The American Board of Nuclear Medicine (ABNM) CertLink program is the mechanism offered to permit diplomates to satisfy American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC) Part 3 requirements on a continuous, quarterly basis as opposed to a periodic (10-year cycle) half-day, high-stakes examination. CertLink offers several distinctive advantages over the previous periodic approach. Although CertLink provides the ABMS-required summative evaluation of diplomate cognitive ability, it is implemented in a formative context, providing participants with questions intended to emphasize common or new clinical aspects of nuclear medicine and molecular imaging. Each question item is accompanied by a critique describing the key concept, together with citation(s) to the literature for diplomates who want deeper understanding, particularly of new innovations in the field.
Approximately 1,250 active ABNM diplomates currently participate in the CertLink program, which launched in April 2018. Earlier this year, ABNM conducted a review and assessment of the program to determine direction(s) for potential future improvement. An important communication pathway leading to feedback from participating diplomates is the opportunity to provide comments to ABNM at the item response/review step in the examination. Review of the initial 3 years was based on the first 108 distinct exam items distributed, with the opportunity for up to 135,000 potential diplomate comments. ABNM received and reviewed 1,136 comments over this period. Each comment was reviewed and investigated by ABNM, but individual responses to commenting diplomates were beyond the scope of board resources. A majority of CertLink question items received diplomate comments. Twenty-six received ≥10 comments; of these, 8 items were excluded from final scoring on the basis of unanticipated problems. Several overall comment themes were identified.
Image Quality and Display. Frequent comments addressed difficulty in review of diagnostic images. In the current CertLink 2.0 release, images are an integral component within the question page, and the zoom feature of the workstation browser program must be employed. When finished zooming in on an image, the browser display must be reset to lower resolution to complete the question and see the next question. The ABNM CertLink FAQ and instruction page on the Web will be updated to document this approach. In addition, ABNM will further emphasize image quality and clarity in future published items, recognizing the critical image-rich aspect of nuclear medicine and molecular imaging practice.
Review of Questions and Images with Item Critique. Another frequent comment was the desire to re-review a question and images at the level of item feedback and critique stage of the examination. Current feedback is limited to identification of the correct vs. incorrect scoring of the diplomate response, together with a brief discussion of the key concept in the question and citation(s) to supporting literature. ABNM is investigating the possibility of redisplay of questions and images as a part of the feedback phase, and, if feasible, this will be added as an update to the examination procedure.
Key Point/Focus of Question(s). Diplomates also commented on the relationship of the key concept of an exam item to the current practice scope of the diplomate. In this context, it must be appreciated that ABNM certification covers the entire spectrum of practice in the field. ABNM does not offer subspecialty certifications for focused practice areas such as cardiovascular or pediatric nuclear medicine and molecular imaging or for diplomates who may not have ongoing experience with related therapy and theranostics. Continued ABNM certification applies to the entire breadth of nuclear medicine and molecular imaging content. An advantage of the CertLink approach is that it permits diplomates to remain current in aspects of practice that are potentially outside the constraints of their present practice—the formative aspect of CertLink, directing diplomates to literature resources for further learning and clarification.
Additional comments identified item-specific aspects. These included the possibility of incorrect scoring: incorrect key distractor, multiple correct distractors, or no correct distractor presented. Each comment was investigated by ABNM, and, in some instances, unanticipated problems with items were confirmed. In most such instances, such items were deleted from final scoring of the overall exam. In addition, ABNM conducts a retrospective psychometric statistical analysis of each item to identify items that did not perform as intended. In most instances, these were also deleted from final diplomate assessments, supporting the overall validity of the summative CertLink results for satisfaction of MOC Part 3 requirements.
ABNM CertLink is fully operational and functioning as intended. However, it is not a “final product” and will continue to undergo prospective changes and improvements, many at the suggestion of participating diplomates. Diplomates are encouraged to continue offering comments during item review. These constitute important input for potential program modifications. ABNM will further strengthen item delivery and feedback aspects of the program, with continued emphasis on supporting participant awareness of important clinical innovations and changes throughout all aspects of nuclear medicine and molecular imaging. Diplomates who have not yet activated participation in CertLink should consider enrolling to obtain the benefits of both ABMS Part 3 evaluation as well as formative resources and assistance with the evolving landscape of clinical practice.
- © 2022 by the Society of Nuclear Medicine and Molecular Imaging.