Emergency medicine certification is undergoing an evolution. The American Board of Emergency Medicine (ABEM) will soon begin a pilot of its new certification examination, MyEMCert. An alternative to the ConCert Examination—one of the four components of maintenance of certification—MyEMCert was developed based on extensive conversations with emergency physicians and related professional organizations. The new exam will consist of eight modules that can be taken remotely.

ABEM President Robert L. Muelleman, MD, FACEP
Credit: ABEM

Robert L. Muelleman, MD, FACEP, ABEM President and professor and past chair of the department of emergency medicine at the University of Nebraska Medical Center in Omaha, recently responded in writing to ACEP Now’s questions about ABEM’s efforts to redesign its certification program.

Q: It sounds like ABEM has moved forward with developing MyEMCert. What’s guiding your approach?

A: The short answer is that emergency physicians are guiding our approach. Once ABEM decided to change the options for how a physician can stay certified, we sought advice from every corner of the specialty. We held a national summit that was attended by leaders from every emergency medicine organization as well as a testing expert from the American Board of Medical Specialties (ABMS). [ACEP President-Elect] Bill Jaquis and [ACEP Executive Director] Dean Wilkerson attended that summit, and Bill was a significant contributor. One of our richest sources of information was from leaders of ACEP state chapters. We also held a focus group with leaders from the American Academy of Emergency Medicine. Finally, we surveyed all 36,000 ABEM-certified emergency physicians and heard back from about 13,000 of them.

We heard some clear messages. First, physicians wanted job and career security, and second, they wanted the process to stay certified to help them become better doctors. There was a clear desire to shift recertification from testing to learning. Another important signal we got was that emergency physicians wanted to interact with ABEM about once per year.

MyEMCert is different than any other recertification approach by any other specialty because it’s being designed to meet the needs of emergency physicians as they themselves have described. That includes being able to take the modules remotely without going to a Pearson VUE testing center. The modules will include 30 to 50 questions and will be open book. Because the modules will be time-limited, physicians will still need to use their judgment about when they want to look something up. Finally, it’s ABEM’s intent to share key testing points and medical advances on our website so that physicians can anticipate what material they need to learn.

Q: What is the implementation timeline?

A: ABEM will be conducting a pilot in 2020. To be clear, that’s not when physicians will be able to recertify using MyEMCert. The pilot is an important step for us to make sure that MyEMCert is functioning properly and will meet the educational objectives to remain certified. If the pilot goes well, we will introduce most but not all modules in 2021. In 2022, all of the eight different modules will be available.

Q: Who will be able to recertify using MyEMCert?

A: Physicians whose certification ends in and after 2022 will be able to recertify using MyEMCert. It’s important for physicians who are interested in recertifying by MyEMCert to complete as many of the modules as possible in 2021 when they are first available. I think trying to complete eight modules in a single year will be a tremendous amount of work, and you might be better off taking ConCert.

Q: What will ACEP’s role be in MyEMCert?

A: ACEP has an important role. MyEMCert will focus on assessment for learning. But as you know, ABEM has a traditional emphasis on developing standards for the specialty and in physician assessment. We believe that MyEMCert can drive the transformation of our specialty, but in order to do that, ACEP and other emergency medicine organizations will need to be the educational engines for emergency physicians. A point-in-time test or even repetitive testing won’t be as effective unless there is a sophisticated educational program that reinforces and promulgates the information. That’s the kind of work that ACEP is really good at.

Q: It seems like ABEM has been making some adjustments to ConCert. What can you tell us about that?

A: We realize that physicians who recertify before 2022 want changes now, and so we’re doing just that. This year, we started offering ConCert twice per year so that physicians who don’t pass won’t have to wait 12 months before taking it again. And by offering ConCert two times per year, physicians can choose which examination date works best for them. Another change that will start in 2020 is to provide physicians a reference to look up information. Even though most of the test questions on ConCert are not fact-recall questions, we do want to offer an online resource to physicians while taking ConCert. A final decision about what reference to provide has not been made. However, of the physicians who answered the ABEM all-diplomate survey, most identified UpToDate as their preference.

Q: With MyEMCert, what does the future of ConCert look like?

A: In the short term, ConCert will still be available to physicians who want to use it, which we think will be around 20 percent of physicians. A couple of the challenges with keeping ConCert is physician cost. Providing physicians options is expensive and could drive up the costs of staying certified. We’re very sensitive to that, so we’ll be watching those numbers closely and will need to constantly reexamine the viability of keeping ConCert.

Q: Why did ABEM drop its Continuing Medical Education (CME) reporting requirement?

A: ABEM is constantly examining its certification program. We value physician input and read every comment on every survey we receive. We received more than 30,000 survey responses in various forms last year. Because the Lifelong Learning and Self-Assessment (LLSA) activity is designed to function as a CME activity, we asked for and received a waiver from ABMS to discontinue requiring physicians to attest to obtaining CME credits. Obviously, most physicians have a CME requirement to maintain their license. Nonetheless, if ABEM can reduce the number and complexity of the requirements for staying certified, we want to do that. For example, we eliminated the patient satisfaction survey requirement, we eliminated the patient safety LLSA requirement, and we eliminated the need to attest to obtaining self-assessment CME requirements. Another way we’ve added value to staying certified is that physicians who pass the Oral Certification Examination or ConCert in 2018 or afterward can receive 60 AMA PRA Category 1 credits at no cost through an arrangement with the American Medical Association.

Q: How will the recommendations included in the final report of the ABMS Vision Commission on redesigning continuing certification affect ABEM?

A: ABEM has closely reviewed the recommendations coming from the Vision Commission. The commission, convened by the ABMS, was a 27-person panel made up of representatives of every major stakeholder group in medicine, such as state medical societies, specialty societies like ACEP, consumer groups, clinical physicians, and others. The commission was charged with redesigning continuing certification. ABEM believes that MyEMCert is on track to be closely aligned with the recommendations of the Vision Commission, so we don’t think any of their recommendations will run counter to the development of MyEMCert. That’s important because the design of MyEMCert is being driven by what emergency physicians are requesting, and ABEM wants to create a process and credential for the specialty that meets the needs of the public, physicians, and specialty.