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FPHM: A License to Drive Change

HM-Focused Pathway

To add to this, at around the time I was getting ready to register for the exam, it was announced that this would be the first year ABIM would be offering the FPHM pathway, which is designed to recognize those of us who concentrate our practices on hospital medicine. This to me was an excellent opportunity to recertify in a field in which I actively practice, hopefully making the exam more applicable to what I do, but the flip side was that no one would have taken this particular exam before. Admittedly, when I first signed up, I felt like I was either a guinea pig or a pioneer.

To obtain the FPHM, one must do not one but two projects requiring turning in data on process-improvement projects. Hospitalists who intend to certify with the FPHM will be well served by participating in safety, quality, and process-improvement projects, as we often already do. These projects can be used to complete the required Practice Improvement Modules.

Furthermore, I found that doing such projects is the best way to prepare for the new content, which deals specifically with HM on the actual exam. The internal-medicine topics were covered, just as they are in the nonfocused exam, and anyone who reviews for the exam with available study aids (e.g. review books, courses, or practice questions) will have adequate exposure to these topics.

However, a colleague in my HM group chose not to take the focused practice exam, largely because there was no previously established review material to use as study aids. I anticipate that future study aids will contain references to these questions, but for now I felt that material was adequately covered just by completing the Practice Improvement Modules and by being involved in process improvement projects at my hospital. In fact, attendance at one Institute for Healthcare Improvement (www.ihi.org/IHI/Programs) conference would probably cover the topics nicely.

To all of my colleages considering the MOC in FPHM exam, I wish you luck. I feel that any practicing hospitalist is likely to be able to satisfy the requirements of the FPHM pathway without doing too much more than they would in their daily practice or their usual exam preparation. I also found the ABIM staff useful and helpful, and recommend you use the “contact ABIM” link on their website with any questions.

Focused practice is exactly what we should be driving for. TH

Dr. Ammann is medical director of the hospital medicine division at Wentworth-Douglass Hospital in Dover, N.H.

Similar, Yet the Same

FPHM examination is “fair test” for career-minded hospitalists

By Jason Carris

Mel Anderson, MD, FACP, wasn’t required to take the boards in October; he’d passed the American Board of Internal Medicine’s (ABIM) Maintenance of Certification secure exam and fulfilled the knowledge and process improvement requirements in 2007. But having practiced as a hospitalist for years and anticipating that his program at the Denver VA Medical Center will expand in the near future, Dr. Anderson jumped at the chance to recertify with ABIM’s new Focused Practice in Hospital Medicine (FPHM) exam.

“I was happy to see that the FPHM was available,” says Dr. Anderson, assistant professor of medicine and associate director of the internal-medicine residency program at the University of Colorado Denver. “Having done both outpatient and inpatient internal medicine, I have really grown to appreciate that hospital medicine really is its own subspecialty of medicine, with its own set of clinical challenges and areas of knowledge, skills, and attitudes. Seeing that more formally recognized in the form of focused practice, that was reaffirming to me.”

Launched in early 2010, the FPHM pathway to recertification offered its first secure exam Oct. 25. Nearly 400 hospitalists signed up for the FPHM, and 140 took the test. Results will be made available to test-takers later this month.

Having taken the traditional, internal-medicine exam just three years ago and then the HM-specific exam three months ago, he says the subject matter of the FPHM test was “pretty much spot-on.” He recently talked to The Hospitalist about his experience.

For career hospitalists—those who have been involved in QI activities and are making HM a career focus—the FPHM makes sense.

Question: How did the subject matter in the FPHM test relate to your everyday practice?

Answer: The clinical content was very much what we see. It had a decent mix of some ICU topics—not too much, because I know that a substantial number of hospitalists don’t see ICU patients. The quality improvement questions … were clearly concepts that I expect most hospitalists to be familiar with. So I thought it was a pretty fair test. It was a good test in that you were plainly able to see what was being asked of you. That aspect of the test was very successful.

Q: What differences did you notice in the two tests?

A: There were a lot more similarities than differences: the general layout of questions, in terms of a lot of clinical history and an entire case being laid out for you, and then a series of four or five answers. That pattern is a familiar one, and it’s all medicine. The things that were different were, contentwise, various ambulatory issues not covered and ICU topics covered much more than they were in the traditional IM exam. And certainly the quality-improvement piece was something that was not present in the general exam and is something that is appropriate for hospitalists.

Q: Have you completed the other MOC requirements for the focused practice?

A: I believe I will need to do the more frequent self-assessment [QI] modules to both qualify for the FPHM and maintain it. I’ve built time into my academic year in the late winter/early spring.

Q: Would you recommend the FPHM for the hospitalists in your group?

A: This really isn’t for someone who is in hospital medicine as sort of something between what came before and what comes after. For career hospitalists—those who have been involved in QI activities and are making HM a career focus—the FPHM makes sense. I think the most important thing is making sure that is you.

Q: You didn’t have to take this test, so why did you choose to be among the first to go the FPHM route?

A: I wanted to put my money where my mouth is. If I call myself a hospitalist, am I up to the task of showing that based on the certified exam and the other requirements of this path of recertification, that I hold myself to that standard both personally and professionally?

The next FPHM test date is May 19. Registration for the spring exam is open until Feb. 15 through the ABIM website (www.abim.org). Registration for the fall exam is May 1-Aug. 1.

Q: Were you nervous?

A: No, not really. It was actually sort of a fun test.

Q: Do you expect to pass?

A: Yes, I do, and I also hope that I do.

Jason Carris is editor of The Hospitalist.

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