Call for Candidates for AMA Nomination for the American Board of Family Medicine, Inc.

The AMA is soliciting AMA member candidates for nomination by the AMA Board of Trustees to serve as an At-Large member of the Board of Directors of the American Board of Family Medicine, Inc. (ABFM).

TERM The term of this position is 5 years, from April 2020 to April 2025. The ABFM will elect the new director at its ABFM Annual Board Meeting in April 2020, and the newly elected director will take office immediately following adjournment of the meeting.

TIME REQUIREMENT The ABFM Board of Directors holds three official meetings per year: a Winter Meeting in the beginning of each year; an Annual Meeting in the spring; and an Interim Meeting in the fall. Board members are appointed by the ABFM Chair to serve on specific committees. Meetings of these committees are conducted in conjunction with each Board meeting. Additional meetings will be called as needed, utilizing webinars and conference calls when possible.

CRITERIA FOR NOMINATIONS TO ABFM

ABFM Requirements 1. Candidate must be a family physician certified by the American Board of Family Medicine, Inc.

2. Directors must be certified by the ABFM for the duration of their term of office.

3. In addition to a track record of leadership and ability to work with a group, the ABFM welcomescandidates who are women, minorities underrepresented in medicine, early in career, or workwithin rural communities.

4. With respect to skills, the work of ABFM is multifaceted. To provide context to candidates, theABFM has provided the attached executive summary of its new strategic plan and an overview ofits activities.

AMA Requirements Each nominee recommended by the AMA must be a member of the AMA at the time of nomination. If appointed, he/she must maintain AMA member status throughout the term of appointment. AMA membership does not guarantee a position. Non-members may activate their membership online at www.ama-assn.org/go/join or call AMA Member Relations at 800.262.3211.

TO APPLY FOR NOMINATION To apply for nomination, complete and email the following documents to Mary Grandau at mary.grandau@ama-assn.org. The documentation must be received no later than Monday, December 16, 2019.

Call for Candidates for Nomination for the American Board of Family Medicine, Inc. Page 2

Rev 112119

1. Completed electronic Application for AMA Nomination for External Leadership Position – ABFM (MS Word document preferred). This document is included on the AMA Medical Education Leadership Opportunities Web page as part of the position posting.

2. Current abbreviated curriculum vitae [not to exceed three (3) pages].

3. Current full curriculum vitae.

4. Statement from the applicant (not to exceed 2 pages) addressing his/her interest in serving on the ABFM Board and his/her philosophy of family medicine.

5. Optional: Up to two letters of recommendation, addressed to the AMA. Note that, if nominated, letters of recommendation may be included as part of the nominee materials sent to the requesting organization.

Please direct questions to: Mary Grandau Program Administrator AMA Council on Medical Education Ph: 312-464-4515 mary.grandau@ama-assn.org

An Introduction to the American Board of Family Medicine

Founded in 1969, ABFM is a not-for-profit, private organization whose mission is to serve the public and the profession through certification, research, educational standards and support for improvement of health care. As of March 31, 2019, ABFM has 90,729 diplomates and is the third largest of 24 boards which make up the American Board of Medical Specialties (ABMS). ABMS is a confederation of all specialty boards and defines common standards for board certification across medicine.

ABFM was the first purely primary care specialty board of the ABMS. ABFM administered its first certification examination in 1970 and was the first ABMS specialty board to:

1. Issue time-limited, seven-year certificates to its diplomates (the term used to describe a board-certified physician).

2. Require continuing medical education (CME) and a required chart audit for re-certification 3. Include other specialists on its Board of Directors 4. Have the same cognitive knowledge assessment exam and standard setting for initial

certification and recertification 5. Publish its own journal

ABMS was also one of the first to have public members on its Board of Directors

1. BOARD CERTIFICATION IN FAMILY MEDICINE

ABFM’s primary role is to support family physicians who are committed to achieving excellence in improving the health of their patients, their families, and their communities. Certification is voluntary and requires attaining high standards and a lifelong commitment to learning and professional development. In addition to maintaining the highest ethical standards and a full, valid, and unrestricted license to practice medicine in the US or Canada, diplomates must obtain 150 CME credits and do one Knowledge Self-Assessment and one Performance Improvement activity every three years. Diplomates must also pass an independent test of medical knowledge. In 2019, ABFM launched a pilot alternative – Family Medicine Certification Longitudinal Assessment (FMCLA) – to the every 10 year, one day exam. A graphic depiction of the Continuous Certification process for Family Medicine Certification is shown below, followed by a description of each of the components.

Professionalism

This component focuses on professional standing, which includes ethical practice, meeting and maintaining standards of competence, and integrity. ABFM has defined these standards in the ABFM Guidelines for Professionalism, Licensure, and Personal Conduct. Among the specifics of the Guidelines, physicians must either (1) hold a medical license which is currently active, valid and full in the United States, its territories, or Canada, and not be subject to any practice privilege limitations, or (2) select the status of Clinically Inactive, and hold either an Unlimited License, or a Qualified Clinically Inactive Medical License. A review of a physician’s professionalism or personal conduct by the Credentials Committee is triggered if the physician is sanctioned by a legally constituted entity with control over aspects of a physician’s practice of medicine (e.g. state licensing board). ABFM does not adjudicate these cases, but the Credentials Committee does review evidence provided by the sanctioning entity and by the physician if they appeal certification action. ABFM aids diplomates and candidates who ask for help considering consequences before they sign any consent agreements. Since 2013, the average number of cases reviewed annually is 785 (only 0.9% of all diplomates). Of these, a much smaller number (75, or 0.09%) of Diplomates will lose their certificate or have a gap in certification as a result of a license action. Half of those who lose certification will subsequently regain certification once they are able to fully comply with the Guidelines.

Self-Assessment and Lifelong Learning

Rigorous self-assessment of clinical knowledge, along with a commitment to lifelong learning, are a foundation of clinical excellence. The ABFM has developed activities to allow physicians to self-assess their knowledge episodically or continuously, depending upon their preference.

Knowledge self-assessment (KSA) activities focus on ongoing, lifelong learning and mastery of up-to-date information. KSAs were developed by ABFM to cover the 20 diseases and conditions identified by the Institute of Medicine as essential to improving the quality of health care in the United States. They are completed through online modules or formal group sessions and allow for reference use and multiple retakes to achieve a score of >/80% correct. In 2018 physicians completed 85,111 KSAs individually and 3,769 as part of a group event. On evaluation, diplomates reported that the module content was very/extremely relevant (>80% of respondents) and useful (>75% of respondents). Between 60%-80% reported at least one change in their clinical practice as a result of their completion of a KSA (depending on the topic).

ABFM provides multiple other pathways to accomplish knowledge self-assessment including self-assessment activities developed by the AAFP or other ABMS member boards, and the ABFM’s newest option, the Continuous Knowledge Self-Assessment (CKSA). At the April 2019 meeting of the board of directors, two new external KSAs were approved: a Palliative Care KSA and the Advanced Life Support in Obstetrics® course. CKSA is a self-assessment activity in which diplomates receive 25 questions to complete online or via an app on a quarterly basis. Completion of four quarters of activity will meet the Knowledge Self-Assessment requirement required in each three-year stage. The evidence and

rationale for the correct answer is provided for each question; at the end of one year of participation, diplomates can access a performance improvement report which identifies the gaps in their knowledge and which they can use to select their own CME and self-study. The report also provides a prediction of how they would perform on the 10-year exam if it were to be taken at that time. Diplomate interest in CKSA has been high, with a range of 17,282-19,768 participating in each of the four quarters of 2018. Collectively, CKSA has been accessed and utilized by over 31,000 family physicians.

Summary data on family physician participation in Self-Assessment activities in 2018 are shown below:

Performance Improvement

Clinical excellence is not just about knowing the right answers, but also providing the right care to patients. It is for this reason that ABFM includes a requirement for clinically active diplomates to complete at least one quality improvement exercise every three years. Measuring care outcomes and comparing performance against evidence-based quality benchmarks allows physicians to improve the care that they deliver. This involves identifying an area for improvement in their practice, gathering baseline data for a starting point, implementing a change to improve or close the gap in care, and re-measuring to assess the impact of that change.

A large variety of options exist for meeting this requirement including: • PI modules developed by the ABFM (based on commonly seen conditions such as hypertension,

diabetes, etc.) • A self-directed pathway, in which physicians select a gap in practice or something they wish to

improve and follow an ABFM-developed template for identifying the problem, collecting baseline measures, implementing a change, and re-measuring. This is the pathway offers the greatest flexibility, highest relevance and lowest burden. It is also ideal for physicians who are in practices with a more narrow scope or those who do not have continuity panels

• PRIME registry - for physicians who participate in the PRIME registry their pre- and post- implementation data can automatically and seamlessly be submitted to meet the PI requirement for continuous certification. The registry also helps to identify gap areas for improvement

• Activities through an organizational sponsor (locally through the physicians’ hospital or health system, as part of a Practice Transformation Network or through NCQA recognition for diabetes, heart disease/stroke, or patient centered medical home, etc.)

• The ABMS multi-specialty portfolio programs

• AAFP developed activities and AAFP-approved PI-CME • ResPip – essentially a self-directed pathway for residents and faculty to report on any QI

activities they are doing in their teaching practice or service(s) to receive PI credit • A Preceptor Pathway – for community physicians who have learners in their practice; they can

work on improving their teaching skills using the measure, implement change, remeasure approach. This requires an organizational sponsor.

Evaluation of the ABFM PI modules reveals that 84% of participants found them relevant, 63.2% reported practice changes as the result of the module and 91.2% had a favorable impression of them.

Cognitive Expertise

There is abundant evidence that medical knowledge drives quality of care: the more clinicians know, the higher the quality of care they provide. Unfortunately, there is also ample evidence that clinicians are not as good at recognizing what they do not know. This provides the rationale for regular knowledge self-assessments, as described above, to identify gaps that can direct meaningful self-study and/or CME participation. It is also the reason that ABFM requires regular, independent assessments of medical knowledge. It is this independent assessment of cognitive expertise, in addition to other traits, that sets board-certified family physicians apart from non-physicians and other noncertified medical practitioners with less training and experience. Regular participation in cognitive assessment also assures the public that board-certified physicians are up to date and aware of the latest advances in clinical care.

ABFM currently fulfills this requirement through the provision of a formal written examination every 10 years. Two options now exist for accomplishing this: either a one-day exam taken in a secure testing center, or the new longitudinal assessment alternative (FMCLA). FMCLA is currently in its initial pilot year in 2019 and has been extended to include those Diplomates who will be in their tenth year and due to take the examination in 2020.

Examination questions are developed and tested through a multi-step process that follows a blueprint based on actual family medicine practice nationally, as gauged by the National Ambulatory Medical Survey. ABFM engages volunteer family physician test-item writers who receive initial and ongoing training by content development staff. All items are pre-tested for clarity and ability to discriminate between excellent family physicians and those with a weaker knowledge base. Practicing family physicians and members of the ABFM Examination committee review each question on multiple occasions for clarity, clinical appropriateness and consistency with current evidence. For an item to be approved, it must have a critique explaining the rationale for the answer, the reasons that the other options are incorrect, and an evidence-based reference for each item.

- On the One Day Examination, candidates/diplomates have 320 multiple choice questions. This includes a single 45-question module that provides an opportunity to tailor the examination to their practice by focusing on emergent/urgent care, hospital medicine, women’s health, sports medicine, general ambulatory family medicine, maternity care, or geriatrics. In 2018, 95.1% of candidates receiving their medical education in the United States passed the initial certification exam and 91.8% passed the continuing certification exam. ABFM assists with exam preparation through tutorials and sample exam questions which can be reviewed online.

In 2018, a pilot of providing early results to examinees was implemented and 91% of candidates were able to receive preliminary results within 5 working days. This process will now be implemented as a standard practice after each examination going forward.

A recent study of family medicine and internal medicine exam candidates showed that most began studying two months or more before the exam, often studying things beyond what they look up for their routine patient care. Most described positive changes in their practices because of studying. Consistent with self-efficacy theory and adult education models, most came away feeling more confident about their competence and quality. That said, a number reported that studying cut into their family time and some felt resentment about having to study topics that are not part of their current scope of practice.

- In 2019, ABFM launched a pilot of an alternative to the single day exam—the Family Medicine Certification Longitudinal Assessment (FMCLA). Diplomates in good standing and due to take the examination in 2019 were able to choose between the traditional exam and a “longitudinal” approach in which they answer 25 questions/quarter, at any time and any place, with an open book and up to 5 minutes per question. The correct answer, a critique of all the answers and a reference are then given to the candidate.

The intent is that FMCLA will be able to provide both a summative judgement (the Diplomate has sufficient cognitive expertise to be certified) and a formative assessment (guidance specific topics the Diplomates should learn more about). When given the choice of the traditional examination vs. the longitudinal assessment pilot, 71% of the 2019 cohort chose to participate in the FMCLA pilot. When comparing these two groups, they are similar across age, gender, practice types and scope of practice.

A full evaluation is in progress; the major question is whether the longitudinal format is comparable to the one day format in making overall judgements regarding the cognitive expertise of family physicians. Early feedback is very positive, with many reporting that the new structure is much more convenient and supports learning.

Retention in Certification

ABFM closely tracks trends in participation in Family Medicine Certification. As of July 1, 2019, there are 93,089 family physicians who are actively certified with ABFM. Retention trends have remained high and are shown below.

Costs of Certification

The annualized cost of Family Medicine Certification has not changed over time, other than a reduction of payment that occurred in 2012. In 2003 (15 years ago) the 10-year cost was $1960, which is

annualized to $196 a year. Payment previously was episodic, which resulted in periodic payments of larger amounts of money. Diplomates requested a flattened payment structure and one that locked in their pre-payment over a period into the future. This change was made in 2005 to reduce the single payment impact and to allow for unlimited participation in all activities for all in continuous certification. ABFM offers flexible payment options for the continuous certification process through the online Physician Portfolio. Prepayment allows diplomates to lock in a fixed cost for all future years with unused prepayments being fully refundable. Physicians are also able to simply pay annually. Once they pay the fees for a stage, they can access any activities available in their Physician Portfolio and can complete as many as they would like for no additional fee. The CME credit awarded with the activity does not have any additional cost. We are pleased that the cost of the continuous certification process has been at a flat annual rate since the inception of the program, even with the addition of new activities.

We are also pleased that we were able to lower our fees and have held them constant since 2012 at $200 per year, even with substantial new investments having been made in evolving Continuous Certification since that time. ABFM also recognizes Diplomates who continue to participate in certification well into their 70s and 80s, even if they are no longer practicing, so we recognize this dedication and commitment by offering a 50% discount on certification fees.

Time and burden are also considered “costs” of the certification process. We have excellent back end data from our IT systems that shows the average time for a physician to complete a KSA is five hours. Most quarterly CKSAs are completed in less than two hours. The time to complete a PI activity is as variable as the type of activity selected. For physicians who are already doing quality improvement activities in practice and choose the self-directed activity choice, the application process for submission takes, on average, 10-15 minutes to complete.

Taken together, with the required PI activity and KSA plus additional points, all certification requirements can be met with an investment of 8-10 hours annually. Some physicians choose to spend more money and time by joining their colleagues in a group KSA or an AAFP-sponsored activity that meets all of their stage requirements. While some prefer this, it is not required for meeting certification requirements.

Burden is also something that family physicians associate with the cost of certification. To date, there is no literature showing that certification is linked to burnout. Unlike daily intrusions and administrative burden in practice, board certification is not something physicians engage with on a daily basis. In fact, it does not actually require even annual participation as long as requirements are met during each three-year stage. ABFM has taken steps to create valuable options that are relevant to practice AND reduce burden on family physicians, as our board and staff do clearly understand the pressures of daily practice

2. IMPROVING RESIDENCY TRAINING

Through the Accreditation Council on Graduate Medical Education (ACGME) and with other partners, (AMA, AAFP, etc.) ABFM helps to set the standards for the structure, content and rigor of residency training in family medicine. Established in 1969, the ACGME Review Committee for Family Medicine (RC-FM) is responsible for establishing standards and reviewing family medicine postgraduate medical education programs in the United States. Specifically, ABFM sets training standards that programs must meet in order for their graduates to be eligible to become board certified.

There are currently 614 accredited family medicine residency programs in the US, training 12,624 future family physicians (2018 data). A total of 4,152 medical students and graduates matched to family medicine residency programs in 2019, which is the most in family medicine’s history as a specialty and 112 more than in 2017.

The growth of family medicine residency graduates over time is shown below, along with the increasing number of initial certifications awarded by the ABFM.

ABFM considers the three years of residency as the first 3-year stage. During this time, residents must complete the requirements necessary for eligibility for initial certification in order to be eligible for initial certification. To support family medicine program directors’ commitment to improving education, ABFM has developed strategies to improve the likelihood of trainees achieving initial certification. These include moving the date of the initial certification examination from the end of training (July) to April, calibrating in-training examination (ITE) items on the same scale as the certification examination, creating a probability estimate of passing the certification examination for all residents taking the ITE, providing all ABFM assessment and performance improvement tools to residents for free, and launching the Residency Performance Improvement Program (ResPIP) which facilitates giving residents credit for their efforts to improve quality of care. To support osteopathic residents in residencies making the transition to the single accreditation system, ABFM has developed an osteopathic pathway, which allows any graduate of a three-year osteopathic residency to complete ABFM requirements and sit for the exam until 2022.

ABFM also encourages and supports fundamental innovation in residency education. ABFM has lead numerous national initiatives to drive innovation in family medicine residency education including the Preparing the Personal Physician for Practice (P4) and the Length Of Training (LOT) projects, a residency

based quality improvement collaborative involving 24 primary care residencies in the Carolinas and Virginia called the I3 Collaborative, the Colorado Patient Centered Medical Home (PCMH) project, and, in conjunction with the Association of Family Medicine Residency Directors, the Clinic First and Family Medicine National Innovation in Continuity Clinic Experience (FM-NICCE) collaborative. Also, ABFM’s research department has worked in collaboration with the Association of Family Medicine Residency Directors to provide all residency directors in the country with outcomes data for each of their graduates after three years through the National Residency Graduate Survey.

A major long-term goal for the specialty has been to increase the number of family medicine residencies. To that end, ABFM has participated in a National Academies initiative to improve the social accountability of the GME system and to reform GME funding to better meet the needs of society and is currently participating in the AAFP-sponsored 25X2030 Initiative to increase the percentage of graduating medical students who choose family medicine as a specialty to 25% by the year 2030.

3. RESEARCH

ABFM funds, conducts, and publishes research that is devoted to creating, evaluating, and maintaining cutting-edge certification methods, advancing the scientific basis of Family Medicine and Primary Care, and promoting professionalism and value in health care This research enterprise was initially created in 2008 as a strategic initiative, in partnership with the Robert Graham Center for Policy Studies. An in-house research department was established in 2012 and today includes a Senior Vice President for Research and Policy, a Vice President for Research, and a staff of quantitative and qualitative research experts and data analyst. This department conducts rigorous and independent research to support the business needs of ABFM by exploring the relationship between Family Medicine Certification (FMC) and the quality of care family physicians provide, assessing the validity of our assessment programs, understanding the practice activities and needs of Family Medicine trainees and diplomates, and linking these discoveries to the improvement of ongoing certification. The research staff further support ABFM’s mission by exploring what comprises effective, high value primary care.

Through collaboration with other individuals and organizations, ABFM also seeks to understand the ecology of family physicians’ work, including changes in family physician demographics and scope of practice over time, as well as the environment in which they deliver health care. Consideration of the impact of health care market forces, practice organization, social deprivation, and changes in health care policy on family physicians’ ability to provide high quality care to their community is part of this focus. ABFM has also forged collaborations with a variety of institutions, including Virginia Commonwealth University, Case Western Reserve University, the University of Missouri, University of Houston, Oregon Health & Sciences University, Harvard University and Stanford University as well as the American Boards of Internal Medicine and Pediatrics. Supported by robust datasets and highly capable researchers, the department has been prolific in its research productivity publishing 209 research articles since 2010!

A key feature of ABFM’s support of family medicine research is the provision of opportunities for scholarly collaboration for residents, early faculty, and senior investigators in Washington DC (in conjunction with the Center for Professionalism and Value in Healthcare) and at the ABFM offices in Lexington. Scholars typically are on site for two weeks at a time. These opportunities expand in 2019-20 with the addition of a yearlong fellowship opportunity at the new Center for Professionalism and Value in Washington DC, partnering with George Washington University and offering opportunities to research, policy and leadership skills towards the advancement of our discipline. Over the years, numerous scholars have worked with ABFM researchers to identify and study questions that matter for the discipline. Many active family medicine researchers across the United States have participated in these scholarships and published articles with ABFM staff.

4. LEADERSHIP DEVELOPMENT

ABFM cultivates leaders in Family Medicine to expand the specialty’s contribution to the health of the public. ABFM, along with the Pisacano Leadership Foundation and ABFM Foundation, supports programs focused on development of physician leaders who will lead improvement in health and health care across the country:

Pisacano Leadership Foundation / Pisacano Scholars

The Pisacano Leadership Foundation seeks to positively influence the health of the people through enhancement of the specialty, which it accomplishes through the identification of current US medical students who have potential to become future leaders in family medicine and providing them with professional development, mentoring, and financial assistance. By aiding medical students and physicians who demonstrate the highest levels of scholarship, leadership, character, interpersonal skills and community service, the Foundation supports the development of family physicians who can then make relevant contributions to primary care for generations to come.

To date, a total of 140 Pisacano Scholars have participated in the program. One Pisacano Scholar alum have gone on to serve as a member of the ABFM Board of Directors, and several serve as item writers and content developers for the ABFM. Pisacano Scholar alums are often speakers at the Foundation’s annual leadership conference.

Pisacano Scholars have taken on many roles in family medicine: one department chair; five residency directors, 10 directors of multispecialty groups, two regional directors of multispecialty groups, several medical directors, and five high ranking leaders in CHCs and underserved clinics. Three Scholars work outside the US in underserved areas, and four scholars run not-for-profits to support programs outside the US. At least three Scholars serve on the boards of other family medicine organizations. There are countless articles published each year by Pisacano Scholars. While the majority of alums are in private practice, they continue to precept students and lead healthy outreach initiatives in their local communities.

Puffer National Academy of Medicine Fellows

Formerly known as the Institute of Medicine (IOM), the National Academy of Medicine (NAM) is one of three academies that make up the National Academies of Sciences, Engineering, and Medicine in the United States. A private, nonprofit institution that works outside of government to provide objective advice on matters of science, technology, and health, the mission of the NAM is to improve health for all by advancing science, accelerating health equity, and providing independent, authoritative, and trusted advice nationally and globally.

In 2011, the Puffer/ABFM Fellowship was established at the National Academy of Medicine to enable talented, early-career health policy and science scholars in family medicine to participate actively in health- and medicine-related work of the National Academies and to further their careers as future leaders in the field. In considering qualifications for the Puffer/ABFM Fellowship, preference is given to candidates who have a demonstrated interest in and focus on health quality and health services and have an M.D., Ph.D., or D.O. The program especially welcomes nominations of under-represented minority candidates. Over a two-year period, the Puffer/ABFM Fellows continue to work at their main academic post while being assigned to a health and medicine-related board of the National Academies. The fellowship includes attendance at a one-week orientation to health policy in October, the Fall National Academies Annual Meeting and the meetings of their assigned board. Additionally, fellows participate actively in the work of an appropriate expert study

committee or roundtable, including contributing to its reports or other products. This experience introduces the Puffer/ABFM Fellow to a variety of experts and perspectives, including legislators, government officials, industry leaders, executives of voluntary health organizations, scientists, and other health professionals. The initial Puffer Fellow is now an elected member of the National Academy of Medicine, and other Fellows continue to shape the seminal work of this revered institution on behalf of Family Medicine and Primary Care.

5. ADVANCING THE SPECIALTY OF FAMILY MEDICINE

Since its inception, ABFM has been committed to develop the broad specialty of Family Medicine not only through board certification, but also through support of the scientific, clinical, and educational foundations of the discipline.

The Journal of the American Board of Family Medicine

Published since 1988, the Journal of the American Board of Family Medicine (JABFM) is the official peer-reviewed journal of the American Board of Family Medicine (ABFM). Believing that the public and scientific communities are best served by open access to information, JABFM makes its online articles available free of charge and without registration. JABFM is indexed by Index Medicus, and other services. JABFM publishes six bimonthly issues per year, comprising original material from authors with new knowledge to contribute to the understanding and advancement of family medicine research and clinical practice. JABFM also serves as an important forum for the specialty of family medicine, and as a source of news from ABFM.

Annals of Family Medicine

ABFM is one of seven sponsoring organizations for the Annals of Family Medicine. Created as an outcome of the Future of Family Medicine project, and in recognition of the increasing need for outlets for impactful research, Annals seeks to identify and address important questions about health and the provision of patient-centered, prioritized, high-quality health care. It welcomes clinical, biomedical, social and health services research. Caroline Richardson, MD became the Editor in 2019 following Kurt Stange, MD, PhD who served in that capacity since its inception. Annals has become the premier scientific journal for family medicine. It publishes original research, methodology, and theory, as well as essays from reflective clinicians, patients, families, communities, and policymakers. It publishes selected systematic reviews that build on current knowledge to advance new theory, methods, or research directions.

Education and Faculty Development

Working with the Society of Teachers of Family Medicine, ABFM has supported a series of initiatives to improve faculty development and strengthen community precepting by family physicians. With the help of many partners, this work has led to major changes in CMS teaching physician rules, and, this year, with support from the ABFM Foundation, a new national collaborative focusing on improving onboarding of medical students and improving active engagement of preceptors has begun. A key part of the collaborative will be the granting of ABFM performance improvement credit for either improvement of quality metrics or improving teaching performance. With respect to residency training, in addition to the initiatives described above, ABFM has partnered with the American Board of Internal Medicine, the American Board of Pediatrics, and the Macy Foundation to fund the Primary Care Faculty Development Initiative (PCFDI) and the evaluation of a HRSA sponsored follow-on project Physicians Accelerating Clinical and Educational Redesign (PACER). These initiatives have developed and spread a model based on the clinical implementation of the

Patient Centered Medical Home in residencies by teaching faculty the skills necessary for assessment and quality improvement.

Center for Professionalism & Value in Health Care, Washington, DC

Health care in the United States is in the midst of transformational change, leaving professional self-regulation and the public trust at risk. To meet this challenge, the ABFM Foundation has made a strategic investment in the creation of the Center for Professionalism and Value in Health Care. Founded on July 1, 2018, The Center is based in Washington, DC, with Robert Phillips, MD, MSPH serving as the founding Executive Director.

The Center aims to create a space where patients, health professionals, payers, and policymakers can work to renegotiate the social contract while supporting physician engagement in improving the health care system and improving the health of their communities. It will seek to define value across the healthcare spectrum by reaching beyond medicine to engage the broader health care community, including patients and families, to help better define professionalism and value and to determine how to measure and improve it. This collaboration will include anyone interested in professionalism and value in health care including other specialty boards, other professions, and other organizations interested in working together on this common ground. The current activities of the center focus on the development of meaningful measures for primary care, the further development of the PRIME registry, and engagement with policy makers about the importance of Board Certification.

• PRIME Registry

The PRIME registry is a patient data tool developed by ABFM for clinicians and practices. It allows patient data to be extracted from an EHR and turned into actionable quality measures presented in an easy to use, personalized dashboard which brings the clinical data to life. PRIME was developed to help reduce administrative and reporting burden in practice, to improve care quality, and ultimately to assure competence and support clinical professionalism. The PRIME electronic dashboard displays 69 Clinical Quality Measures at the clinician, practice, and individual patient level, simplifying the ability to track patient care and target opportunities for improvement. It includes integrated MIPS and PI Activity modules and supports reporting for CPC+ Track 2, CPCI, and other quality programs. Currently, ABFM subsidizes the total cost of the registry for board certified family physicians. More than 4000 clinicians, including over 1600 family physicians, are actively using the PRIME registry which is tracking of care of almost 4,000,000 unique patients.

PRIME is also a federally certified Qualified Clinical Data Registry (QCDR) which makes it an approved reporting vehicle under MACRA. As a QCDR, PRIME is authorized to propose more meaningful quality measures to CMS. ABFM has focused on developing “measures that matter”—measures which capture the core of what family physicians do. Recent examples include measures of continuity and comprehensiveness of care. Using the PRIME registry and working with numerous collaborators, ABFM will engage CMS to begin to use measures that capture the unique role of primary care. In the spring of 2019, the NQF recognized the measure of patient recorded outcome as the best new measure in its class for the year!

In 2018, the PRIME registry added the Population Health Assessment Engine (PHATE), which uses EHR and community data to map physician or clinic service areas, show clusters of disease or areas of poor outcomes, pull in social determinant data, create a community vital sign for patients, and display community resources for patients and practice. Physicians working with PHATE can easily get ABFM performance improvement credit. With support from the Human

Resources Service Administration (HRSA), we have developed an accompanying online curriculum to better understand the social determinants of health for practicing clinicians, residents, and other students. Finally, in collaboration with researchers at Stanford and Harvard, we are developing an approach to risk adjustment for social determinants and will propose a potential model to CMS based upon this work. Such risk adjustment in payment and other dimensions of care are essential for supporting family physicians who are working to improve the health of their communities.

• Measures that Matter

Primary care is identified as the source of strong outcomes from high performing health systems, even while it appears to produce lower quality care when assessed using disease-based, narrowly-focused quality measures. Misaligned quality measures that have assumed that quality of care can be calculated through the sum of quality measures for individual diseases have resulted in performance data of little clinically actionable value, significant waste in administrative costs, and record high burnout within the work force, leading to the diminished value of primary care for people and populations. This necessitates a more integrated and whole person measure of the primary care function that better align measures that matter and providing sufficient resources to address them.

ABFM Foundation

The ABFM Foundation (ABFM-F) is a supporting organization of ABFM that serves the organization through support of education and research efforts important for the broader mission of ABFM. Recent examples include efforts to identify and evaluate quality metrics that capture the contributions of family medicine, support of Family Medicine for America’s Health, creation of a fellowship for international family physician educators to learn about best practices in family medicine education, evaluation of the Preparing the Personal Physician for Practice and Length of Training initiatives, a national collaborative to improve onboarding of medical students and engagement of family medicine preceptors, and support for the Center for the History of Family Medicine. As of July 1, 2018, the ABFM Foundation houses the Center for Professionalism and Value in Healthcare. Income from two supporting LLCs, ABFM International and ABFM Realty is designated to support ABFM Foundation goals.

6. ENGAGING DIPLOMATES AND PARTNERS

ABFM Communications Department

As a key part of ABFM’s Strategic Plan for 2019- 2025, a key strategy for success is to enhance communication with diplomates and other stakeholders. While the primary means of communication with ABFM diplomates is by email, ABFM also produces a newsletter (The Phoenix), four times per year, manages as newly redesigned website, and produces materials for state chapters, residency program directors, and other groups. ABFM staff and Directors have a prominent presence on site at AAFP’s annual scientific meeting, FMX. In addition, ABFM provides several digital resources designed to help the public understand the value of certification, such as smartphone apps, various social media accounts, and video that is accessible on our website.

A key strategy for engaging Diplomates has been to increase its collaborative engagement of AFP state chapters, not only virtually and with data support, but through more regular presence at their regularly scheduled CME events and other meetings. By the end of 2019, ABFM leaders and the Director of Outreach will have visited 22 state chapter meetings representing states in which 66% of all board-certified family physicians live and practice in a single year. Additionally, we have visited

three meetings of chapter clusters, participated on the program of the AAFP Annual Chapter Leadership Forum, and taken part in a variety of other outreach meetings with health systems, academic and subspecialty organizations, medical schools and residency programs, etc., based on requests and availability. Already for 2020, we have requests to participate in 18 state chapter meetings and one cluster meeting.

In mid-2019, ABFM launched the Diplomate Engagement Network, a virtual feedback group of volunteer family physicians who have agreed to help provide improvement of the certification process. We also enhanced our social media presence and messaging, worked on development of a new style guide for departments to use, and created a Communications Roadmap and calendar for the coming year, all in addition to supporting other departments in their communications needs. In 2020, there are plans to develop a Residency Toolkit for program directors and coordinators and a Welcome to Board Certification packet for new residency graduates.

ABFM Collaborators

ABFM collaborates with other family medicine organizations and specialty boards to promote better health and health care, improve outcomes, and manage health care resources responsibly. Key partners in this work are the American Academy of Family Physicians (AAFP), the Society of Teachers of Family Medicine (STFM), the Association of Family Medicine Residency Directors (AFMRD), the Association of Departments of Family Medicine (ADFM), and the North American Primary Care Research Group (NAPCRG). Collectively, these five, plus ABFM, the AAFP Foundation, and the American College of Osteopathic Family Physicians (ACOFP), are referred to as the “family” of family medicine organizations and meet in person twice annually to foster these collaborative efforts. ABFM also played a key role in establishing the Council of Academic Family Medicine (CAFM) which is an initiative designed to help the academic societies of family medicine speak with one voice while working collaboratively on projects. ABFM also works with other specialty boards on a regular basis. Examples of collaborative work include the development of an IT hub, which allows boards and their diplomates to share resources across boards, and the Multispecialty Portfolio Program, which allows hospitals and healthcare systems to align system quality goals with individual clinician certification. These services have now been licensed to the American Board of Medical Specialties to support multiple different board specialties. ABFM remains extensively involved in ABMS leadership and working committees with Larry Green, MD being the chair-elect of the ABMS Board of Directors and ABFM representatives sitting on the Continuing Certification, Certification, Ethics and Professionalism, Database and Information Technology, Health and Public Policy, and Governance Committees. Additionally, ABFM has strong representation on the newly established committees that are working on implementation of the new Vision Report.

7. 2019 ABFM STRATEGIC PLAN

In the fall of 2018, ABFM undertook a major new strategic planning process. Impressed by the amplitude and pace of change in health care, we used a scenario planning process framed around the following questions:

• What are the core competencies of personal physicians in 2040? • What will be the impact of macroscopic forces that are reshaping health care payment and

delivery – including consolidation, AI/genomics and new business combinations like CVS/Aetna and Amazon/Berkshire Hathaway - have on the role and effectiveness of personal physicians?

• What should ABFM do to support personal physicians now and in 2040?

To answer these questions, and to develop a plan for the future, ABFM invited 20 diverse representatives from across the US to join its staff and board members who were involved in the process. An executive summary of the plan, which was published in in the summer of 2019, can be found at this link: ABFM Strategic Plan. As you will see, we have established an ambitious plan for 2019-2025. The launch phase started this year with the launch and evaluation of FMCLA and with our focus on Diplomate engagement. Phase II will feature refreshing of our Knowledge Self-Assessment and Performance Improvement portfolios and the development of a journal article-based life-long learning activity. Phase III targets re-envisioning quality improvement, re-thinking how we can and should assess professionalism, and exploring new components of board certification. In doing this work, ABFM will closely align with the ABMS Vision Commission’s recommendations and will work closely with the AAFP and other partners.

8. ABFM GOVERNANCE AND LEADERSHIP

The ABFM is governed by a Bboard of directors comprised of 16 physician members, including the immediate past chair, plus two public members. Each director serves a five-year term. The physician members of the board include 11 family physicians and five representatives selected from nominations by the American Boards of Internal Medicine, Obstetrics/Gynecology, Pediatrics, Psychiatry/Neurology, and Surgery. Two family physicians are elected each year with one selected from nominations received from the American Academy of Family Physicians (AAFP) and one selected from nominations received for the “at large” category from other organizations including: the American Medical Association (AMA), the Association of Departments of Family Medicine (ADFM), the Association of Family Medicine Residency Directors (AFMRD), the Society of Teachers of Family Medicine (STFM), and the current board members. Two public members serve on the board. They are considered for a position on the board based upon their ability to assist ABFM in accomplishing its mission, their active experience and performance in their field, their knowledge of health policy or a health-related field and, whether their employment or other relationships represent an inherent or apparent conflict of interest with the interests of ABFM.

Each director, while nominated by a specific organization, does not represent that particular organization on the ABFM board of directors, but serves as an individual acting in the best interest of the public and the specialty. The board of directors of the American Board of Family Medicine holds three official meetings per year. The current composition and terms of ABFM Board members is as follows:

Jerry Kruse, MD (Immediate past Chair) 2014-2019 John Brady, MD 2015-2020 Colleen Conry, MD 2015-2020 Robert Ronis, MD (Psychiatry) 2015-2020 Melissa Thomason (Public Member) 2015-2020 Wendy S. Biggs, MD 2016-2021 Christopher A. Cunha, MD (Pediatrics) 2016-2021 Michael K. Magill, MD 2016-2021 Beth A. Bortz, (Public Member) 2017-2022 Lauren Hughes, MD, MPH 2017-2022 John Mellinger, MD (Surgery) 2017-2022 Daniel Spogen, MD 2017-2022 Robert L. Wergin, MD 2018-2023

Roger W. Bush, MD (Internal Medicine) 2018-2023 Gerardo Moreno, MD, MSHS 2018-2023 Andrea A. Anderson, MD 2019-2024 Mott P. Blair, MD 2019-2024 George Macones, MD (Ob/Gyn) 2019-2024

Board members are appointed by the ABFM Chair to serve on specific committees, where focused work occurs at and between meetings. ABFM committees include: Bylaws, Certification, Examination, Credentials, Operations, Communications, and Research & Development.

The ABFM is led by a President/CEO and senior leadership team. Members of the Executive Leadership Team include:

• President and CEO – Warren Newton, MD, MPH • Executive Vice President – Elizabeth G. Baxley, MD. • Executive Director of the Center for Professionalism & Value in Healthcare – Robert Phillips, MD. • Senior Vice President of Research and Policy – Andrew Bazemore, MD, MPH • Chief Financial Officer and Chief Operating Officer – Roger Bean • Vice President of Operations – Kevin Rode • Vice President of Psychometric Services - Tom O’Neill, PhD • Vice President of Research – Lars Peterson, MD, PhD • Senior Advisor to the President - Martin Quan, MD • President and CEO Emeritus – James C. Puffer, MD

These leaders are supported by 82 very talented professionals who work at the Lexington, Kentucky headquarters, contributing to the various aspects of initial and continuous certification, research, leadership development, and communication. Drs. Phillips and Bazemore as well as the measures development staff will soon reside in the new offices in Washington DC which are located at 1016 16th Street NW.

Health care is in the midst of dramatic transformation, with the amplitude and pace of change unlike any in the history of our specialty. The process is still in its beginning, as health system consolidation accelerates, more and more physicians become employed, advances in AI and genomics reshape care, and new business combinations such as CVS/Aetna and Amazon/Berkshire Hathaway try to claim their part of the health care market. Against this backdrop of dramatic change and uncertainty, the American Board of Family Medicine anchored its recent strategic planning process on four core principles:

1. As family physicians, our most fundamental responsibility is to improve health and health care. This is an expression of the professionalism that is the foundation of our role as family physicians.

2. We are committed to the reform of American health care and improvement of health. No matter how we adapt to local challenges and opportunities, our long-term goal is constant: implementing the triple aim. We work to improve health, achieve better patient experience and reduce cost. We also believe that this goal cannot be accomplished without improving the wellbeing of all who deliver care.

3. Family physicians are essential for meaningful improvement in health and health care. Family physicians are the most widely distributed personal physicians and are leaders in developing the wrap-around systems critical to robust primary care. We are aware of challenges faced by personal physicians and those who try to improve population health, but we are optimistic that new technology and new organizational structures will provide great opportunities to support family physicians and improve the care they deliver.

4. In an age of bitter partisanship, long term progress will only be made with the development of common ground, across specialties, across professions and within communities and geographies. ABFM will pursue a course of engagement and collaboration.

We are dedicated to improving Family Medicine Certification by engaging our Diplomates and serving our specialty, the profession, and the public. As we realize the components of this strategic plan, we commit to being a learning organization that is focused on continuous evaluation and improvement to support a certificate that is valued and trusted by all stakeholders. As you review our new Strategic Plan for ABFM: 2019–2025, I encourage you to find what you are most passionate about. And I ask you to engage—with your time, talent and collaborative spirit—with ABFM as we seek to strengthen the discipline of Family Medicine and improve the health of those who seek a trusting relationship with a personal physician for their care.

Sincerely,

Warren P. Newton, MD, MPH

President and CEO, ABFM

Mission To serve the public and the profession through certification, research,

educational standards and support for the improvement of health care.

Our goal is to help achieve better care, better patient experience and lower cost for all. To accomplish this goal:

• We certify family physicians who demonstrate professionalism, lifelong learning and

self-assessment, cognitive expertise, and commitment to improving the care they provide.

• We engage, support, and partner with our Diplomates over their entire professional careers in the

varied communities and capacities in which they serve.

• We collaborate with organizations, specialties and other partners who share our commitment to

high standards and improvement in health and health care.

• We set rigorous standards for residency training and continuing professional development and

support ongoing innovation in education.

• We conduct research that advances the science of certification, monitors how family physicians

and their practices change over time, and advances the scientific basis of family medicine.

• We support development of future leaders for the specialty, the profession and health care.

Vision Optimal health and health care for all people and

communities family physicians serve.

GOAL 1: ENHANCE CONTINUOUS CERTIFICATION

ABFM will:

Strategic Need:

1. Prioritize continual improvement of the certification portfolio with regular input from Diplomates, our partners, and the public.

2. Implement and evaluate Family Medicine Certification Longitudinal Assessment with intention to spread to all Diplomates. We will explore development of further options for assessment of cognitive expertise.

3. Launch a major update of our Lifelong Learning and Self-Assessment portfolio including new KSAs, access to selected external products, and a journal article-based activity.

4. Update our quality improvement portfolio through review and revising our change packages and by enhancing the opportunity for Diplomates to select options that are most relevant and useful to their practice setting.

5. Explore the development of a limited number of additional certificates to support Diplomates’ unique practice needs and focus.

6. Develop and begin to implement a “next generation” approach for the assessment of professionalism including more robust measures, better transparency, and identification of positive components of professionalism.

7. Continually monitor the effectiveness of the overall certification program and its individual components utilizing Diplomate engagement and feedback, data analytics and qualitative input from Board Members and staff.

As practice models change, as

physician roles grow more complex,

and as new technical means for

measuring the quality of care and

competence evolve, ABFM will adopt

a dynamic, forward-looking approach

for evaluating the knowledge,

attitudes and skills essential for family

physicians. Our goal is to adapt

continuously the methods of

continuous certification to improve

the health of the public, to meet the

needs of family physicians and their

varied practices, and to anticipate the

demands imposed by changes in

patients’ needs and in the health care

environment.

GOAL 2: SUPPORT DIPLOMATES AND THEIR PRACTICES ACROSS THEIR CAREERS

ABFM will:

Strategic Need:

1. Establish the role of an ABFM Ombudsperson for Diplomate experience.

2. Reorganize its communications strategy and operations. The value of board certification, as well as ABFM’s unique contributions and programs, needs to be easily identified and universally known. We will ascertain the needs of key audiences and stakeholders and will use consistent and clear communication to create recognized value across stakeholders and the profession of medicine.

3. Implement a new website and Physician Portfolio. We will simplify our message, change our voice, and put more emphasis on engagement through social media and other communications channels.

4. Develop a virtual network of Diplomates who will provide ongoing input on current activities and future initiatives as we evolve certification.

5. Improve service provided by the ABFM Support Center through a comprehensive strategy aimed at providing greater responsiveness and a better experience for Diplomates.

6. Continue to monitor changes in family physicians, their practices, and the organization of care. We will develop close linkages between what we learn and what we communicate with Diplomates and other stakeholders who impact the future of the discipline.

The need for ABFM to work more

collaboratively with Diplomates is

critical to all other strategic initiatives.

This requires fundamentally changing

the nature of our relationship with

Diplomates to one defined by

partnership and support for lifelong

professional development relevant to

their practice and career while

continuing to assess the competence

necessary for all board-certified

family physicians.

GOAL 3: SERVE FAMILY MEDICINE, THE PROFESSION AND PUBLIC

ABFM will:

Strategic Need:

1. Improve our working relationship with the AAFP and its state chapters through multi-level communication and partnership strategies with executive leadership, specific commissions and collaboration on projects designed to complement ABFM efforts to evolve certification activities. We will work with state chapters, the Robert Graham Center, and The Center for Health Equity and will support specific initiatives such as 25 x 2030.

2. Seek the involvement of family medicine academic organizations in our strategic initiatives. We will support selected collaborative projects that advance the discipline with each of these organizations through the ABFM Foundation.

3. Help the specialty act strategically in response to a rapidly changing environment. This will necessitate a new level of collaboration among the family medicine organizations to better identify and address emerging strategic issues, plan for broader impact, and sustain action over years.

4. Help ABMS develop into a stronger voice for transforming health care. We will support the ABMS governance change and implementation of the Vision Commission recommendations while pushing the profession to address the Quadruple Aim and championing the vital contribution of generalist physicians in improving the health of the public.

5. Engage new partners in helping to transform health care and health professions education. We will identify and prioritize new partners interested in working together to transform care and improve population health in a manner that optimizes the function of primary care and the role of family physicians.

6. Use data to drive dialogue among the family medicine organizations and across the ABMS Member Boards.

7. Help re-establish the social contract and the role of professional self-regulation. Through the Center for Professionalism & Value in Health Care, ABFM will partner with patients, employers, and the ABMS community to better understand the public’s expectations for professionalism and how physician organizations and employers can meet those expectations.

A fast changing, dynamic health care

environment requires rapid and

ongoing adaptation of the specialty in

order to maintain relevance. This will

require closer working relationships

and better coordination with other

family medicine organizations. ABFM

will advance the specialty of family

medicine, the profession of medicine,

and the health of the public through

leadership and broad-based

collaboration within family medicine

organizations and other relevant

partners.

GOAL 4: LEVERAGE CHANGE IN MEDICAL EDUCATION

ABFM will:

Strategic Need:

1. Ground its work in supporting the development of clinical mastery and comprehensive care across the lifetime of a family physician, from residency to retirement.

2. Support the maintenance and expansion of a broad scope of practice and comprehensive care. Family physicians will expand the populations they care for and lead care transformation in many ways. Working with partners, we will support competency and mastery in these areas among Diplomates by building these topics into ongoing certification activities.

3. Drive continued evolution of family medicine residency training. We will provide outcome data to support residency program improvement, influence changes in training requirements necessary to meet the health needs of the public, and support an increase in the numbers, quality, and distribution of Family Medicine residency programs.

4. Support the development of a more robust pipeline of US medical students interested in family medicine. Working with partners, we will focus on improving precepting quality and retention as well as support the 25 x 2030 Initiative and the importance of generalist physicians.

5. Continue to invest in the future leaders of the discipline through the Pisacano Scholars, the Puffer Fellows, and ABFM’s Scholars program. With partners, we will explore ways to support the ascension of family physicians to leadership roles in health systems.

6. Use robust data resources and evolving access to external data options to support Diplomate efforts to improve care and to create feedback loops for training programs. We will pursue funding to support this research and partner with other specialties to maximize the potential.

The importance of ongoing and rapid

evolution of the education of

physicians throughout their careers is

critical given the changes in health

care. Working with traditional and

new partners and building on our

research of the ecology of family

medicine, we will define standards for

knowledge and scope of practice for

achievement of clinical mastery by

family physicians. In doing so, we will

help drive innovation, evaluation, and

evolution in education for

physicians in residencies and across

their careers.

ABFM will:

1. Hire a new Senior Vice President for Research and Policy who will identify themes and priorities for the next phase of our research enterprise, develop new data resources and methods for outcomes studies, and develop a nationally distributed research network to answer questions that matter for the specialty, the profession, and the public. We will continue to build research relationships with key academic partners and agencies that extend our capacities and the value of our data platform.

2. Use the PRIME Registry as a platform for developing and advocating for Measures that Matter and for studying relationships between family medicine and meaningful outcomes. We will continue to develop partnerships with researchers and organizations with similar interests to transform the measures used to assess and pay for primary care.

3. Use the Population Health Assessment Engine (PHATE), underpinning research, and evolving relationships to improve clinic, community, and policy responses to social determinants of health.

4. Continue to invest in technology and expansion of data resources and capabilities in order to deliver and assess knowledge.

5. Continue to develop research collaborations aimed at defining what professionalism and value mean in 21st century medicine by enhancing the metrics and accountability of professionalism, realigning how clinicians are valued and paid, supporting the intrinsic values of providing care, and reducing the risk of burnout.

6. Support the development of research within the discipline of family medicine. We will continue to provide students, residents, fellows, and faculty hands-on research experience and policy exposure while providing appropriate access of our data to partners supportive of our overall agenda.

GOAL 5: INVEST IN DATA, RESEARCH AND TECHNOLOGY THAT WILL SUPPORT DIPLOMATES, CHART THE COURSE OF THE DISCIPLINE AND HELP THE PROFESSION IMPROVE THE HEALTH OF THE PUBLIC

Strategic Need:

With the dramatic changes taking

place in health care, new data and

tools will transform the practice of

Diplomates. ABFM’s research will be

necessary to anticipate, detect, and

respond to new trends and will

provide opportunities to improve the

ABFM’s operations and approach to

assessment. We will invest in research

and embrace new technology and

artificial intelligence tools.

ABFM will:

1. Develop the Center for Professionalism & Value in Health Care with a goal of changing the public dialogue about the role of professionalism in health care. We will conduct research that will explore the meaning of professionalism for patients, employers, and the public through partnerships with them and all other interested parties.

2. Incorporate professionalism, the social contract, and health equity into all plans for evolving certification and communications.

3. Include health equity into its program of lifelong learning and quality improvement. We will support organizations and people developing innovative curricula in professionalism, the social contract, advocacy, health equity, and social drivers of health at all levels of education.

4. Develop new approaches to the assessment of professionalism that support greater transparency and robustness while simultaneously exploring the measurement of positive aspects of professionalism.

5. Support the development and evaluation of new approaches to teach professionalism, the social contract, and health equity.

GOAL 6: PROMOTE PROFESSIONALISM AND THE SOCIAL CONTRACT

Strategic Need:

Commercial pressures, depersonalization

through technology, commoditization of

health care, and widening social

inequities will erode the public’s trust in

health care. In an environment in which

health care is increasingly seen as a

business, and professionalism is called into

question, our commitment to patients’

needs, to the doctor-patient relationship,

and to health equity needs to be a part

of all we do. ABFM will promote

professionalism and the social

contract in all its activities, functions, and

programs.

Values Strategic Action

In a complex and rapidly changing health care environment, we act strategically on behalf of the public to shape the future of health

care. Our decisions will be open, evidence-based or informed, and we will be publicly accountable for them.

Collaboration We work with Diplomates and all who share our commitment to improve health and health care.

Continuous Improvement We are committed to ongoing quality improvement in all that we do. We regularly review the effectiveness of our programs and

policies and work to improve our performance.

Learning as an Organization We will learn from Diplomates, other specialties and professions and the public, and change what we do as the

result of what we learn.

Equity We will recognize the voice of the public, the plight of those most vulnerable, and the complex demands of the careers of

Diplomates. We strive for justice and fairness in all that we do.

Diversity In order to optimize the directions and decisions we make, we are committed to diversity in our organization and our specialty.