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Liaison Committee for Specialty Boards

The American Medical Association's Council on Medical Education in conjunction with the American Board of Medical Specialties sponsor the Liaison Committee for Specialty Boards. Following is the criteria for approval of subspecialties by the AMA Council on Medical Education (AMA/CME), the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS).

Approval of new examining boards in medical specialties
Since 1934, medical specialty boards have been officially approved jointly by action of the ABMS and the AMA/CME. This process begins with review by the Liaison Committee for Specialty Boards (LCSB), an organization sponsored by the ABMS and the AMA/CME.

The LCSB consists of four voting representatives from the ABMS Executive Committee and four voting representatives from the AMA/CME. The Chairman of the AMA/CME serves as Chairman of the LCSB. A senior staff member of the ABMS serves as Secretary of the LCSB (without vote). The Secretary of the AMA/CME also serves on the LCSB (without vote). The LCSB meets on the call of the Chairman at no fixed intervals, but meets annually.

The functions of the LCSB are:

1) to receive applications for approval as a medical specialty certifying board;

2) to evaluate applications according to the current version of the Essentials for Approval of Examining Boards in Medical Specialties;

3) to hold hearings on such applications if appropriate to do so;

4) to have the Secretary forward approved applications to the sponsors of the LCSB (the ABMS and the AMA) along with the recommendations of the LCSB. Both the ABMS and the AMAICME must act affirmatively by a 2/3 majority if a new board is to be approved. LCSB is not required to ratify the actions of its sponsors; and

5) to notify the applicant of the action of the sponsors of the LCSB. If the application is disapproved, the applicant may reapply after 12 months.

Action on applications for approval of examining boards in medical specialties is based on the Essentials for Approval of Examining Boards in Medical Specialties, a collaborative effort of the ABMS and the AMA/CME begun in 1934. The original Essentials for Approval of Examining Boards in Medical Specialties was based on recommendations of the ABMS Committee on Standards and Examinations and was approved by the AMA House of Delegates in June 1934. The Essentials have undergone several revisions, both major and minor, since 1934. The present twelth revision of the Essentials is a joint document approved by both organizations. It embodies the policies of both the ABMS and the AMA pertaining to specialty boards while retaining each organization’s privilege of independent consideration and action. The Essentials describe the standards and procedures by which applications for approval of new examining boards are evaluated.

The approved specialty boards and the current list of categories of certification in each of those specialties are listed on the inside front cover and in Table 1 of this edition of the ABMS Annual Report and Reference Handbook.

Twelth revision of essentials for approval of examining boards in medical specialties approved by the House of Delegates of the AMA in November 2005

Section I. Function of the Liaison Committee for Specialty Boards (LCSB)
The American Board of Medical Specialties (ABMS) by authority of its Member Boards and other member organizations, and the American Medical Association Council on Medical Education (AMA/CME), by authority delegated by the AMA House of Delegates, have established the LCSB consisting of four representatives selected from each body. The Chairman of the AMA/CME shall be the Chairman of the LCSB. A senior staff member of the ABMS shall be the Secretary of the LCSB but shall not vote. The Secretary of the AMA/CME shall attend meetings of the LCSB but shall not vote.

The purpose of the Liaison Committee is:

A. To receive applications for approval of medical specialty boards and make recommendations to its parent bodies.

B. To provide a mechanism for contact with petitioning groups through the Secretary of the LCSB on matters related to approval of new specialty boards and for transmission of decisions of the ABMS and the AMA/CME to applicants.

C. To determine as expeditiously as possible if the applicant board has complied with the Essentials for approval.

To assist in attaining these objectives, the LCSB is authorized to appoint consultants known to the ABMS and the AMA/CME to be qualified and knowledgeable in the special field which the new specialty board intends to represent.

Section II. Definition of a Specialty Board
A specialty board is a separately incorporated, financially independent body, which determines its requirements and policies for certification, selects the members of its governing body in accordance with the procedures stipulated in its bylaws, accepts its candidates for certification from persons who fulfill its stated requirements, administers examinations, and issues certificates to those who submit to and pass its evaluations.

Section III. Objectives and Functions of Specialty Boards
A fundamental objective of all approved boards is to act in the public interest by contributing to the improvement of medical care by establishing the qualifications for candidates and by evaluating individuals who apply for certification.

The primary function of all approved specialty boards is to evaluate the qualifications of candidates who apply and to certify as Diplomates those who are found to be qualified.

To accomplish this function, specialty boards shall:

A. determine whether or not candidates have received adequate preparation in accord with educational standards established by the specialty board;

B. conduct comprehensive evaluations of the knowledge and experience of such candidates; and

C. issue certificates to those physicians found qualified under the stated requirements of the board.

A related function of approved specialty boards is to assist in maintaining and elevating the standards of graduate medical education and facilities for specialty training in collaboration with other concerned organizations and agencies.

Section IV. Criteria for Recommending Approval of New Certifying Boards
A. The establishment of a new specialty board signifies the differentiation of a new specialty, which must be based on major new concepts in medical science.

B. A new medical specialty board must represent a distinct and well-defined field of medical practice. It may entail special concern with the problems of patients according to age, sex, or organ systems or with the interaction between patients and their environment.

A new certifying board must be based on substantial advancement in medical science. The needed training must be sufficiently complex or extended that it is not feasible to include it in established training programs.

C. A specialty board must require evidence that its diplomates have acquired capability in a stated area of medicine and will demonstrate special knowledge in that field.

D. A plan must be presented whereby preparatory programs in graduate medical education will be developed for accreditation by the Accreditation Council for Graduate Medical Education (ACGME). New boards may be permitted under conditions stated by the petitioning board and approved by the LCSB to approve training or experience or a combination of both as equivalent to that acquired in accredited training programs until accreditation by the ACGME is in place.

E. The applicant must present satisfactory evidence that the proposal has broad professional support in the field of medical practice making application to become an ABMS certifying board, and that approval will promote and enhance recognition of a single standard in preparation for practice in that field.

F. In order to promote public and professional understanding and recognition of a single standard in each specialty and to promote efficiency of the evaluation process, only one certifying board will be recognized in each specialty.

G. While it is recognized that considerable variation among certifying boards may be permitted, the operational plan must include satisfactory details in the following areas:

(1) Names, professional affiliations and professional accomplishments of the sponsors.

(2) Structure—the composition of the board should provide for representation of appropriate organizations and for effective operation of the board.

(3) Content of the field—data from a detailed analysis of the professional area, including present and future public needs and professional interests should be presented. Such analysis should be used for development and continued evaluation of standards for certification.

(4) While requirements may not be fully developed at the date of application, a plan for development and validation of the requirements should be presented.

(5) A detailed plan for evaluating individual candidates should be presented.

(6) The financial support for a valid, objective program of candidate evaluation, as well as other necessary activities in graduate education, must be included in the plan. The data presented should include projected numbers of potential diplomates and projected certification fees.

Section V. Procedure for Approval of New Specialty Boards
A. The application should be directed to the Secretary of the LCSB who also serves as Executive Vice President of the ABMS.

B. The LCSB may conduct a hearing before making a recommendation on any application.

C. The application should adhere to the following outline:

(1) The name of the proposed specialty board asking for approval.

(2) The proposed objectives and function of the petitioning board.

(3) The names of the sponsoring organizations.

(4) A detailed statement describing how compliance with each of the criteria in Section IV is achieved.

(5) A description of the proposed organization, the names and professional qualifications of the proposed officials, the names and addresses of the founding members, their qualifications, and the organization which each member represents.

(6) A copy of the proposed or existing Constitution and Bylaws.

(7) A copy of the proposed or existing Articles of Incorporation.

(8) An outline of the qualifications to be required of applicants for certification.

(9) The number and names of institutions providing residency or other acceptable training programs in the specialty, the total number of residencies available, and the number of residency training programs that can be developed.

(10) The approximate number of physicians engaged in the practice of the specialty.

(11) A copy of the proposed application form for candidates for certification.

(12) Provisions, if any, for certifying physicians practicing in the specialty without examination or accredited training. The statement should include the qualifications and the number of physicians to be certified in that manner.

D. The responsibility of the LCSB is not limited to initial evaluation of the certifying boards in medical specialties. Proposed changes in policy that differ substantially from those policies and procedures that prevailed at the time of approval should be reported to the Secretary of the LCSB for transmittal to the LCSB for action as required.

E. The LCSB shall submit a report and recommendations to the ABMS and the AMA/CME for consideration by their members within one year after receipt of the application.

F. The ABMS and the AMA/CME shall independently act on the application after receiving a recommendation for approval from the LCSB. An affirmative vote of two-thirds of the members of each of the ABMS and the AMA/CME, present and voting provided a quorum is present, is required to approve the new board. Each parent of the LCSB shall report its action to the Secretary of the LCSB. If one of the parents disapproves, it must transmit the reasons for disapproval to the LCSB.

G. If possible, within twelve months of receipt of the application as defined in Section V.C., the LCSB shall inform the petitioning group of its decision.

H. The petitioner may file a formal appeal in the event of a negative decision by the LCSB. The petitioner must file a written appeal within six months of notification of a negative decision by the LCSB to the Secretary of the LCSB who will transmit that information to the ABMS and the AMA/CME. The appeal will be heard by a five-person panel consisting of two members of the ABMS Executive Committee who are not members of the LCSB (appointed by the ABMS Executive Committee) and two members of the AMA/ CME who are not members of the LCSB (appointed by the AMA/CME). These four individuals will choose a ‘public member" who may not be a member of the ABMS or the AMA/CME. The appeals panel will review the appeal of the petitioner, include an opportunity for the petitioner to be heard in person, and transmit its recommendations to the LCSB. After considering the recommendations of the appeals panel, the LCSB will take final action on the appeal and will notify both the petitioners and the parents of the LCSB.

I. Following approval by the LCSB, the ABMS, and the AMA/CME, the board shall not issue new certificates to individuals who received certification prior to approval without requiring that each meet the same requirements as candidates applying for board certification after approval.

Section VI. Meetings of the LCSB
The LCSB shall meet at least annually at the call of the Chairman. On petition of five members of the LCSB, the Chairman shall call a special meeting. The Chairman may also call a special meeting to conduct any business which comes to the attention of the Secretary of the LCSB.

Section VII. Amendments or Revisions of the Essentials for Approval of Examining Boards in Medical Specialties
Amendments or revisions of the Essentials must be approved by the ABMS, the AMA Council on Medical Education and the AMA House of Delegates. Those amendments or revisions that have been approved by two-thirds of the LCSB shall be transmitted by the Secretary to these parent groups for consideration and vote. Changes in the Essentials shall take effect on approval of the ABMS, the AMA Council on Medical Education and the AMA House of Delegates.