Good morning, everyone. I'm Eric Wood. My talk this morning is going to be about board certification in occupational medicine. I'm a professor here at the University of Utah School of Medicine in occupational medicine. I direct the occupational medicine program. I have no other disclosures to make besides that. I will kind of preclude that by saying that I am a former director of the American Board of Preventive Medicine. I haven't finished my nine-year term last summer. I'm actually filling in today, pitching in, if you will, for the current vice chair, Jeff Levine, who's not available to give the talk at this point. The goals today, I'm going to describe the requirements for achieving board certification by the American Board of Preventive Medicine in occupational medicine. Our current chair is Wendy Braun, specialist in general preventive medicine and public health. Beth Baker, our former president of AECOM, who's actually in this room, and hopefully Beth will help me out if I'm misstating anything as we go along. A couple of the others, just to kind of point out, of course, there's many on the list, but just in the interest of time, Jeff Levine, again, is the current vice chair of American Board of Preventive Medicine. Basically, what that means is Jeff will not only oversee the creation of the examination, which you're all going to be, or maybe some of you will be at least, sitting for sometime later in the fall of this year or subsequent years. Other ones of occupational medicine amongst us is John Meyer. Many of you may remember him as having run the review course for the board certification course for many years. He joined the board last summer, replacing my seat. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. Heather O'Hara. And important to recognize that these are, the first two at least, are relatively newer boards that the American Board of Preventive Medicine oversees. And undersea and hyperbaric is very closely aligned with us, but kind of an older board and very much smaller. Again, kind of just highlighting that again, and then finally, I guess I didn't mention before medical toxicology. That's actually split with another of the boards, the American Board of Emergency Medicine as well, so we kind of have co-responsibilities, the American Board of Preventive Medicine with them. So I want to start off by just going over what the cycle is each year. For this year, we saw, and this is what we saw last year in the 2021 exam cycle. This represents when people are getting their applications in line for the exam cycle. So it starts in. up having additional fees for being in the latter part of the cycle. The sooner you get it in, probably the better for all of you. Just because if there are things that are a little bit outlying, we have more opportunity and time to either assist you in getting your materials in in time, or if it turns out there's an identified reason early when you may not be eligible this year, it helps so you don't set yourself up for preparing when you might need to go for the next year, for instance. So in occupational medicine, we saw a total number of 78 residents last year apply for the board certification, and then another 27 applied in what's called the special pathway. And I'll go over more details of the different pathways, residency and special pathway, and the other one is called complementary pathway. But primarily the people in the special pathways have already had board certification in one of the other two specialties, public health, general preventive medicine, or aerospace medicine, then applying for their occupational medicine board. So a smaller number. That is a pathway that, you know, some of you in this room may be looking at as well. And then vice versa, after you do your occupational medicine board, you have the potential to get one of the other boards as well in subsequent years. There's a window that you have to do it before, otherwise seven years beyond that, you won't have that opportunity anymore. This is the sum total of registrations for board certification from 2006, I believe, till last year. And just kind of, I'll go a little more detail into occupational medicine on the next slide, but you know. And then you have the opportunity to open for a grandparenting period of time as fellowships ramp up as well. And then much bigger spike in 17 when addiction medicine came on board. And also, same thing, people are still able to kind of exam for that who, I'm not going to go too much into the details on that, there's other groups that will do that, but essentially what we're seeing is a slow taper. And this is typical of all medical specialties when they first come online, is you'll have a large spike, pent-up demand, people who are ready to take the examination become board certified. And then that tapers with time as fellowship training, residency training programs ramp up so that they can meet the ongoing demand for time. So bottom line here is the majority of people who are now in the American Board of Preventive Medicine certification track are coming from these seats of clinical informatics and addiction medicine, much bigger than us as the smaller specialties. So this is us, occupational medicine, similar time frame 2006 to last year. And this is the amount of people who registered to take the examination. And this is something that kind of going back to, you know, the Sappington lecture that started out our conference in terms of where we are for building up the specialty. And you know, you can see the trend in time of how many people are continuing to become certified. And I think overall we're seeing a relatively flattened curve in terms of how many people are coming into the specialty for the board certification. And unfortunately we're seeing more people tapering off at that point as, you know, the older people either retire or pass on. So ultimately what I want to see here, what I want to show you here is we had, you know, a high back here in the first year that we're looking at in this slide, at least 126. A little bit of a spike, which I don't know if I can explain, in 18 up to close to that same level. Beth, do we have information? So it brought us up back to a little bit closer where we've been in the last couple of years, hovering around a little bit over 100 each year. So that's about where we are. Again, most people are coming in through residency pathways, a fair number are coming in through special pathway. And hopefully, you know, with some of the potential bolus of monies that may be coming forward through HRSA, for instance, we'll continue a trend upwards to replace those numbers. These are the pass rates going, again, over that same period of time. And there's the two curves here, one, the blue is the core examination, and two, the yellow is the specialty OM examination pass rates. What we're seeing is last year, somewhere around 90% of people who took the examination passed the examination. Importantly, and I'll get into the details of this, the two parts of the examination, this is probably one of the most important things for everybody who's going to take the exam this year, are going away and to combine one examination. But overall, what we're seeing is that people did pretty well, usually in the core exam, a little more challenging for the OM examination. We slice and dice this a little bit more, too, in terms of, you know, how you look at people who've been through the residency training pathway versus folks who came in through some of the other pathways. And so there's a little bit of a nuance in that, and typically, we see a little bit, you know, 5 to 10 percentage points even difference in terms of how they pass people who've been residency trained, too. So now we'll get into, and please, if anybody has questions, don't hesitate to shout it out from the room. We're small enough where I can repeat the question at the time and answer it for those in the audience here as well as those online, and I think we're going to have it recorded as well. So eligibility requirements and pathways. So key eligibility requirements, the professionalism comes into medical licensure. So you have to have an unrestricted license in all of the states or territories in where you practice. And just a little side note, this is really important as you go on in your career, especially, you know, many times people will move state to state. Maybe they'll do locums work, maybe they'll do, you know, specialty work or they'll pick up another license. But occasionally we see people get tripped up where they may have many, many licenses. I mean, as many as 20 licenses in some instances. And the important thing is you have to have a full unrestricted license in those states that you practice. And this is where, again, kind of looking to the future for you, if you are in all those states, make sure you're paying attention to all the fine print of what happens in those states' licensure requirements. They may add, you know, extra CME time that you have to do for whatever opioids or, you know, whatever other trends are going to be coming in the future. And the important thing is if you fail to pay attention to that fine print, you may end up getting a restricted license in that state. And while that may not automatically disqualify you from being certified, it's going to take a lot of work to kind of catch up and, in fact, in some instances it may, in fact, make it so you get decertified because you've got a restriction on your license. So, you know, it doesn't happen that much, but I want to make sure that, you know, you do keep aware of that, that if you've got those active licenses, make sure you do everything you need to keep them active in the state where you're licensed. You have to have a medical degree or equivalent, and I'll give you the references to the website to look exactly what that means, but essentially it's MD or DO license, a Canadian license, or other licenses from other countries that have been accepted as well. And then, finally, you need to have the successful completion of a training program or the practice experience which makes you eligible under the other pathways, and I'll get to that shortly. And shortly is now. So the three kind of active ones available now include residency pathway, complementary pathway, and a special pathway. And I didn't bring it up in the slides, but if there's any of you in the room that are looking at the alternative pathway, this is your last year for doing it. And just briefly, I'll just state what the requirements are now if anybody has questions stop me, but it's essentially you have to have completed medical school in 1984 or earlier to be eligible for the alternative pathway. And if you do that, please come up to me at the end of the talk and ask for any more specifics, but again, it's kind of spelled out again on the website pretty well. So the residency pathway is, we'll get into the details of this, relatively straightforward. The complementary pathway, this is a little bit more nuanced. There aren't that many people that come through this pathway, but it provides a short of getting a full residency training program in one year period of time. So how you'd be, and this you'll have to work with a residency training program to actually qualify for the complementary pathway, and several of the programs across the country do offer this. So if you're looking at doing this, basically the rules are you have to have at least two years of prior residency training. You have to have one full year in the residency training program of residency time. This actually, this last bullet is no longer valid, so please ignore that one on the two of the last five years from 2022 forward. You have to have completed the graduate coursework, and then you have to, again, I'm going to go in a little more detail on the other requirements in the next two slides on both the changes that occur this year for the complementary pathway, and then also for the next one, the special pathway. So again, I know the names are always confusing for people. The residency pathway, relatively straightforward what it is. The complementary pathway is just a nuanced program that was developed about 10 years ago to allow people to complete a residency training program in one year period of time, and then the final pathway is the one where the special pathway is one where you've already been certified in one of the other two specialties, and then you can take a board certification in one of the other two specialties. Did I say that in a way that leaves people confused? Because I know it often trips people up, and the nomenclature itself is just one of those ones that many of us get hung up on. So what changed this year, and this is for the people who want to apply and take the test examination this year, is changes in the complementary pathway. Again, before you're getting into the residency training program one year, you have to have completed two years, so that's kind of the entry-level requirements if you're going into this at the programs. And that can be anything. It can be any two-year program of any specialty at all, or even multiple programs if you took a transitional year and a something else year. Where you do your training, basically you need to get a letter from the program director to make sure you met all the requirements of that. This is the part that you'll work with the residency training program director, and again, if you're coming in this year, this is stuff that's got to be completed already in the past. So basically, the one-year PM residency includes, in our specialty, eight months of direct patient care. Then finally, this is the important one, the complementary pathway graduates have to have an MPH or equivalent degree. So an MPH or the program that most, the 24 programs, you know, they've all been vetted for the master's degree programs that they have. The MOH, is that okay? The MOH is okay. Yeah, yeah, yeah. As a matter of fact, the MOH is, well, I'm sorry, but I think my program offers the MOH, and so I have a certain bias against, for that particular degree. But thank you for that excellent question. The question was, and for the audience on the streaming, the question was, is the MOH, there's several master's degrees, the MOH is one of many that are considered equivalent to the MOH, or the MPH. And then the MPH and direct patient care requirements are no longer, are what have been used to supersede the previous requirement of the two of five years of practice. There's a question in the back? The one-year residency, is that discretion of the program, or are there a list of these programs that have set, that will offer the one-year residency? So the question is, the one-year program, is that at the discretion of the program, or is there a list of programs that are providing that program? There's not a list of programs that are offering that. I think all of the programs do have that potential, but you would need to speak with the program director directly in order to kind of find out if they're offering that. And there's some nuance to each program's availability to do that, including funding and space, and how many residents that they can accept, and a number of different factors that come into play. Each year we see a small number, less than 10 people who are applying for the board through the complementary pathway. But it offers people a mid-career break, at least, if you will, for many people, to kind of take that residency training program. And just to be aware, too, there's a couple of programs, or at least one main one, PEN, that offers kind of a mid-career type of opportunity in that way, a training-in-place model, so that if you're able to get, you know, a funded position, particularly through your organization or some other way to help pay for that, there's nuances to that training program, I'd direct you to PEN for that. But it's an opportunity to take that training in that fashion. Did I get your question? So, and again, special pathway. So for those in this room who may be applying for that, you have either board-certified in aerospace medicine or public health and general medicine, and then you want to be able to take that examination for occupational medicine this year. For those of you who are taking the occupational medicine exam this year for your first board specialty, in subsequent years you can, in turn, apply for one of those other two specialties. Big important change this year is that you can only do that once. So you can't take both occupational medicine this year, general health public medicine next year, and aerospace medicine the next year. If you want to do a third one, you actually have to go through the full residency training program for that. The other kind of... Sorry. Question? Is there a time length? Like, let's say you did the training 10 years ago, does it matter? It does, and Beth, please jump in and correct me if I'm wrong, if there's been a change But the rule is now it's within seven years of your first board, and I'll let Dr. Baker correct me if I'm wrong. I think that is the case for now. It has been changing over the years. So the question again was, what is the time limit for taking a second specialty examination? And Dr. Baker corroborated what my belief is, was that it is a seven-year limit from when you take that first examination. And again, from now on, it's only one more, so it's not like you can dovetail the next one after another seven years, so 14 years from your original certification without taking additional training time. And whenever the requirements change, you can just go to the ABPM website and we'll have those requirements, because we have, unfortunately, two full special and complimentary slides there. Thank you. So, Dr. Baker said that make sure that you check the ABPM website, and we'll have that link directly on the slides here for you, abpm.org. The other, so, just two other nuances, get a little bit inside game, is if you're applying for the special pathway, both vice chairs for that, where you're applying for, as well as the one you came from, are going to have to review your file and both get together and agree that you're qualified based on their qualifications. And then you also need, this is an important one, too, and people do get stripped up on this sometimes, you have to have three letters of reference, and two of those three must be from somebody who's board certified in that specialty. So, essentially, kind of the idea there is that somebody who knows what the work that you're planning to do as a specialist in that pathway is able to provide the documentation that you're qualified to take the examination from their knowledge of you as an applicant. So, again, here, as we talked about earlier, are the links, the website, www.theabpm.org. The is important because somebody else grabbed the ABPM domain earlier than ABPM did, and then you'll be able to find it. And one thing that I know has been really helpful that's been created is this Am I Eligible tool, and it really will help step through for you if you have all the ducks in a row, if you will, to make sure that you're able to get qualified for the examination that year. So, again, the timeline, and again, we'll go back to the actual dates for this year, just make sure that you get your stuff in as early as you can. The window is open already for making the initial application, and then there are kind of markers that if you don't meet the timeline in advance that you're going to have to pay more money, actually, for the certification to go through. And also, I think, again, kind of an important thing is that, you know, if you're not sure if some of the things that you're hoping are setting you up for qualification, you can get a little bit more in advance time working with the team at ABPM to make sure that you've got what you need. So, the exam itself and the timelines. So, beginning in 2022, for the specialty certification examination, important change is there are not two tests. So, up until 2021, through 2021, we had a core examination that everybody had to take in one block of time of four hours, and a specialty examination everybody has to take in one block of time. What has essentially happened is that we've kind of shrunk down the total number of questions that you have to take to about 200 over a period of an exam that's going to go on for about four and a half hours for a limit, at least. And of that, 150 of those questions are going to be in occupational medicine, and 50 are going to be common questions that are going to be shared with aerospace and general preventive medicine. So, again, one block of time, four and a half hours you'll have, you know, up to four and a half hours if you need it. For those, if there's someone in the room that has a history of taking the exam in the past years and failed one of those two examinations, and this happens not uncommonly, is you'll pass one, the core, and fail the specialty, or vice versa. And so, in that instance, those individuals only had to take the one that they failed in the subsequent year. Moving forward, your only option is going to be taking that one combined examination. A question in the back? Yeah, do you happen to know, so for that extra 50 questions, are they going to be the same on all three exams each year, or are they going to have a random question bank, and the 50 may or may not be the same for all three of the specialty exams? So, the question is, of those 50 core examinations that are going to be blended into this 200 question examination, are they going to be same for A, I believe, all three pathways, and B, is it going to be the same from year to year? It's more just, are they going to take those 50 questions each time and put the same 50 questions in all three exams? Obviously, there would be a certain number of questions they would probably randomly select, so I guess what I'm asking is, are the core 50 questions going to be the same on all three specialty exams, each time the exam is given? The question is, are the core 50 questions going to be the same each time the exam is given? And the plan at this point is, yes, that those 50 questions will be common to all three pathways. And as Dr. Baker pointed out, they will change year to year. And I'll get into a little bit of the nuance on how that exam process changes each year too, because it's important for validation of the examination. I'll just kind of, a little bit of background on that too. So, next question, what's the content? So, we really want you to be able to apply knowledge rather than a relation of isolated facts. I think in the past, for those who have taken many exams in the past, there's much more of an emphasis on a little rote learning. And so, the idea is that these questions are being constructed much more to reflect a practice pattern, to make sure that we get the full spectrum of the competencies for occupational medicine, as well as, again, that core examination for all three. High frequency, high impact patient or patient public population-based questions. And an emphasis on clinical situations or kind of the decisions that you need to make as a practicing occupational medicine physician outside of the clinic as well. The breakdown, and this is the global breakdown in terms of our blueprint, is 20% are going to be on the prevention exposure assessment, hazard recognition and control. So, things like industrial hygiene, ergonomics, toxicology, you know, the kind of preventive arm of our specialty. 60% are going to be on clinical care, clinical vignettes. And then, 20% are going to be on the OEHS administration and systems-based practice. When you get into the website, you'll see much more detail on the blueprint. The blueprint, or what the examination is directed towards, has really broken down, not by percentage points, but the whole spectrum of things, largely reflective of what we know for the competencies from the ACOM, helps prepare us for some of the competencies that we think are common to the specialties. But, you know, it's a really good idea, I think, for you to get into the website, look at that blueprint, and kind of focus areas, particularly if you're feeling like you're not as strong in some areas versus another, on where you can kind of, you know, work your efforts to making sure that you're well-prepared for the examination. But you've got, you know, six months or so to get prepped for that, too. What type of questions? It's multiple choice, single best answer. So, you know, in the past, many of you have, I'm sure, taken examinations where you've had, again, many of these kind of recall. We can't get entirely away from recall, because there are some common facts that you need to know. We try to frame it in a question that's much more relevant to clinical practice. But, you know, there's just things you, as a physician, need to know to understand how to take care of patients. You know, where is this particular nerve, in the median nerve, for instance. Interpretation. So, we want you to be able to look at some study design. What are the fatal flaws of that? How do you make that interpretation? You know, how do you diet? We'll give you a clinical vignette. What's the diagnosis? You know, looking at that scenario, kind of, with the question. And then the problem solving. I'll give you a little bit more detail on that core foundational materials, you know, whether it's epidemiology, biostatistics, or other aspects of management of patient or population health. You'll have a calculator available on the computer. Drugs will be listed by name. Oftentimes, you'll have both the generic, as well as, usually, generic name only. But sometimes, there may occasionally slip in a common drug name. But they'll always be with the generic with that. And then, any kind of laboratory questions, any questions looking at labs, you'll have normative values listed alongside with it, as well. So, don't, you know, make sure you focus energies on things that are important for your studies. What's not on the exam? So, this is more modernized in terms of, you know, what we're looking at for psychometrics and how to appropriately test candidates. You're not going to see questions that are true-false. You're not going to see those questions, the K-type questions, where you have all of the above, none of the above, A, B, B, C, whatever that type of a thing. It's going to be one single best answer. Try to avoid any of the trick questions. The exam committee works a lot at trying to, kind of, root out those types of things. And then, we don't just throw out questions to see, how does this perform this year, kind of a thing. And, you know, the other thing is, usually, there's a lag between information that's out in the public versus when it gets put on the test. So, you know, there may be some questions related to COVID now that we're three years into the pandemic. But, you know, typically, it's not things that, what did we learn within the last 12 months, you know, that you'd see in the New England Journal, for instance. It's got to be accepted, time-tested, evidence-based type of a scenario. So, exam timeline. So, the exam occurs end of October, early November. That's when all the exams will be tested at the testing centers. And, I believe it's going to be at the prometric testing centers again. And, this is the part where candidates get really, kind of, anxious after they take the exam. It takes a while to score it. So, you know, one thing, again, to bear in mind, you know, we've got a professional testing organization that helps do the psychometrics to look at the examination. And then, the board comes together with that information to make sure that the test that we're giving that year, the form, actually is an accurate assessment of the candidates. And so, they're initially scored, a raw score, early November, December. The process that occurs next is called key validation over the next several weeks. And, again, essentially what happens is we look at each and every question. Some of them are, you know, performed very well. Some of them seem to not work well when you look at the entire cohort. So, you need to examine those low-performing type questions. And then, at that point, the committee gets together and said, did we key it wrong? Is there maybe something wrong with how the either question or answers or distractors was laid out? And then, that decision will be made either each year. You know, there's a handful of questions that typically gets thrown out just because they don't perform very well. New questions that have been written. And then, again, each candidate will be re-scored after that validation process occurs. January, the results come in together. Again, it's kind of reviewed for the standardization to see if there's, you know, a reasonable, if there's, and make sure there's nothing that looks out of line with what previous years is. And kind of getting to earlier question on how many exam questions get carried year to year. There's about a third of the questions, and this varies from year to year. We're working with the psychometricians. But about a third of the questions are carried forward one year to the next. And that's to help ensure that the candidates that took the exam in 2019, if we've got 70% passing that year or 90% passing that year, when you look at what happens in 2021 or 2022, those cohorts can be looked at as a relatively equal band of, you know, it's not like we've got a whole bunch of really smart candidates that came in this year. And maybe we do have a whole bunch of smart candidates. And maybe we'll get 100% pass. But basically, looking at that kind of common core, it allows us to say that the exam performed equally from one year to the next. And we're looking at the same kind of level of competency from one year to the next. I hope I didn't make that more confusing than I meant to. Questions? I think what I'm trying to suggest is we've got a professional group of psychometricians that look to make sure that the questions themselves perform in a valid fashion. And then we've got a group of very seasoned exam writers from the board and outside of the board who are kind of reviewing to make sure that the questions that we're presenting really reflect what an occupational medicine physician needs to know. So, you take the exam in October, November, you'll get scored, you'll get your test. And if you pass, your certification will read valid from January 1st of 23. So, subject to continuing compliance and certification and everything, the exam will expire 10 years December 31st from when you took and were initially board certified. So, to be a little more clear, you pass the exam in 2022, the effective date of your certification will be January 1, 23, and that will then subsequently expire so long as you're not falling out of the continuing certification process on December 31st, 2032. Bottom line here is important too, those who passed and recertified after January 1, 2019, you're going to be subject to the annual fee of $175 to maintain your certification. All right, important dates. This is something that you'll want to make sure you keep in touch with as you're applying for the examination. So, it's already open, the application window's already open. You'll be able to register for the exam on May 25th. The window closes for registration. You know, this is probably the real deadline for you, June 30th. We'll get a late application, which will cost you a lot more money after July 1st, and that in turn will close the 15th, and then registration for exam will close on September 16th. The window for the exam, just keep this in mind for your scheduling for the fall, October 30th, 10th to October 30th. I'm sorry, earlier I may have said it goes into November, but I think this year we're closing it out the last day of the exam on October 30th. And then we, again, there's a little bit of variability on when the exam scores come out, early February 2023. And just as you're looking for your exam results, I think there's an attempt to try to roll them all out at one time, but oftentimes there's a little bit of a trickle. So, if one of your friends gets notification and lets you know that they passed the exam and you didn't hear notification, don't automatically assume that you failed. It could take upwards, I've seen this, upwards of a week's period of time. I know as a residency program director, I often get frantic calls when X, Y, and Z pass and I didn't get my score, but, you know, just give it a little bit of time and patience and contact the board if you're really worried about it. But I think it's generally, I shouldn't say that because the board office people might get mad at me, but just give it a little bit of time. So, the test is only one year, once a year? Okay, so the question is the test is only one year exam at this point, and this is getting into this next phase of questions for sure. So, the exam I was just talking about was only the initial examination for getting certified. So, that's for people who, you know, recently completed residency, coming through the complementary pathway, or testing for the special pathway. For those of you who are already certified, this is big moves are changing right now. And so, I'm going to go ahead and talk about what you need to think about for, you know, the coming years. And so, I just, I won't spend too much time about this. We can spend more later if you have questions on it, but I want to kind of just overview kind of a 30,000 foot level. So, the American Board of Medical Specialties is an organization which basically provides guidance and framework for all of the specialties that we are familiar with. There's 24 individual medical boards. And so, it's a confederation of boards. The American Board of Preventive Medicine is one of the 24 boards. So, the American Board of Surgery, American Board of Internal Medicine, Family Medicine, you know, you name it down the line. All of them pretty much agree to abide by the framework, the rules, that the American Board of Medical Specialties requires. And so, many times, the ABPM will be, you know, will have to make rules that are responsive to the American Board of Medical Specialties. And these are things we can't change. And so, the American Board of Medical Specialties, in large part, in reflection to the community at large, when there were some concerns about ongoing continuing certification process, have revamped the whole process by which boards continue to, are given framework for continuing to certify active diplomats. And this changed, essentially, in October 2021. And now, all the individual boards have timeline to get in line with the new requirements for the new continuing certification process. So, you know, the American Board of Preventive Medicine has been working carefully to be in alignment with that and provide something for our diplomats that is appropriate to make sure that we're keeping rules to a minimum, if you will, but also kind of making sure that we're not letting people, you know, not maintain their level of qualifications and competency for the practice. So, anyhow, ABPM is obligated as part of this confederation to abide by those rules. So, for the change to this continuing certification process, probably the big bottom line, getting to your question on the test, is that the test will be going away, essentially. I think the plan is that for those that don't want to go to this new process of ongoing certification question bank, and I'll get to the details of that. Beth, correct me if I'm wrong, but I think the plan will be for at least perpetuity for the time being to allow people who don't want to do annual test questions, and maybe getting ahead of myself, I'll come back, but to continue the examination. To answer your point, the 10-year certification exam is going away. Unfortunately, and this may apply to several of you in the room, for 22, 23, that exam certification process will still be required. So, for those who are set to expire in this year and next year, you continue to have to take the 10-year recertification examination. After that, things change, and that's where we're going to get into the details here, I hope. So, phase one, a little bit easier in terms of how you do your lifelong learning and self-assessment. We basically just want you to be able to attest that you've achieved 20 CME credits per year. So, I would advise you to make sure that you have records on hand, because there is at least a potential audit process of individuals, but basically we're just going to ask you to sign the document. Yes, I did 20 credit hours. If you went to the conference here, you got it, 20 hours of CME, at least you went to the classes and such, 20 hours of CME per year. And then you're going to also ultimately pay this annual fee of what is now $175 per year, versus the one big block that you have to pay every 10 years to take the examination process. Phase two, this is the important part, is the longitudinal assessment program. The anticipation and expectation is that as of January 1st, 2025, all of us will at least have the opportunity to enroll in this longitudinal assessment process. So what's happening now is one of the subspecialties, clinical informatics, is graciously piloting a longitudinal assessment program. And what they're doing is they've got all of their cohort doing test banks. And I think it's 12 per year that they're doing. And so what they're doing is they were, the pilot part is we're doing what kind of questions are appropriate. And there's three groups within this cohort. Some are doing three-minute questions, some are doing five-minute questions, some are doing 10-minute questions. Each, I'm sorry, I said that 12, I said this wrong, but every six months they're required to do 12 of these questions, so 24 total per year. So these are questions that are designed to be a little more challenging than you'd get typically in the board certification examination. They're open book. So that's where the mid-time, you know, frame comes in importantly so that, you know, you're able to kind of look at things. So, you know, you don't want to make it really, you know, incredibly hard to look up things for a three-minute question versus a 10-minute question. It launched in April 21. It's going to finish in March 31, 23. And so far what we're looking at in the interim results are people seem pretty satisfied at least with this group of clinical informaticists. So you can see that overall over 80 percent of the questions are deemed relevant to the practice. It looks like the one that seems most satisfactory to the applicants are these 10-minute question banks. And so, again, this is a pilot project that one of the subspecialties is doing, and, you know, the idea I think is that pretty much if this is successful, that's what's going to launch forward for those of us in occupational medicine and the other specialties as well. A question? Maybe I missed it. I'm sorry. When you say 3, 5, 10, is that the amount of time they have to take each question or is it a total of just a 10-minute, you know, subspecialty? Good question. Thank you. So, again, I misspoke earlier. There are 12 questions that are given every six months, or you have to complete over every six months. You can do it at whenever you want. You know, you can do it on the commute in on the train kind of a thing, for instance. But you will have a period. You'll get the test in. You'll get the question. You'll pick it up however you pick it up on your phone or your laptop or whatever. And then once you kind of start, you've got three minutes to finish. Or if you're in the 5-minute cohort, you've got five minutes to finish. Or if you've got the 10, 10 minutes to finish. And that's for one of the 12 questions. So in the 10-minute cohort, if you've got 12 questions to do in six months, you've got 120 minutes total time to complete those questions. Again, you can sit down and do them one block if you want. And do you take that two hours all at once or is that broken up, you can take each question? Yeah, it's designed that you can take it at your leisure over that period of time. So you could do, you know, one or two a month. You could, you know, like some of us, you could wait till the witching hour and leave yourself 120 minutes at that six-month window. No, no. So that's the idea is that this longitudinal assessment process will allow you to kind of, you know, deliver the timeframe that works for you. And you know, maybe you can do it at lunchtime between patients kind of a thing. And again, they're kind of designed to be a little higher level, a little bit more, you know, responses to if you fail, you know, what are the reasons why you may have failed this question with a paragraph or something like that. And so, you know, and this is in process, it's a process of development for a committee that will start working on this for occupational medicine over the next coming couple of years. So the question is if you fail them, will you get a chance to retake them? And it's a great question that, to be honest, is still in development of how we're going to be doing this. So I can't remember, I don't get too much into the details of, you know, pass-fail kind of a cycle or timeline even at this point. In part because we're getting a little bit cart ahead of the horse because it's still being built out for this 25, you know, launch date. But ultimately there will be mechanisms available for those that don't pass the question banks to allow a pathway for certification through some training module. Oh, thanks. I'm sorry. Beth, would you mind maybe getting the mic if you're, if this looks, this sounds, so again, by full disclosure, I had been on the board until last year, Dr. Baker is currently on the board. So the discussions that are occurring, the question that you're asking, I think is something that Dr. Baker can answer more. So the intent is it's a practice-based question that's relevant to off-med practice. Unfortunately, we all do different types of off-med practice. If you miss a few, the intent would be give you somewhere where you could go and say, say it's an ergonomic question, do a, you know, one hour online course on ergonomics or something like that. If you miss a bunch of questions and really are way below the norm, at some point you may be required to take that written exam. But the intent is it's more of a learning process that you can potentially miss a few. And I think that's appropriate because we all do such different stuff. When you say take that written exam, you mean the old exam that we've all been taking through our career? Right. Right. But that's people who are way below the norm. And so the intent would be there's hardly anybody would ever have to do that. But you could miss a few, and then the idea would be give you a list of courses, ACOM or whatever, that you could do a one-hour, you know, course or read something to learn that topic. And then you would have to provide documentation that you did that course. It's all in development. So I'm sorry. Yeah. And these questions are, I think, important to, you know, feedback to the board is important for this. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. 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board certification

occupational medicine

American Board of Preventive Medicine

residency pathway

complementary pathway

special pathway

exam registration

certification process changes

clinical informatics