In 2021, the American Board of Emergency Medicine (ABEM) launched its new certification process, MyEMCert, which established a five-year recertification cycle. ABEM has announced that its established process, ConCert, will be discontinued after 2022, and MyEMCert will be required of all physicians seeking recertification.
Explore This IssueACEP Now: Vol 40 – No 12 – December 2021
The transition began nearly five years ago, explained Marianne Gausche-Hill, MD, president of ABEM. “That’s when we began to study many of the changes that other specialties were undertaking in continuing certification,” she said. In 2017, ABEM convened a meeting of EM organizations to discuss the issue, which was followed by a series of focus groups and a survey of all ABEM-certified physicians. In 2020, a pilot of approximately 1,200 ABEM-certified physicians taking MyEMCert modules was conducted to provide feedback.
Although it has been years in the making, the move away from the familiar ConCert process, which has operated on a 10-year certification cycle, has sparked some concern and questions from the emergency medicine community as to what EM residents and physicians can expect from the new model.
Components of MyEMCert
MyEMCert consists of four modules and one Improvement in Medical Practice (IMP) activity, all of which must be successfully completed over a five-year period to receive recertification. This is in contrast to ConCert, which is taken all at once every 10 years. The MyEMCert assessment includes Key Advances (ie, new medical advances), a feature that has been integrated into the modules to keep physicians up-to-date. “In addition, physicians will need to maintain a medical license in compliance with ABEM policy and attest to the ABEM Code of Professionalism,” said Dr. Gausche-Hill. “For physicians in a five-year cycle, not completing these requirements at the end of five years means losing their certification.” She adds that the process for initial certification “is being reviewed but will likely remain a rigorous examination process.”
To help physicians prepare, ACEP launched PEERcert+ (www.acep.org/PeerCertPlus), a tool composed of questions and image-based study aids designed to mirror the MyEMCert exam. “When ABEM announced that the recertification process was changing, ACEP wanted to provide its members with a product that would help them not just prepare to pass the exam but also to continue to provide optimal patient care at the bedside,” explained Maria Moreira, MD, FACEP, medical director of continuing education and simulation at Denver Health in the Office of Education, associate professor of emergency medicine at the University of Colorado School of Medicine, and Editor-in-Chief for PEERcert+.
“We wanted to mirror the new testing structure, so we developed questions pertaining to specific case presentations,” said Dr. Moreira. “The components of each PEERcert+ module also include typical core content questions and key advance questions based on ABEM’s Key Advance Articles. We also developed first-aid tool kits as quick references for learning and test taking.” She notes that the existing PEERprep and PEER tools are still in place for physicians preparing for initial certification.
The new format represents an overhaul in the entire assessment approach. MyEMCert is designed to be an online assessment, so physicians will no longer need to travel to a testing site. Moreover, the modules are all taken open-book. “Physicians can take modules at any time from any place,” said Dr. Gausche-Hill. “And because they are open-book, they are assessments for learning rather than assessments of learning.”
Impact on Physicians
The immediate effect of the transition from ConCert to MyEMCert on individual practitioners varies from nonexistent to considerable, depending on when they originally received their ABEM certification. As Dr. Gausche-Hill explained, physicians seeking to recertify have had the option to do so by either taking the ConCert Exam and Lifelong Learning and Self-Assessment (LLSA) tests or MyEMCert, depending on where they are in their certification cycle. Some physicians, she said, might complete a combination of MyEMCert modules and LLSA tests.
The opportunity to take ConCert will end after the 2022 examinations are given, and LLSA tests will no longer be available once all currently certified physicians transition to the five-year certification cycle. “Eventually—probably around 2025–2026—LLSAs will be phased out, and MyEMCert and IMP activities will be the components of continuing certification,” Dr. Gausche-Hill said. “These changes result in a physician completing fewer total activities over any 10-year period.” She adds that physicians can check their requirements based on their certification end date using the √ ABEM Reqs feature on the website.1
When this transition is complete and all physicians are taking MyEMCert, everyone will have five years’ time in which to complete the recertification requirements. Until then, physicians who are up for recertification in less than five years’ time and choose MyEMCert will still be required to complete all of its components by their certification end date.
Heather Studley, MD, FACEP, an emergency physician at Brigham and Women’s Hospital in Boston, is one such physician. She received her certification in 2011 and was therefore up for recertification this year. Given that this is a transitional year, she could either take the written ConCert exam as originally planned or opt for MyEMCert and complete all its requirements in just one year.
“At first, I was miserable about it,” said Dr. Studley. “But ultimately, I actually found it way better than having to study for the written boards and go sit down in a testing center.” To prepare, she reviewed information from the ABEM website on the new format and referenced the UpToDate resource while taking the tests. She passed all but one test, which she passed on the second try.
The decision was a lot easier for Anand Swaminathan, MD, MPH, FACEP, assistant clinical professor of emergency medicine at St. Joseph’s Hospital in Paterson, New Jersey. Dr. Swaminathan took his 10-year written boards in 2019. With MyEMCert, he has until 2024 to complete his exams, so he opted to do just one module this year. “I did the ‘Abnormal Vital Signs and Shock’ section and passed on the first try,” he said. “The questions were as difficult as those on the standard written exam, but having a smaller chunk to take on and having resources available made it much more palatable.” Having taken his written exam so recently, Dr. Swaminathan did not need to study in advance. During the test, he used the online textbook CorePendium and the open-source search engine FOAM Search for reference.
The flexibility of taking exams from any place and at any time—and even to pause an exam at a moment’s notice, then get back to it when it is convenient—is likely to find favor with most physicians. Based on their experiences, both Dr. Studley and Dr. Swaminathan have mostly positive reviews for MyEMCert.
“I don’t think there’s much I would change,” said Dr. Swaminathan. “I think it’s a very reasonable assessment in comparison to the prior format.” Dr. Studley feels that the MyEMCert exam questions are more concise than those on the ConCert exam, but she does see room for improvement. “They still need to work out the kinks in terms of questions that are vague or confusing because they’re not worded very well,” she said. “But as an alternative to the written boards, it’s much better.” She also benefited from the open-book, instant-feedback format of the new exams. “If I’m looking up a question, I’m referring my memory or I’m learning something in that moment. Either way, with the type of learner I am, I’m more likely to retain the information.”
The cost impact of the change from ConCert to MyEMCert on physicians is more a question of payment schedule than total fee amount. Some physicians, such as Dr. Swaminathan, feel that the price for maintaining certification overall is too high, “particularly for a fresh graduate,” he said. MyEMCert, however, does not introduce new fees to the recertification process. “In terms of cost, it is the same as under the ConCert format. That is, the annualized cost is the same with MyEMCert as it was under ConCert,” explained Dr. Gausche-Hill. “The bottom line is that it is a more level payment system without the large single fee associated with the ConCert Exam.”
A Call for Relevance
The overall message that came out of those ABEM meetings and focus groups, and especially the emergency physicians survey, was that the existing certification content had been falling short. “Physicians let us know that they wanted something more clinically relevant, convenient, and that would help them learn about new advances in medicine,” said Dr. Gausche-Hill. “Obviously, this is a value to their patients, who are receiving care based on the most up-to-date medical advances. Emergency medicine benefits from having physicians who are being kept up-to-date and for being a leader in quality assessment.” It was this feedback that ABEM used to develop MyEMCert.
As Dr. Moreira explains, PEERcert+ was designed to support an optimally relevant and clinically useful recertification experience. “We wanted to create a product that physicians could continue to use to stay up-to-date on the best care of patients,” she said. “PEERcert+ tries to mirror the presentation of those patients to our departments so we can put all the information we need to know into the appropriate context.”
Dr. Studley found the MyEMCert content more applicable to her daily practice than the written boards she took in 2011. “For that test, I had five questions on sarin nerve gas,” she said. “Well, if you’re trying to test me on the spectrum of what’s relevant in my practice, it’s definitely not sarin nerve gas. So with MyEMCert, there were less of those sorts of obscure questions and much more practical questions on topics related to our day-to-day practice.”
Dr. Gausche-Hill acknowledges that any change to a process that has been in place for decades is not going to be a simple endeavor. “Creating a new type of test using a new technology platform has been expensive and challenging,” she said. “Creating a type of question that embeds learning and instant feedback takes a great deal of work. However, ABEM was able to meet our commitment to ABEM-certified physicians.” She encourages physicians to contact ABEM and/or use the organization’s online resources to facilitate a smooth recertification experience.
“We are lifelong learners,” concluded Dr. Moreira. “Medicine changes, and we need to stay on top of these changes to provide our patients with the best evidence-based care.”
Linda Kossoff is a freelance medical writer based in Woodland Hills, California.