The following milestones describe highlights of the events that shaped ABEM's history.
ABEM IN THE 1960s AND 1970s
EM is the 23rd recognized medical specialty in the United States. In the early 1960s, the United States public began to demand improved quality of care in hospital emergency departments. In response, hospitals developed full-time emergency services. As a result, a number of physicians began developing the training and practice of EM.
To support this growing physician group, new organizations formed, such as the ACEP and the University Association for Emergency Medical Services (UA/EMS), which is now the SAEM. These organizations became the focal point for emergency physician education and the development of high-quality training programs.
In 1973, the AMA sponsored a conference on physician education in emergency medical care. In 1975, the AMA approved a formal section on EM.
In the early 1970s, ACEP members developed the Committee on Board Establishment (COBE). The Committee began the arduous process of setting forth the standards for credentials and certification in EM.
ABEM was incorporated in 1976. During this same period, there was increased interest in providing EM graduate training programs. The UA/EMS and ACEP established the Liaison Residency Endorsement Committee whose endorsement process patterned the Liaison Committee for Graduate Medical Education and used the AMA-approved standards for reviewing and accrediting graduate training programs.
In 1977, ABEM administered a full-scale field test using the examination produced by COBE and the Office of Medical Education Research and Development (OMERAD) at Michigan State University. This examination used written item formats and a unique case simulation oral examination.
In 1976, ABEM submitted an application to ABMS seeking primary board status. This application was referred to the Liaison Committee for Specialty Boards (LCSB), a committee comprised of AMA and ABMS representatives. The LCSB conducted open hearings intended to elicit support or opposition to the application. At the close of these hearings, the LCSB recommended primary board approval and sent the recommendation to its parent bodies. The AMA Council on Medical Education approved this recommendation, but the ABMS defeated it.
At the suggestion of various ABMS members, representatives from other specialty boards held a lengthy series of discussions from which a recommendation emerged for a second application, this time seeking approval for a conjoint board (modified). The LCSB hearings resulted in a recommendation for approval, which again was submitted to the parent organizations. The AMA Council on Medical Education and the ABMS approved this application.
In September 1979, EM became the 23rd recognized medical specialty.
The original ABEM sponsors were ACEP, AMA, and UA/EMS, and the following seven specialty boards: American Board of Family Practice (ABFP); American Board of Internal Medicine (ABIM); American Board of Obstetrics and Gynecology (ABOG); American Board of Otolaryngology (ABOto); American Board of Pediatrics (ABP); American Board of Psychiatry and Neurology (ABPN); and American Board of Surgery (ABS).
Directors elected from the sponsoring specialty boards’ nominees provided great assistance throughout ABEM’s development.
ABEM IN THE 1980s
ABEM offered the first EM certification examinations in 1980 and certified its first diplomates in that year.
ABEM contracted OMERAD at Michigan State University to develop and present an annual workshop for ABEM item writers, beginning in 1985. This annual workshop is now developed and conducted internally. ABEM contracted OMERAD in 1986-1987 to develop a high-level, formal training program for ABEM oral examiners, which has continued to expand with additional refinements.
In May 1987, ABEM submitted an application to ABMS for conversion to primary board status. The ABMS Assembly defeated this application by a vote of 52-48, with six abstentions. (Approval requires a two-thirds ABMS Assembly vote.) Following that vote, ABEM officers and directors engaged in a series of active discussions with its sponsors and other ABMS Member Boards, during which many of the issues and concerns raised by the 1987 application were clarified and resolved.
On May 11, 1989, ABEM submitted a new application to ABMS for conversion to primary board status. ABEM's sponsors and most other ABMS Member Boards supported this application. On September 21, 1989, the ABMS Assembly voted unanimously to approve the ABEM application. Ten years after the 1979 original vote making ABEM an ABMS Member Board with conjoint (modified) status, ABEM took its place as an ABMS Member Board with full primary board status.
ABEM offered recertification for the first time in 1989.
ABEM IN THE 1990s
During 1990, guidelines for five-year combined training programs were approved for Emergency Medicine/Internal Medicine and Emergency Medicine/Pediatrics. Upon completion of these training programs, physicians can access the certification examinations in EM and Internal Medicine, or EM and Pediatrics.
Soon after receiving primary board status, ABEM began working with other ABMS Member Boards to develop subspecialty certification for ABEM diplomates. The table at the end of this document lists each subspecialty.
On June 12, 1993, ABEM dedicated a new headquarters building in East Lansing, Michigan. The building is a unique design and represents the Board’s dedication to quality and high standards.
In June 1994, ABEM initiated the LSEP and recruited 1,008 emergency physicians to be lifetime participants. The study gathers information on professional interests, attitudes, and goals; training, certification, and licensing; professional experience; well-being and leisure activities; and demographic information. In 1996, ABEM initiated the ABEM LSEMR.
In the fall of 1997, ABEM established the Presentation to Training Programs (PTP) through which directors deliver information in person to all ACGME-accredited EM residency training programs on a rotating three- or four-year basis. The purpose of the presentation is to enhance communications between ABEM and residents; to clearly identify ABEM as the premier certifying body in EM; and to answer the most important questions residents have about certification, training, and other issues in medicine and EM.
In 1997, a task force was appointed to define the context and processes by which a new Core Content for Emergency Medicine could be created. The task force initially included representatives from the sponsor organizations: ABEM, ACEP, SAEM, and the Council of Emergency Medicine Residency Directors. Representatives of the RRC-EM and the EMRA were added as consultants following the first meeting. ABEM was designated as the administrative organization for the project.
In February 1999, ABEM and ABIM approved guidelines for a six-year combined training program that, upon completion, provides physicians the option for triple certification in EM, Internal Medicine, and CCM.
In December 1999, after 20 years of service to ABEM, Benson S. Munger, Ph.D., retired his position as the first ABEM Executive Director. Dr. Munger was recognized for his insight, skill, and focus on the importance of establishing and nurturing the ABEM family with his creativity, leadership, warmth, and other seminal contributions to the specialty. In March 2000, Mary Ann Reinhart, Ph.D., was selected as the new ABEM Executive Director. Dr. Reinhart began her work with ABEM in 1985 as a faculty member in OMERAD and joined ABEM in 1988. She served as Deputy Executive Director from 1995–2000.
The Board of Directors commissioned the Maintenance of Certification (MOC) Task Force in 1999. Its goal was to evaluate current needs and trends in medical specialty recertification in order to develop a new approach to recertification. From the work of the Task Force, ABEM developed the EMCC program. The EMCC program is anchored in the ABMS MOC® guidelines for all Member Boards that were developed in conjunction with the ACGME program designed to train and assess residents in specialty-specific components of competence.
EMCC is composed of the four ABMS MOC® components: Professional Standing, LLSA, ConCertTM, and APP.
ABEM IN THE 2000s
The Core Content Task Force II received approval of The Model of the Clinical Practice of Emergency Medicine (EM Model) from sponsoring organizations in February 2001. ABEM adapted the EM Model for use as an examination blueprint for all of the ABEM examinations. The fall 2002 written certification and recertification examinations were constructed in accordance with the EM Model.
In 2002, ABEM completed an extensive renovation of its headquarters building in East Lansing, Michigan, incorporating all building space for ABEM use.
In 2003, ABEM and ABIM approved the first six-year combined training program for EM/IM/CCM.
In January 2004, ABEM implemented the first three components of EMCC. APP was scheduled to begin in 2010.
On April 5, 2004, diplomates were granted access to EMCC Online, the interactive EMCC portion of the ABEM website that provides ABEM diplomates access to a secure, personal homepage where they can track their status within the EMCC program.
In 2004, ABEM implemented a new program to replace the former PTP. The new program, called Residency Visitation Program (RVP), includes more options to share topics of interest with EM residency programs, faculty, and attending physicians. These include meeting with the chief resident, faculty, department chair, or others identified by the program; meeting in venues identified by the program; and giving a presentation in an area of the director’s expertise.
July 1, 2004, through June 30, 2005, ABEM celebrated its 25th Anniversary. Several events celebrating ABEM’s founders and ABEM’s many accomplishments were held throughout the year.
In January 2005, the bylaws were changed to create a BOD comprised entirely of emergency physicians. The amended bylaws were supported by all of ABEM’s sponsors. The following boards withdrew as sponsors in January 2006: ABIM, ABOG, ABP, ABPN, ABS.
As planned, the 2005 LLSA test was posted on April 1, 2005, and retired on March 31, 2008. This was the first LLSA test to be retired.
An MOC program in Medical Toxicology was developed for implementation in 2006, and began in January 2006. The first LLSA test was implemented in June 2009 and the Medical Toxicology Subboard recommendations regarding the implementation of Assessment of Practice Performance were approved.
In 2005, ABEM administered the last paper-and-pencil written certification examination and for the first time began development of a computer-delivered examination to be administered in testing centers in November 2006. The name of the “written” certification examination was changed to “qualifying” examination, a label that reflects its essential purpose in the certification process.
The 2006 Medical Toxicology certification examination and the MOC cognitive expertise examination were changed to computer-delivered examinations for administration in computer-based testing centers.
In 2006, ABEM and ABFM approved guidelines for a five-year combined training program that, upon completion, provides graduates the opportunity to seek certification in both EM and Family Medicine.
In September 2006, after consideration of a comprehensive proposal prepared by ABEM diplomates in conjunction with the American Board of Hospice and Palliative Medicine, a board that is not a Member Board of the ABMS, ABEM joined nine other ABMS Member Boards in sponsoring the newly-approved ABMS subspecialty of HPM. The first certification examination was given in 2008.
In March 2007, the American Board of Physical Medicine and Rehabilitation was approved by ABMS as a co-sponsor of Sports Medicine.
In February 2008, an Initial Certification Task Force was established to review the initial certification process to assure that the content and methods used to determine whether candidates meet current standards of practice remain relevant and effective. It is likely that some of the project’s outcomes will lead to adjustments in the methods and timing of candidate evaluation activities. It will likely take four or five years to complete this project.
On June 1, 2009, the first Medical Toxicology LLSA test became available on ABEM’s website.
ABEM IN THE 2010s
In January 2010, APP, the fourth component of EMCC began for some diplomates who were able to attest to completion of their APP requirements by using EMCC Online.
On March 31, 2010, after almost 23 years of service to ABEM, Mary Ann Reinhart, Ph.D., retired her position as the second ABEM Executive Director. Through her creativity and leadership, ABEM continued to make seminal contributions to the continued development of the specialty.
On May 1, 2010, Earl J. Reisdorff, M.D., was selected as the new ABEM Executive Director. Dr. Reisdorff had been active with ABEM as an oral certification exanibation examiner since 1994, an item writer for the qualifying examination from 1999-2009, a Senior Case Reviewer for the oral certification examination, and participated as a member of the Case Development Panel.
Effective September 1, 2010, the AMA increased the number of AMA PRA Category 1 Credits™ from 25 to 60 credits for successfully attaining board certification by passing the oral examination or successfully maintaining certification by passing the ConCertTM examination. Diplomates are given up to six years from the effective date on their certificate to apply for the credits.
On September 28, 2010, the ABMS, at its General Assembly meeting, approved EMS as its 112th subspecialty, making it the sixth subspecialty available to ABEM diplomates. An EMS Examination Task Force, composed of 12 EMS physicians, was appointed by ABEM and began working on the development of the EMS subspecialty examination in February 2011. The first examination is scheduled for the fall of 2013.
In 2011 ABEM introduced the next phase of EMCC by changing the requirements and frequency of the EMCC activities required to continue certification. These changes emphasized that all four components of EMCC have value in demonstrating an EM physician’s performance improvement. The changes will be phased in over the next several years.
On April 1, 2011, ABEM diplomates were able to apply for CME for completing the 2011 LLSA CME Activity. This opportunity was the result of an unprecedented collaboration between ABEM, ACEP, and AAEM. Diplomates can apply for the AMA PRA Category 1 Credit™ for this activity through either AAEM or ACEP. A similar opportunity is also available with the 2012 LLSA CME Activity.
In May 2011, the bylaws were changed to create a new standing committee, the Finance Committee. The previous Executive Finance Committee was changed to the Executive Committee.
In July 2011, the BOD created the Communications Committee, which was charged in part with assisting the BOD to define how to maintain effective and efficient communications with internal and external audiences, and reviewing the efficacy and efficiency of communications efforts.
On September 21, 2011, at the General Assembly meeting of the ABMS, ABEM and ABIM co-sponsorship of the subspecialty of Internal Medicine-Critical Care Medicine (IM-CCM) was unanimously approved. Emergency physicians can now participate in Internal Medicine–sponsored Critical Care Medicine (CCM) fellowships and be eligible to seek board certification. IM-CCM became the seventh subspecialty certification available to ABEM diplomates.
In November and December 2011, an experimental pilot multiple choice question (MCQ) examination was administered to emergency physician volunteers at Pearson VUE testing centers. The purpose of this examination—which was the culmination of the work of the ICTF Task Force—was to explore the use of new stimulus types on ABEM examinations. A pilot oral examination was administered in June 2012.
In April 2012, the name of the EMCC program was changed to ABEM MOC. ABEM, along with the other 23 ABMS Member Boards, agreed to adopt common terminology that reflects the continuous nature of the program and clarifies that physicians certified in all specialties participate in the same type of certification process.
In April 2012, an application process for external organizations that wish to obtain ABEM pre-approval for APP activities was made available on the ABEM website. Once an activity is approved, ABEM diplomates can receive credit toward their ABEM MOC APP requirements for completing the activity. ABEM is encouraging the development of such activities in order to expand available options for ABEM diplomates.
In June 2012, ABEM was approved by the Centers for Medicare and Medicaid Services (CMS) to participate in the Physician Quality Reporting System (PQRS) MOC additional incentive program in 2012. ABEM diplomates who participated in the program received an additional 0.5% reimbursement on their Medicare billings if they met their basic PQRS reporting requirements. ABEM was approved to participate in the program again in 2013 and 2014.
In September 2012, the Emergency Medicine Milestones were approved. The EM Milestones are a matrix of the knowledge, skills, abilities, attitudes, and experiences that should be acquired at different points during EM training. The EM Milestones Project was a joint initiative of the ACGME and ABEM, and was supported by representatives of the Association of Academic Chairs of Emergency Medicine (AACEM), AAEM, ACEP, CORD, EMRA, RRC-EM, and SAEM.
Beginning in 2013, the ConCert™ examination was no longer the final step in renewing certification; the four parts of MOC became de-linked. Diplomates can therefore register for and take the ConCert™ examination in any of the last five years of certification, even if they have not completed all of their MOC requirements. However, at the end of a diplomate’s ten-year certification, any outstanding MOC requirements will result in loss of certification.
At its winter 2013 BOD retreat meeting, the ABEM BOD participated in a strategic planning session that led to a new mission statement for ABEM, “To ensure the highest standards in the specialty of Emergency Medicine.”
In May 2013, the Board of Directors of the ACGME approved allowing emergency physicians to formally enter Surgical Critical Care (SCC) fellowships, thus providing a pathway for EM diplomates to train for and take the SCC subspecialty certification examination. Certification in SCC is through the American Board of Surgery (ABS).
The first certification examination in EMS took place in October 2013. Because some physicians were unable to schedule to take the examination at an agreeable location or date, an additional administration was scheduled for March 2014. The first EMS LLSA reading list was posted in July 2013, and the first test was posted in June 2014.
The first certification examination in Clinical Informatics, which is open to diplomates of all ABMS Member Boards, took place in the fall of 2013, and 44 ABEM diplomates took the exam.
Subspecialty certification in Pain Medicine, which had been open to diplomates of any ABMS Member Board, will be soon available only to diplomates of a co-sponsoring board. In April, 2014, ABEM was approved by the ABMS to become a co-sponsor, thus allowing ABEM diplomates to continue to have access to the examination.
In spring 2014, ABEM launched a Patient Safety LLSA, jointly developed by ABEM and ACEP. The activity, which has an optional CME activity, will be required during the first five years of certification, counts toward the LLSA test requirement, and can be used toward fulfilling the Part II CME requirement, including the self-assessment credit requirement.
In September 2014, ABEM marked the 35th anniversary of Emergency Medicine’s recognition as a medical specialty.
In the fall of 2014, ABEM recognized physicians who had marked 30 or more years of being ABEM–board certified in Emergency Medicine with a special certificate. Over 950 diplomates had accomplished the milestone, and their names were included in the fall issue of the ABEM Memo, and posted on the ABEM website. Certificates will be awarded annually to diplomates who achieve the milestone.
In October 2014, ABEM convened a summit of representatives from AACEM, AAEM, AAEM Resident Student Association, ACEP, CORD, EMRA, RRC-EM, and SAEM to critically review the ABEM MOC Program. One purpose of the Summit was to provide current information about the ABEM MOC Program to the EM community, and solicit ways in which the program might be improved.
The EMS Task Force transitioned to the EMS Examination Committee and held its first meeting on November 18, 2014. The Committee is charged with writing the EMS Certification Examination and EMS LLSA tests, overseeing the EMS certification eligibility criteria, crafting the EMS MOC Program, and maintaining the Core Content of EMS Medicine.
2014 marked the third and final year of ABEM’s participation in the PQRS MOC additional incentive program. During the three-year period, ABEM diplomates made nearly 12,000 applications to the program, and received an estimated $3.8 million in additional Medicare reimbursements.
The Policy on Board Eligibility took effect on January 1, 2015. Physicians who had not achieved certification will be considered board eligible on that date or the date that they graduate from an ACGME-accredited EM program, and will remain board eligible for five years after that date whether or not they have applied for certification. Physicians who delay any certification activity have additional requirements (LLSA tests and CME) until they become board certified.
A new format integrating dynamic stimuli into the testing process was introduced in the November 2014 Qualifying Examination and the spring 2015 Oral Certification Examination. In addition, the examinations incorporated new specifications, grounded in the EM Model and a detailed description of what a board certified emergency physician knows and is able to do (their knowledge, skills, and abilities, or KSAs). The revised testing formats and specifications warranted reconsideration of the existing passing score criteria. After deliberation on several factors, the Board approved a new passing score of 76 on a scale of 0 to 100 for the Qualifying Examination. Following the spring administration, the Board determined the final passing score for the Oral Certification Examination to be 5.38. Both examinations continue to be criterion referenced.
During 2014-2015, ABEM endowed a fellowship within the Institute of Medicine (IOM). The ABEM Fellowship is a two-year fellowship that provides early-career, health-science scholars the opportunity to experience and participate in evidence-based health care or public health studies that affect the nation’s health.
In spring 2015, ABEM announced its entry into social media with pages on Facebook and LinkedIn. The pages are intended as yet another means to share recent news and important information with diplomates, residents, EM programs, and the public.
The following ABEM subspecialties were approved in the 2010s: Anesthesiology Critical Care Medicine, Emergency Medical Services, Internal Medicine-Critical Care Medicine, and Pain Medicine.
Anesthesiology Critical Care Medicine
Emergency Medical Services
Hospice and Palliative Medicine
ABA, ABEM, ABFM, ABIM*, ABOG, ABP, ABPMR, ABPN, ABR, ABS
Internal Medicine-Critical Care Medicine
ABEM*, ABP, ABPM
ABA*, ABEM, ABPMR, ABPN
6/1/2014 - 8/9/2014
Pediatric Emergency Medicine
ABEM, ABFM*, ABIM, ABP, ABPMR
Undersea and Hyperbaric Medicine
* Administrative board responsible for examination development, analysis, scoring, and preparation of exam results.
** First examination available to ABEM candidates.
ABEM diplomates also have pathways to subspecialty certification in Brain Injury Medicine (throught the American Board of Physical Medicine and Rehabilitation), Clinical Informatics (through the American Board of Preventive Medicine), and Surgical Critical Care (through the American Board of Surgery).