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A-Plus Achievement

Timing is everything. Christopher Columbus, Abraham Lincoln, Harry Truman … each benefited from perfect timing and, in turn, helped change the course of history.

HM has had great timing, too. With numbers now estimated at more than 30,000 hospitalists nationwide, HM is systematically changing the way patients are cared for in the hospital. The maturation process is equally evident. In less than two decades, HM has organized annual meetings, developed educational programs, established a peer-reviewed journal, and published core competencies.

The next step in the evolutionary process: the Recognition of Focused Practice (RFP) in Hospital Medicine through the American Board of Internal Medicine’s (ABIM) maintenance of certification (MOC) program. Registration for the RFP in HM should be available by May 2010, with the first MOC in fall 2010.

“The timing is perfect. It’s appropriate,” says Robert Wachter, MD, FHM, chief of the hospital medicine

Board Certification, With a Healthy Dose of HM

ABIM’s new Recognition of Focused Practice (RFP) in Hospital Medicine establishes a recertification process for career hospitalists. The ABIM committee’s goal, according to Dr. Wachter, has been to create “the most rigorous, generally accepted certification for our field.”

Although it will mirror the IM recertification test in many ways, the RFP in HM test questions will focus on patients and the three core principles of HM practice: quality, patient safety, and clinical care transitions.

“That’s what the MOC means to me,” says Dr. Wiese, SHM president-elect and chair of the ABIM Hospital Medicine Maintenance of Certification Question Writing Committee. “That these individuals that have gone through the four parts of certification and can say, with confidence, that they meet the criteria that a patient would like to see in a hospitalist. They must be a competent internist knowledgeable in hospital-based care, and they must be able to demonstrate [expertise] in patient safety, quality, and transition of care.”

The RFP in HM test will have four parts:

  • Citizenship. Physicians must be licensed and in good standing and fulfill any applicable procedural requirements. This is similar to the standard ABIM test; however, RFP in HM candidates will have to demonstrate a to-be-determined minimum patient census and have passed advanced cardiac life support (ACLS) training.
  • Self-Evaluation Program (SEP). The SEP is a scoring system designed as a lifelong learning tool. The SEP is an open-book module that tests clinical and practical knowledge.
  • Secure Exam. The “rough blueprint” is a 75% inpatient, 25% outpatient split, according to Dr. Wiese. Outpatient questions will focus on the fundamentals—for example, how to set up a successful first clinic visit following discharge.
  • Performance Improvement Module (PIM). The PIM focuses on physicians improving their practice. One difference for the RFP in HM certification is that the PIMs will be required every three years, according to Dr. Wiese. “They will be more team-focused … and identify other physicians, nurses, and hospital staff. For most hospitalists, you are doing this kind of stuff anyway,” he says. “We’re driving at continual practice improvement. We must be offering it in our hospitals.”—JC

division, professor, and associate chair of the Department of Medicine at the University of California at San Francisco, a former SHM president, and author of the blog Wachter’s World. “We knew we needed to ripen and mature. It’s like watching your child growing up: their first steps, first day of school, graduating high school. This has a lot of the same feeling. This is one more statement that the field is real, here to stay, and vitally important to medicine.”

The new pathway to board recertification is as meaningful to HM’s founding fathers as it will be to the next generation of hospitalists. It represents validation to physicians who have chosen a career in HM, and it offers early-career physicians a specialized path to recertification. Moreover, hospitalists agree the RFP in HM provides accountability to the profession and patients.

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