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.
Any logical person will question the reason for all the acronyms and duplication in this program. There is no proven benefit of MOC to patients or physicians. It is past time for ABMS and its affiliates to end MOC and make Board Certification a lifetime one. Meaningful CME activities are plenty and ABFM does not need to redesign the wheel.
Dears Sirs=
I am sending my comment from Santiago de Chile.My knowledge about Familiar Medicine is scanty(in my country, only Catholic University has this speciality), but only I would like to ask, if the program has more items(because I see only very few problems that can present in the family)
We, were working, since few years ago, with the relationship between members of the family.Using special questions, we could identify Disfunctional Families,We use Tests developed by Panamerican Health Office and determine, what was called =Apgard Familiar( it is an score, that nothing has to do with Apgard Test , used in Newborn, but this score was telling us, that in this family we are going to find, since Drugs Problems-Alcohol Problemas-Bad Relation ship between members of family , many times ending in ViolenceIf this problems are not present, we are sure that they appear in the future
I left this Program almos 10 years ago.I would like to know, if you teach this point of view of familiar Medicine.I do not pretend nothing more.Professor Isidoro Horwitz, Chairman in that time of Panamerican Health Office said=The most important NUCLEUS of the SOCIETY, it is not the individual, , but the FAMILY
There is no need to subject doctors to a marathon of questions in one sitting, that’s not how we collect or use knowledge. It’s archaic and stress inducing, forcing the crammers to cram knowledge.
Over the years there have been numerous suggestions all of which are quite possible and easy to implement, take your pick. I have learned from reading journalwatch and following apps such as Figure1 because the information is spaced out and repetitive. Even the weekly questions sent out by knowledge+ are far more useful and less diarrhea inducing than sitting down and answering a face-slapping barrage of questions. As the shortage of family docs grows and more doctors learn that they can become financially independent quite early in their careers the ABFM will have a tough time convincing people to sit through the torture or pay for re-certification.
I want to comply with whatever measures are best for ensuring my continued best practice. However, I find these changes so confusing that I fear slipping off track for continued certification, now renewed for some 30 years of practice. Call me old-fashioned, but I do so want to keep up with the changes; just don’t see how to apply some of the requirements in my current practice. Help!
@John Mosby, in defense of the ABFM they actually have very helpful reps who are an email or phone call away and they will help you through the process. The website they run is impossible to navigate so I always find myself having to reach out to them, They haven’t let me down yet.
Indeed. I just concluded a very helpful chat with them and cleared up several of my questions. I expect to return to that source as I work through the process of completing the Part IV Performance Improvement Activities. I was stumbling over the instructions for Alternative PI Activities. Thanks for your suggestion, Sir.
I agree with many posts, MOC is a time wasting money wasting idea, but some states do not keep physicians who are not board certified, how can you prove your self smart and intelligent by taking 240 questions in one day, with limited information presented in questions to solve the case. This is not how we practice. Patients do not present like that! So what is the use, is it not enough to attend the CME or keep credit hours. I can understand the need of it after residency, but honestly in the real world practice, sitting through that exam is useless, to me Journals like AAFP, NEJM and other resources have been plenty to keep my CME and knowledge. In my entire fellowship I referred to Journal articles which was more helpful than studying for the boards, which I feel like is cramming info. And I practice well so far, in last 10 yrs. But I have to take time off and away from my practice and my patients to take it. Is it worth it?
I agree with a lot of the posters here about redundant, costly, time-consuming, and ultimately ineffective activities. Medicine is not practiced the way we take test questions. You need a benchmark to get people into medical school, through residency, and out to practice, but, ultimately, the journals and organized meetings/discussions with colleagues have been my absolute best guidance for treating my patients. I would agree as well that the process is confusing and intimidating when we’re just out here trying to treat patients. Another thing to worry about and have to spend time figuring out. And, as Mohammad mentioned, “they actually have helpful reps who will help you through the process”. Yes, but so have other historically tyrannical and unnecessary requirements. I hate the “this is to help you” argument and would agree that this is reinventing the wheel. I’m in practice 10 years now and, due to persistently annoying requirements such as this, have already found non-medical vocations to devote my time towards. It’s nice that Family Practice is too busy to fight for itself against such annoying requirements, but eventually your relative may have to go see the GI for their pharyngitis! See ya.
The addition of MOC activities is simply a way to generate income for the ABFM. The head I am told makes $680,000 per year salary plus benefits and retirement. It is a pure and simple money grab for their unit. 7-10 year testing is not enough. I have taken the exams 6 times since 1978. 40 years in practice. I attend frequent CME programs pertinent to my patient problems. Now in order to take the exam again I have to do additional MOC busy work and pay for the privilege to do this MOC busy work besides the $1,500 for the exam. MOC is to capture more dollars from other CME providers. The ABIM has a $2.5 million dollar condo in the Caribbean for their “Board Retreats”. NICE! Capitalism run amuck!