APCA Update for APDVS: Inteleos and the Physicians Vascular Interpretation (PVI) Examination

Transcription

1 APCA Update for APDVS: Inteleos and the Physicians Vascular Interpretation (PVI) Examination

2 Disclosures No financial conflicts of interest Volunteer service on Council of Alliance for Physician Certification and Advancement (APCA) Volunteer service on Boards of Directors: Society for Vascular Ultrasound (SVU) Intersocietal Accreditation Commission (IAC) Vascular Testing Joint Review Committee for Education in Diagnostic Medical Sonography (JRC-DMS)

3 APCA.org ARDMS was established in 1975

4 APCA, a spin off of ARDMS, was created in 2016 to exclusively serve the physician community APCA.org

5 Inteleos: the umbrella company APCA.org

6 Physician Vascular Interpretation(PVI) Examination Specialty Cardiology 1383 Vascular Surgery 1356 Not Available 393 Radiology 217 Other 184 Vascular Medicine 117 Interventional Radiology 50 Internal Medicine 38 Family Practice 14 Cardiothoracic Surgery 11 Emergency/Trauma Care 6 Obstetrician/Gynecology 3 Surgery 3 Crritical/Intensive Care 2 Phlebology 1 Increased numbers of cardiologists since 2010, now declining Vascular surgeons now largest group of specialists seeking certification Registered Physician in Vascular Interpretation (RPVI ) certification is required by ABS to register for Certifying Examination Candidates not required to be currently certified Currently offered in two testing windows each year

7 Cumulative First Time Pass Rates Specialty Count Percent pass on first attempt Cardiology Vascular Surgery Radiology Other Vascular Medicine Interventional Radiology Internal Medicine Family Practice Cardiothoracic Surgery

8 PVI Examination Updates PVI Exam will be available year-round (on demand), starting July 2017 New eligibility (prerequisite) requirements can be used starting in July 2017 Existing eligibility requirements can be used through December 2017

9 PVI Examination Administration with Pass/Fail Passed Failed

10 PVI Examination Statistics Year 1 ST -time pass rate % % % % % Vascular Surgery Comparison of Specialties Number Percent of total Fall Pass Rate Spring Pass Rate % 80% 84% Cardiology % 79% 84% Radiology 39 7% 90% 92% Vascular Medicine 14 2% 79% 82% Other 42 7% 64% 71% APCA.org

11 PVI Examination Statistics Year APCA.org 1 ST -time pass rate % % % % % Declining pass rates associated with changing demographic Year Median Age

12 Taking it for Vascular Surgery Boards Performance in Fall 2016 Vascular Surgery

13 Test Getting Harder? Passing standard most recently revised in Spring 2016 PVI-representative panel of judges Criterion-referenced standard-setting methodology Focus was on how much one needs to know, not how many should pass The passing standard raised slightly Spring pass rates only dropped a bit Fall pass rateswere significantly lower Item Response Theory enables equating the passing standard Reuse validated ( good ) test items as scaling links Cut score is higher on questions judged to be more difficult On easier sets, cut score is lower Conclusion from psychometric analyses: Changes in pass rates reflect differences in people, not the test

14 Average Percent Correct per Domain by Reason for Taking Exam 79% 77% 77% 78% 78% 76% 75% 75% 74% Vascular Surgery Board Other Reason 71% 68% 72% Content Domain CEREBROVASCULAR (14%) ABDOMINAL (16%) PERIPHERAL ARTERIAL - DUPLEX IMAGING (14%) PERIPHERAL ARTERIAL - PHYSIOLOGIC (15%) PERIPHERAL VENOUS (22%) LABORATORY TECHNOLOGY AND OPERATION (18%)

15 Vascular Surgery Specialty (1 st -timers, Fall 2016, N=101) 32 claimed Vascular Surgery specialty, But were NOT taking PVI for the Boards Average Scaled Score = claimed Vascular Surgery specialty, And WERE taking PVI for the Boards Average Scaled Score = 579 T-test (df=99) = 2.34, p =.02 Spring looked similar, but not as dramatic

16 Implications for Vascular Surgery PDs Performance of residents and fellows on PVI is inferior to that of vascular surgeons in practice Amount of interpretation experience may be important (more is better) Lower pass rates appear due to subset of lower performers Subgroup with less preparation Individual preparation Program differences in curriculum, interpretation experience

17 Suggested Curriculum Program must include didactic instruction and training in the interpretation of vascular laboratory studies Curriculum content not specified by APCA for ACGME-accredited programs For other post-graduate medical education programs not accredited by ACGME, RCPSC, or AOA (e.g. vascular medicine): 48 weeks of clinical training 30 hours of didactic instruction relevant to interpretation and other vascular laboratory topics 40 hours of observation or supervised participation in a vascular laboratory setting

18 Options for Study Characterize factors associated with PVI examination performance APCA to collect additional information about program, level of training with application Current status of vascular laboratory education Survey of vascular surgery program directors Resources, didactic content, practical experience Assessment relationship of performance on PVI examination to performance on ABS examinations

19 Revised PVI Eligibility Requirements Licensed MD or DO or equivalent outside of US/Canada Clinical vascular ultrasound experience Minimum of 500 cases Interpreted over preceding 36 months Up to 100 may be didactic or simulated Submit case log

20 Documented Interpretation Experience Cases must be distributed over testing areas: Carotid duplex ultrasound (extracranial cerebrovascular) Transcranial Doppler (intracranial cerebrovascular) Peripheral arterial physiologic testing (excludes ankle/brachial Index (ABI) and single level exams) Peripheral arterial duplex ultrasound Venous duplex ultrasound Visceral vascular duplex ultrasound No more than 50% of the total coming from any one area

21 Requirements for Didactic/Simulated Cases Equivalent to cases in a clinical diagnostic setting: Indications and relevant clinical information presented Complete technical information for examination provided, including images, cine loops, worksheets, and sonographer notes Interpreting physician completes final report in format that meets IAC Vascular Testing Standards and Guidelines and compliant with requirements for clinical documentation and billing Feedback from educator or supervisor indicating that the interpretation met standards or what changes were required Time to complete interpretation should not be less than what would be required in a clinical diagnostic setting Case details are available for audit

22 Case Logs Submit patient log or other record of interpretation experience Documentation must be maintained three years following the date of application approval Case logs subject to audit Must include: Date of case Testing area Whether the case was simulated/didactic or clinical Name of supervising physician/medical director Clinical site

23 Maintain the Certification Attestation of compliance with standards and policies CME 30 APCA/ARDMS-accepted CME credit hours in vascular ultrasound (three year period) Annual renewal fee: $100

24 Volunteer Opportunities Write test items Review items Help set passing standard (passing score) Roles in governance positions leos_volunteer_rc4_updated-v2.mp4?dl=0

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26 Vascular Technology Examination Scoring Issue ARDMS recently discovered technical problem with the calculation of scaled scores affecting Vascular Technology (VT) examinations administered from September 6, 2016 to March 14, 2017 Resulted in some individuals incorrectly receiving a failing score Administrations of VT examinations temporarily halted and the corrected scaled score calculation was applied ARDMS verified the issue was limited to the ARDMS Vascular Technology (VT) examination Those affected have been notified that they passed the VT examination