[TCT2008]建议医生不要延误参加介入资格再认证

Physicians Advised Not to Delay Recertification

（北京安贞医院 苑飞 翻译）

要点：

• 虽然对于许多介入心脏病学家来说介入再认证是个新过程，但是它的要求是很容易满足的。
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2009年很多介入心脏病医生将要开始介入资格再认证，正如专家在本文标题中说的，医生应该现在就开始，避免最后不必要的匆忙。

George D. Dangas, MD, PhD，ACC介入心脏病学理事会主席，解释说新的多分支的再认证程序的要求是介入心脏病学家所并不熟悉的。这一过程可能好像令人恐惧，但是再认证程序的要求是清楚的，需要医生花时间去学习他们应该掌握的东西。

Dangas在采访中说：“最大的误解是人们认为他们将只需要出席并参加考试，像10年前一样。”

再认证过程有几部分组成，其中每部分都在美国内科学委员会网站(www.abim.org)上进行了明确的解释。另外，为了预约考试介入心脏病医生必须首先在自我评价中获得总共100个积分。

Dangas在与Jeffrey J. Popma医生共同署名发表在《JACC: 心血管介入分册》的文章中写道再认证过程至少应该在医生介入资格过期前1年开始。


来自于纽约哥伦比亚大学医学中心的Dangas还说医生需要在[ABIM]网站上仔细阅读再认证过程详细内容。

考试资格

一旦进入认证程序，医生将可以通过以下3种途径获得进行考试所需要的100个积分：家庭自学部分，实践提高部分和模拟操作部分。

除了上述3种途径，所有介入心脏病医生必须证明在过去2年中处理了至少150例介入病例，同时参与了一个介入治疗质量提高程序。

“再认证的本意是使那些过去已经获得介入资格的人们能够跟上今天技术的发展。” Dangas说。

家庭自学部分

医生能够从家庭自学部分中获得60个积分，这是介入心脏病学医生最熟悉的形式。这些开卷考试能在家中完成，而且没有时间限制，与之前的资格认证考试没有明显区别。其中包括2个主要部分，介入心脏病学部分（1题20分，另2题各10分）和20分的心血管疾病部分。

实践提高部分

Dangas认为这部分相对于家庭自学部分更客观，而且需要的不仅仅是粗略地复习。他说：“人们已经习惯于有问题和答案的考试，但这一部分是许多人不熟悉的，有这不同的临床口味。”

实践提高部分或PIMs能够提供每题20到40分，再认证过程中必须至少完成1个PIM题目。

与介入心脏病学相关的PIM目前是就诊到球囊扩张时间。然而介入心脏病学医生通过PIM能够满足在血管风险和预防心脏病学实践的要求。

PIM中新的部分是收集和分析患者的医疗质量数据。医生需要空出充裕的时间进行收集和回顾这一信息。

Dangas说：“在开始前需要详细计划大量工作，并且具有可行性。”

关键点在于实践小组能够选择一个单独的PIM，并得到所有参加实践成员的认同。这一部分在ABIM网站上的“自我指导PIM”中阐述。

不接触患者的医生可以选择另一个给非临床医生提供的替代部分，网站上解释道。

医学模拟操作部分

Dangas解释道，虽然是非强制性的，但是模拟操作是评价医生技术能力的唯一方法。

医生通过成功的模拟操作可以得到20分，在今年的主要医学会议上医生可以在模拟器上进行3小时的培训和自测，今年在TCT上有85个模拟操作点。

模拟操作之前从来没有进入过资格认证考试的范围，目前还不是强制性的是因为ABIM需要对它进行观察和优化，Dangas说。

再认证的鼓励
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Dangas提醒道，虽然许多医生对再认证程序并不认同，但是他们无法逃避。

“如果有人阅读网站上的说明，并花时间去研究程序的标准，他将得到很好的解释。迷惑源于对程序标准的断章取义和对取消程序的期望。”

（来源：www.tctmd.com）

Physicians Advised Not to Delay Recertification     
  
Key Points:

• Even though the procedure is new for many interventional cardiologists, the requirements can easily be met if addressed promptly.

By TCT Daily Staff

With many interventional cardiologists due for recertification starting in 2009, physicians should begin the process now to avoid unnecessary stress later, according to an expert on the topic.

George D. Dangas, MD, PhD, who chairs the Interventional Cardiology Council of the American College of Cardiology, explained that the new, multi-pronged recertification requirements may be unfamiliar to most interventional cardiologists. And while the process might seem daunting, the requirements are clearly laid out, provided physicians are willing to take the time to learn the steps they need to take.

"The biggest misconception is that people think they’ll just be able to show up and take a test like 10 years ago," Dangas said in an interview.

The process involves several components, each of which is explicitly described on the website of the American Board of Internal Medicine (www.abim.org). In addition to scheduling a recertification exam, interventional cardiologists must first earn a total of 100 points in the self-evaluation overview.

Dangas, who co-authored an article with Jeffrey J. Popma, MD, outlining the requirements in the June issue of the Journal of the American College of Cardiology: Cardiovascular Interventions, said the process should begin at least one year in advance of a physician’s certification expiration date.

"Physicians must go the [ABIM] website and read what it says," said Dangas, of Columbia University Medical Center in New York, NY.

Qualifying for the exam

Once enrolled in the Maintenance of Certification program, there are three ways a physician can earn the 100 points needed to sit for the exam: home study modules, practice improvement modules, and simulation sessions.

In addition to these three pathways, all interventional cardiologists must prove they have performed a minimum of 150 interventional cases in the past two years and demonstrate participation in an interventional quality improvement program.

"The essence of recertification is to bring people who have been certified in the past up to speed with what is happening today," Dangas said.

Home study modules

Physicians can earn up to 60 points through home study modules, the most familiar format for interventional cardiologists.

These open-book exams can be completed at home with no time limit and do not dramatically differ from the initial certification examination. There are two modules available in interventional cardiology (one for 20 points and two for 10 points each), and another 20 points can be earned by taking a cardiovascular disease module.

Practice improvement modules

These modules are less intuitive than the home study modules and require more than a cursory review, Dangas said.

"People are used to taking tests with questions and answers, but these modules have a different clinical flavor that many people are unfamiliar with," he said.

Practice improvement modules, or PIMs, can provide 20 to 40 points each, and completion of at least one PIM is mandatory for recertification.

The only PIM specific to interventional cardiology currently is the door-to-balloon time continuous quality improvement module. However, interventional cardiologists can also satisfy this requirement by taking a PIM on general cardiovascular risk or one on preventive cardiology practice performance.

What is novel about the PIM component is that it requires the collection and analysis of data related to patient care, including questionnaires mailed to patients. Physicians should be sure to leave enough time to gather and review this information, Dangas said.

"There are a lot of activities that need to be planned well ahead of time and can be executed by the office staff," Dangas said.

A key point is that a practice group can choose to submit a single PIM for approval that would count for all members of the practice. Instructions with information on this topic are also on the ABIM website under "self-directed PIM."

Physicians who do not interact with patients can complete an alternative module for clinically inactive physicians, which is also explained on the website.

Medical simulation sessions

While not a mandatory step, simulation sessions are a unique way to evaluate physicians on their technical competence, Dangas explained.

Physicians can earn 20 points for successfully completing a simulation session, which can entail three hours of training and self-testing at a simulator during major medical conferences throughout the year. There are 85 simulation spots available during TCT this year.

Simulation has never before been included as part of a recertification exam, and the fact that it is not yet mandatory may indicate that the ABIM sees room for refinement, Dangas said.

Incentives for recertification

While many physicians are resistant to the recertification process, they should not put it off, Dangas cautioned.

"If someone looks at the website and spends some time reviewing criteria, it’s really well explained," he said. "The confusion is propagated because people read different pieces of it and they hope it will just go away."