★ The United States public began to demand improved quality in emergency departments. Thus, hospitals developed full-time emergency services, and a number of physicians began developing the training and practice of EM. New organizations were formed, such as ACEP and the University Association for Emergency Medical Services (UA/EMS), which is now the Society for Academic Emergency Medicine (SAEM).
★ The American Medical Association (AMA) sponsored a conference on physician education in emergency medical care.
★ The AMA approved a formal section on EM.
★ The American Board of Emergency Medicine (ABEM) was incorporated. During this same period, there was increased interest in providing EM graduate training programs. The UA/EMS and ACEP established the Liaison Residency Endorsement Committee for the endorsement of graduate training programs.
★ ABEM submitted an application to the American Board of Medical Specialties (ABMS) seeking primary board status. This application was referred to the Liaison Committee for Specialty Boards (LCSB), a committee comprised of AMA and ABMS representatives. The LCSB recommended primary board approval and sent the recommendation to its parent bodies. The AMA Council on Medical Education approved this recommendation, but the ABMS defeated it. At the suggestion of various ABMS members, representatives from other specialty boards held a lengthy series of discussions from which a recommendation emerged for a second application, this time seeking approval for a conjoint board (modified). The AMA Council on Medical Education and the ABMS approved this application (see Figure 1).
★ SEPTEMBER: EM became the 23rd recognized medical specialty (see Figure 2).
★ ABEM offered the first EM certification examinations.
★ MAY: ABEM submitted an application to ABMS for conversion to primary board status. The ABMS Assembly defeated this application.
★ SEPTEMBER 21: The ABMS Assembly voted unanimously to approve the ABEM application (see Figure 3). Ten years after the 1979 original vote, ABEM took its place as an ABMS Member Board with full primary board status.
★ Guidelines for five-year combined training programs were approved for emergency medicine/internal medicine (IM) and emergency medicine/pediatrics. Upon completion, physicians can access the certification examinations in EM and IM or EM and pediatrics.
★ ABMS approved subspecialty certification in pediatric emergency medicine, with ABEM
and the American Board of Pediatrics (ABP) as co-sponsors.
★ ABMS approved sports medicine as a subspecialty, with by ABEM, the American Board of Family Practice, the American Board of Internal Medicine (ABIM), and ABP as co-sponsors.
★ ABMS approved medical toxicology as a subspecialty, with ABEM, ABP, and the American Board of Preventive Medicine (ABPM) as co-sponsors.
★ A task force was appointed to define the context and processes by which a new core content for emergency medicine could be created. The task force included ABEM, ACEP, SAEM, and the Council of Emergency Medicine Residency Directors. Representatives of the Resident Review Committee for Emergency Medicine (RRC-EM) and the Emergency Medicine Residents’ Association (EMRA) were later included. ABEM was the administrative organization for the project.
★ FEBRUARY: ABEM and the American Board of Internal Medicine (ABIM) approved guidelines for a six-year combined training program for triple certification in EM, IM, and critical care medicine (CCM).
★ The Board of Directors commissioned the Maintenance of Certification (MOC) Task Force. From the work of the task force, ABEM developed the Emergency Medicine Continuous Certification (EMCC) program. The EMCC (professional standing, Lifelong Learning Self-Assessment [LLSA], ConCert, and Assessment of Practice Performance [APP]) program is anchored in the ABMS MOC guidelines for all member boards.
★ ABMS approved undersea and hyperbaric medicine as a subspecialty, with ABEM and ABPM as co-sponsors.
★ FEBRUARY: The Model of the Clinical Practice of Emergency Medicine (EM Model) was approved. ABEM adapted the EM Model as an examination blueprint for all of the ABEM examinations.
★ ABEM and ABIM approved the first six-year combined training program for EM/IM/CCM.
★ JANUARY: ABEM implemented the first three components of EMCC. APP was scheduled to begin in 2010.
★ JANUARY: The bylaws were changed to create a board of directors comprised entirely of emergency physicians.
★ ABEM administered the last paper-and-pencil written certification examination and for the first time began development of a computer-delivered examination to be administered in testing centers in November 2006.
★ JANUARY: The following boards withdrew as sponsors: ABIM, American Board of Obstetrics and Gynecology, American Board of Pediatrics, American Board of Psychiatry and Neurology, American Board of Surgery.
★ JANUARY: An MOC program in medical toxicology began.
★ The medical toxicology certification examination and the MOC cognitive expertise examination were changed to be computer delivered.
★ ABEM and the American Board of Family Medicine approved guidelines for a five-year combined training program in both EM and family medicine.
★ SEPTEMBER: In conjunction with the American Board of Hospice and Palliative Medicine, ABEM joined nine other ABMS member boards in sponsoring the newly approved ABMS subspecialty of hospice and palliative medicine. The first certification examination was given in 2008.
★ JUNE 1: The first Medical Toxicology LLSA test became available.
★ JANUARY: APP, the fourth component of EMCC, began for some diplomates.
★ SEPTEMBER 1: The AMA increased the number of AMA PRA Category 1 Credits from 25 to 60 credits for successfully attaining board certification by passing the oral examination or successfully maintaining certification by passing the ConCert Examination. Diplomates are given up to six years from the effective date on their certificate to apply for the credits.
★ SEPTEMBER 28: The ABMS, at its General Assembly meeting, approved EMS as its 112th subspecialty, making it the sixth subspecialty available to ABEM diplomates.
★ FEBRUARY: An EMS Examination Task Force, composed of 12 EMS physicians, was appointed by ABEM. The first examination was administered in the fall of 2013.
★ ABEM introduced the next phase of EMCC by changing the requirements and frequency of the EMCC activities required to continue certification.
★ APRIL 1: CME for completing the 2011 LLSA CME activity became available. This opportunity was the result of an unprecedented collaboration between ABEM, ACEP, and the American Academy of Emergency Medicine (AAEM). Diplomates can apply for credit for this activity through either AAEM or ACEP. CME is available with the 2011, 2012, 2013, and 2014 EM LLSAs, the Patient Safety LLSA, the 2013 Medical Toxicology LLSA, and the 2014 EMS LLSA. ABEM did not raise fees during 2013–2014.
★ SEPTEMBER 21: The subspecialty of Internal Medicine-Critical Care Medicine (IM-CCM) was unanimously approved. Emergency physicians can now participate in IM–sponsored CCM fellowships and are eligible to seek board certification. IM-CCM became the seventh subspecialty certification available to ABEM diplomates.
★ JUNE: ABEM was approved by the Centers for Medicare and Medicaid Services (CMS) to participate in the Physician Quality Reporting System (PQRS) MOC incentive program. An additional 0.5 percent reimbursement on Medicare billings is available for meeting their basic PQRS reporting requirements. ABEM was approved again in 2013 and 2014. More than 4,100 ABEM diplomates applied for the 2013 bonus, receiving an estimated $2.3 million for participating. EM participated in the PQRS MOC to a greater extent than any other specialty.
★ SEPTEMBER: The Emergency Medicine Milestones were approved. The EM Milestones are a matrix of the knowledge, skills, abilities, attitudes, and experiences that should be acquired at different points during EM training. The EM Milestones Project was a joint initiative of the Accreditation Council for Graduate Medical Education (ACGME) and ABEM, and was supported by representatives of the Association of Academic Chairs of Emergency Medicine (AACEM), AAEM, ACEP, Council of Emergency Medicine Residency Directors, EMRA, RRC-EM, and SAEM.
★ The ConCert examination was no longer the final step in renewing certification, delinking the four parts of MOC. Diplomates can, therefore, register for and take the ConCert examination in any of the last five years of certification, even if they have not completed all of their MOC requirements. However, at the end of a diplomate’s ten-year certification, any outstanding MOC requirements will result in loss of certification.
★ MAY: The Board of Directors of the ACGME approved allowing emergency physicians to formally enter surgical critical care (SCC) fellowships, providing a pathway for EM diplomates to train for and take the subspecialty certification examination. Certification in SCC is through the American Board of Surgery (ABS).
★ OCTOBER: The first certification examination in EMS took place. The first EMS LLSA reading list was posted in July 2013, and the first test is in June 2014.
★ FALL: The first certification examination in clinical informatics, which is open to diplomates of all ABMS Member Boards, took place, and 44 ABEM diplomates took the exam.
★ APRIL: ABEM was approved by the ABMS to become a cosponsor of the subspecialty certification in pain medicine. Subspecialty certification in pain medicine, which had been open to diplomates of any ABMS member board, will be soon available only to diplomates of a cosponsoring board, so this allows ABEM diplomates to continue to have access to the examination.
★ SPRING: ABEM launched a patient safety LLSA, jointly developed by ABEM and ACEP. A CME activity worth 20 credits was also available with the Patient Safety LLSA.
★ JUNE: ABMS approved anesthesiology critical care medicine subspecialty certification co-sponsored by the American Board of Anesthesiology and ABEM.
★ The enhanced oral exam was launched. The new format more closely resembles the manner in which physicians receive and integrate information into emergency care.
★ FEBRUARY: The In-training exam was offered in an online format for the first time.
★ MARCH: Addiction medicine was approved as a subspecialty by the ABMS, open to any physician certified by an ABMS member board.
★ The ABA and ABEM approved combined training in anesthesiology and emergency medicine. Upon completion of these training programs, physicians can access the certification examinations in both specialties.
★ ABEM and the American Board of Osteopathic Emergency Medicine (AOBEM) joined
other EM organizations to form the Coalition on Medical Merit Badges (COMMB). COMMB maintains that participation in either ABEM MOC or AOBEM OCC programs supersedes the need for additional “merit badge” training (eg, advanced cardiac life support). COMMB works to educate other organizations and credentialers about the content of continuing certification programs in order to reduce such requirements for emergency physicians.
Dr. Klauer is an ACEP Board member; CMO–hospital-based services, chief risk officer, and executive director–patient safety organization at TeamHealth; ACEP Now medical Editor in Chief; and clinical assistant professor, University of Tennessee and Michigan State University College of Osteopathic Medicine.
Dr. Counselman was President of ABEM in 2014, and is distinguished professor of emergency medicine and chair of the department of emergency medicine at Eastern Virginia Medical School in Norfolk, and member of the Emergency Physicians of Tidewater.