B. Hadley Wilson, MD, FACC, ACC President
Joseph C. Wu, MD, PhD, FAHA, AHA President
James C. Fang, MD, FHFSA, HFSA President
Jodie L. Hurwitz, MD, FHRS, HRS President
George D. Dangas, MD, PhD, MSCAI, SCAI President
Achieving and maintaining clinical competence in the practice of cardiovascular medicine is fundamental to providing appropriate, patient-centric, high-value health care and is part of the ethical and professional duties of all physicians in their responsibility to patients and the public.
Since its inception in 1941, the American Board of Internal Medicine (ABIM) has been tasked with evaluating and certifying cardiologists to ensure that they meet specific educational and training standards. While this arrangement initially made sense, the field of cardiovascular medicine has evolved significantly over the last few decades, establishing itself as a distinct medical specialty with unique care pathways, knowledge base, patient-focused guidelines, specialized training, expected competencies and its own derivative subspecialties, separate and distinct from internal medicine.
Recognizing this rapid evolution and the need for a contemporary certification process tailored to the specific professional and educational needs of cardiologists, the American College of Cardiology (ACC), the American Heart Association (AHA), the Heart Failure Society of America (HFSA), the Heart Rhythm Society (HRS) and the Society for Cardiovascular Angiography and Interventions (SCAI) joined forces in 2023 to request the creation of a new, independent Board of Cardiovascular Medicine under the auspices of the American Board of Medical Specialties (ABMS) that will ultimately represent the entire “house of cardiology.”
The new Board, if approved, would focus on supportive learning rather than episodic testing, and provide a collaborative approach to assessments that foster continuous knowledge and skills competency. It would also be:
- Directed by an ultimate responsibility to the public;
- Focused on patients at the center of all decisions;
- Affirmed by professionalism, equity and well-being;
- Centered on relevance to real-world practice;
- Aligned with cardiovascular subspecialties and team-based care;
- Supportive of both established and innovative educational methods and assets;
- Accountable for nonclinical competencies necessary for effective care delivery; and
- Committed to sustained value for cardiovascular professionals and their patients that respects time, cost and administrative burden.
These key principles fully align with the rigorous, recently developed ABMS “Standards for Continuing Certification,” which promote integrated, specialty-specific programs that further a diplomate’s continuous professional development and emphasize improvements in health care quality, safety, and value. (1)
One of the key goals of the new Board, in addition to optimizing initial certification, would be to address current challenges in the continuing recertification landscape, such as moving away from one-time, high-stakes assessments. These assessments are perceived as punitive and less effective in promoting lifelong learning and practical skill development. Increasing clinician frustrations with these assessments highlight the limitations of a system emphasizing passing test scores in favor of sustained, personalized learning to support closing knowledge gaps and improving skills.
Under the proposed Board, continuing certification assessments would inform focused learning opportunities and guide cardiologists toward personalized learning resources. Aligning with psychologist George Miller’s Pyramid of Clinical Competence, the focus of the new Board would shift from simply testing what physicians know or do not know to testing the full hierarchy of competence: knowledge, application of knowledge, clinical skills competency and clinical performance. (2) In the future, this may involve embracing novel forms of competency assessment, including hands-on and virtual simulations, augmented reality, Objective Structured Clinical Examinations (OSCEs), and peer-to-peer problem-solving activities that provide richer and more rewarding experiences for physicians. Documenting clinical competence can and should evolve into a more cost- and time-efficient, technology-based, supportive process to achieve the goal of optimal patient care and outcomes.
Incorporating advanced technology that is already revolutionizing communication, education and clinical support in health care would be another key focus of the new Board. For example, Application Programming Interfaces (APIs) could facilitate seamless digital education-credit transfer, while real-time reporting through credit tracking dashboards would offer clinicians an efficient means of managing and tracking progress. Automation would increase efficiency and be more convenient and time saving for physicians, while also lowering costs and allowing for proactive identification of those with deficits in certification requirements.
Beyond clinical competence, there is also an opportunity to address nonclinical competencies that are increasingly – and rightfully – being recognized as critical to health care transformation, including diversity, inclusion, health equity, professionalism, communication, leadership and well-being.
While we are excited by the potential for the new Board and are hopeful that we have successfully made the case for why one is needed, we are still likely months away from an official decision from ABMS. It is important that physicians currently participating in maintenance of certification (MOC) through ABIM, whether through the Collaborative Maintenance Pathway (CMP), Longitudinal Knowledge Assessment (LKA), or the 10-year examination, should continue to do so. If the new Board is approved, a process for initial certification and a seamless transition of current diplomates to the new Board’s competency-based, continuous certification will be implemented, preserving existing credits and certification status. Regular updates are available on the website, CVBoard.org.
Meanwhile, we continue to work closely with ABMS as they work through the application review process. A public comment period is expected in the coming months. It will be important that all of us take part in making the case for a new, independent Board of Cardiovascular Medicine.
At the end of the day, achieving and maintaining proficiency in clinical cardiovascular knowledge and skills are essential for delivering suitable and valuable health care, constituting a core aspect of our ethical and professional obligations to our patients. The effort to create the new Board aligns with the evolving needs of our patients, the latest scientific advances and our professional progress, offering an innovative and contemporary approach to certification. Now is the opportune time for the “House of Cardiology” to unite and transform the future of cardiovascular medicine.
- American Board of Medical Specialties. Standards for Continuing Certification. Nov. 1, 2021. https://www.abms.org/newsroom/abms-announces-new-standards-for-continuing-certification/ (Accessed Feb. 27, 2024)
- Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990 Sep;65(9 Suppl):S63-7. doi: 10.1097/00001888-199009000-00045. PMID: 2400509.
The joint society Leadership Page is simultaneously published in JACC, Circulation, Journal of Cardiac Failure, Heart Rhythm, Journal of the Society for Cardiovascular Angiography & Interventions.
