How does one know when it’s time to step down from a position that has meant so much—particularly when you are so passionate about a cause such as emergency medicine?

For Mary Ann Reinhart, Ph.D., who is retiring as the American Board of Emergency Medicine’s (ABEM) executive director effective April 1, 2010, the answer is surprisingly simple.

“I truly believe that I’ve given ABEM the best I can give it, and no one should stay on longer than that,” she said. “I’ve accomplished the goals I set for myself, and I’m happy with what I’ve done. It’s time for me to build new goals and take on new challenges and new ways to have fun.”

Having fun is a common thread that Dr. Reinhart has woven throughout her every initiative during her 10 years as ABEM’s executive director and her previous 5 years as its deputy executive director—and it’s a powerful way to motivate busy emergency physicians to volunteer their time for ABEM.

“I believe there are two keys to that success,” Dr. Reinhart said. “First, make certain that they have challenging, rewarding work in which they have an interest, and help them achieve lots of success in that. And second, treat them warmly, respectfully, and help them have a good time.”

Dr. Reinhart deserves far more credit, said Dr. Brooks Bock, chief executive officer of Colorado Mountain Medical in Vail, Colo., and a past ABEM president.

“The entire ABEM board is a volunteer group, and I think it’s Mary Ann’s commitment to excellence, her hard work, and her genuine passion for emergency medicine that cause people to step up their own work product and really give a significant effort,” Dr. Bock said.

A Passion for Education

Perhaps Dr. Reinhart’s greatest passion is the development of standards and the ongoing education and evaluation of emergency physicians.

“I firmly believe that board certification and physician self regulation are critical to a well-functioning health care system,” she said. “I’ve always believed in education and training. While I realize that many exceptional people can come to talent and skill in an area through their own resources, I also believe that all of us can do better if we have experts teaching us and marking our progress along the way.”

The board and Dr. Reinhart led ABEM as it accomplished a number of important changes during the past decade.

ABEM raised standards for examiner training, as well as expectations for the reliability and validity of examiners’ efforts administering examinations.

Dr. Reinhart oversaw the research and development project to create “The Model of the Clinical Practice of Emergency Medicine” (EM Model), a scientifically based practice analysis of clinical emergency medicine.

In 2001, the six sponsoring organizations approved the EM Model, which ABEM then adapted for use as an examination blueprint for all future written certification and recertification examinations.

Dr. Reinhart is “a very intelligent, charming, warm individual who works tirelessly to promote the specialty of emergency medicine,” said the current ABEM president, Dr. Debra Perina.

She recalled just how critical Dr. Reinhart’s admirable people skills were to the EM Model’s approval.

“Mary Ann is quite skilled at negotiations and is able to, through open discussions, bring consensus to a group that’s quite disparate in the beginning,” Dr. Perina said. “I remember this specifically with the development of the EM Model, which is one of the accomplishments that I think stand out during her tenure as executive director.

“No other specialty has a written model that is data driven and reflects the actual practice of that specialty,” she added. “That emergency medicine has it is largely through the collective efforts of multiple organizations, led by ABEM. Mary Ann was instrumental in helping to bring those parties together to reach consensus.”

Dr. Reinhart’s interest in examinations extended to each test question, and thus she developed ABEM’s Item Writers Workshop for volunteers who help write ABEM’s test questions.

“This is an opportunity for us to help train our item writers to a comfort level that feels good to them and that works for the board, and it’s also an opportunity for them to bring their families and for all the writers and their families to get to know each other,” Dr. Reinhart said. “It’s truly been a lot of fun over the years.”

“This workshop is a wonderful chance for our item writers to get feedback and further education on how to write a good test item,” Dr. Perina said. “The science behind the writing that our item writers learn is something that Dr. Reinhart taught initially, and she has since passed on this legacy by teaching others to do the same. I believe it’s been the pivotal point in terms of our development of such a valid exam.”

Dr. Reinhart’s examination standards of excellence have made an invaluable contribution to ABEM’s overall reputation, said Dean Wilkerson, ACEP’s executive director.

“Mary Ann has helped create a process for physicians who come through residency to prove their knowledge and skill, and then with their recertification to make sure they’re staying at a high standard for our specialty,” he said.

“She has helped position ABEM to where it’s now regarded as one of the best specialty boards in medicine,” he added. “Therefore, there’s a confidence that emergency physicians who are board certified have undoubtedly earned that credential.”

LLSA and the Online Shift

In bringing ABEM’s Lifelong Learning and Self-Assessment (LLSA) to fruition in 2004—one of the four components of the ABMS’ “Maintenance of Certification®” process—ABEM shifted from paper-and-pencil to Internet- and computer-delivered testing and developed more flexible item banking, scoring, and oral examination scheduling systems.

These changes allowed ABEM to accommodate fluctuating numbers of candidates and increase flexibility about when and how examinations are delivered.

“We recognized that the only way we could deal with the breadth of the LLSA program was by having it work for our diplomates in an online system, and allowing them to access it anytime they wanted to,” said Dr. Reinhart. “It was a huge challenge to make that shift from pencil-and-paper to the Internet for such a complex, high-stakes assessment system.”

During this time, ABEM also substantially increased its subspecialty-related activities, joining nine other ABMS member boards in 2006 to sponsor a subspecialty in Hospice and Palliative Medicine.

In addition, thanks largely to Dr. Perina and Dr. Reinhart’s work with content experts and other ABMS member boards, ABMS is currently considering ABEM’s application for an Emergency Medical Services subspecialty, which is expected to be approved during the coming year. ABEM content experts are also hard at work with the American Board of Internal Medicine, assisted by Dr. Reinhart, developing an application for joint internal medicine/critical care subspecialty recognition.

The Future of ABEM

As she looked toward the future, Dr. Reinhart said such relationships are vital for ABEM’s future.

“I believe it’s critical for ABEM to continue to maintain its positive working relationships with other emergency medicine organizations. We are one specialty, and we must work together to keep emergency medicine strong and to keep our standards high,” she said. “In addition, it will be important for our board to maintain its positive and productive working relationships with the other ABMS member boards, and to keep a strong and influential position with the ABMS itself.”

While ABEM’s board of directors is currently in search of its third chief executive, Dr. Reinhart will be a difficult person to follow.

“Someone once said to me, ‘When you see something that’s done really well in a well-managed, highly professional organization like ABEM, it doesn’t happen by accident,’ ” Mr. Wilkerson said. “I think that’s definitely true here, and Mary Ann deserves a lot of credit for maintaining incredibly high standards for ABEM and everything they do.

“If you look at their publications, their Web site, their staff and their oral exams, everything is done exceptionally well, in my opinion, and that’s a credit to her,” he added. “Whoever comes behind her has some big shoes to fill.”