Core Content in Phlebology A Call for Stakeholder Comments

On behalf of the Board of Directors of the American Board of Phlebology (ABPh), I would like to invite all individual stakeholders to comment on our “Core Content in Phlebology” draft.

The 45-day comment period began on January 16, 2012, and will close at 5:00 PM CDT on February 29, 2012. All comments are welcome and will be compiled for consideration. If you have questions, please email Christopher Freed, Executive Director, at [email protected].


Significant innovations and major new concepts in the diagnosis and treatment of vein disorders have come from physicians and surgeons with a variety of specialty backgrounds. This contributes to the significant and expanding interest in phlebology. However, at present there is no standardized venous training program in the US, and the level of specialty training in venous disease is very diverse and often inadequate across existing training programs in all specialties.

Curriculum Task Force

In a major effort involving representatives from societies around the country and the world, the ABPh convened a Curriculum Task Force in 2011 with the charge of standardizing training in phlebology. The Task Force is comprised of 24 leaders in venous disease from phlebology, vascular surgery, interventional radiology, vascular medicine and dermatology. The charge was to use a collaborative approach to develop a consensus comprehensive curriculum in phlebology. Ultimately, ABPh seeks to improve patient outcomes on a national and international scale, but to achieve this, formal training standards in venous disease must be established.

Core Content in Phlebology

As the first step towards achieving these goals, a draft of the “Core Content in Phlebology” was written by the multispecialty based Curriculum Task Force, outlining the areas of knowledge and competency considered essential for its practice. Seventy “Advisors,” key leaders from various disciplines, have been invited to critique the Core Content draft.

The Core Content document will provide the framework for establishing training requirements. Importantly, it forms the basis for professional discussion of these standards and their impact on specialty and subspecialty training.

Letter of Support from the AMA

We have received a letter from the AMA in support of our efforts. Dr. Jeremy Lazarus, President-elect of the AMA, stated in a letter dated October 3, 2011, “I wanted to send this note of congratulations, as both a physician and President-elect of the AMA, to you and the leadership of the American Board of Phlebology. I am impressed with the effort to establish a core content document in venous disease. Efforts to increase professional standards in medicine are something both the AMA and I vigorously support… I wish you all the best in the pursuit of your goal - the elevation of professional standards of care for venous disease patients.”

American Board of Medical Specialties (ABMS)

The ABPh is seriously evaluating the possibility of ABMS recognition. The ABMS has been critical toward the development of modern medicine. The ABMS states, “The development of new medical specialties has been an essential feature of the growth of modern scientific medicine.” While a core of basic knowledge is central to each medical specialty, this core changes with new technology and time. Subspecialties expand the medical focus of different areas within the core specialty. This has led to the development of more than 150 subspecialty certificates being granted by ABMS Member Boards. A number of these subspecialties are under more than one primary specialty board.

Outcomes Sought from the Core Content Effort

The outcomes we seek are to:

  1. Outline the knowledge necessary to identify and manage venous, arteriovenous, and venolymphatic conditions and their sequelae;
  2. Improve the standards, consistency and dependability of training across all the different specialties that treat venous disease; and
  3. Provide a benchmark against which to assess the knowledge of practitioners of venous medicine and surgery.

The Key Goal Is to Improve Patient Care

We believe development of the “Core Content in Phlebology” will pave the way to improve educational standards and to standardize comprehensive training in venous disease. These improvements are critical to achieving our goal of improving patient care.

We Solicit Your Comments

We solicit your comments and suggestions as a stakeholder in the field of venous disease. We hope you will agree to participate, and we assure you we will value your comments and suggestions as we seek to finalize this document. You can access the comments process via the ABPh website. Please email me ([email protected]) or Christopher Freed ([email protected]) if you have any questions.

A background statement on the ABPh is below.

The ABPh, an independent non-profit organization, was established in 2007 to:

  1. Improve the standards of medical practitioners and the quality of patient care related to the treatment of venous disorders and all aspects of venous disease;
  2. Serve the public and the medical profession by establishing initial and continuing qualifications for certification and maintenance of certification as physician specialists in the practice of phlebology;
  3. Examine physician candidates for certification and maintenance of certification in the practice of phlebology;
  4. Award certifications in phlebology to candidates who meet the established requirements;
  5. Maintain a registry of physicians who are Diplomates of the Board; and
  6. Establish educational standards for teaching and training programs in phlebology.

As of the conclusion of the 2011 exam cycle there are 520 diplomates of the ABPh. These individuals come from a variety of specialty backgrounds including vascular surgery, general surgery, vascular medicine, interventional radiology, emergency medicine, dermatology, gynecology, anesthesiology, internal medicine and family practice. As diverse as their professional roots are, all have made a formal commitment to excellence in the treatment of venous disease patients.

The ABPh Exam Process

The ABPh Exam is open to licensed physicians in the U.S or Canada who meet rigorous prerequisite qualifications. There are three major pathways to qualification:

  • Fellowship Pathway
  • Residency Pathway
  • Experience Pathway

The ABPh examination was developed using the Standards for Educational and Psychological Testing, which establishes procedures for exam development to insure valid interpretation of score results. Standards are published and adopted by the American Educational Research Association, the American Psychological Association, and the National Council on Measurement in Education. Exam items are written, reviewed and approved by an item writer committee, consisting of subject matter experts and psychometricians. The subject matter experts are selected to ensure gender, geographic and primary specialty diversity. The committee goes through a rigorous process, with the input of psychometricians, to add new items each year. The committee then selects items to be on that year’s exam, with a content weighting based on the ABPh board-approved content document.

The computer-based examination is comprised of approximately 200 multiple-choice questions, with items on Basic Science (8%), Venous Diseases and Syndromes (20%), Diagnostic Tools and Screening (10%), Duplex Ultrasound and other Imaging Modalities (25%), Treatment (35%), and Professional Standards (2%). Certification is for a period of ten years, during which time participation in an ongoing Maintenance of Certification (MOC) program is required, and at the end of which time a re-certification examination must be taken.

Psychometricians analyze every item after they are presented on a test. Statistical analysis is done to assess how well the item yielded useful information about candidate ability. Items that fail to perform properly increase the error of the exam and therefore do not contribute to the precision of the pass/fail decision made about candidates. Any item that performs poorly is flagged for possible deletion. All comments from examinees are reviewed and considered. The reliability and standard error of measurement are carefully evaluated for each exam. To date, each of the ABPh exams to date has performed very well on these measures, and they compare well with the exam performance of established ABMS boards.

The level of performance required for passing a credentialing test should depend on the knowledge and skills necessary for acceptable performance and should not be adjusted to regulate the number or proportion of persons passing the test. The ABPh Exam follows this model, called Criterion-Referenced testing. The pass point was determined by careful analysis and judgment of acceptable performance in consultation with ABPh consultant psychometricians.

Each exam is equated to a benchmark scale initially established in 2008, with a new benchmark established every five years. A test equating process is designed to calculate differences in the difficulty of examinations among administrations and then adjust the scale of the current test administration so that the same criterion standard can be used. By accounting for differences in difficulty across years, all candidates have a comparable opportunity to pass the examination, regardless of when they take the test. For example, if the test administered in a particular year was found to be more difficult relative to other years’ tests, the percent correct necessary to pass would be lowered to be equivalent to the criterion standard. On the other hand, if a test administration was easier, the percent correct necessary to pass would be higher to be equivalent to the criterion standard.

Lifelong Learning and Assessment

Commitment to lifelong learning and assessment is the goal of maintenance of certification (MOC) programs. The guiding principle of MOC is to continually foster excellence in patient care. Since its inception, the ABPh has recognized the importance of MOC, and has been committed to development of this program. The ABPh PHLEB-MOC program commenced in January 2012. More information is available on the ABPh website.

Educational Standards

As presented in the invitation to comment above, the ABPh multispecialty based Curriculum Task Force has developed a draft “Core Content in Phlebology,” outlining the areas of knowledge and competency considered essential for its practice. We believe development of the “Core Content in Phlebology” will pave the way to improve educational standards and standardize comprehensive training in venous disease. These improvements are critical to achieving our goal of improving patient care.

Improving Patient Care

Medical boards share a common mission and purpose. They promote excellence in the practice of a given medical discipline to better serve both patient and public interests. The mission of the ABPh is to advance the care of patients with venous disorders by improving the quality of practitioners treating them. We are pursuing this goal by offering a rigorous exam process, a commitment to lifelong learning and assessment, and the development of standardized comprehensive training in venous disease.

American Board of Phlebology

PO Box 29920 San Francisco, CA 94129-0920

Steven E. Zimmet, MD, President Christopher Freed, Executive Director

Contact: (877) 699-4114 [Toll Free] (415) 561-6276

Email: [email protected]