ABVLM: A Look Back and a Look Ahead

The ABVLM was formed in 2007 in response to concerns that most physicians delivering vein services had not had formal training and that those with formal training, regardless of primary specialty background, had a very diverse and generally inadequate level of knowledge and training in venous and lymphatic medicine. Thus, the knowledge and techniques in current use had to be learned primarily through conferences, peer-to-peer interactions and other post-graduate experiences. While post-graduate educational opportunities continue to expand, there has been relatively little change in formal training opportunities.

In an effort to advance the field, the ABVLM has chosen to develop a rigorous certification examination, requiring compliance with a maintenance of certification program in order to maintain diplomate status, as well as seeking to advance educational standards.

The ABVLM is an independent non-profit organization that has been inclusive from its inception, with board members coming from dermatology, emergency medicine, family practice, interventional radiology, vascular medicine and vascular surgery. It is not affiliated with any member society, but seeks to collaborate with all key stakeholders in order to raise educational standards and ultimately improve patient care.

The Certification Process and Exam

An important question is how best to establish a threshold of knowledge and competence in treating venous and lymphatic disorders, so that clinicians may strive to exceed that threshold and patients may recognize those who have done so.

We know that adequate knowledge is essential to the development of medical expertise and effective clinical decision-making. Given the fact that physicians from many different backgrounds are delivering vein care, and that formal training in the field is generally recognized as being deficient, surely it is reasonable and useful to have some way of identifying those who possess a foundation of knowledge and experience in the management of venous disease. Unfortunately, existing specialty board exams do not achieve the desired goal.

The value of certification comes from assessing a clinician’s training and from establishing a formal measure of a clinician’s knowledge base, as well as in the knowledge gained by the candidate preparing for the examination.

The ABVLM certification exam is open to US and Canadian physicians with full and unrestricted licenses who, in addition, meet the residency, fellowship, or experience track requirements. These requirements are available on the ABVLM website.

Extensive psychometric analysis is performed on every exam item and of each exam as a whole. The ABVLM exams demonstrate performance in line with those of mature ABMS boards.

After seven exam cycles, there are now 675 ABVLM diplomates with specialty backgrounds reflecting the diversity of physicians providing care to venous patients.

Education

Education is at the core of what physicians do. An important question is how to assure that physicians now and in the future will be able to obtain comprehensive training in venous and lymphatic disorders, so that patients can receive care from clinicians who are well-trained.

Major vein societies share a common mission to improve the quality of patient care. This can be best achieved by establishing educational standards for teaching programs in venous and lymphatic medicine.

The ABVLM has embarked on a collaborative, multispecialty consensus process to establish educational standards for training in venous and lymphatic disease. This is a threestep process involving the development of core content, program requirements and curriculum implementation.

Step One: Core Content

Core content outlines the areas of knowledge considered essential in the field—it is quite distinct from a curriculum. The core content provides a framework for development of a curriculum for a venous and lymphatic specialist, as well as for accreditation standards and certification testing.

A curriculum is an operational process by which the core content is integrated into the academic elements of an educational program. In most cases, there is a model curriculum developed by the program directors’ organization in the discipline. It is based on the core content, but expands to include goals and objectives, instructional methods, assessment and training environment. Not all training programs have the same curriculum, as their circumstances and resources differ, but they nevertheless all reference core content.

The “Core Content for Training in Venous and Lymphatic Medicine,” endorsed by the ACP and the AVF, was published in Phlebology in October 2014. The core content task force was comprised of highly regarded leaders from dermatology, interventional radiology, phlebology, vascular medicine and vascular surgery. Input was also obtained from numerous other experts in venous and lymphatic disease from around the world.

Step Two: Program Requirements

It is well recognized that the pathway to a vein practice is diverse, and there is no commonly accepted format for physician education and training. Program requirements or institutional requirements for physicians who wish to specialize in the care of patients with venous and lymphatic disorders are conspicuously absent.

To address this deficiency, the ABVLM is developing program requirements for graduate medical education in venous and lymphatic medicine, which are meant to serve as a guide for a one-year fellowship. This draft is being finalized and reflects the work of over 20 experts from six specialty backgrounds. Dr. Anthony Comerota is chairing this group.

If one were to be recognized as a venous and lymphatic specialist, it would be reasonable that the physician be knowledgeable about the treatment of all aspects of venous and lymphatic disease, although the individual physician may not perform all procedures taught during training. It is important to recognize there is a difference between knowledge of treatment options and their indications, contraindications, etc. and procedural and technical skills. A program requirements document defines which areas require knowledge vs. procedural/technical skills. There is no implication in the core content that physicians are expected to perform all procedures. In fact, there is no specialty where a physician performs every procedure they may have been exposed to in their training.

Our goal is to have a consensus-based document vetted by the key stakeholders in the field. The ultimate goal and natural result of this initiative is improved patient care.

Step Three: Curriculum Implementation

The ABVLM has established a Curriculum Advisory Council, tasked with developing strategies to implement the core content and program requirements into curricula for residency and fellowship programs. The CAC will meet in Fort Lauderdale in January 2015 as part of a generous grant funded by the American College of Phlebology Foundation. A report of the meeting will be forthcoming.

The ABVLM wishes to thank all those leaders who contributed to the core content and program requirements, and to those who participated in the CAC for their knowledge, vision and leadership.

Members of the Curriculum Advisory Council

ABVLM Board of Director Representatives

  • A. ComerotaT. Carman
  • R. Min
  • S. Rathbun
  • M. Rosenblatt
  • S. Zimmet
  • Riyaz Bashir
  • Thom Rooke
  • J. Benenati
  • N. Khilnani
  • S. Vedantham
  • G. Munavalli
  • T. Nguyen
  • B. Gray
  • R. Kolluri
  • M. Jaff
  • L. Kabnick
  • P. Lawrence
  • F. Lurie
  • M. Meissner
  • T. Wakefield

In order to be fully recognized, a field must have both appropriate educational standards and training opportunities, as well as a way to establish a threshold of knowledge and competence. We hope these initiatives will help further the goal of improving the quality of physicians practicing in the field, thereby improving patient care.

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