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FOCUSED PRACTICE in HOSPITAL MEDICINE Maintenance of Certification (MOC) Examination Blueprint

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FOCUSED PRACTICE in HOSPITAL MEDICINE Maintenance of Certification (MOC) Examination Blueprint ® FOCUSED PRACTICE IN HOSPITAL MEDICINE Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop the Purpose of the Hospital Medicine MOC exam Hospital Medicine MOC exam blueprint The MOC exam is designed to evaluate the knowledge, Based on feedback from physicians that MOC assessments diagnostic reasoning, and clinical judgment skills expected of should better reflect what they see in practice, in 2016 the the certified hospitalist in the broad domain of the discipline. American Board of Internal Medicine (ABIM) invited all certified The exam emphasizes diagnosis and management of prevalent hospitalists and those enrolled in the focused practice program conditions, particularly in areas where practice has changed to provide ratings of the relative frequency and importance of in recent years. As a result of the blueprint review by ABIM blueprint topics in practice. diplomates, the MOC exam places less emphasis on rare This review process, which resulted in a new MOC exam conditions and focuses more on situations in which physician blueprint, will be used on an ongoing basis to inform and intervention can have important consequences for patients. update all MOC assessments created by ABIM. No matter For conditions that are usually managed by other specialists, what form ABIM’s assessments ultimately take, they will need the focus is on recognition rather than on management. The to be informed by front-line clinicians sharing their perspective exam is developed jointly by the ABIM and the American on what is important to know. Board of Family Medicine. A sample of over 100 hospitalists, similar to the total invited Exam format population of hospitalists in age, gender, geographic region, and time spent in direct patient care, provided the blueprint The traditional 10-year MOC exam is composed of 220 single- topic ratings. The ABIM Hospital Medicine Exam Committee best- answer multiple-choice questions, of which approximately and Internal Medicine Board have used this feedback to 50 are new questions that do not count in the examinee’s update the blueprint for the MOC exam (beginning with the score. ABIM’s Longitudinal Knowledge Assessment (LKA™) Fall 2016 administration). for MOC, slated to launch in 2023, is a five-year cycle in which physicians answer questions on an ongoing basis and receive To inform how exam content should be distributed across feedback on how they’re performing along the way. More the major blueprint content categories, ABIM considered information on how exams are developed can be found at the average respondent ratings of topic frequency and abim.org/about/exam-information/exam-development.aspx). importance in each of the content categories. A second source of information was the relative frequency of patient Examinees taking the MOC exam will have access to an external ® conditions in the content categories, as seen by certified resource (e.g., UpToDate ) for the entire exam. Most questions hospitalists and documented by national health care data describe patient scenarios and ask about the work done (that (described further under Content distribution below). is, tasks performed) by physicians in the course of practice: Diagnosis: To determine prioritization of specific exam content within each • making a diagnosis or identifying an major medical content category, ABIM used the respondent underlying condition ratings of topic frequency and importance to set thresholds for • Testing: ordering tests for diagnosis, staging, or follow-up these parameters in the exam assembly process (described • Treatment/Care Decisions: recommending treatment or further under Detailed content outline below). other patient care • Risk Assessment/Prognosis/Epidemiology: assessing risk, determining prognosis, and applying principles from epidemiologic studies • Pathophysiology/Basic Science: understanding the pathophysiology of disease and basic science knowledge applicable to patient care JULY 2021 1 Clinical information presented may include patient photographs, How the blueprint ratings are used to assemble radiographs, electrocardiograms, and other media to illustrate the MOC exam relevant patient findings. Exam tutorials, including examples Blueprint reviewers provided ratings of relative frequency in of question format, can be found at abim.org/maintenance- practice for each of the detailed content topics in the blueprint of-certification/exam-information/hospital-medicine/exam- and provided ratings of the relative importance of the topics tutorial.aspx. for each of the tasks described in Exam format above. In rating importance, reviewers were asked to consider factors such as Content distribution the following: Listed below are the major medical content categories that • High risk of a significant adverse outcome define the domain for the Hospital Medicine MOC and LKA exams. The relative distribution of content is expressed as • Cost of care and stewardship of resources a percentage of the total exam. To determine the content • Common errors in diagnosis or management distribution, ABIM considered the average respondent ratings • Effect on population health of topic frequency and importance. To cross-validate these self-reported ratings, ABIM also considered the relative frequency • Effect on quality of life of conditions seen in the National Hospital Discharge Survey. • When failure to intervene by the physician deprives a Informed by these data, the Hospital Medicine Exam Committee patient of significant benefit and Internal Medicine Board have determined the content Frequency and importance were rated on a three-point scale category targets shown below. corresponding to low, medium, or high. The median importance ratings are reflected in the Detailed content outline below. The Hospital Medicine Exam Committee and Internal Medicine CONTENT CATEGORY TARGET % Board, in partnership with the physician community, have set the following parameters for selecting MOC exam questions Inpatient and transitional care: 63.5% according to the blueprint review ratings: Cardiovascular disorders 12% • At least 75% of exam questions will address high-importance content (indicated in green) Pulmonary disease and critical care 12.5% medicine • No more than 25% of exam questions will address medium-importance content (indicated in yellow) Gastroenterologic and hepatic disorders 10.5% • No exam questions will address low-importance content Nephrologic and urologic disorders 8.5% (indicated in red) Endocrinologic disorders 5% Independent of the importance and task ratings, no more than Hematologic and oncologic disorders 3.5% 20% of exam questions will address low-frequency content (indicated by “LF” following the topic description). Neurologic disorders 7.5% Allergic, immunologic, dermatologic, 4% and rheumatologic disorders Palliative care, medical ethics, and 6.5% decision‐making Consultative co‐management 15% Quality, safety, and clinical reasoning 15% Total 100% The Hospital Medicine MOC exam may cover other dimensions of medicine as applicable to the medical content categories, such as infectious disease and clinical epidemiology. JULY 2021 2 The content selection priorities below are applicable beginning with the Fall 2016 MOC exam and are subject to change in response to future blueprint review. Note: The same topic may appear in more than one medical content category. Detailed content outline for the Hospital Medicine MOC exam – High Importance: At least 75% of exam – Medium Importance: No more than 25% – Low Importance: No exam questions questions will address topics and tasks of exam questions will address topics and will address topics and tasks with with this designation. tasks with this designation. this designation. LF – Low Frequency: No more than 20% of exam questions will address topics with this designation, regardless of task or importance. INPATIENT AND TRANSITIONAL CARE: CARDIOVASCULAR Risk Assessment/ DISORDERS Treatment/ Prognosis/ Pathophysiology/ (12% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science HYPERTENSION (<2% of exam) Secondary Hypertensive crisis PERICARDIAL DISEASE (<2% of exam) Acute pericarditis LF Cardiac tamponade LF Constrictive pericarditis LF ISCHEMIC HEART DISEASE (3% of exam) Stable angina pectoris Unstable angina pectoris ST-segment elevation myocardial infarction Non-ST-segment elevation myocardial infarction Right ventricular infarction LF Other ischemic heart disease (cocaine-induced chest pain) ARRHYTHMIAS (2% of exam) Atrial fibrillation or flutter Atrioventricular nodal reentrant LF tachycardia Atrioventricular reciprocating tachycardia and Wolff-Parkinson- LF White syndrome JULY 2021 3 – High Importance: At least 75% of exam – Medium Importance: No more than 25% – Low Importance: No exam questions questions will address topics and tasks of exam questions will address topics and will address topics and tasks with with this designation. tasks with this designation. this designation. LF – Low Frequency: No more than 20% of exam questions will address topics with this designation, regardless of task or importance. INPATIENT AND TRANSITIONAL CARE: CARDIOVASCULAR DISORDERS continued… Risk Assessment/ Treatment/ Prognosis/ Pathophysiology/ (12% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science ARRHYTHMIAS continued… (2% of exam) Atrial tachycardia and multifocal atrial tachycardia Ventricular arrhythmias Long QT syndrome and torsades LF de pointes Bradyarrhythmias and conduction defects Sudden cardiac death
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