Effective July 2016, the ABFM SAM (American Board of Family Medicine Self-Assessment Modules for Maintenance of Certification) have undergone important changes.
The ABFM Family Medicine Certification process is designed to measure physician performance, enforce a standard of quality health care, and encourage physicians to develop a habit of lifelong learning. SAMs, categorized as Self-Assessment and Lifelong Learning activities, offer diplomates an opportunity to:
- Evaluate and improve their knowledge in a specific chosen area, so the diplomates can focus on an area that is directly applicable to their area of family medicine
- Earn CME credit toward maintaining certification while gaining skill in an area that will be relevant to their own individual practice
- Participate in educational activities that encourage lifelong learning in areas that are of specific interest to the diplomate
ABFM SAM Program Changes
ABFM SAM had been defined as having two key components: knowledge assessment and clinical simulation. However, in 2016, the ABFM made the decision to officially separate these components into two individual activities: a 60-question Knowledge Self-Assessment (KSA) and Clinical Self-Assessment (CSA). Previously, physicians were required to take both the KSA and the CSA in order to fulfill the requirements to maintain their certification. Going forward, physicians are required to complete the KSA as their minimum Self-Assessment activity; physicians may also choose to take the CSA to earn points but doing so is not required.
How does this affect physicians who are currently in the process of fulfilling requirements in the previously-existing ABFM SAM program? If they have begun their SAM activity before the change occurred, they may continue with their chosen activity to achieve the minimum KSA requirement and earn 15 points toward recertification. However, they must complete both the KSA and CSA parts of that SAM activity to earn full credit — the 60-question knowledge assessment and the clinical simulation. Completing the KSA alone will not earn partial credit. Any SAM in progress will need to be completed no later than July 31, 2017.
Knowledge Self-Assessment (KSA)
ABFM Knowledge Self-Assessment (KSA) activities allow diplomates to evaluate their performance in a 60-question assessment in a particular domain. It is not a test, because diplomates can work on the KSA on their own time, refer to resources, and try as many times as they need to complete the assessment questions successfully. In order to fulfill the KSA requirement, however, diplomates must answer at least 80 percent of the questions in each competency area correctly. After one unsuccessful attempt, diplomates can retake the KSA in “review mode” that offers additional information on each question that was missed, assisting the diplomate in finding the correct answer.
Each KSA activity focuses on a specific area of knowledge in family medicine, and is worth 10 points. These areas of knowledge represent 16 core competencies in family medicine that a successful diplomate should be able to master, and they relate to specific topics that physicians will come across frequently in a typical family medical practice. These areas of core competency, often referred to “domains” for each KSA, are listed below:
- Asthma KSA
- Care of the Vulnerable Elderly KSA
- Cerebrovascular Disease KSA
- Childhood Illness KSA
- Coronary Artery Disease KSA
- Depression KSA
- Diabetes KSA
- Health Behavior KSA
- Heart Failure KSA
- Hospital Medicine KSA
- Hypertension KSA
- Maternity Care KSA
- Mental Health in the Community KSA
- Medical Genomics KSA
- Pain Management KSA
- Preventive Care KSA
- Well Child Care KSA
At every stage of Family Medicine Certification, diplomates will be expected to successfully complete a Knowledge Self-Assessment activity; the KSA being the only required activity for fulfillment of the Self-Assessment and Lifelong Learning requirements of the ABFM Family Medicine Certification process.
Clinical Self-Assessment (CSA)
Although the KSA is the only required activity, the Clinical Self-Assessment (CSA) offers diplomates an opportunity to earn points and increase their knowledge by participating in patient care scenarios. At this time, physicians can earn 10 certification points in addition to 8 CME credits each time they successfully complete a KSA; physicians can earn 5 certification points and 4 CME credits for the successful completion of a CSA.
Clinical Self-Assessment activities provide diplomates with an opportunity to understand, experience, and assess the impact of health care on a patient, through simulated patient care scenarios. Participating in these scenarios, diplomates can test and hone their knowledge of patient management skills including therapeutic interventions, investigations, and the ability to take initiative and responsibility in patient care.
Guidelines for KSA and CSA
The new Self-Assessment and Lifelong Learning process allows for flexibility for physicians, but there are some important guidelines to remember. Physicians can attempt to complete multiple activities in a year, but they cannot work ahead to the next stage to earn credit toward MOC (although “working ahead” activities can count toward CME credit). The ABFM provides a Physician Portfolio so diplomates can track their progress at any time.
ABFM SAM, Lifelong Learning, and Self-Assessment
The ABFM aims to make maintaining certification a process that is not just about testing and measuring performance, but also about establishing the habit of lifelong learning for physicians. In the ABFM Summer 2016 Phoenix newsletter, ABFM President James C. Puffer, MD writes:
The process of certification is an important part of continuing professional development, and it now emphasizes continuous self-assessment, lifelong learning and focused quality improvement throughout the career of a family medicine physician.
The ABFM asserts that KSA and CSA activities encourage physicians to reflect on their own knowledge and skill level, developing the capability to accurately assess themselves. Beginning with the option to choose their own KSA or CSA based on knowledge modules that are most relevant to their own practice and area of interest, Self-Assessment and Lifelong Learning is intended to guide diplomates through a process that enables them to make the choices that will help shape their level of ability, knowledge, and individual practice of family medicine.