March 2001
Volume 65 |
Number 3
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SUBSPECIALTY NEWS
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| ABA,
ASA and ACGME: Collaboration, Clarification and Less Confusion |
Francis P. Hughes, Ph.D.
Executive Vice-President American Board of Anesthesiology
The American Board of Anesthesiology (ABA), ASA and the Accreditation
Council for Graduate Medical Education (ACGME) are separate, independent
and distinct organizations with different missions. However, ABA
often works in concert with ASA and the Residency Review Committee
for Anesthesiology (RRC) of ACGME to accomplish specific objectives.
Their collaborative efforts help to explain why each organization
often receives correspondence from anesthesiologists and residents
about matters that are more appropriate for one of the other organizations
to address. Understanding the mission of each organization may
help to clarify their responsibilities and authority with regard
to ongoing collaborative activities and to avoid confusion as
they work in concert on new initiatives.
Organizational Missions
ABA exists to maintain the highest standards of practice and
training in anesthesiology. It fulfills its mission by establishing
and maintaining criteria for the designation of Board-certified
anesthesiologists and by conducting examinations to determine
whether candidates meet the required standards for certification
as an ABA diplomate. ABA also informs the RRC about the training
required for admission to ABA’s system for examination and certification.1
The purpose of ASA is to advance the specialty of anesthesiology
and safeguard the professional interests of its members. It does
this, in part, through fostering and encouraging education, research
and scientific progress in anesthesiology by recommending standards
of postgraduate education for qualification as a specialist in
anesthesiology and by recommending standards for approval of postgraduate
training centers.2 ASA also provides specific opportunities for
the ongoing education of anesthesiologists.
ACGME's mission is to improve the quality of health in the United
States by ensuring and improving the quality of graduate medical
education for physicians in training. ACGME establishes national
standards for graduate medical education. It delegates accreditation
authority to RRC, which uses national standards to accredit and
continually assess graduate medical education programs in anesthesiology.3
Although the three organizations have different missions, they
share common educational and quality objectives and work in concert
to accomplish them.
Ongoing Collaborative Efforts
ABA, ASA and the American Medical Association Section Council
on Anesthesiology appoint three representatives each to RRC. Then,
RRC considers applications for accreditation of new training programs.
It reviews the ACGME-approved Program Requirements for Residency
Education in Anesthesiology and anesthesiology subspecialties
every five years and proposes revisions to them. The committee
meets biannually to review reports prepared by trained residency
program inspectors to assure that the programs are in substantial
compliance with the program requirements.
ABA and ASA formed the Joint Council on In-Training Examinations
in 1975 to develop one written examination to assess the progress
of residents in training. Each organization appoints seven representatives
to the In-Training Council. In 1975 and 1976, the Council administered
the In-Training Examination to residents, and ABA administered
a different written examination to candidates for certification.
Since 1977, the Council has administered the annual In-Training
Examination to ABA candidates as well as residents. The In-Training
Council reports a score on the entire examination only to residents-in-training
and their training program directors. ABA reports a score on a
subset of the total test only to candidates in its certification
system.
ABA develops the Board’s voluntary recertification examination
without ASA input. Nevertheless, based on examination analyses,
the Board informs the Chair of the ASA Section on Education and
Research about topics that could be useful for ASA's refresher
courses and other educational programs.
New Collaborative Initiatives
The American Board of Medical Specialties (ABMS), ACGME and
the Council of Medical Specialty Societies (CMSS) are aware of
the quality improvement concepts that have been widely applied
within health care organizations. They independently approved
a description of the competent physician that identifies six general
competencies physicians should possess. They are working in concert
to ensure that evaluations of physicians in residency training
and throughout their professional career assess these competencies.
Physicians representing ABA, ASA and RRC have drafted an anesthesiology
resident evaluation plan that identifies specialty-specific elements
of the six general competencies and methods to evaluate them.
All ABMS member boards are committed to evolving their recertification
programs into maintenance of certification (MOC) programs that
assess these six general competencies.
One of the basic components of an MOC program is evidence of
a commitment to lifelong learning and involvement in a periodic
self-assessment process. ABMS and CMSS are encouraging their member
organizations to collaborate to develop specialty-specific, lifelong
learning and self-assessment programs. ABA and ASA have formed
an ad hoc planning group to explore the potential for collaboration
with development and maintenance of a program of lifelong learning
and self-assessment for certified and noncertified anesthesiologists.
ABA and ASA collaboration would ensure convergence of the program’s
educational curriculum and the content of the examination of cognitive
expertise that ABA would administer to MOC candidates. There may
also be the opportunity for ABA-ASA collaboration with the development
of other components of the anesthesiology MOC program.
Education is the common bond among ABA, ASA and ACGME; however,
there are differences among their purposes. RRC accredits programs
that train anesthesiologists, ABA certifies anesthesiologists
who meet its standards and ASA provides educational and self-assessment
opportunities for practicing anesthesiologists to maintain and
improve their competencies, in addition to advancing the specialty
and safeguarding the professional interests of its members. These
differences are not diminished by ongoing endeavors in which the
functions of the three organizations converge. The differences
will remain even as the three organizations explore new collaborative
initiatives to accomplish common objectives.
Bibliography:
American Board of Anesthesiology. Booklet of Information. November
2000; Section 1.0, Purposes.
American Society of Anesthesiologists. Bylaws. 2001; Section
1.00, Purpose.
American Medical Association. Graduate Medical Education Directory
2000-2001. 2000; Section I, Introduction:11.
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Francis
P. Hughes, Ph.D., resides in Cary, North Carolina. |
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