Take a Minute - October 10, 2006

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American Board of Medical Genetics

Business & Program Directors Meeting

October 10, 2006

The ABMG Combined Business/Program Directors meeting was called to order at 6:40 pm, President, Nancy Carpenter, presiding.

The mission and purpose of ABMG is the accreditation of training programs in the laboratory specialty areas of clinical biochemical genetics, clinical cytogenetics, and clinical molecular genetics. The ACGME accredits the clinical genetics residency programs. ABMG develops the certification examinations, reviews credentials and approves applicants for the examinations in each of the four specialty areas. The next certification examination is scheduled for August, 2007.

We have also developed the Maintenance of Certification (MOC) process for our diplomates which will soon be expanded (EMOC). Details of expanded MOC will be presented later.

The administrative work would not be accomplished without the experienced staff members: Dia Pellerin, Sharon Robinson and Karla Matteson. The successful growth of the organization is dependant on the members of the Board of Directors: Jean Amos Wilson, Arthur Aylsworth, Tina Cowan, Bill Gahl, Greg Grabowski, Jacque Hecht, Jeff Innis, Cindy Moore, Maren Scheuner, Charles Schwartz, Georgia Wiesner, and Greta Seashore. Board members present were asked to stand and be recognized.

Minutes of previous meeting had been posted on the website; a motion was made and seconded to review the posted minutes.

TREASURER’S REPORT – Cynthia Moore
We continue to utilize the financial investment firm, City Group Smith Barney. As of August 31, 2006, total assets were estimated to be $1.2 million ($313,000 in the long term investments and $886,000 in the checking and short term accounts mostly in the form of CDs with laddered maturity dates to cover ongoing and anticipated expenses. There has been a change in the financial cycle, with the examinations being offered every two years beginning 2007. Prior to the 2005-2007 timeframe, revenue and expenses were reviewed over a 3 year cycle. Enhancements to improve our financial footing are being discussed. After our 2006 summer retreat, we contracted with the accounting firm of Rubino and McGeehin to assist the Board in developing a budget tool. This tool allows us to categorize our expenses to specific categories. The Financial Committee will use this tool to aid in the organizations’ financial planning and decision making. During this two year exam cycle, incoming revenue (application fees) is anticipated in late 2006, while the examination fees are anticipated in early 2007. Our two major expenditures include consulting fees with ePlus Inc. (Rochester, NY) for our web-based program for EMOC and the creation and administration of the certification examinations; both of these expenses are estimated at about $250,000 each. An anticipated drop in the total assets because of these two large expenses in 2006 is expected.


GENERAL ANNOUNCEMENT
Bruce Korf announced that Harvard Medical School, in partnership with the Center for Genomics, will be issuing a $20,000 trainee award. They are looking for applicants to bring attention to the discipline. Program Directors are encouraged to nominate applicants.

COMMITTEE REPORTS
ACCREDITATION COMMITTEE - Georgia Wiesner, standing in for current chair, Art Aylsworth. The Accreditation Committee is charged with examining programs for suitability for training. The committee reviews the full range of laboratory activities, including clinical activities, however, accreditation for clinical genetics residencies is granted through the ACGME.

Current efforts include streamlining reporting and application to eliminate duplication. Expanded sections to be completed will include how training occurs and how trainees will receive experience in the clinical realm, objectives of training, how to communicate results to patients etc. Expansion of these activities will include a computerized database. We hope that the new application process, expected to be available 2Q2007, will include database forms and an online application process. Since accreditation fees have not been increased since 1996, accreditation fees will be increased for 2007; the fee for accreditation will be $2,000 for the first program and $500 for each additional specialty.

New accreditation rule: Program directors, training directors and laboratory directors must participate in life long learning activities. Program Directors are required to participate in EMOC, regardless of the date of their certification. Those with non-time-limited certification must also participate in EMOC.


CREDENTIALS COMMITTEE – Jeff Innis, standing in for the current chair, Greta Seashore. The Credentials Committee receives applications from individuals applying for certification. Applicants with a degree earned outside the US and Canada are required to submit a transcript evaluation from an outside organizations, such as the AACRO or WES, before they matriculate into a training program. We strongly encourage that degree equivalency be reviewed by committee prior to entering the training program. Individuals with an MD degree earned outside the US and Canada and applying for certification in clinical genetics, are required to have an ECFMG certificate. If training was in a country where English is not the primary language, the ECFMG certificate will fulfill the English requirement. MDs a with a degree earned outside the US or Canada applying for certification in the laboratory specialties, in addition to having their degree reviewed, will be required to have either an ECFMG certificate or take the TOEFL-iBT (replacement for TSE) exams to fulfill the English speaking requirement. PhDs earned outside the US and Canada must have TOEFL-ibt.

Applicants’ whose degrees were earned outside the US should visit the ABMG website for details. A petition is not necessary, but documentation of specific requirements is necessary.

MD’s for the specialty of clinical genetics who have completed training outside the US are required to write to the Credentials Committee prior to entering an ACGME approved clinical genetics residency to determine possibility of credit for training outside the US. If the applicant is board-certified in a specialty other than genetics from a Board outside of the US and Canada, the Committee may grant up to 2 years of credit. The determination of the length of training credit, 0-12 or 24 months, rests solely with the Credentials Committee. If approval is granted for only one year, it is possible that the additional ACGME residency can be completed either before or after Clinical Genetics training, but this must be reviewed by the Committee. We note that the requirements to enter a residency or laboratory-based training program are set by the program, not the ABMG. ABMG sets the requirements for acceptance to sit the certification examination.

EXPANDED MAINTENANCE OF CERTIFICATION (EMOC) – Stuart Schwartz
The final offering of the current MOC examination process (2 year literature review exam) was offered at the 2006 ASHG meeting. If a diplomate failed this exam, additional opportunities will be offered after the scores have been released. Applicants can schedule a special testing site and retest prior to December 31st.

Part II of EMOC is comprised of four parts that represent life-long learning, accumulation of 250 CMEs over 10 years and literature modules and associated testing (participation in 3 over 10 years). We anticipate that the first literature modules will be available online by March 2007.

EMOC part III represents cognitive expertise, which can be fulfilled by an exam that will be offered in 2008 or 2009 and will be more practical than the certification exam.

EMOC part IV, expected to be ready in 2010.

The total of 250 CMEs is considered to be a relatively low number compared to other ABMS boards. PhDs are required to have CEUs, equivalent to CMEs. Diplomates should begin collecting CMEs in 2006. ABMG does not award CMEs; but we recognize CMEs from accrediting bodies.

Those certified prior to 1993 can start 10 year EMOC process at any time.

COMBINED TRAINING PROGRAMS
The current opportunities for combined training programs are in Pediatrics/Medical Genetic, Internal Medicine/Medical Genetics and Maternal Fetal Medicine/Medical Genetics – this is a new opportunity with Obstetrics and Gynecology (5 year program). Program directors should explore opportunities to establish combined residency programs in their institutions

SUBSPECIALTY TRAINING IN MEDICAL BIOCHEMICAL GENETICS
The ABMG is working on subspecialty certification in Medical Biochemical Genetics; the proposal has been sent to the American Board of Medical Specialties (ABMS). It will be “first read” by the Assembly in March 2007 and, at this time, if there are no adverse comments, will receive final approval in September 2007. Similar action has been taken by the ACGME for the approval of accreditation of subspecialty programs. Favorable comments have been received thus far. This subspecialty training is for MD clinical geneticists with a 1 year medical biochemical genetics subspecialty, and will focus on the management and treatment of biochemical disorders. Potential start dates for candidates are the end of 2007 to early 2008. The first exam may be offered as early as 2009.

GENERAL BOARD BUSINESS
Two new policies, disciplinary /appeal and complaints for individuals/programs for genetics professionals have been recently reviewed by the Board; these will be posted on the website.

EMOC requires that we implement automation of office processes for accreditation, certification and EMOC. In addition, trainees and diplomates will be able to review their status on an individualized private webpage. Each diplomate will also receive z an annual email that includes a fees notices and a status report. The associated software will cost over $250,000. Because of these costs, we will institute an annual required EMOC fee for those participating and continue collecting voluntary dues for those not participating. The annual fee will be $300 per year in addition to the fee for the Part III certification exam. It is estimated that this process will cost the diplomate around $3,500 for the ten year period, not including fees for CMEs or part IV modules. Part IV for PhD is within our control; however, it is outside of our control for MD’s.

The handout that was distributed to the attendees at this meeting will be emailed to all diplomates along with a letter from Matteson with the process, as well as being posted on our website.

Election Results: Two new board members were recently elected, Cynthia Powell, clinical geneticist and Kristin Monoghan, PhD medical geneticist. Both will begin their term January 2007. Officers – At the recent board of director’s meeting, Stuart Schwartz was elected to the position of President, Cynthia Moore to Vice-President/President-elect, Tina Cowan to Secretary for 2 years, and Charles Schwartz to Treasurer for 1 year (fulfilling Moore’s term). Georgia Wiesner will be completing her 6 year tenure on the board. She represented us on a number of committees, RRC, was President and Past President, and a very hard worker for the board. Carpenter presented her with a small token of appreciation.

Stuart Schwartz presented Carpenter with a token of appreciation. Carpenter also will be completing her 6th year on the Board. She served as current president and one additional term as president, chaired the Credentials Committee and many other committees. She too is a very hard worker.

OTHER BUSINESS
Arthur Beaudet asked about training in traditional cytogenetics vs. array CGH for both for molecular and cytogenetic trainees and asked if they are learning skills that will soon be outmoded. The Board looks at types of training being done through the Accreditation Committee as well as training from the point of view of the trainee through the logbooks. Aray CGH is a technology for the logbook in cytogenetics as well as molecular genetics. Should the two certification areas merge into one? Audience response was no, they should not. Stuart Schwartz, leading a subcommittee on the standardization of lab training, indicated that techniques are part of that training. ABMG can help set standards; respond to where training needs should focus. Accreditation is granted for a period of 5 years, so we do not have the opportunity to monitor requirements, except on a rolling basis. New requirements are set as a suggestion / recommendation and then turned into requirements. Implementation of requirements to programs may cause problems, big implications for accredited sites. Are the training sites keeping up with the state of the art?

Obstetrics and Gynecology has reduced the term of training by 1 year, to four years. Pediatrics and Internal Medicine is five years. OB approached us with a 4 year residency and we have a 2 year program, combined to 5 years. There are months of overlapping rotations, 12 months of genetics, non OB genetics, with no research time included. Peds/IM have 6 months of rotations. We will talk with Peds/IM to see if they can overlap. We are in the process of talking with the other boards and they are amenable to the discussion. Arthur Beaudet felt that dropping the research time is integral to the program and needs to be discussed by the membership. RRC requirements are18 months with 6 months of electives.

A certificate holder from Framing Success was raffled off as a door prize for those present at the meeting. For those interested in ordering an ABMG frame to display their certificate, order forms were distributed for www.framingsuccess.com.

There being no further business, the meeting was adjourned at 7:30 pm.

Respectfully submitted,
Sharon Robinson, MS
Administrator