Posts by Burke Kealey

The Tale of The Black Knight: ABIM a Year in Review

I passed! Let me tell you I was nervous. Perhaps it isn’t the smartest thing in the world to announce publically on your blog  that you are up for recertification and preparing to sit for the secure examination. It was only after I did this that it occurred to me that it could be rather embarrassing if I didn’t pass. And then of course I outed my fellow blogger, Brad Flansbaum, as also sitting for the Focused Practice in Hospital Medicine exam. Luckily, we both passed, as did 85% of test-takers, so neither he nor I have to endure the pity of the readers. As I reflect on the tumultuous year past, not just in my own life, scrambling to fulfill the requirements of MOC and hours upon hours studying, but also in the very public spectacle of the ABIM and Rich Baron, the public face of the organization, taking blow…

A “Never Event” Happened to My Family Member. Don’t Let It Happen to You.

It is odd being on the other end of the doctor/patient interaction and having a surgeon calling me in the middle of the night apologizing for a mistake. I was scared and then I started to feel anger creeping in. How could this happen? Swiss cheese models and checklists danced in my brain. The analytical part of me was appreciative of the straight-forward manner the surgeon spoke to me, holding nothing back and owning up to the mistake, telling me the hospital would be investigating and assuring me that my family would incur no costs due to the error. He had performed an unnecessary abdominal surgery, a Never Event in the lexicon of patient safety. As you may know, Never Events are loosely defined as events that should never happen. The history of Never Events is rooted in the patient safety and quality revolution of the last two decades. In 1999 the Institute of Medicine produced…

New Research That Helps Us Detect Delirium Faster & Easier

Delirium is one of the most vexing of problems we face in hospitalized patients. It is hard to treat and just as hard to diagnose. In the next issue of the Journal of Hospital Medicine an original paper “Preliminary Development of an Ultra-Brief 2-Item Bedside Test for Delirium” is being published from Donna Fick, PhD, who led a team of researchers, including Sharon Inouye, MD, MPH and Ed Marcantonio, MD. As the paper points out only 12-35% of delirium cases are detected in routine care! This paper seeks to find a better and easier to use screening tool for delirium. The research team recently developed and published on a three minute test called the 3D-CAM. It has a 95% sensitivity and 94% specificity. A great result, but they recognized that even three minutes may be hard to accomplish in the busy atmosphere of a hospital. They then set out to…

How Much Does the ABIM’s MOC Program Really Cost?

Our esteemed "The Hospital Leader" editor, newly minted Master in Hospital Medicine, and all-around big shot, Dr. Brad Flansbaum, and I are both recertifying for the ABIM Boards and we have both elected to take the Focused Practice in Hospital Medicine exam this year. As such, we are both very invested in the goings on in the ABIM, especially since they increased the requirements for recertification in 2014 and have slowly, kinda, sorta backtracked in the face of vigorous criticism. Every few weeks Flansbaum and I end up discussing the hot events around this topic, or more often our own tedious progress in studying for the exam. In our last conversation, Dr. Flansbaum pointed me to a recently published article from the Annals of Internal Medicine, “A Cost Analysis of the American Board of Internal Medicine’s Maintenance of Certification Program.” Now this is my kind of study—basically a back of the napkin exercise…

Keeping up with the ABIM

You can recall some of the famous apologies and non-apologies of the recent past. Bill—“Even presidents have private lives.”  Kanye—“It starts with this… I’m sorry, Taylor.”  And in early February, we added this one.  Rich- “We got it wrong. We are sorry.” Now don’t get me wrong, apologies are good and a necessary first step toward healing and returning to normalcy. Dr. Baron’s American Board of Internal Medicine (ABIM) apology seemed sincere even if it was only accompanied by minor changes in the Maintenance of Certification (MOC) process. That apology was of course in response to the groundswell of defiance that had been growing for the last year, mostly focusing on the increased requirements and fees that came about with the early 2014 changes to the ABIM MOC process that upped the number of “points” required, upped the fees, and dropped the reporting period to every two years from every…