Clinical Informatics Subspecialty Practice Pathway Extended for Three Additional Years

William Hersh, MD, Professor and Chair, OHSU
Blog: Informatics Professor
Twitter: @williamhersh

A three-year extension to the Practice Pathway of board certification eligibility for the clinical informatics (CI) subspecialty has been approved by the American Board of Medical Specialties (ABMS) for the American Board of Preventive Medicine (ABPM). This is the second extension of the so-called “grandfathering” pathway that now allows physicians with a primary boarded specialty to achieve board eligibility without formal fellowship training through 2025. This means that physicians who desire to become board-certified in CI will be able to qualify to sit for the board examination by time working in the field or completing “non-traditional” training, the latter which may include a master’s degree from a “24 month Masters or PhD program in Biomedical Informatics, Health Sciences Informatics, Clinical Informatics, or a related subject from a university/college in the US and Canada, deemed acceptable by ABPM (e.g. NLM university-based Biomedical Informatics Training),” such as the online Master of Science Program at Oregon Health & Science University (OHSU).

The CI field has expressed mixed feelings on this extension. In particular, a group of CI fellowship Program Directors published a letter in the journal Applied Clinical Informatics (ACI) opposing the extension, noting that the time for grandfathering has passed, and extending the practice pathway will adversely impact pursuit of fellowships. I rebutted this letter, arguing that the field must find alternatives to two-year in-place fellowships to allow broader entry into the field. In particular, a two-year in-place fellowship may place undue burdens on those who wish to become board-certified in CI long after they completed their primary training and would be unable to uproot from job, family, and/or other obligations.

Here are some snippets from my ACI letter arguing for alternatives to in-place fellowships:

I agree that we have passed the point where the Practice Pathway should allow physicians to become board-certified with essentially no formal training. However, I argue instead for this approach to be transformed into a method by where those who are unable to halt careers, salary, and family to pursue a pathway to certification that is mostly virtual and asynchronous yet still rigorous and supervised. Ironically, the pandemic has taught us that CI practice and education can be carried out in a mostly virtual format.

The in-place model for fellowship training made sense in the 20th century model of career development, where one completed education and training in their chosen profession and then entered the workforce for their career. In the 21st century, however, many professionals, especially in knowledge careers, change career pathways long after their primary education and training experience.

I oppose CI fellowships being completely remote, but it would be novel and innovative if there were some sort of hybrid training pathway, with fellows connected to an institution that could offer courses and allow supervised, mentored training experiences in healthcare organizations. Fellows would participate in a mostly remote way, but also have periodic in-person experiences, including stints that might be for several weeks or more and would involve direct interaction with faculty and colleagues. The field of Hospice and Palliative Medicine developed such an approach prior to the COVID-19 pandemic. Even CI somewhat emulates this approach now, as a half-dozen CI fellowships make use of online didactic courses from OHSU.

I applaud that for now the Practice Pathway will still allow those to pursue board certification. Hopefully the CI field can transition to a training process beyond the Practice Pathway that allows entry into the field without an in-place fellowship. As informaticians, we should be at the forefront of pioneering this approach in graduate medical education.

What are eligibility requirements for the CI subspecialty? They are essentially unchanged from the last time I posted about them in this blog in 2019, with the exception that the “grandfathering” pathway is now available through 2025.

This article post first appeared on The Informatics Professor. Dr. Hersh is a frequent contributing expert to HealthIT Answers.