ABFM Research Update: Using Diplomate Feedback to Inform Quality Improvement in Certification

While the scope and impact of its work continues to grow, the American Board of Family Medicine (ABFM) research department considers the evaluation of Family Medicine Certification (FMC) its top priority, from tracking participation over time; assessing choice of, and satisfaction with, specific activities; measuring changes in care from completing specific FMC activities; and updating foundational knowledge of certification. Described below are some important examples of research studies related to board certification.

• In the transition from periodic certification to a continuous program, the ABFM found that participation in certification was higher among those in continuous certification.^1–3 No difference was noted among Diplomates by rural or urban location, though those who practiced in high poverty and underserved areas were less likely to complete certification requirements.⁴ A study of all Diplomates who initially certified from 1980 to 2000 showed that the percentage of Diplomates who did not attempt to continue certification dropped from just above 10% to less than 6%.⁵
• In a qualitative study of both family physicians and general internists regarding their preparation for a continuing certification examination, respondents indicated that they changed their strategy for staying current in their medical knowledge by engaging with a different scope of information and by adopting different study methods.⁶ A vast majority of these physicians reported gaining knowledge relevant to their practice from examination preparation.⁷
• In collaboration with the Federation of State Medical Boards, researchers found that family physicians who were ABFM certified were less likely to have any state medical licensing action and if they were, the severity of the action was lower than those incurred by non-certified family physicians.⁸
• With regard to the reasons that family physicians participate in certification, a 2017 study found that a majority of Diplomates were required to maintain certification for the purposes of employment, credentialing, or payer reimbursement.⁹ However, the same proportion also reported that they maintained certification to update their medical knowledge and improve the quality of care they deliver. In line with these findings, ABFM has shown that Diplomates with higher disease-specific exam scores in diabetes and hypertension were more likely to complete diabetes and hypertension activities.¹⁰
• Diplomate satisfaction with the old Self-Assessment Modules (SAMs) was high in the initial rollout.¹¹ When satisfaction with the components of the SAMs was tracked over time, the ABFM found that the clinical simulation component was ranked less favorably.^12,13 The ABFM used these results to split the SAM into separate knowledge and clinical simulation activities. Diplomates have also reported higher satisfaction with PI Activities¹⁴ and useful comparative feedback on practice performance.¹⁵ Completion of PI Activities in diabetes and hypertension were associated with improvements in quality measures.^16–18 Positive improvements in quality measures in asthma, diabetes, and cardiovascular disease were also found in prospective studies.^19,20

Aggregate feedback data from ABFM research efforts are placed on an internal ABFM business intelligence platform and are actively viewed by staff to inform continuous quality improvement efforts related to ABFM certification. Additional studies are under way that will continually update the information from Diplomates regarding the value of ABFM certification and its process and activities. These findings are critical to ensuring the value to both Diplomates and the public.

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