® INTERVENTIONAL CARDIOLOGY Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop Purpose of the Interventional Cardiology the Interventional Cardiology MOC exam MOC exam blueprint The MOC exam is designed to evaluate whether a certified Based on feedback from physicians that MOC assessments interventional cardiologist has maintained competence and should better reflect what they see in practice, in 2016 the currency in the knowledge and judgment required for practice. American Board of Internal Medicine (ABIM) invited all certified The exam emphasizes diagnosis and management of prevalent interventional cardiologists to provide ratings of the relative conditions, particularly in areas where practice has changed frequency and importance of blueprint topics in practice. in recent years. As a result of the blueprint review by ABIM This review process, which resulted in a new MOC exam diplomates, the MOC exams will places less emphasis on rare blueprint, will be used on an ongoing basis to inform and conditions and focuses more on situations in which physician update all MOC assessments created by ABIM. No matter intervention can have important consequences for patients. what form ABIM’s assessments ultimately take, they will For conditions that are usually managed by other specialists, need to be informed by front-line clinicians sharing their the focus will be on recognition rather than on management. perspective on what is important to know. Exam format A sample of over 275 interventional cardiologists, similar to the total invited population of interventional cardiologists in The traditional 10-year MOC exam is composed of 220 single- age, gender, time spent in direct patient care, and geographic best-answer multiple- choice questions, of which approximately region of practice, provided the blueprint topic ratings. The 50 are new questions that do not count in the examinee’s score. ABIM Cardiovascular Board Interventional Cardiology Exam ABIM’s Longitudinal Knowledge Assessment (LKA™) for MOC, Committee and Cardiovascular Board have used this feedback slated to launch in 2022, is a five-year cycle in which physicians to update the blueprint for the MOC exam (beginning with the answer questions on an ongoing basis and receive feedback Fall 2017 administration). on how they’re performing along the way. More information on how exams are developed can be found at abim.org/about/ To inform how exam content should be distributed across exam-information/exam-development.aspx). the major blueprint content categories, ABIM considered the average respondent ratings of topic frequency and importance Examinees taking the traditional ten-year MOC exam will have ® in each of the content categories. access to an external resource (e.g., UpToDate ) for the entire exam. Most questions describe patient scenarios and ask To determine prioritization of specific exam content within each about the work done (that is, tasks performed) by physicians major medical content category, ABIM used the respondent in the course of practice: ratings of topic frequency and importance to set thresholds for Diagnosis: these parameters in the exam assembly process (described • making a diagnosis or identifying an further under Detailed content outline below). underlying condition • Testing: ordering tests for diagnosis, staging, or follow-up • Treatment/Care Decisions: recommending treatment or 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 Some questions require interpretation of pictorial material, How the blueprint ratings are used to assemble such as coronary angiograms, ventriculograms, intravascular the MOC exam ultrasound images, nuclear perfusion studies, computed Blueprint reviewers provided ratings of relative frequency in tomograms, magnetic resonance images, electrocardiograms, practice for each of the detailed content topics in the blueprint echocardiograms, and peripheral vascular imaging studies. and provided ratings of the relative importance of the topics Exam tutorials, including examples of question format, can for each of the tasks described in Exam format above. In rating be found at abim.org/maintenance-of-certification/exam- importance, reviewers were asked to consider factors such information/interventional-cardiology/exam-tutorial.aspx. as the following: • High risk of a significant adverse outcome Content distribution • Cost of care and stewardship of resources Listed below are the major medical content categories that define the domain for the Interventional Cardiology MOC and • Common errors in diagnosis or management LKA exams. The relative distribution of content is expressed • Effect on population health as a percentage of the total exam. To determine the content • Effect on quality of life distribution, ABIM considered the average respondent ratings of topic frequency and importance. Informed by these data, the • When failure to intervene by the physician deprives a Interventional Cardiology Exam Committee and Cardiovascular patient of significant benefit Board have determined the medical content category targets Frequency and importance were rated on a three-point scale shown below. corresponding to low, medium, or high. The median importance ratings are reflected in the Detailed content outline below. The Interventional Cardiology Exam Committee and CONTENT CATEGORY TARGET % Cardiovascular Board, in partnership with the physician community, have set the following parameters for selecting Case Selection and Management 23% MOC exam questions according to the blueprint review ratings: Procedural Techniques 22% • At least 75% of exam questions will address high-importance content (indicated in green) Complications of Coronary Intervention 8% • No more than 25% of exam questions will address Catheter-Based Management of 10% medium-importance content (indicated in yellow) Noncoronary Disease • No exam questions will address low-importance content Basic Science 5% (indicated in red) Anatomy, Anatomic Variants, and 6% Independent of the importance and task ratings, no more than Anatomic Pathology 15% of exam questions will address low-frequency content Pharmacology 14% (indicated by “LF” following the topic description). Cardiac Imaging and Assessment 7% Miscellaneous 5% Total 100% JULY 2021 2 The content selection priorities below are applicable beginning with the Fall 2017 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 Interventional Cardiology 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 15% of exam questions will address topics with this designation, regardless of task or importance. CASE SELECTION AND Risk Assessment/ MANAGEMENT Treatment/ Prognosis/ Pathophysiology/ I (23% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science I.A CHRONIC ISCHEMIC HEART DISEASE (7% of exam) Clinical characteristics I.A.1 (demographics and comorbidities) Laboratory abnormalities and I.A.2 cardiac catheterization (hematology, coagulation, and chemistry) Renal insufficiency and cardiac I.A.3 catheterization Noninvasive testing before I.A.4 diagnostic catheterization I.A.5 Selection of treatment modality I.A.6 Interventional therapy I.A.7 Surgical therapy I.A.8 Medical therapy Preoperative cardiac evaluation for I.A.9 noncardiac surgery Preoperative revascularization I.A.10 before noncardiac surgery I.B UNSTABLE ANGINA AND NON-ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (UA AND NSTEMI) (6% of exam) Evaluation and risk stratification of I.B.1 the UA and NSTEMI UA/NSTEMI – pharmacologic I.B.2 management UA/NSTEMI – timing of cardiac I.B.3 catheterization UA/STEMI – percutaneous coro- I.B.4 nary intervention (PCI) 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 15% of exam questions will address topics with this designation, regardless of task or importance. CASE SELECTION AND MANAGEMENT continued… Risk Assessment/ Treatment/ Prognosis/ Pathophysiology/ I (23% of exam) Diagnosis Testing Care Decisions Epidemiology Basic Science I.C ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) (6% of exam) I.C.1 STEMI systems of care I.C.2 Primary PCI – procedure I.C.3 Primary PCI – stents I.C.4 Primary PCI – thrombectomy I.C.5 Primary PCI – outcomes I.C.6 Right ventricular infarction LF I.C.7 Multivessel PCI Primary PCI following I.C.8 cardiopulmonary arrest I.C.9 STEMI – differential diagnosis I.C.10 Acute aortic dissection LF I.C.11 Therapeutic hypothermia I.C.12 Fibrinolytic therapy LF I.C.13 Transfer for PCI I.C.14 Rescue PCI LF I.C.15 Surgical therapy in STEMI LF I.C.16 Medical management after STEMI I.D STEMI COMPLICATIONS (4% of exam)