Introductory Remarks by the President of the American Board of Medical Specialties

The American Board of Medical Specialties (ABMS) serves as the umbrella organization for 24 specialty boards that serve as the primary source of voluntary physician specialty certification in the United States. Ophthalmology began the tradition of certifying specialty Boards in 1917. In 1933, The American Board of Ophthalmology, along with three other recently formed boards, established the ABMS as an organization to oversee the common standards for establishing new specialties in the U.S. physician workforce and to develop and oversee the standards by which certification and more recently ABMS Maintenance of Certification® (ABMS MOC) are implemented. Currently, there are more than 600,000 physicians who are board-certified by one of the 24 Boards; that is equivalent to an estimated 85% of the U.S. physician workforce. Therefore, ABMS board certification serves as a very valued process and useful tool to help assure the public that the profession of medicine can maintain excellence through self-regulation. In 1999, ABMS in collaboration with the Accreditation Council for Graduate Medical Education (ACGME) agreed to a set of six areas for physician competencies. These competencies now serve as the basis for initial physician training in specialty care for all ACGME-approved residency programs and for evaluation for initial board certification and MOC. These competencies include: patient care, medical knowledge, interpersonal and communication skills, professionalism, systems-based practice, and practice-based learning and improvement. The ABMS MOC program evaluates these competencies through a comprehensive four-part program. Part 1 is professional standing, Part 2 lifelong learning and self-assessment, Part 3 knowledge examinations, and Part 4 assessment and improvement of practice performance. It is in the context of these six competencies and four-part comprehensive evaluation that the use of simulation should be viewed both as a tool for skill development and maintenance, but also for professional evaluation. A few ABMS Boards use a standardized simulated patient encounter experience as part of their initial certification process, including ABEM, whose oral certification examination uses examiner–examinee role-playing as part of a series of simulated patient encounters. Also, several ABMS Boards are either using simulation in Part 2 of MOC or piloting work using simulation. A very different type of simulation being used by the American Board of Family Medicine (ABFM) is a product called ClinSim. ABFM uses ClinSim as part its MOC program. This is a system that uses computer-based simulation to evaluate how a physician moves through a series of diagnostic and therapeutic decisions. The American Board of Internal Medicine (ABIM) is exploring simulation technology in the evaluation of technical and procedural skills. ABIM is focused on how simulation tools can be used to demonstrate technical skills competency for a select group of cardiology-related procedures. There is a rapidly growing interest among the Boards in using simulation, so it would be reasonable to expect that the use of simulation in physician initial training and lifelong learning will increase as the science of simulation evolves. For this interest to translate into increasing use of simulation, the science of simulation will need to set goals for continued rapid growth by both demonstrating the validity and reliability of these techniques and also demonstrating how competency in the use of simulation relates to clinical outcomes. In addition, it will be important for the field of simulation to build tools and techniques that can be easily adopted and that are scalable to large numbers of users at a reasonable cost. With these goals met, there should be every expectation that simulation will become an integral part of continual professional development and its attendant lifelong evaluation of professional certification.