we can go
through some of these slides aswell. So this is what I have
prepared to talk about sort ofnotable notable transitions over
the last few years, I will saythat I was selected to be on the
board two years ago, because I'msort of finishing my second
year. So I stepped into theboard at a BIM during a era of
(01:26):
high transition, and lots ofchanges. So I've been super
busy, and it's been a whirlwindof of learning on my part.
If you have questions, or topicsyou want to talk about that
aren't on this slide, we can goahead and scrap the slide deck
and talk about those. If youwant to hear about sort of the
(01:47):
things that I thought might behighlighted over the last two
years, we can go ahead and anddo that as well.
Okay.
Just as background, I did wantto give you guys sort of the
demographics hmm, right now, weright now we have a little over
41,000 42,000, emergencymedicine boarded physicians, I
(02:10):
did a Google search. And atleast some statistical says that
there's what 58,000 practicingemergency physicians in the US.
So of those 50 8000s, aboutabout 42,000 Are our board
certified in a BIM. The otherones are either not em
specialists are board certifiedin another certifying community
(02:31):
and not a BIM.
age wise, this is what a BIM,the emergency medicine community
of a BIM looks like. This usedto be, they always talk about a
bimodal distribution of ofEmergency Physicians and, and as
you can see, that's not reallypairing anymore. The The other
mode, the the bump in the slideused to be over there where the
(02:54):
yellow bump is, and that's thepeople that certified through
the practice pathway. Before thefirst 10 years that a BIM was in
existence, there was an abilityto become a BIM certified
without residency training. Andthat expired about 10 years
after a bems was started. Andthat's that bump, there are the
(03:16):
people that certified throughpractice only. And you can see
they're gradually retiring, andthe rest of the population is
residency trained. And you cansee it's more of just a single
mode. We have a lot of youngphysicians, and then as we taper
on and get older, we eitherretire or move on to other
things.
This is what emergency medicinelooks like across the nation.
(03:38):
What's not shown here are theGSA set members who are spread
throughout all these states.
This is based on where peopleput their address and not what
state there were, you know, GSAsaid, what they're lined up to
be.
GSA Sep, in and of itself has Iwant to say I think they told me
(03:59):
1100 members, which puts us aslike the ninth largest chapter,
compared to all the other statechapters, and we're sort of
speckled in between there. Andthen, worldwide, we have
somewhere around 60 or 80 peoplethat are deployed with apps
outside the US.
If you look at sub specialties,you can see EMS has the most
(04:20):
subspecialty trainees, amongstall emergency physicians
followed by med talks. If youadd up all of the critical care
pathways between emergencymedicine and anesthesia and
general surgery, critical careis right about the same as
medical toxicology and then theother subspecialties have less
trainees.
Going back to the update.
(04:44):
As I mentioned, the last twoyears has been pretty dramatic
for everybody and certainly hasbeen dramatic for specialty
training and certification.
Some of these were affected bythe pandemic and others we had
already sort of plan to do paypandemic wise, of course, we had
a challenge in trying tomaintain certification, both
(05:04):
initial certification andcontinuing certification for
emergency physicians, because ofthe pandemic and, and lock downs
and things. So we rapidlyconverted the continuing
certification exam to online.
And you can see that up there.
I'll talk a little bit laterabout how we're going to sunset
that. And that's been somethingthat's been planned for a little
bit longer. We also had achallenge in
(05:28):
initial certification in thefinal phase of initial
certification, which is the oralboards.
The oral boards traditionallyhas been an in person exam. And
we rapidly converted that inperson exam to a virtual exam.
It took us about a year to dothat. And in that year, we had a
backlog of about a year and ahalf of emergency physician
(05:49):
candidates, which weren't ableto board certify, certainly the
military sort of group wasimportant, because just like
some of the civilians, your payis based on whether you're board
certified or not. So we reallymade an effort and a priority at
a ban to refocus our and realignour sort of priorities and make
(06:13):
fixing that backlog ofphysicians that were candidates
but not board certified, andmake getting them through the
process to be able to be boardcertified.
i It wasn't a huge undertaking,I'm proud to say that the board
made it a priority. And we fixeda backlog of like you can see
5000 candidates, that's about ayear and a half of people, as
(06:35):
well as taking care of thepeople that were continuing to
come and now we have a backlogof zero. So over the course of
last year, we instead of doingtwo oral exams a year, we did
eight oral exams last year, fixthe backlog of all those people.
And now we're back up to youknow, training and doing board
certification for people thatare just coming out of training.
(06:56):
I'm pretty proud to say that.
The other thing is on the slidein black I have slides for so I
can sort of talk through thosequickly. The only other two
things that I don't have slidesfor down the bottom, focus
practice designation in advancedemergency medicine, ultrasound
is something that's new, we justhad our first ATM us
(07:16):
exam last month, those scoresare being finalized and the
people should get their scoresand whether they passed or not
here pretty quickly if any ofyou took that exam, did you take
the exam?
Have you gotten your score back?
Okay, well, the scores are beingfinalized, you know, they they
have to be, you know, sortedout. But once that sorting is
(07:39):
done, you should get your scorepretty quick.
Anytime we develop a new exam,that's one of the challenges in
getting the scores back ismaking sure those questions sort
of ferret out from a statisticalstandpoint, and making sure it's
a fair exam. And then setting apassing rate is always a
(07:59):
challenge and takes a littletime.
And then, as as you heard thespecialty leaders, John and all
the other ones, talk abouthospital administration,
leadership and management,emergency medicine is a major
player in that. And the AmericanBoard of Emergency Medicine
applied to our our sort ofparent group, the American Board
(08:20):
of Medical Specialties, to seeif we can sponsor a specialty
and hospital administrationleadership management. That
application won't be approved ordisapproved for a while. But the
board felt like this is a strongand common practice pathways and
probably going to become a morecommon practice pathway for
(08:41):
emergency physicians in thefuture. So we're looking to be
the sort of the sort ofsponsoring board for that new
specialty. That doesn't meanthat only emergency physicians
will be able to apply for thatspecialty, it'll, it'll just be
that a ban will be thesponsoring board. And that's
better than other specialtiescan apply. But we'll be the ones
to give out their certificate.
(09:02):
I do think it's a it's a benefitfor emergency medicine as a
whole though.
Going through the slide deck, Isort of mentioned,
you know, we focused a littlebit during the pandemic on
initial certification and reallyput most of our resources
towards the oral board exam andtransitioning from an in person
exam to a virtual exam and thengetting rid of our backlog. But
(09:25):
one of the things that we'vealso done during the pandemic is
focused on continuingcertification and sort of
updating and hopefully preparingto stay nimble in the future as
far as maintainingcertification, and making sure
that our physicians maintain thequality of Emergency Medicine to
our patients. And that's reallya bems mission.
(09:49):
Many ways we've done that, butprobably the most significant
way is through a transition fromthe high stakes continuing
certification exam that you justtake once every 10 years and
trustAs it transitioning away from
that to something called myanswer which I can go over. In
doing that, we converted to afive year certification cycle
and an annual fee. And I thinkthe five year certification
cycle is where a lot of peoplehad a lot of heartache. So I'm
(10:10):
happy to answer questions anddiscuss sort of why we made
those decisions.
I don't know if anybody wants tochime in and ask questions now.
Butwe are transitioning depending
on when your certificationexpires, your next certification
will be a five yearcertification instead of a 10.
Year. We did that for a numberof reasons. One is because we
(10:33):
got rid of the continuingcertification exam that was a 10
year cycle. And the rest of thecycles that your continuing
certification relies on was afive year cycle already. The
other reason we did it isbecause the public expects
physicians to update andmaintain their
(10:57):
knowledge, skills and attributesin their practice more than
every 10 years.
I think a BIM was smart inrecognizing this, and and sort
of transitioning early towards ashorter certification cycle. As
it turns out, our parent body,the American Board of Medical
Specialties, just sort ofannounced their future plans.
(11:22):
And now every specialty is goingto have to shorten their
certification cycle towardssomething shorter, primarily,
because it's something that asyou know, we're trying to govern
ourselves. We think public isgoing to benefit from
specialists making sure they're,they maintain their knowledge,
skills and attributes over ashorter time period than every
(11:44):
10 years. And it makes sense,you know, from a public's point
of view, do you really want youremergency 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 toughpill to swallow.
(12:06):
Initially, three modulesfor storage. Yes.
Yep. Eight, I'll go into it.
Yeah, I'll go into Yeah.
Surgeon at what point? Do Iresearch? My research
department?
Yep.
(12:31):
Yep, I looked at you, yourrecertification. You know, it's
probably at the end of Decemberor one year or something. But
when you when you initiallystart your five year
certification study cycle, youcan start taking my insert.
I guess my question wasall the research
(13:00):
I'll show you. Let me let me goto the next slide. I'm just
going to whip through theseslides. If I can.
We transition to an annual fee.
So instead of paying these biglump sums, and having, you know
dropping giant amounts of yourpay of your pocketbook, every,
you know, five years or 10 yearsor something, we just
transitioned to a an annualcertification fee, the costs
(13:21):
remain the same, you're justdoing it sort of every year as
opposed to in lump sums everyfive or 10 years.
If you want to know yourrequirements, you can go to the
website and punch in the yearthat your certification ends.
And then you can find out whatyour requirements are. And this
is a little QR code. If youreally want to look it up, you
can do that.
(13:42):
I'm gonna let him take apicture, then I'll move on and
then this will answer yourquestion.
Okay, so let's talk about myanswer. It's an open book test.
The idea is you take it alone asopposed to the LLC, which we
sort of, you know, encouragepeople to take as a group, it's
a four hour time limit, it'sdone on your computer at home.
It's open book in you getimmediate feedback. The big
(14:02):
difference from my point of viewis that it is focused more on a
formative type of learning,which is more educational than a
summative type of test, which ismore evaluative. So certainly
there is an evaluation componentand you do get a pass fail. But
the questions and the testitself are developed. ABMS focus
(14:23):
is more on a learning andreinforcement type test than it
is a you know, test yourknowledge of the Krebs cycle,
which only two or three peoplein the room that are
toxicologists are reallyinterested in.
I think this is good where yourquestions can be answered. So
there's eight modules, all ofthose eight modules throughout
those eight modules. It coversthe the whole of the emergency
(14:45):
medicine as far as the emergencymedicine model, which is sort of
you know, the Bible for whatemergency medicine covers. There
are you take four modules everyfive years. So you'll take for
those modules in the next fiveyours when whenever your
certification expires, and youstart a new cycle in that five
years, so in that five years,you'll take for em, sort of my
insert modules, and then thenext five years will take the
(15:09):
other four. Does that answeryour question?
Okay.
Okay.
I certainly.
Okay. Yep.
My question forya, so it's a little bit of
(15:31):
semantics. From my point ofview, you haven't started, you
haven't recertified until yourcertification ends. So your
certification ends in December,in January, you can start taking
my answers.
Does that make sense? So therewas a lot of confusion, a lot of
people felt like when they tookthe continuing certification
(15:52):
exam, then they wererecertified, and your
recertification from an a BIMpoint of view starts on the day
that your certification ends. Soyou could take four modules in
January if you wanted to. Butyour certification wouldn't end
until 2027. Does that makesense? Okay, three sections,
(16:13):
there's core questions, there'squestions sets, which are just,
you know, a group of questionson the same type of patient or
something. And then there's keyadvances, which I think are is
one of the most sort of excitingthings, and what's going to
propel our specialty in thefuture. Those key advances are
about 1/5 of the of the test.
And those key advances are justkey elements of emergency
physician, which are newupdates, which we believe every
(16:36):
emergency physician should know.
And they we get those frompractice advances in the
specialty, we get those fromclinical policy, sort of updates
from other specialties,including our own, and then
suggestions from the literature.
And we have a body ofvolunteers, which are all
practicing emergency physicians,that will have developed those,
(16:57):
and then even publishes a briefsummary or synopsis on those
that we put on the website,there's always, there's also
videos, all kinds of stuff. Andthose are available for you, as
you take your modules. The ideais that that's going to sort of
(17:17):
translate this new knowledge tothe whole specialty, little bit
emergency medicine, and to ourpatients faster than we have
historically done. You guysknow, historically, there's
rapid adopters, people that areup on the literature that are
adopting things super quick,sometimes there can be a
downside to that, because someof the new things we do, don't
always last that long. There'sthe rest of sort of a bulk of
(17:40):
emergency medicine or whateverspecialty, adopts it later, and
then they're slow adopters. Andour vision is to take some of
these key advances that arealready accepted as important in
our specialty, and translatethose to the whole of Emergency
Medicine faster. And so thesekey advances will be
incorporated into those eightmodules, and allow us to improve
(18:04):
emergency medicine across theboard faster than we have in the
future. And I I'm excited aboutit. I hope you are too, but I
think it accelerates learning,and it accelerates our ability
to improve care for ourpatients.
Yeah.
(18:25):
Your first time here.
Now?
Yeah, yes. SoI 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 yourfirst 10 years of certification.
(18:47):
Right. So you're, you're gonna,you're gonna maintain that you
have the ability to do reallywhatever you want. You can take
the concert, if you want to takeit before the end of this year,
the continuing certificationexam, the one time high stakes
exam, or you can take my insert,modules, and a mixture of llsa
(19:07):
and miam cert and the way tofigure out what MCs, what
options you have is to go tothis website, which is the APM
website and you can log onyourself, you punch in the year
that your certification ends,and it'll give you a list of
what your options are and howyou can do it. So for people
that are still on that initial10 year certification, you have
the option to sort of, you know,take a smorgasbord of options
(19:28):
and now however you want to playit out, you can once you finish
that initial 10 yearcertification and jump into
those five year certificationmodules you'll be required to do
for my insert modules every fiveyears.
I did want to talk about acouple other things. You know a
(19:50):
BIM publishes a lot of publicstatements that we think are
important for the specialty.
We've published a statement onthe value of
of board certification.
Obviously,we published statements that
about how we believe thedelivery of emergency medicine
care is best done by, or atleast best led by, by emergency
(20:12):
medicine trained physicians.
We just recently published apublic statement, sort of
providing support for statemedical boards, and their
ability to discipline physiciansif they feel like the additional
physicians have done things thataren't, that are unprofessional.
(20:34):
And along those veins, wepublished and enacted a code of
professionalism in April, thatall of you will have to attest
to, when you go on a BIM to takethose miam cert exams, or, or
any of the other business you doon a BIM, you're going to have
to attest to astatement of professionalism.
Just to back that up in August,we published a specific
(20:58):
statement about medicalmisinformation.
We are not trying to stifle youknow, debate or or, or, you
know, real discussion aboutmedical evidence. But if you're
using your ABM certification toforward
(21:21):
ideas that can potentially harmpatients, we didn't feel like
that was going to serve thespecialty or the value of your
board certification well. And soif you do break that code of
professionalism, there is theoption that you may it could
lead to denial of your evencertification if you're not
certified yet. And withdrawal ofit if you are, certainly there's
(21:44):
a due process and appealsprocess and things. But I have
gotten a lot of pushback fromthat. And I'm happy to discuss
what our thoughts are, and whywe're doing it and and not why
we're doing it. Like I said,we're not trying to stifle true
scientific discussion. We'retrying to keep people from using
the weight of their ABMcertification to to
(22:06):
push ideas that may harmpatients.
I am proud to say that a ban wasprobably was one of the first
specialties to come out with aprofessionalism and
misinformation statement. Andsince then, other large bodies
such as the AMA, the AmericanBoard of Medical Specialties,
(22:27):
our parent group,the federal, state medical
boards have all come out withsimilar statements. But I am
proud to say that a Ben was oneof the first to come out ahead
of the bunch to say that we'regoing to stand up for sort of,
against medical misinformation.
Just other things we've done, wedid sort of develop a strategic
(22:50):
framework, it's going to allowus to stay sort of nimble, and
adapt and improve in the future,which is what I think is going
to become more and moredifficult to do. As you know,
things change so much morerapidly with the development of,
of online information and thingslike that we're gonna need to be
staying nimble.
We also sort of started aninitiative of diversity, equity
(23:14):
and inclusion.
Making sure that we understandthe diversity of thought,
equity and medical services,inclusion. And the trust that
you build with inclusion issomething that we Amen board
believe is going to be importantfor us to move forward in the
future. And and stay up to dateand serve our patients best. You
(23:39):
can see listed a number of waysthat we're initiating this dei
process into our tests, as wellas our staff and everything else
we do today. Then.
The last thing I want tomention,
you know, we put a lot of effortinto continuing certification,
(24:00):
revamping it and starting myinsert and all that stuff. Now,
it was sort of planned, but it'ssort of timely with the
discussions of the workforce,that we're starting an
initiative looking at the frontphase of ABM, which is the
initial certification process.
We started initiative calledbecoming certified initiative.
We've held it we sort of stoodup a becoming certified Task
(24:22):
Force. And right now we're inthe process of gaining ideas
from a number of stakeholders.
You can see we develop astakeholder advisory group,
which is emergency physiciansfrom all kinds of different
areas from all kinds ofdifferent levels from
leadership, including residents,including
(24:44):
patient advocates. There's a,you know, basically a whole
rainbow of people on thisstakeholder advisory group that
we're trying to get input from.
We have sent out surveys toprogram directors, to leaders of
emergency tovarmints to IBM Certified
physicians.
(25:04):
To get feedback, I had focusgroups, and then just finally,
in March just finished a summitof about 50 or 60 people that we
gathered to develop ideas, andhopefully we'll be coming up
with some good ideas to revampand update the way that we
initially certify candidates.
(25:27):
That's all I got. I know I'm alittle bit late, but I tried to
catch up onquestions. I thought this
honestly, I thought you weregonna be a tougher crowd, and I
thought I was gonna get a lotmore, I was gonna get a lot beat
up a lot more. SoI am open to taking some some
difficult questions. Don'tDon't? Don't be shy.
Yeah.
(25:50):
Yeah, so the oral board examwill stay virtual for
candidates.
You know, the oral board exam isa tough bird, primarily due to
the, the security of the test.
And so transitioning to an oralformat was a really big
challenge from a securitystandpoint,
(26:10):
to make sure that, you know,it's secure, and people don't
cheat and, and stay fair. We arecommitted to maintaining that
virtual portion for thecandidates. But the, the
administrate the peopleadministrating it, the people
administering the test, I'm notsure that's gonna stay virtual.
(26:31):
And right now what the goal isto make it probably hybrid, it's
easier to have the people, it'seasier to be sort of
standardized and consistent. Ifyou have all the people
administering the test in thesame place, you can, you can
standardize it and make surethat you're teaching the same
things and testing the sameknowledge that way easier. But
(26:52):
we recognize that it's going tobe difficult. So it's probably
going to be a hybrid for thepeople administering the test
and virtual for the test takers.
Yes.
(27:15):
Yes,no. But we are, you know, those
those modules are continuallyupdating. And as you can
probably attest from taking theultrasound test, they're working
progress. And when you testedthe the initial versions, I'm
sure there were some horriblequestions. And we're continuing
to edit and update and improvethose. And as time goes on,
(27:40):
we'll go through those tests getout old knowledge, or, or bad
tests, based on stats and inputting new ones.
tough question to answer. Theintent is to only keep it at
(28:00):
eight.
We are looking at incorporatinga one more module, which would
be a resuscitation module, howthat's going to be incorporated.
Whether it's going to be arequirement or optional, is
something that's still underdebate. But I guess I'm a major
proponent of adding a ninthmodule, which would be a
(28:22):
resuscitation module because Ithink that's sort of you know,
sort of what we dobut that's it's still up in the
air right now.
We've endocrine till the end iswhat you're saying.
(28:43):
Yeah, so that's, that's one ofthe that's one of the Intents is
to, you know, get rid of some ofthe merit badge type stuff that
people do you know that Abrahamhas already a sort of a
statement that says, hey, youshouldn't need those merit
badges it's not shouldn't as aneasy thing to say but.
(29:16):
Be happy, happy.
Not only that your service andinstruction match, totally
respect to your neighbor.
(29:37):
Ha.
But my argument would be that,you know, a TLS all of those BLS
(29:57):
those are made for the massesand not for emergency
physicians.
So if we, if we do incorporate aresuscitation module, it'll
probably be focused more onemergency physician level care,
as opposed to more of a, youknow, ACLs, a TLS, BLS, you
know, for the masses type care.
So hopefully it'd be a littlebit more advanced.
(30:19):
That's all I got.
Thank you. Yes, please, please.
Wait. She had a question.
Yeah.
Yeah, I think the triples areprobably a sort of a beast of
the past because it's toodifficult to get the triples
sort of organized into a virtualformat. So we have transitioned
(30:42):
to a different one has anybody?
Yeah, so you're talking about soa structured interview,
was our way to try toincorporate some of the skills
and attributes, you know,troubleshooting, and things like
that, that we tested with thetriple now is a structured
interview, and we're actuallystarting to do to to structured
(31:05):
interview cases now toAll right, thank you.
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