New Cardiology Certification Board: What's the Plan?

The proposal by the major cardiovascular societies in the US to form a new board of cardiovascular medicine to manage initial and ongoing certification of cardiologists represents something of a revolution in the field of continuing medical education and exam of competency. 

Five US cardiovascular societies — the American College of Cardiology (ACC), the American Heart Association (AHA), the Heart Failure Society of America (HFSA), the Heart Rhythm Society (HRS), and the Society for Cardiovascular Angiography & Interventions (SCAI) — have now joined forces to propose a new professional certification board for cardiovascular medicine, to be known as the American Board of Cardiovascular Medicine (ABCVM). 

The ABCVM would be independent of the American Board of Internal Medicine (ABIM), the current organization providing maintenance of certification for cardiologists as well as many other internal medicine subspecialties. The ABIM's maintenance of certification process has been widely criticized for many years and has been described as "needlessly burdensome and expensive." 

The ABCVM is hoping to offer a more appropriate and supportive approach, according to Jeffrey Kuvin, MD, a trustee of the ACC, who has been heading up the working group to develop this plan. 

Kuvin, who is chair of the cardiology at Northwell Health, Manhasset, New York, a l arge academic healthcare system, explained that maintenance of certification has been a topic of discussion across the cardiovascular community for many years, and the ACC has a working group focused on the next steps for evaluation of competency, which he chairs.

"The topic of evaluation of competence has been on the mind of the ACC for many years and hence a work group was developed to focus on this," Kuvin noted. "A lot of evolution of the concepts and next steps have been drawn out of this working group. And now other cardiovascular societies have joined to show unification across the house of cardiology and that this is indeed the way that the cardiovascular profession should move." 

The general concept behind the new cardiology board is to separate cardiology from the ABIM. 

"This is rooted from the concept that cardiology has evolved so much over the last few decades into such a large multidimensional specialty that it really does demarcate itself from internal medicine, and as such, it deserves a separate board governed by cardiologists with collaboration across the entirely of cardiology," Kuvin said. 

Cardiology has had significant growth and expansion of technology, tools, medications, and the approach to patients in many specialities and subspecialties, he added. "We have defined training programs in many different areas within cardiology; we have our own guidelines, our own competency statements, and in many cases, cardiology exists as its own department outside of medicine in many institutions. It's just time to separate cardiology from the umbrella of internal medicine." 

The new cardiology board would be separate from, and not report to, the ABIM; rather, it would report directly to the American Board of Medical Specialties (ABMS), the only recognized medical certification body in the US. 

Under the present system, managed by the ABIM, clinicians must undergo two stages of certification to be a cardiologist. First, they have to pass the initial certification exam in general cardiology, and then exams in one of four subspecialties if they plan to enter one of these, including interventional cardiology, electrophysiology, advanced heart failure or adult congenital heart disease. 

Next, clinicians enter the maintenance of certification phase, which can take three different forms: 1) taking another recertification exam every 10 years; 2) the collaborative maintenance pathway — a collaboration between ACC and ABIM, which includes evaluation, learning and a certified exam each year; or 3) longitudinal knowledge and exam — in which the program interacts with the clinician on an ongoing basis, sending secured questions regularly. 

All three of these pathways for maintenance of certification involve high stakes questions and a set bar for passing or failing. 

Under the proposed new cardiology board, an initial certification exam would still be required after fellowship training, but the maintenance of certification process would be completely restructured, with the new approach taking the form of continuous learning and exam of competency. 

"This is an iterative process, but we envision with a new American Board of Cardiovascular Medicine, we will pick up where the ABIM left off," Kuvin notes. "That includes an initial certifying examination for the five areas that already exist under the ABIM system but with the opportunities to expand that to further specialties as well."

He points out that there are several areas in cardiology that are currently not represented by these five areas that warrant some discussion, including multimodality imaging, vascular heart disease, and cardio-oncology. 

"At present, everybody has to pass the general cardiology exam and then some may wish to further train and get certified in one of the other four other specific areas. But one topic that has been discussed over many years is how do we maintain competency in the areas in which clinicians practice over their lifetime as a cardiologist," Kuvin commented. 

He said the proposed cardiology board would like to adhere to some basic principles that are fundamental to the practice of medicine. 

"We want to make sure that we are practicing medicine so that our patients derive the most benefit from seeing a cardiologist," he said. "We also want to make sure, however, that this is a supportive process, supporting cardiologists to learn what they know and more importantly what they don't know; to identify knowledge gaps in specific area; to help the cardiologist fill those knowledge gaps; to acknowledge those gaps have been filled; and then move on to another area of interest. This will be the focus of this new and improved model of continuous competency."

The proposed new board also says it wants to make sure this is appropriate to the area in which the clinician is practicing.

"To take a closed book certified exam every 10 years on the world of cardiology as happens at the current time – or the exams conducted in the other two pathways – is often meaningless to the cardiologist," Kuvin says. "All three current pathways involve high stakes questions that are often irrelevant to one’s clinical practice." 

"The crux of the changes we are proposing will be away from the focus of passing a test towards a model of helping the individual with their competency, with continuous learning and evaluation of competency to help the clinician fill in their knowledge gaps," he explains.

He described the new approach as "lifelong learning," adding that, instead of it being "a punitive pass/fail environment with no feedback, which causes a lot of discontent among clinicians," it will be a supportive process, where a clinician will be helped in filling their knowledge gaps. 

"I think this would be a welcome change not just for cardiology but across medical specialties," Kuvin said. 

He also pointed out the ABMS itself is considering a continuous competency approach, and the proposed new cardiology board aims to work with the ABMS to make sure that their goals of continuous competency exam are matched. 

"The world has changed. The ability to access information has changed. It is no longer imperative for a clinician to have every piece of knowledge in their brain, but rather to know how to get knowledge and to incorporate that knowledge into clinical practice," Kuvin noted. "Competency should not involve knowledge alone as in a closed book exam. It is more about understanding the world that we live in, how to synthesize information, where we need to improve knowledge and how to do that." 

Kuvin acknowledged that asking clinicians questions is a very helpful tool to identify their knowledge base and their knowledge gaps. "But we believe the clinician needs to be given resources – that could be a conference, an article, a simulation - to fill that knowledge gap. Then we could ask clinicians some different questions and if they get those right then we have provided a service." 

Tactile skills for cardiologists needing to perform procedures – such as interventionalists or electrophysiologists may be incorporated by simulation in a technology-based scenario.

On how often these exams would take place, Kuvin said that hadn't been decided for sure. 

"We certainly do not think an exam every 10 years is appropriate. We envision, instead of an episodic model, it will be rather a lifelong journey of education and competency. This will involve frequent contact and making sure knowledge gaps are being filled. There are criteria being set out by the ABMS that there should be a certain number of touch points with individuals on an annual as well as a 5-year basis to make sure cardiologists are staying within specific guardrails. The exact nature of these is yet to be determined," he said. 

Kuvin added that it was not known yet what sort of hours would be required but added that "this will not be a significant time burden."

The application to the ABMS for a separate cardiology board is still ongoing and has not yet received formal acceptance. Representatives from the five US cardiovascular societies are in the initial stages of formulating a transition board. 

"The submission to the ABMS will take time for them to review. This could take up to a year or so," Kuvin estimates. 

This is the first time the ABMS has entertained the concept of a new board in many years, he noted. "It will be a paradigm shift for the whole country. I think that cardiology is really at the forefront and in a position where we can actually do this. If cardiovascular medicine is granted a new board, I think this will help change the approach of how physicians are assessed in terms of continuous competency not just in cardiology but across all specialties of medicine."

He added: "We are confident that we can work within the construct of the ABMS guidelines that have been revised to be much more holistic in the approach of continuous competence across the board. This includes thinking beyond rote medical knowledge and thinking about the clinician as a whole and their abilities to communicate, act professionally, work within a complex medical system, utilize medical resources effectively. These all have to be part of continuous competence."

Noting that the ABIM has received criticism over the costs of the certification process, Kuvin said they intend to make this "as lean a machine as possible with the focus on reducing the financial [burden] as well as the time burden for cardiologists. It is very important that this is not cumbersome, that it is woven into clinical practice, and that it is not costly." 

But he pointed out that building a new board will have significant costs. 

"We have to think about developing initial board certification examinations as well as changing the paradigm on continuous certification," he said. "This will take some up-front costs, and our society partners have decided that they are willing to provide some start-up funds for this. We anticipate the initial certification will remain somewhat similar in price, but the cost of ongoing continuous competency exam will be significantly reduced compared to today's models."

Kuvin said the collaboration of the five participating US cardiovascular societies was unprecedented. But he noted that while the transition board is beginning with representatives of these individual societies, it will ultimately be independent from these societies and have its own board of directors. 

He suggested that other societies representing other parts of cardiology are also interested. "Cardiology has recognized how important this is," he said. "Everybody is excited about this."

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The Pharmacy Technician Certification Board Grants Funding to Propel Training and Advancement for Pharmacy Technicians Across the Country

Recipients of PTCB Partnership Funds Program Include State Associations in Hawaii, Iowa, New Jersey, Pennsylvania, Tennessee, Texas and Washington

WASHINGTON, Dec. 12, 2023 /PRNewswire/ -- The Pharmacy Technician Certification Board (PTCB), the nation's first and most-trusted pharmacy technician credentialing organization, has announced the most recent recipients of their Partnership Funds Program. Initiated in 2019, this program aids the efforts of state pharmacy associations that are dedicated to acknowledging the contributions of pharmacy technicians, fostering medication safety, and advancing the roles of these professionals. The recently-awarded grants will offer crucial support for innovative projects aimed at addressing pressing needs within the pharmacy technician profession.

PTCB has recently awarded funding to seven state pharmacy associations.

The recipients of the most recent grants are the Hawaii Pharmacists Association (HPhA), Iowa Pharmacy Association (IPA), the New Jersey Society of Health-System Pharmacists (NJSHP), Pennsylvania Pharmacists Association (PPA), Tennessee Pharmacists Association (TPA), Texas Pharmacy Association (TPA), and the Washington State Pharmacy Association (WSPA).

"These funds underscore our commitment to driving positive change in the pharmacy technician profession," said Ryan Burke, PharmD, Senior Director of Professional Affairs at PTCB, who oversees the program. "By supporting these projects that are closely tied to current initiatives in pharmacy practice, we are actively contributing to the evolution and growth of pharmacy technicians, and ultimately improving patient care and outcomes."

The Hawaii Pharmacists Association (HPhA) will undertake the Pharmacy Technician Advancement and Recruitment (PTAR) project. PTAR aims to advocate for pharmacy technician recruitment and provide education sessions addressing workforce needs, work environment conditions, and career opportunities. The initiative will involve engagement with local pharmacies and healthcare organizations, supplemented by the creation of a comprehensive resource guide. The project is slated for completion by the end of 2024.

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The Iowa Pharmacy Association (IPA) is set to launch "Charting a Pathway Forward: Career Development for Pharmacy Technicians." This project focuses on supporting the growth and sustainability of the pharmacy technician workforce, emphasizing role advancement and responsibilities. IPA will create a Pharmacy Technician Career Guidebook and host Idea Sharing Symposiums with technicians, employers and others to foster collaboration and idea generation. The project is expected to conclude by October 2024.

The New Jersey Society of Health-System Pharmacists (NJSHP) will provide education and training to health system pharmacy technicians related to sterile compounding, non-sterile compounding and hazardous drug compounding, in particular with regard to the updated USP 795 and 797 chapters, and key considerations in the USP 800 chapter. This initiative will include in-person workshops and on-demand recordings, with a workshop scheduled for January 2024.

The Pennsylvania Pharmacists Association (PPA) will embark on the "Community Health Worker (CHW) Expansion in the Community Pharmacy Enhanced Service Network (CPESN)" project, focusing on improving access and promoting safe and effective medication use through specially trained pharmacy technicians. The project will support the completion of a 16-week CHW training by pharmacy technicians at five identified pharmacies, with completion anticipated by mid-2024.

The Tennessee Pharmacists Association (TPA) is also engaged in Community Health Worker training, offering scholarships for up to 40 pharmacy technicians. This initiative aims to bridge the gap between pharmacy technician expertise and community health empowerment, with the training provided through online CHW courses. Completion is expected by the end of 2024.

The training of Community Health Workers will also be the focus of the Texas Pharmacy Association (TPA). The organization will introduce a CHW training program for up to 30 pharmacy technicians. This program aims to cultivate the dual role of pharmacy technician/CHW, demonstrating the positive impact they can have on patient outcomes. Completion is anticipated by the end of 2025.

And finally, the Washington State Pharmacy Association (WSPA) will implement a Technician Product Verification (TPV) project, advocating for the expansion of pharmacy technicians' roles in community pharmacy practice. The project will include a toolkit, a TPV PTCB-Recognized Education/Training Program, and a poster presentation at the WSPA Annual Meeting. Completion is targeted for the end of 2024.

These Partnership Fund Grants exemplify PTCB's dedication to advancing pharmacy technician roles and fostering innovation within the profession. By supporting these projects, PTCB aims to strengthen the pharmacy workforce and improve patient outcomes nationwide.

About PTCB

The Pharmacy Technician Certification Board (PTCB) is the nation's first, most trusted, and only nonprofit pharmacy technician credentialing organization. Founded on the guiding principle that pharmacy technicians play a critical role in advancing medication and patient safety, PTCB has established the universal standard of excellence for those supporting patient care teams by offering the industry's most-recognized credentials, including the PTCB Certification for Certified Pharmacy Technicians (CPhT).

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