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ABEM « The Central Line

Archive for category ABEM

Critical Care Certification for Emergency Physicians – The “Grandfather” Pathway

Dr. Francis L. Counselman

By Francis L. Counselman, M.D., CPE, FACEP

In the August 2013 issue of ACEP News, the various pathways available to current and future emergency medicine residency graduates to achieve Critical Care Medicine (CCM) certification through fellowship training were reviewed. In this issue, the options available to ABEM diplomates who completed a Critical Care Medicine fellowship prior to the establishment of the current pathways will be discussed.

First, there is no “practice only” pathway for Critical Care Medicine. All CCM certification requires successful completion of ACGME-accredited CCM fellowship training, and practice of Critical Care Medicine. Secondly, there is no “grandfather” pathway available through the American Board of Surgery (ABS) for Surgical Critical Care. This decision by ABS was made for internal policy consistency, and there are no exceptions. Finally, like all “grandfather” pathways, there is a time-limited window during which one can apply for certification. Please make yourself aware of these dates.

American Board of Internal
Medicine (ABIM) Critical Care Medicine
For Internal Medicine-Critical Care Medicine (IM-CCM), the “grandfather” pathway requires both the completion of a 24-month CCM fellowship and the practice of Critical Care Medicine. This pathway is scheduled to close on June 30, 2016. For the 24-month CCM fellowship to count, it must meet one of the following criteria: a) an ACGME-accredited IM-CCM fellowship completed prior to September 21, 2011; b) an unaccredited IM-CCM fellowship that subsequently became ACGME-accredited on or before December 31, 1992; or c) an ACGME-accredited fellowship in another critical care specialty (i.e., Surgical CCM, Anesthesiology CCM).

The second component, the practice portion, is a little more complicated. The EM applicant must have met the practice criteria as of the date on which the application is submitted to ABEM. For at least three years, not necessarily contiguous, of the five years prior to submitting the application (including the 12 months immediately prior to submission), the applicant must have met one of the following criteria: a) 40% of post-training clinical practice time in the practice of CCM; or b) 25% of total post-training professional time in the practice of CCM.

Finally, for those ABEM diplomates who completed an ACGME-accredited IM-CCM fellowship in the recent past (i.e., between September 21, 2008, and September 20, 2011) criteria can be met if, during 60% of the time between completing fellowship training and applying for certification, the applicant completed one of the following: a) 40% of post-training clinical practice in the practice of CCM or; b) 25% of total post-training professional time in the practice of CCM.  For example, if an applicant completed fellowship training on June 30, 2011, and applied for certification on July 1, 2013, 60% of the time (i.e., 24 months) would be 14.4 months.  So, during that 14.4-month period between completion of fellowship training and application submission, the applicant must meet either the 40% or 25% criterion, as described above.

Physicians whose total practice exceeds 40 hours per week may use 40 hours as the denominator for the “40%” or “25%” calculations for either of the above scenarios.

American Board of Anesthesiology (ABA)
Critical Care Medicine (ACCM)
ABEM diplomates seeking certification through the “grandfather” pathway must have completed both an ACGME-accredited ACCM fellowship program (one or two years in length) and the CCM practice component by the time of application submission, and no later than June 30, 2018; this is the final date of the last application period within the grandfather pathway. The ACCM fellowship training must have been started prior to July 1, 2013.  In order for the fellowship program to count, it must have been ACGME-accredited at the time of the applicant’s training; it does not count if the fellowship subsequently became accredited.

For the practice component, during the two years immediately preceding the application submission, the applicant must have completed one of the following: a) 40% of post-training clinical practice time in the practice of CCM, or; b) 25% of total post-training professional time in the practice of CCM. For either calculation, if total practice time exceeds 40 hours per week, 40 hours may be used as the denominator for the “40%” or “25%” calculation.

Additional Details
For both the IM-CCM and ACCM eligibility criteria, the “practice of CCM” is strictly defined. An acceptable practice must occur in a designated critical care unit.  Caring for critically ill patients in the ED does not count toward the practice component. For more detail on what constitutes the practice of CCM, please visit the ABEM website at www.abem.org

For all CCM subspecialty pathways, the ABEM diplomate must: meet the requirements of the ABEM Maintenance of Certifications (MOC) program at the time of application and throughout the certification process; be in compliance with the ABEM Policy on Medical Licensure; and provide information about someone who can independently verify the physician’s clinical competence in CCM, successful completion of ACGME-accredited CCM fellowship training, and the physician’s practice of CCM. No opportunities for CCM certification existed just two years ago for emergency physicians, but we now have three pathways going forward, including two grandfather pathways. It is a very exciting time for emergency physicians interested in Critical Care Medicine. The opportunities that now exist are the direct result of the hard work, persistence, and energy of many of our colleagues. To all involved, “Thank you!”

Dr. Counselman is Chairman of the Department of Emergency Medicine at Eastern Virginia Medical School, and President-elect of ABEM.
Here’s a link to the first article in this two-part series

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ABEM Loses Power, Extends MOC Deadlines

Editor’s Note: Power distributions from an ice storm have impacted business at the American Board of Emergency Medicine, and they have asked ACEP to help spread the word about their special circumstances.

A significant ice storm on Dec. 22 caused power and communication outages with the ABEM headquarters. These disruptions are continuing while the utility companies actively work on restoring dependable service. Please be advised that intermittent disruptions are possible during the next several days. ABEM apologizes for any inconveniences physicians may have encountered in trying to reach its office or website services.

All December 31, 2013, deadlines for completing MOC activities and PQRS MOC Additional Incentive Payment requirements have been extended to January 10, 2014, 11:59 p.m., EST.

Holiday Hours
The ABEM office will be closed from Dec. 25, 2013, through Jan. 1, 2014.

However, contingent upon the restoration of the power and communication outages the ABEM office is currently experiencing due to the ice storm, staff will be available on December 26, 27, 30, and 31 from 8:30 a.m. to 4:30 p.m. EST to provide assistance with ABEM MOC requirements.

Questions about your ABEM MOC requirements can be sent to MOC@abem.org, or you can call 517.332.4800 for assistance during the times noted.

 

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RESUSCITATING YOUR MOBILE DEVICE

We all know how quickly things change in the ER. One minute you’re quietly browsing the Web, the next you’re running a code. Ironically, with all the chaos that surrounds our workplace, your laptop, iPhone, smartphone, iPad or other personal mobile device may actually be more at risk than your patients are.
All kinds of people move through the ER. Some are more than willing to commit crimes of opportunity. All it takes is for an expensive device to be left unattended for a moment and it can be gone. And despite what you might assume, not all homeowner policies cover the full value of stolen personal devices, especially ones used professionally.
It only gets worse. If somehow your device crashes to the floor and is rendered unusable, factory warranties won’t cover the repairs. Even supplemental policies, the kind offered by many retailers, exclude damage caused by full liquid submersion. (Before you ask where or how full submersion occurs, consider how many people carry cell phones and iPods in their shirt pocket wherever they go—including the bathroom.)
It wasn’t until all this was pointed out to me that I looked into the coverage for my devices. There were significant gaps. I became concerned that accidental damage would not only leave me without the use of my laptop or iPhone, but also that sensitive professional data would also be compromised or lost, raising liability issues.
My advice is for you to check out your policies for yourself. Considering how important our mobile phones and computing devices have become, the last thing you want is to face an expensive repair or replacement due to something that happened on the job. (In case you’re wondering, there are insurance companies that cover mobile devices against theft or virtually any kind of accident. The ones I found were The Worth Group, Apple Care, Square trade, mobile protect for iPhone. Some of these do not cover theft some do. The one I felt that was the most cost effective and covered thief was The Worth Group. As always do your own research and look at all your options. For now, I have only covered the items that the kids play with and the electronics at risk of being stolen.

Also, one important item to remember. Make sure you have any electronic device that might have access to patient data or has patient data under PIN. You dont want any HIPAA fines..

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The next Vaccine rush

Texas A&M was recently given a 40 million dollar grant from the U.S. Department of Defense to develop vaccines from tobacco.  What is amazing is that this 21 aces with 145,000-square-foot facility could produce a billion vaccines in a month. Clinical trials should begin late 2011. Dont worry about nicotine. The plants do not have any.

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Number 27: The Answer is C

(Or: Give Me The Right Answers, ABEM!)

courtesy Wikimedia Commons

Today we residents are post-inservice exam, put together by The American Board of Emergency Medicine, and I can say this about the test: I’m glad I’m not an intern anymore. I’ve obviously still got a lot to learn, but it’s nothing like the feeling of overwhelmth (yes, just made that up) you feel halfway through your internship thinking, “I’m supposed to know the answer to this?”

But today I’m not writing about those mushy-gushy feelings and experiences. No no. Today, I want answers.

I was always annoyed with standardized medical tests (primarily the USMLE) where you left the exam with a) no idea how you performed and b) no real feedback for several months. At this point, I don’t really care if I missed a question about cyclic GMP on USMLE Step I, but for the inservice exam, it’s a different story. This is stuff that I apparently need to know. And so, please, ABEM: I want to know the right answers.

If the point of the inservice and the boards is knowledge and learning and requiring a certain level of competency of emergency physicians, then why not give us feedback so we don’t actually screw something up with an actual patient? What, the answer wasn’t ceftriaxone? Why not? What is it that I’m not understanding about the case that you thought it so important a concept as to test it? If a resident answers that he or she wants to use an ABG to rule out a pulmonary embolism, or decide to get abdominal films as the test of choice for right lower quadrant pain, shouldn’t we be telling that resident (or his or her program) that there’s some serious educating that needs to happen?

ABEM: I want an email with feedback on the questions I missed, or wasn’t sure about. Have me optionally fill out my email address in bubble format, and when you scan through my answers and calculate my percentage, email me the answers. Or, if you don’t want to share the questions because you recycle them, email me the specific topic. Not just “management of status epilepticus,” but “second and third line agents for status epilepticus.” Not just “tick borne disease,” but “treatment of pediatric lyme disease.”

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