Pediatric Hospital Medicine Content Outline In-Training, Initial Certification, and Maintenance of Certification Exams THE AMERICAN BOARD of PEDIATRICS Table of Contents Overview ................................................................................................................................................................................ 1 Development of the Pediatric Hospital Medicine Content Outline ................................................................................. 1 Content Domains ............................................................................................................................................................... 1 Universal Tasks .................................................................................................................................................................. 1 Development and Classification of Exam Questions ....................................................................................................... 2 Sample Question ................................................................................................................................................................ 2 Exam Weights ....................................................................................................................................................................... 3 Detailed Content Outline ................................................................................................................................................... 4 Domain 1: Medical Conditions .......................................................................................................................................... 4 Domain 2: Behavioral and Mental Health Conditions ..................................................................................................... 6 Domain 3: Newborn Care .................................................................................................................................................. 6 Domain 4: Children with Medical Complexity ................................................................................................................... 6 Domain 5: Medical Procedures ......................................................................................................................................... 7 Domain 6: Patient- and Family-Centered Care ................................................................................................................. 7 Domain 7: Transitions of Care........................................................................................................................................... 7 Domain 8: Quality Improvement, Patient Safety, and Systems-Based Improvement ................................................... 7 Domain 9: Evidence-Based High-Value Care.................................................................................................................... 8 Domain 10: Advocacy and Leadership ............................................................................................................................. 8 Domain 11: Ethics, Legal Issues, and Human Rights ...................................................................................................... 8 Domain 12: Teaching and Education ............................................................................................................................... 8 Domain 13: Core Knowledge in Scholarly Activities ........................................................................................................ 8 Overview CONTENT DOMAINS This content outline was developed to serve as the The knowledge for safe and effective practice as a blueprint for the ABP’s pediatric hospital medicine pediatric hospitalist has been categorized into 13 examinations. This outline identifies for all important content domains, presented in the table below. A more stakeholders (eg, prospective candidates, diplomates, detailed breakdown of the knowledge subdomains the public, training programs, professional associations, within each domain is provided in the detailed content employers) the knowledge areas being measured by outline, beginning on page 4. Each exam question (also these exams. All pediatric hospital medicine in-training, referred to as an item) included on a pediatric hospital initial certification, and maintenance of certification medicine exam is classified according to the content (MOC) examinations adhere to the specifications within domain and subdomain to which it is most closely this outline. aligned. If an item does not align with a content domain and subdomain, it is removed from the item pool and is DEVELOPMENT OF THE PEDIATRIC HOSPITAL MEDICINE not included on an exam. CONTENT OUTLINE Pediatric Hospital Medicine Content Domains The initial draft of this content outline was developed by 1. Medical Conditions * a diverse, representative panel of 11 practicing 2. Behavioral and Mental Health Conditions * pediatric hospitalists. The panel identified the 3. Newborn Care * knowledge required of pediatric hospitalists in clinical practice and categorized that knowledge into content 4. Children with Medical Complexity domains and subdomains. Subsequently, all pediatric 5. Medical Procedures hospital medicine fellowship program directors (N = 47) 6. Patient- and Family-Centered Care were invited to review the draft outline and provide 7. Transitions of Care comment. Responses were received from 15 program 8. Quality Improvement, Patient Safety, and directors, and the panel used that feedback to update Systems-Based Improvement the draft content outline. 9. Evidenced-Based High-Value Care Next, the ABP conducted a large-scale survey of 10. Advocacy and Leadership practicing pediatric hospitalists to validate the draft 11. Ethics, Legal Issues, and Human Rights content outline. Survey responses were obtained from 12. Teaching and Education 800 full-time, clinically active pediatric hospitalists. The 13. Core Knowledge in Scholarly Activities survey asked participants to rate the frequency and * Items that fall within domains 1-3 are also classified to a criticality of the content domains and subdomains. The universal task (see below). survey also collected open-ended comments from respondents in order to identify any important content UNIVERSAL TASKS areas that had not been included in the draft outline. To help ensure the clinical relevance of the pediatric The survey results were used to make final revisions to hospital medicine exams, the practice analysis panel the outline and to establish the exam weights (ie, the identified a set of four universal tasks that reflect the percentage of exam questions associated with each primary ways in which medical knowledge can be content domain). The content domains that were rated applied in clinical practice: (1) core science and as highly critical and frequently required in practice pathophysiology, (2) epidemiology and risk have been weighted more heavily than the domains assessment, (3) diagnosis and evaluation, and (4) rated as less critical and/or less frequently required. management and treatment. Each item that falls Establishing the exam weights in this manner helps to within content domains 1, 2, or 3 (medical ensure that ABP’s pediatric hospital medicine exams conditions, behavioral and mental health conditions, are measuring the full breadth of knowledge required for or newborn care, respectively) is classified according clinical practice, while also placing an appropriate to the universal task to which it is most closely amount of emphasis on the content domains that were aligned. If an item within those domains does not identified by the field of practicing pediatric hospitalists align with one of the universal tasks, it is removed as being critically important. from the item pool and is not included on an exam. The universal tasks are described more fully below: 1 1. Core science and pathophysiology: Apply Once an item has been written, it is then reviewed and foundational and evidence-based knowledge of revised, if necessary, by the Pediatric Hospital Medicine diseases and conditions commonly seen in Subboard, a large, diverse panel of practicing pediatric hospitalized children, including normal and hospitalists. During the revision process, each item is abnormal functions of the body and mind in an also reviewed by a medical editor to ensure accuracy age-specific developmental context and by ABP staff editors who standardize question style, 2. Epidemiology and Risk Assessment: Recognize format, and terminology; correct grammar; and eliminate patterns of health and disease and understand ambiguity and technical flaws, such as cues to the the variables that influence those patterns and answer. the impact that those patterns may have on patient management principles Once the subboard has approved an item, it is included 3. Diagnosis and Evaluation: Use available in the item pool and is made available for future exams. information (eg, patient history, physical exam) All approved items in the pool, including items that have to formulate differential diagnoses, choose been used previously on an exam, are reviewed appropriate tests, and interpret test results to periodically for accuracy, currency, and relevance. reach a likely diagnosis 4. Management and Treatment: Formulate a SAMPLE QUESTION comprehensive management and/or treatment To illustrate how items are classified, consider the plan, including appropriate