APCA Update for APDVS:Inteleos and the Physicians’ Vascular Interpretation (PVI) Examination

Disclosures

• No financial conflicts of interest• Volunteer service on Council of Alliance for Physician

Certification and Advancement (APCA)• Volunteer service on Boards of Directors:

– Society for Vascular Ultrasound (SVU)– Intersocietal Accreditation Commission (IAC) – Vascular Testing– Joint Review Committee for Education in Diagnostic Medical

Sonography (JRC-DMS)

APCA.org

ARDMS was established in 1975

APCA.org

APCA, a “spin off” of ARDMS, was created in 2016 to exclusively serve the

physician community

APCA.org

Inteleos: the umbrella company

Physician Vascular Interpretation(PVI) Examination

SpecialtyCardiology 1383Vascular Surgery 1356Not Available 393Radiology 217Other 184Vascular Medicine 117Interventional Radiology 50Internal Medicine 38Family Practice 14Cardiothoracic Surgery 11Emergency/Trauma Care 6Obstetrician/Gynecology 3Surgery 3Crritical/Intensive Care 2Phlebology 1

• Increased numbers of cardiologists since 2010, now declining

• Vascular surgeons now largest group of specialists seeking certification

• Registered Physician in Vascular Interpretation® (RPVI®) certification is required by ABS to register for Certifying Examination– Candidates not required to be currently

certified• Currently offered in two testing

windows each year

Cumulative First Time Pass Rates

Specialty Count Percent pass on first attempt

Cardiology 1333 96Vascular Surgery 1284 95Radiology 212 98Other 177 96Vascular Medicine 113 97Interventional Radiology 49 98Internal Medicine 33 87Family Practice 14 100Cardiothoracic Surgery 11 100

PVI Examination Updates

• PVI Exam will be available year-round (on demand), starting July 2017

• New eligibility (prerequisite) requirements can be used starting in July 2017

• Existing eligibility requirements can be used through December 2017

PVI Examination Administration with Pass/Fail

0

200

400

600

800

1000

1200

1400

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Passed Failed

PVI Examination Statistics

APCA.org

Year1ST-time pass rate

2012 92%

2013 90%

2014 84%

2015 85%

2016 81%

Comparison of Specialties

NumberPercent of

total Fall

Pass RateSpring

Pass RateVascular Surgery

247 43% 80% 84%

Cardiology 226 40% 79% 84%

Radiology 39 7% 90% 92%

Vascular Medicine

14 2% 79% 82%

Other 42 7% 64% 71%

PVI Examination Statistics

APCA.org

Year1ST-time pass rate

2012 92%

2013 90%

2014 84%

2015 85%

2016 81%

Year MedianAge

2010 412011 402012 392013 382014 372015 362016 35

Declining pass rates associated with changing demographic

“Taking it for Vascular Surgery Boards”

Performance in Fall 2016Vascular Surgery

Test Getting Harder?• Passing standard most recently revised in Spring 2016

– PVI-representative panel of judges– Criterion-referenced standard-setting methodology– Focus was on how much one needs to know, not how many should pass

• The passing standard raised slightly– Spring pass rates only dropped a bit– Fall pass rateswere significantly lower

• Item Response Theory enables equating the passing standard– Reuse validated (“good”) test items as scaling links– Cut score is higher on questions judged to be more difficult– On easier sets, cut score is lower

Conclusion from psychometric analyses:Changes in pass rates reflect differences in people, not the test

76%

74%

77%

68%

78%

72%

79%

75%

77%

71%

78%

75%

CEREBROVASCULAR (14%)

ABDOMINAL (16%) PERIPHERAL ARTERIAL - DUPLEX

IMAGING (14%)

PERIPHERAL ARTERIAL -

PHYSIOLOGIC (15%)

PERIPHERAL VENOUS (22%)

LABORATORY TECHNOLOGY AND OPERATION (18%)

Content Domain

Average Percent Correct per Domain byReason for Taking Exam

Vascular Surgery Board

Other Reason

Vascular Surgery Specialty (1st-timers, Fall 2016 , N=101)

32 claimed Vascular Surgery specialty,But were NOT taking PVI for the BoardsAverage Scaled Score = 598

69 claimed Vascular Surgery specialty,And WERE taking PVI for the BoardsAverage Scaled Score = 579

T-test (df=99) = 2.34, p =.02

Spring looked similar, but not as dramatic

Implications for Vascular Surgery PDs

• Performance of residents and fellows on PVI is inferior to that of vascular surgeons in practice– Amount of interpretation experience may be important (more is

better)

• Lower pass rates appear due to subset of lower performers– Subgroup with less preparation

• Individual preparation• Program differences in curriculum, interpretation experience

Suggested Curriculum

• Program must include didactic instruction and training in the interpretation of vascular laboratory studies

• Curriculum content not specified by APCA for ACGME-accredited programs

• For other post-graduate medical education programs not accredited by ACGME, RCPSC, or AOA (e.g. vascular medicine):– 48 weeks of clinical training– 30 hours of didactic instruction relevant to interpretation and other

vascular laboratory topics– 40 hours of observation or supervised participation in a vascular

laboratory setting

Options for Study

• Characterize factors associated with PVI examination performance– APCA to collect additional information about program, level of

training with application• Current status of vascular laboratory education

– Survey of vascular surgery program directors– Resources, didactic content, practical experience

• Assessment relationship of performance on PVI examination to performance on ABS examinations

Revised PVI Eligibility Requirements

• Licensed MD or DO– or equivalent outside of US/Canada

• Clinical vascular ultrasound experience– Minimum of 500 cases– Interpreted over preceding 36 months– Up to 100 may be didactic or simulated

• Submit case log

Documented Interpretation Experience

• Cases must be distributed over testing areas:– Carotid duplex ultrasound (extracranial cerebrovascular)– Transcranial Doppler (intracranial cerebrovascular)– Peripheral arterial physiologic testing (excludes

ankle/brachial Index (ABI) and single level exams)– Peripheral arterial duplex ultrasound– Venous duplex ultrasound– Visceral vascular duplex ultrasound

• No more than 50% of the total coming from any one area

Requirements for Didactic/Simulated Cases• Equivalent to cases in a clinical diagnostic setting:

– Indications and relevant clinical information presented– Complete technical information for examination provided, including

images, cine loops, worksheets, and sonographer notes– Interpreting physician completes final report in format that meets IAC

Vascular Testing Standards and Guidelines and compliant with requirements for clinical documentation and billing

– Feedback from educator or supervisor indicating that the interpretation met standards or what changes were required

– Time to complete interpretation should not be less than what would be required in a clinical diagnostic setting

• Case details are available for audit

Case Logs• Submit patient log or other record of interpretation experience• Documentation must be maintained three years following the

date of application approval– Case logs subject to audit

• Must include:– Date of case– Testing area– Whether the case was simulated/didactic or clinical– Name of supervising physician/medical director– Clinical site

Maintain the Certification

• Attestation of compliance with standards and policies

• CME – 30 APCA/ARDMS-accepted CME credit hours in vascular ultrasound (three year period)

• Annual renewal fee: $100

www.apca.org/volunteer

Volunteer Opportunities

• Write test items• Review items• Help set passing standard (passing score)• Roles in governance positions

https://www.dropbox.com/s/p4nt7qh0vni6mpf/20161212_Inteleos_Volunteer_RC4_updated-v2.mp4?dl=0

Vascular Technology Examination Scoring Issue

• ARDMS recently discovered technical problem with the calculation of scaled scores affecting Vascular Technology (VT) examinations administered from September 6, 2016 to March 14, 2017• Resulted in some individuals incorrectly receiving a failing score• Administrations of VT examinations temporarily halted and the

corrected scaled score calculation was applied • ARDMS verified the issue was limited to the ARDMS Vascular Technology

(VT) examination• Those affected have been notified that they passed the VT

examination