American Board Of Radiology - AAPM HQ

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American Board of Radiology- Current Issues and Considerationsfor Radiological PhysicistsG. Donald Frey, Ph.DACMP Meeting 2011Department of Radiology and Radiation ScienceMedical University of South CarolinaCharleston, SCPhysics Trustees andAssociate Executive Director G. Donald Frey Geoffrey Ibbott 2012/2014 RequirementsMaintenance of Certification Cognitive Exam for MOC (Physicists)RO portfolioRichard Morin MNP PortfolioTopicsDX PortfolioStephen Thomas AED for Physics1

Current Emphasis-Minimum Education2012/2014 Requirements Clinical Experience in MedicalPhysics Requirement has been dropped forPart 1Three years of clinical experience isstill required for Part 2 Or completion of a two year CAMPEPresidency3 advanced undergraduate orgraduate physics courses3 graduate medical physics courses2 undergraduate or graduate biologycourses2012 Requirements As of 2012 either a CAMPEP degreeor a CAMPEP residency is required tosit for the ABR Exam Last year to apply under currentsystem was 2010Beginning with the 2011 cycle either A CAMPEP Accredited DegreeOR A CAMPEP Accredited Residency2

2014 Requirements As of 2014 a CAMPEP residency isrequired to sit for the ABR ExamMissionThe mission of The American Board ofRadiology is to serve patients, the public, andthe medical profession by certifying that itsdiplomates have acquired, demonstrated,and maintained a requisite standard ofknowledge, skill and understandingessential to the practice of diagnosticradiology, radiation oncology and radiologicphysicsWhy the Change?Six Competencies1. & Medical KnowledgePatient CareInterpersonal & Communication SkillsProfessionalismPractice-based Learning &ImprovementSystems-based Practice3

Tools – Initial Certification Standards for physics educationStandards for medical physicseducationStandards for clinical trainingStandards for experienceExaminations In 2002 ABR announced that in 10years they would require CAMPEPtrainingA number of meetings with stakeholders Poorly Educated(Basic Knowledge)Poorly Educated(Clinical Education)Narrow Clinical BaseParts 1,2 and OralTen Years to CAMPEP Early 21st CenturyAAPM, ABR, CAMPEP, (Many Others)New Model for Professional EducationNew Model forClinical Medical Physics TrainingEducation in Physics(Under Graduate Degree)Degree in Medical Physics(CAMPEP Graduate Degree)(4 yrs)Degree in Physics(Graduate Degree)( 2 yrs)CAMPEP SupplementaryAcademic Training in MPClinical Training(CAMPEP Residency)(2 yrs)4

By 2020Poorly Educated(Basic Knowledge)Poorly Educated(Clinical Education)CAMPEP Academic EducationResidencyEffects of the Initiatives onApplication NumbersNarrow Clinical BaseResidencyRecent Application NumbersWritten Exam Pass Rates (%)Part 1 applications haveapproximately doubled since2007 and should peak thisyear.Record number of oral examsthis year ans orals should peakin 2013,Jan 20105

Failure Rates:non-CAMPEP vs. CAMPEP2003 - 2009Oral Exam Pass Rates (%)Jan 2010Jan 2010New Certificates per Year Above 200 per yearThis is widely viewed as more than theprofession can sustainSerious Issues Remain Number of ResidenciesTotal Number of Medical PhysicistsNeededRole of the Professional DoctorateHow to Accommodate PhysicistsTrained in Other Countries6

MOC – No significant changesThe Boards want the publicand governmentalauthorities to acceptparticipation in MOC asbeing reasonable evidencethat the practitioner ismaintaining his or herprofessional skillsGeneral StructureABMSABRMajor policies and structuresABIMETCSignificant variationDXRPROMinor variation7

ProfessionalStandingMOC Is Dynamic PracticeQualityImprovementMOCLifelongLearning &SelfAssessmentThe MOC Requirements Change Refined by ABMS and Individual BoardsNew Elements Come into Effect in theLater Years of Each CycleCognitiveExpertiseABR Personal Data BaseProfessionalStandingTwo PathsUnrestricted LicenseAttestation8

Lifelong LearningSDEP’s for PhysicistsLifelongLearning &SelfAssessment 25 hours of MPCEC or Category I 80% for RO in ROSAMS RO 1 per yearMP 2 per year15 hours per year can come fromSDEP’s Self Directed Educational ProjectThe ABMS is adjusting the SAMRequirements so this will change soon.The net result will probably that somefraction LLL will have to havean evaluation componentSelf Assessment Modules 20 [2 per year] physicists10 [1 per year] radiation oncologistsSome SAMS are on-lineMost professional organizations offerSAMs at their meetingsThere is a list of approved SAMs onthe ABR website9

MOC – Lifelong Process MOC is intended to be a continuousprocess thus there are limits to theamount of Life-long learning and SAMcredits that are acceptable each year Life-long LearningSAMS504 MP & 2 ROTemporary Catch-up ProvisionThis provision to the MOC Participation policy allowsdiplomates with a certificate expiring from 2009-2015 tocomplete triple the normal yearly MOC requirements duringa calendar year starting in year seven (7) of the MOC cycleand extending into the three year grace period, ifnecessary.Temporary Catch-up ProvisionDetails of provision:Is available to all Diagnostic Radiology, Radiation Oncologyand Radiologic Physics diplomates with a certificateexpiring from 2009 - 2015.Reporting triple the normal requirements is not availableuntil year 7 of MOC cycle and extends through the end ofthe 3 year grace period, if needed.This provision to the MOC Participation Policy will expire onDecember 31, 2018Getting 03025105025203026000000050505050200There is a point where it is impossible not to have a lapse in yourcertification. Enters “Non-recoverable” status10


Maintenance of CertificationCognitive ExamCognitiveExamCognitive Exam One per CycleTake in years 8, 9, 10(This may change)Pilot was given in2009First Exam 2010 Required by ABMS So all ABMS boards have an exam in alldisciplinesSome research shows that an examimproves performanceHowever – some groups like the RoyalCollege in Canada do not require one12

Study Guides Are Provided 30% basic70% new materialClinical ProtocolsStandardsRelevant DocumentsIssues Exam Validation Criteria ReferencedValidatedMost people will maintain theircompetencyExam needs to be sensitive andspecificExam needs to be acceptable tolegislators, and regulatorsExam needs to be acceptable to thegeneral publicStatus Pilot in 2009 Pass Rate 75%Exams available Years 8-10Exam was given in Fall 2010Very Small Numbers13

PracticeQualityImprovementPQI - Rationale All diplomates musthave training inPQIAll must becontinuouslyinvolved in the PQIprocessFirst Steps Training is the First StepWe need to learn to do effectiveprojects that improve health and safetyWe need to incorporate PQI into thefabric of the culture of our workIt took Toyota more than 20 years totransform it’s manufacturing culture Significant issues of quality and safety inmedicine Institute of Medicine “To Err Is Human”Industrial Experience fromManufacturing Process ControlABR PQI ProcessThe first year isallocated to training inPQI. The best way todo this is to do a SDEP,14

emeasure& TrackReview &Analyze DataCreate &ImplementImprovementPlanTypes of ProjectsNewProjectSafety forPatients,Employees& Public PracticeGuidelines&StandardsSurveysWorking on a number of fronts to make it“easier”Group Practice projects SocietySponsoredReportTurnaroundTimes &CommunicationPQI Developments IndividualAccuracyOf Analyses&Calculations Physics and physician componentsInstitution projects – whole “health system”for example. Would get “deemed status”from ABMSTemplates – make personnel projects easier15

Fee’s and Late Fees ABR has had a significant expenseassociated with MOC Fees MOC StaffIncreased fees for ABMSThe ABR Takes the FollowingSteps to Keep EnrolledIndividuals InformedLate (or No) Payment HasBeen An Issue Not nearly so much for physics as forthe other disciplinesHowever since on January 1, 2009 alate fee of 100 applies for those whohave not paid the previous years fees.For original enrolled individuals the fee wasconstant for all 10 years of the cycle.This will start to increase on an annual basisbeginning with the group having certificatesexpiring in 2018 and will apply to othergroups when they finish their first cycle. 1) Discussions held at ABR Booth at society meetings2) Pamphlets distributed at various society meetings3) Trustee presentations at various society meetings4) Articles, announcements in paper and electronic newsletters of various societies5) The Beam6) Articles published in Medical Physics and other journals7) Email from the ABR8) Snail mail/postcards from ABR9) Website content and FAQs10) Direct email responses to individual email questions11) One-on-one phone conversations with diplomates in office12) Surveys16

MOC The full integration of the MOCprocess so its components are fullyintegrated into the training and practiceof diplomates will be lengthyHowever this process will strengthenthe professions and increase publictrust17

The mission of The American Board of Radiology is to serve patients, the public, and the medical profession by certifying that its diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill and understanding essential to the practice of diagnostic radiology, radiation oncology and radiologic physics Six Competencies 1. Professional & Medical Knowledge 2 .

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