What Should Physicians Know About Hypertension? The Implicit Knowledge Requirements in the Maintenance of Certification Self-assessment Module

摘要

BACKGROUND AND OBJECTIVES: The American Board of Family Medicine (ABFM) Maintenance ofCertification process requires family physicians to have a core knowledge base in key areas such ashypertension and diabetes care but does not define this knowledge in specific terms. We developeda method of content analysis to evaluate what type of knowledge is assessed on the ABFM's HypertensionSelf-assessment Module (SAM) to better understand what the implied knowledge of a familyphysician should be. METHODS: In this qualitative descriptive analysis, we categorized the 60 questionscomprising the knowledge assessment portion of the Hypertension SAM, version 2.20.03, intodiagnosis, treatment, or etiology/general knowledge questions. Diagnosis and treatment questionswere graded for relevance to typical family practice. Diagnosis questions were coded regardingimportance. Treatment questions were subdivided into drug or nondrug treatments. Drug treatmentitems were categorized as testing knowledge of safety/tolerability issues, effectiveness issues, or costconsiderations. RESULTS: The 60 questions represented 213 specific items of knowledge. Most (71%)of the items on the SAM focused on therapy, with the remainder evaluating knowledge of diagnosisissues or general knowledge. Of the therapy-related items, the items were evenly split betweenknowledge of safety/tolerability and knowledge of effectiveness (47.1% each). The remaining itemsrequired knowledge of nondrug therapy. No items evaluated knowledge of the relative cost of treatmentor cost-effectiveness. With regard to the relevance of the tested information, only 70% of theitems test knowledge that would be commonly needed in the practice of family medicine. CONCLUSIONS:There is currently no consensus on the discrete set of skills and knowledge that should be held bya competent family physician. In the absence of a comprehensive set of goals and objectives, theknowledge content being assessed in the SAMs can at least inform teaching programs about whattheir learners will be required to know to maintain certification. For the content area of hypertension,most of the knowledge required was regarding drug treatment. Interestingly, 30% of the knowledgecontent being assessed was found to be neither important nor commonly needed in the care of patients.We recommend that more work be done to define the specific knowledge and skills requiredfor a competent family physician and that future maintenance of certification modules be written toassess mastery of these core requirements.