Welcome, everyone. The ASGE and our sister GI societies collectively appreciate your participation in tonight's webinar. My name is Ed Dellert and I will be your staff facilitator for tonight's presentation. Just to let you all know that we are very grateful to the ABIM and their collective team who is here tonight and providing important information on their webinar, which will be the launch of their longitudinal knowledge assessment, What You Need to Know. Now, it is my distinct pleasure to introduce our moderator for tonight, Dr. Jennifer Christie, who is ASGE vice president of our board and professor of medicine at Emory School of Medicine. Dr. Christie. Thank you so much, Ed, and good evening, everyone. As Ed mentioned, my name is Jennifer Christie and I am ASGE vice president this year. And I'm so happy that you have joined us this evening and to partner up with ABIM, as well as my co-moderator and facilitator, Ed Dellert. Welcome to the presentation from the American Board of Internal Medicine on the Longitudinal Knowledge Assessment and What You Need to Know. This program is brought to you by ASGE, the American College of Gastroenterology, the American Gastroenterological Association, and the American Association for the Study of Liver Diseases. Tonight, we are so excited to have the opportunity to meet with ABIM on the longitudinal knowledge assessment and learn the benefits of this new program. ABIM wants to hear from you and to understand your experience and will answer any questions following this presentation. This presentation is being recorded and will be available on ASGE's learning, online learning platform, GI-Leap. Tonight, we have Ms. Florence Nickens, who will deliver the initial presentation. Ms. Pickens is the program operations manager at ABIM. Additionally, we have several other members who will be available for questions from ABIM. We have Dr. Furman McDonald, who is Senior Vice President for Academic and Medical Affairs. We also have Helene Brooks, who is Director of Strategic Alliances. We have John Held, Director of Communications and Brand Management, and also Monique Lau, Program Associate for Strategic Alliances. Again, thank you for joining tonight. Please note, there will be a question and answer session following the presentation. Please submit your questions in the Q&A as the program is ongoing. At this time, I will turn the program over to Florence Pickens. Thank you. Thank you, Dr. Christie. This is a presentation to give an overview and to answer frequently asked questions about our newest assessment, the Longitudinal Knowledge Assessment. Before we get into the Longitudinal Knowledge Assessment, just a brief promo to highlight the Physician Portal app from ABIM. This app was designed by ABIM in collaboration with physicians to be a new user-friendly way to track your progress in the MOC program. We hope that this will make it easier to keep up with your MOC program requirements. You can track MOC assessment deadlines, your MOC points progress. You can customize reminders for assessments, points, and payments. That's my brief commercial for today. Moving on to the Longitudinal Knowledge Assessment, or the LKA as we tend to call it. As many of you are hopefully already aware, the LKA launched in January of this year. And this is an opportunity to allow our diplomats to maintain board certification at a speed that works for them, or at least that's the intention from ABIM. Since we first announced the LKA in 2019, ABIM undertook a significant physician engagement effort to ensure that physician voices were heard, that we incorporated feedback, and that the finished assessment product would work for physicians. And here you see some of the ways that we were able to engage physicians and gather that information. As I noted, the Longitudinal Knowledge Assessment launched this year. You see here all of the areas that are available for 2022, with four additional specialty areas set to roll out in 2023. Those particular areas for 2023 were put on a delay because those areas were so heavily impacted. Those physicians were so critical to providing care during the pandemic. ABIM relies on our physicians to help us craft our items for our assessments, and we did not think it was appropriate to ask physicians who were so busy in their practices to take time away from that patient care to volunteer with ABIM to help us craft those new assessments. So, 2023 will be the year for those. Some important dates for the LKA and our other assessments. December 1 is when ABIM's registration and enrollment opens, and so the 2022 assessments became available for registration and enrollment on December 1 of 2021. Questions for the first quarter of the 2022 LKA became available January 4, and an important upcoming date, March 31, will mark the end of the first quarter for the LKA. Questions for the first quarter will retire at the end of March, and you will not then have access to them. So, if you're on the fence and thinking about the LKA, now is a great time to come in and enroll so that you have the opportunity to do those first quarter questions. And now let's just walk through some of the features of the LKA. A big one that we know physicians were looking forward to is that there's no appointment necessary. Once you enroll in the LKA and questions become available to you, you can drive the pace at which you answer those questions. So, you can decide you're going to carve out a little time once a week, or maybe you'd prefer to sit down and do them all in one setting. As long as they're completed by the end of the quarter, the choice is up to you. You'll have four minutes per question to answer each question. We realize that some questions you may want a little more time than that for, and so you do have a 30-minute time bank that you can decide to add a minute or two to a question where you think that time will be useful for you. And this is 30 minutes per year that physicians are given for the LKA. The LKA provides immediate feedback, rationales, and references. And of course, this is a change from our traditional MOC exam. The LKA does have a participation requirement. So, each year you'll be offered 120 questions. Over the course of the five years of the LKA, you need to complete 500 of the 600 questions offered. So, there's 100 questions that are offered as a sort of life happens opportunity. So, there may be a quarter where you find you can't get to the questions because you have, because work is too busy or life is too busy. Over the course of that five years, you do have an opportunity to not open 100 of those questions. Physicians can enroll in the LKA in the year in which their assessment is due. So, if you're not sure when your next assessment is due, you can log into your physician portal at abim.org and check the dates for your certificate. It will tell you when the assessment is due for you. Diplomates have the opportunity to use any resource that you might use in your practice, with the exception of a colleague or another person. There's an opportunity to earn MOC points over the five years that you're engaged in the LKA. So, you can apply for the MOC over the five years that you're engaged in the LKA. For each correct answer, you'll earn 0.2 MOC points. Finally, the performance standard at the end of the five-year cycle gives the pass-fail result for the LKA. And, as I noted, the LKA gives physicians an opportunity to earn MOC points. And so, you'll see that first you answer your question is correct. We will automatically calculate that you've earned 0.2 MOC points. That will then be added to your activities counter to show you that you've earned the MOC points. And, just a little bit about the timing for how the LKA works. So, it is a five-year cycle for the LKA, and questions are rolled out quarterly over the course of the year. Each quarter, you'll see 30 questions, and each quarter, you'll see questions. And, as I noted, over the course of the five years, you'll be offered 600 questions, and you'll be able to set up your own schedule for completing those questions. Feedback and rationale are both presented on an ongoing basis. So, you'll be able to set up your own schedule for completing those questions. Feedback and rationale are both presented on an ongoing basis, and you'll see an updated score report on a quarterly basis after the first year. So, that will help you to identify areas where you're doing well, areas where you may need to spend some additional time. And, finally, as we noted earlier, the result will be given at the end of the five-year cycle. At the end of that cycle, you'll receive a result. For the successful result, you'll have the choice to make of whether to continue with the LKA the next year, or to switch and take the 10-year MOC exam the next year. So, this dashboard gives you a peek at what the LKA looks like. You can see the information that's available when you log in to take the LKA. It will allow you to track your progress over the five years. Also, over the quarter, you have an opportunity to set some reminders for yourself, and you can track your use of the time bank, which gives you 30 minutes each year, and what we call the Life Happens opportunity, which is the 100 unopened questions over five years. So, there's quite a lot of information available at a glance here. Okay. So, who is eligible? Physicians who are currently certified and in their due year are eligible to take the LKA if it's available in their specialty. The exception is a physician who may be in the grace year. Physicians in the grace year are not eligible for the five-year LKA because it takes more than a single year to complete. When you are participating in the LKA, you will continue to be reported as certified throughout that cycle, again, with a pass-fail decision at the end of the five years. For certificates earned before 1990, physicians are also eligible for the LKA. You will have a grace – I'm sorry, not a grace year. You will have an assessment due date in your portal, so please log into your portal to check what your assessment due year is, and you can then opt for the LKA in your due year. And finally, for a physician who has a LAPS cert, the LAPS certificates are eligible to take the LKA to meet the assessment requirement, but please note, because the LKA takes five years to complete, you would be reported as not certified until the end of the five-year period, and if you were successful on the LKA, you would be reported as not certified. And your other requirements are met at that time, the status would change to certified. I always like to just put in a reminder, we have so much focus on the assessment, and of course, that's the point of this particular presentation, but also to remind our diplomates that the MOC program is the assessment plus the 100 MOC points that are due every five years. And I will also point out that while there's a five-year MOC point requirement and the LKA is a five-year cycle, those due dates may not necessarily line up for you, so you'll want to keep track of your points and your assessment separately to make sure that even though you're doing the LKA, that you're going to hit your points requirement when needed. So, let's talk a little bit about how the LKA can help you stay on track with your overall MOC requirements. Someone who's participating in the LKA will be answering questions on an ongoing basis and earning points, and so they will not have any problem earning some points every two years in order to meet the participation requirement that we have for the overall MOC program. And of course, you can earn up to 24 MOC points per year, so there's an opportunity to earn quite a few of your 100 points through the LKA. And of course, a past decision on the LKA would meet your assessment requirement. So, that's a lot of information, and we realize that it is, so we realize that you may want to take a little bit slower dive into some of that information. You can do so at the microsite abim.org slash LKA, where you can walk through FAQs and other information that you may be interested in finding here. And finally, we're going to have some time after this presentation to look at the questions that have come into the Q&A section, but if you have questions after this, please know that you can always log into your portal and view your physician portal. If you have questions, you can call ABIM Monday to Friday. Our customer care team is happy to answer questions, or you can reach out to us by email, and again, we will respond to your questions. So, I'll just say thank you, and I will turn it back over to Dr. Christie. Thank you, Lawrence. That was extremely informative. We have a lot of really wonderful questions from our attendees, and we'll do our best, like we said, to answer as many of them as we possibly can during the next 40 minutes or so. So, the first one, this question, it's specific to this physician whose certificate is valid until 2025, but the question is, when do I need to start the LKA program? And this can apply to a lot of folks who may have a different certification date, so can you just clarify that? Right. So, you become eligible for the LKA in your due year. So, if 2025 is your due year, you'll want to come in at the end of 2024, December 1, 2024, is when you would be eligible to either enroll in the LKA or register for the traditional assessment, and in January of 2025 is when questions would open for the 2025 LKA year. Okay, very good. Thank you, and then the next question is, I was thinking about, I'm in LKA, by the way, everyone, which I do appreciate. I can do this, you know, in the comfort of my home and my PJs, but Dr. DeWitt wants to know, would it be possible to give us the option to eliminate questions in up to two topics in the LKA? For example, he's a therapeutic endoscopist and he hasn't seen a hepatology patient for over 20 years, yet it's 30% of the test. What are your thoughts about that? Well, I don't know of any plan to do exactly that today, so I would say no. If you opt into the LKA, it will follow the blueprint that's provided at abim.org. Okay, okay, very good. Another question that is very common is, if someone has certification more than one specialty is maintaining two, how would he or she be able to maintain that certification both of those specialties using LKA? Right, you're right. This is a question that we get a lot. So, you are able to enroll in multiple LKAs, but if you are enrolled in multiple LKAs, it means that you will have 30 questions per quarter per LKA area that you've enrolled for. Right, so you would be completing two full LKAs if you enrolled for two different areas. Okay, so you have to do the two complete ones. Okay, got it. There's a lot of good questions. Okay, a lot of folks want to know, what is the target for PATH? You know, you had mentioned, you know, that they'll pass based on the performance standard. What is the PATH rate? How do we find that out? Well, ABIM publishes the information for our score setting on our website. So, if someone wants to take a dive into how do we come up with these things, that information is available. I'm not an expert on that piece, so I can't give you the details of it, but it is available. Okay, so Ed, can I jump in there? You can. Yeah, so Jennifer, great question. So, ABIM doesn't set pass rates, so that there's no set pass rate for LKA or for any of its other assessments. Everybody can pass or theoretically everybody could fail. I'll tell you, we've never had a discipline where everybody failed. Actually, most people are going to pass, and by most people, ultimate pass rates are in the 97 percent range, and we expect that to be the case for LKA, if not better. And the reason for that is that it is a criterion-based standard, so it's not a curve, it's not a percent, but you're going to be getting feedback along the way. So, I saw another question in there about, you know, why do I have to wait five years to find out how I'm doing? No, no, no, you'll find out much sooner than five years. In fact, be able to chart how you're doing along the trajectory, and you should know really well coming into the LKA near the end whether or not you're on target to meet the standard, because the goal is learning and assessment, not just the assessment target. The other thing to say is the scoring is unlike a point in time, single point in time assessment, where you've got, you know, 240 questions and you get some right and you get some wrong, and there's, you know, this number. The LKA scoring is being designed so that your early performance, if you're not doing well in the first year, is not going to hurt, you know, count against the score as much as you do later. So, the goal is that you're, it gives you credit for doing better as you go along, and that's about as much as we can say about the scoring right now, because they're still working out those algorithms, but it is a criterion-based standard. It will be the same for, you know, everybody doing the LKA. We won't set a pass rate, but we fully anticipate that most people doing LKA should actually do quite well. Okay, thank you, Dr. McDonald. We have a question from Dr. Vott. So, 100 mock points, if I do more, will they get carried over the next five years, or should I wait? We do not, points only count during the five-year interval in which they are earned. So, no, you can't bank them and do 200 points in this five years and be covered for 10 years. Okay, thank you. And then, this is a pretty easy question. How much does it cost to enroll in the LKA? Well, the LKA does not have a separate fee, right? So, when you come in and you pay your annual fee, it covers the cost of the LKA. Okay, and how much is that? And, John, you'll back me up here. I believe it is $220 for your first certificate and $120 for additional certificates. Florence, you got exactly right, and that does include LKA for each of the certificates. Okay, very good. And then, we have a question about, from Dr. Steinberg. Please go over what happens at the end of five years. If one passes, then what happens? If one doesn't pass, then what happens? Okay, so the LKA is meant to be an ongoing assessment. So, unlike the point in time where you pass a KCI and then you have four years where you're not doing an assessment and you come back and you do another assessment, the LKA is designed to be a series of five-year intervals where you're in the LKA pathway on an ongoing basis. So, at the end of the first five years, you come in, you've done your five years, you get your result, you have a pass. You are due the next year, the next calendar. You'll have an assessment due date that is moved out by one year, and you have a decision to make whether you'll continue with the LKA or you may decide to switch and take a 10-year traditional MOC exam. If you are unsuccessful at the end of five years for the LKA, as with our traditional MOC exam, you would have a one-year grace period. During the grace period, you're not eligible for the LKA, so the 10-year MOC exam would be your option to continue being certified. Okay. Very good. Another question is, will questions be repeated in future years of the five-year LKA program? I don't have any information. I wouldn't expect so, but I see Furman shaking his head, so I'm going to go with no. Okay. It's a lot of work. You have to create more questions, Furman. Well, yes. There'll be some other people helping. I know, I know. Okay. There's a lot of really good questions. While engaging in LKA, what is one's board certification status? So, you come in in your due year and you're certified, right? You will continue to be reported as certified every year that you're meeting the participation standard for the LKA. So, at the end of each year, there's going to be a review to see if you have answered enough questions, essentially, to show that you are participating in the LKA, and it's only at the end of that five-year period that you have a pass-fail decision. So, if you're due in 2022 and you're on the LKA, you come in, you answer all of your questions this year. At the end of the year, your assessment due date is going to update to 2023, and that's what's going to happen for five years. Got it. Okay. And if one, this is from another participant, if one takes the standard recertification before the last certified year but does not pass, is the LKA then still available? It is. It is. So, if you decide to come in a year early and just to see, right, to see, to try the 10-year MOC exam, you can come in, try that exam. If you're unsuccessful on the 10-year exam the year before your due year, it has no effect on your eligibility for the LKA in your due year. So, as long as you are still certified when you sign up for LKA, you're good. Right. The only reason, the only effect, only way a 10-year exam ahead of your due year could affect you is that if you're successful in year nine, then you will no longer be in your due year the following year, right? That's the only difference. But if you're unsuccessful before you're on the 10-year before your due year, you can still come in that December and instead of signing up for another 10-year, you could opt into the LKA. Okay. Okay. And Dr. Fell wants to know, do pre-1990 certified physicians need to pass a test, whether it be the LKA or the 10-year exam or just get the MOC points? So, you will not lose your certification if you are not successful on an assessment, right? I think that's what he's asking. So, effectively, no, you don't need to pass the assessment to keep your certification. As long as you're certified before 1990. Right. With the exception of cardiology and geriatrics, I believe. But yes, for- Lawrence, could I jump in? I think actually the questioner, if I'm looking at the right question, Jennifer, is asking not about whether they lose their certification, which is true. Those who hold certificates from before 1990 are always certified, but it actually asks to remain both certified and participating. Oh, I see, I see. So do they just need to do points to remain participating or will they need to do an assessment and points to remain participating? You need an assessment and points to remain participating. Right, because for those certificates, as we were just sort of discussing, their valid certificate is not at risk, but their participation status is what is changed by whether or not they're engaged in the assessment and the activities for MOC. Okay. So if you're not doing well during the LKA, you're learning you're not doing well, can you switch out to the traditional mock? Will this reflect negatively? Will it say that you failed? You can, if you get to year two or three or four and for whatever reason decide you would prefer to move to the 10-year, you can as long as registration is open for the 10-year. Okay. I hope that answers the question. Jennifer, Florence UK, if I jump in on another part here. Oh, yeah. The question was about reflect negatively. So actually you could go all the way through the LKA to year five and not meet the passing standard in year five. You still have year six as certified to take the long-form exam. The MOC and GI is given twice a year, so you can take it in the spring and the fall. And as long as you pass it, the certification never lapses. Your verification certification page never says anything other than certified in GI. So the answer is no. There's no downside from a reporting standpoint if you don't pass the LKA in year five. You've got through year six then to take and pass the long-form exam. And if you do, in their current rules, you're then certified for 10 years. So no downside. Yeah, or at least your assessment's met for 10 years. Right. Thank you, Florence. Yes, you stuck to your points and other things, but right. Yeah, you're absolutely right. Okay. And you may have addressed this in your explanation, but I'll read it anyway. If one leaves the LKA and then fails the 10-year exam, can they switch back to the LKA? So they're enrolled in the LKA and then said, you know what, I'm going to try to do this 10-year exam and get it over with. And if they don't do well, can they go back to the LKA? As I understand it, you can't go back to the same LKA, but you could be lapsed and then starting a new five-year cycle for the LKA because you are eligible for the LKA when you have a lapse certificate. But then you will be reported as not certified, right? Yes. Dr. Christie, I think the due year piece is where it becomes sort of challenging. So if you're looking to come in and you decide that the 10-year assessment is the assessment you're going to try in your due year and you're unsuccessful and then say, well, I've changed my mind, I'm going to try this LKA, that's where it becomes problematic because you could wind up losing certification during that period. So if you take the 10-year in your due year, you're not successful, you would go into your grace year. We would recommend taking the 10-year again and looking to pass that so that you do not have a lapse in certification. Does that make sense? One of the earlier questions was about taking the 10-year exam early. That is a little bit of a different scenario. But in your due year, what we're looking for is that you've met that assessment requirement in that due year. So failing that 10-year exam will not do that. Does that help clarify a little bit? I think so. One thing you said though, maybe I wasn't aware of it, I don't know if some of the attendees were aware, you said the grace period, there's a grace period? Yes, so for our assessments, if you come in in your due year and you are unsuccessful on that assessment, for the LKA, that would mean that at the end of the five-year cycle, your result is that you failed the assessment. You would, the next calendar year is a grace year for you if your other MOC requirements are up to date. So you have an additional year where you are reported, continue to be reported as certified, and you have one or two opportunities to take an MOC exam in that year. And if you pass that assessment, as Furman noted earlier, you will continue to be reported as certified. Okay. But note that if you're in- You have to maintain your MOC. So that's what we need to know. Yes. And I'll also note that in the grace year, you're not eligible for the LKA. So you can't be unsuccessful on the 10-year in your due year, go into the grace year, and in that grace year, start the LKA because you're not eligible in the grace year. Okay. Sounds good. What preparation is recommended before taking the LKA? I've thought about this a lot too. What do you guys recommend? Well, I don't think we're giving any particular advice about board reviews or a particular study. And I think what we're hearing anecdotally from physicians is that, as you might imagine, there are lots of different approaches from physicians coming in cold to just kind of see how they do, to other physicians who feel more comfortable doing some sort of prep. But usually that prep is particular to themselves and the way that they like to approach assessments. So I don't know. Dr. Fuhrman, do you have something more formal? Do you have something, have you heard something more formal? Yeah, I would actually, the longitudinal knowledge assessment, as the name implies, is not really meant to be a study ahead of time and take a point in time assessment. So the goal is not to study up and then do these 30 questions and study up and do 30 questions. The goal is to begin doing the questions and as it identifies gaps in particular knowledge areas, use that platform to actually learn from what you're doing and then maybe go out and get resources from the GI societies on the things that you are finding that you're having more trouble with. So it allows you to focus your study. And remember the early scoring is not gonna count against as much as the later scoring. So you have that time to kind of focus your study. So while I am, as an educator, a physician educator who led GME programs for many years, I'm never gonna tell somebody don't go, don't study, but for the LKA, I wouldn't recommend going out and doing a large ahead of time studying. That's not the construct of the assessment. The assessment is learn as you go. So really good time to jump in and try the first 30 questions right here at the end of quarter one. You've got quarter two, if you're eligible. So you've got the, it gives you a lot of flexibility to not have to do a bunch of night before the test studying, but rather learn as you go. That's the way it's built. Yeah, because I would say from my experiences that you don't know what the next question is gonna be. So how do you, I mean, so much information, how do you prepare for that? But I think, yeah, just trying to maybe hone in on some of the gaps. The other thing that you mentioned, Lawrence, is that you can use any other resource other than a person, right? So we can go to things like up-to-date and if you have time, you can use those resources. Right, right. We will say that there are four minutes per question. So you're gonna want to think carefully about when you use that time bank to add time, right? You clearly don't have enough time to add time to 120 questions over the course of the year. So, I mean, but as with all assessments, time management is part of it. Yeah, and then along those lines, someone asked, is four minutes the optimal amount of time to answer the question? Well, I don't know about optimal, but I will say that that number is not arbitrary, right? Our research team looked at our assessment experiences as well as other boards to derive that four minute timeframe. Okay. Can I jump in on time? Absolutely. And we now have data to say that not only is it evidence-based derivation, it's working out to be way more than enough time. So, John, I think I'm right that the average is less than two minutes per question. Oh, I didn't know that. Yeah, and that's relatively new, Florence. I think that's this week we learned, at least I learned it. So, that's great news. And I don't know if Jennifer, that comports with your experience, but most people are not needing to tap their time bank to view their questions. They can still go out and look up, check something on up-to-date or whatever your resource is. So, time is not appearing to be a limiting factor here. So, and then along the lines of time, does the wrong question count against you or not? Well, I'm not sure about what against means exactly. I will say that, of course, you're earning points when you get questions correct. And at some point you're going to need to have answered some number of questions correct to be able to pass the assessment. But I don't know that you're exactly losing points if you get one wrong, if that's what they're asking. I think so. I think it's, so indirectly it kind of does because you do need a certain percent correct. Right, yeah. Yeah, it doesn't help you, I guess. A wrong answer doesn't help you, but a correct one does, I guess is how I'm thinking about it. Okay, very good. And then there's some questions in there that say that this was a practice test, something like that, a practice question, which oftentimes I've been relieved to know because I got it wrong. So, what is that? I could take a stab at this, but Furman, I have a feeling you probably have a ready answer for this, yes or no? Florence, I'm completely happy for you to say it, but I will talk about pre-testing if we want to talk about pre-testing. Yes. So, it's a pre-test question. And why I have a pre-test question is because ABIM tests every question before you get it, before they score it and count it, so it's something that could actually affect your score. Every single one of those questions is tested and a certain number of those are the pre-test questions that are in this mix on the LKA. So, it's actually, I've heard and I can understand that you go through, you think about the question, you put the answer, and then you find out, oh, wait a minute, this was a pre-test question, so they're not telling me whether this was right or wrong. But think about it on the other end that when that question is used in the live pool, we'll know that it actually is giving us the information it should give. So, it's a good thing for you to have the pre-test questions in the long run, it's good for your assessment overall. But that pre-test question you just took is not affecting your personal score, it is building the, ensuring that the LKA has longstanding running questions that are reliable and work right like they're supposed to. Okay, very good, thank you. One of the attendees wants to know, will the level of difficulty increase as LKA goes on, or is it similar to the first set of questions, or is it similar in terms of difficulty to future questions? I don't know specifically, I don't have any information about it becoming more difficult over time, that wasn't my, okay, I see Furman shaking his head no. So, no, the intention is not that it will be, it will grow more difficult each year. Okay, I got it. Well, and let me just also say, every year going forward will be the first year for some cohort, right? So, it wouldn't be fair to have them get gradually more difficult, right? You sort of need the same level of difficulty each year because every year is somebody's first year. Right, okay, okay. As far as some other questions online, it says, can we try the LKA questions now, now and then, if we're not eligible, I guess to just sort of test it out for recertification as a tool to determine which assessment we will complete when due? Like, are there sample questions, I think is the question. Well, I can say that there's no opportunity to go into the LKA and try it out because you can only enroll when you're in your due year. And I don't know that we have built the same kind of tutorial for the LKA that we used to see for the traditional MOC exam with a handful of practice questions. Okay, very good. And then I think that the attendees are asking for further clarification about knowing what progress you're making. So at what point in the five-year cycle would you know that you aren't going to pass the LKA? Is it two, three, four? How do we know? Well, you will have access to the questions you've got right and wrong. So I don't think you'll be completely right. The idea is for you to be able to see your progress and how well you're doing on the questions. It's not that you're going to have a target number that you're trying to hit, but you will be able to see how well you're doing as you go through the questions in terms of questions you're getting right and wrong. But you don't know what it means at that point though. As far as passing or failing, is that what you're saying? Yeah, I don't think you'll have a target number if I understand how it's going. Okay. But at some point, when I guess the way I understood is that once you've answered enough questions, at some point, the body will be able to say, you've answered this percentage and you're on track to pass or you're on track to fail. Is there some point that we're given that information? I'm not certain. I'm not certain what that looks like. So I can certainly take that back if no one here. Oh, hang on a second. John, are you saying you can jump in and take this? I was seeing if Furman could, he was having microphone issues, but I can give it a shot. Florence, my understanding is there will be quarterly score reports that you'll get in your second year. And I've seen a mock-up of these. And my understanding is you will get a sense of how you're trending towards the passing standard. And so you'll know beginning in your second year as well as subsequent quarters beyond that if you're trending towards staying above the passing standard or if maybe you're getting close to it and they can use that information as well as your question history to see areas that you might wanna focus more on if you need to do so. The only other thing I would add, Dr. Christie, is that as Furman, I believe noted over time, that later timeframe will be scored more heavily than earlier to give folks an opportunity to do well in the LKA. So if you're not doing as well in the beginning, you're really not sure how this process works, I think as Furman noted, later in time the scoring will happen. So I'll jump in here. The quarterly score reports will give you a picture. If you sort of felt like you didn't do extremely well in the beginning and you see yourself doing better as time goes on, I think there's some comfort to take in that. And again, I think we also noted that we're still figuring out the analysis for these passing scores, but we're trying to make sure that we're giving you as much information as possible over those quarters and at the end of each of those calendar years. So that people should feel pretty confident in how they're doing. Okay. It's having technical difficulties. Yeah, it looks like we lost. We may have lost our physician leader, so. So we'll do our best. So, well, maybe you guys can answer this one. Does the LKA follow the same blueprint as the 10-year exam? I guess in terms of how these questions are developed, et cetera. Yes, the blueprint is the same. So if you're thinking about the fact that you're a practicing gastroenterologist and you've chosen to take a 10-year or an LKA, the concept of what you should have to cover is the same as far as that blueprint is concerned. So the items may not be exactly the same, but the overall percentages of what you would have to know is the same. Okay. Yeah, I think that helps. Dr. Gordon wants to know, is up-to-date embedded in the portal or does it have to be accessed externally? It would have to be accessed externally. It's not embedded in the LKA. Okay, so you have to have a login and an account. Right, you would have to have some sort of, right, individual access to it. And then Dr. Hepps wants to know, if a five-year cycle is substitute for a 10-year exam, why don't we get five years off if we pass the LKA? Okay. Right, well, in part because the LKA is a different animal, right? It's intended to be an ongoing assessment. But as I say, if you get to the end of the five years and you would rather not continue with the LKA, you will have the opportunity to take the point-in-time assessment that would buy you 10 years if you prefer that. Okay. All right, good, good, good, good. All right, I see Dr. McDonald coming on as two of you. Hope you get on soon. Okay, I'm just scrolling through some more. What about, some folks have asked about banking. They've asked about. Banking the unused time for harder questions. How can you advise on how we should use the time bank? Well, I don't know that I'm the best person to advise you on that, but I can say that the 30-minute time bank is standalone and separate from the four minutes per question that you get. So you will have to determine for each question whether or not you think this is one where you need the additional time and that you want to spend from your time bank. But I don't have a particular strategy that I could recommend for managing the time. Yeah. And one thing, Dr. Percy, if I could add on, you won't necessarily know if it's a difficult or an easier question until you open it. And so once you open the question, it's really in your best interest to go ahead and answer it because it's gonna count towards your score either way. Right. And if you need more time, you just use that, you know, the 30 minutes, a couple of the one or two of the 30 minutes that's given to you to selectively decide if you need that time. Yeah, I believe you can add 30-second increments. Yeah, yeah, okay. Very good. There was another question about the, well, there's several questions around the difficulty and is the LK considered similar in terms of difficulty level as the 10-year exam? Do we know that yet? Or is one considered harder than the other? I mean, I have not heard any indication that one is meant to be harder in terms of the content than the other. They're just a different design, if that makes sense. I think the opportunity to learn over time and to have the ability to look up the responses to each question, determine whether or not you got that wrong almost at the outset, and then have the ability with references and rationales to learn from that is sort of the, as Florence noted, just a different design model. So not really speaking to the difficulty of each item, but more overall, the pathway that works better for- For you. Yeah, but I guess one point that was made by an attendee is that the previous two-year exam questions, his opinion was much easier than the 10-year exam. I think that's the premise of that, of this question. Furman, I'm not sure if you heard that, but someone had noted that they believe the two-year knowledge- KCI, yeah. Questions, I don't know if you can hear me, but the two- I can hear you now. I'm sorry, everybody. I got completely kicked out of the webinar. I don't know what happened, but I'm back. No, no worries. I was laughing a little bit. The two-year, someone noted that the two-year KCI questions were much easier than the questions that were given on the 10-year assessment. And I believe they were the same or similar. The same questions, yes. So I just wanted to clarify. I'm glad that people felt good about the KCI. That's good. They were pulled from the same pool. So there was not a different pool of items for the KCI over the 10-year. So it may have felt different because that experience was different. That's what I was going to say. Maybe if you didn't take it in a test center, maybe there just was a level of ease that you had because you didn't have to have that additional layer of getting to a test center and checking in and that sort of thing. And it was shorter. Another thing that did happen between someone would have taken the long-form exam and then a KCI is the advent of having up-to-date available on the test. So there was this, and I did that. I took a long-form and then I took a couple of KCIs. And it really was, you know, it was a different experience at home and being able to look things up. Yeah. So a couple of folks have asked if the goal is to learn as we go, why put a time restriction on it? Well, it's still an assessment, right? And so having the time, the standardized timing is part of that. Okay. Furman, did you have something that you wanted to add? No, I think Florence hit it. So it has to do with the construct of the questions and being able to have learning and assessment. And I will just go back to, let's just work off the evidence. So the amount of time that was given there for each question was intended to allow for the construct to still work, reliability and reproducibility, but give people plenty of time. And then the time bank was added. So if you really need more time, you've got it. But with the average, so the average right now is under two minutes out of four. So you've got more than half the time available on most of the questions and you've got the time bank. Jennifer, I ask you, you're doing it. Are you finding that you're having any trouble with the time? For most of the questions, I am not. But sometimes I look up at the clock. Clock, yeah. Should I rethink this thing? Do I need more time? Should I just not submit yet? So, but generally it's enough time. I have not needed to use the extra 30 minutes yet, but I've only obviously done the first quarter. And Florence, correct me if I'm wrong, that's 30 minutes a year, right? So it's- Correct. Right, so over the course of the five years, you've got two and a half hours of extra time to add to questions if you need. Okay, now I think we have time for one more question. Ed, if you're there, is there one that is burning like a recurrent theme that I missed that maybe you wanna ask? No, thank you, Dr. Christie. I think you've actually been hitting a lot of the themes along the way. So why don't you hit your last question and we'll take that as our last one for tonight's webinar. Okay, sounds good. I'm trying to get to the very end here. So can you just talk very quickly again about the MOC? Because I know that's one of the things that my colleagues and I, we kind of always try to understand. Right, so at its most basic, you need to have a valid state license. You need to pass an assessment by your due date. You need to earn 100 MOC points every five years, and you can check the date for that in your position portal. And you need to complete some activity that earns MOC points every other year. Doing those things will maintain your certification. Okay, and the LKA allows us to acquire- Cover a lot of those bases, right? Because you're in your due year, you start the LKA, and even if you're a little rocky at the start, you're still gonna get a year added on to your assessment due year every year that you meet that participation standard straight through those five years, right? And at the end of that, you'll be successful or you're not, but you still have an additional calendar year to come in and pass a traditional MOC exam. So you've effectively bought yourself six years of certification by choosing the LKA. Assuming you're keeping up with your MOC points as well. Well, the LKA gives you MOC points. So Jennifer, it's every five questions you get right, you get an MOC point. So over a course of the five years, you could hit the full 100 points if you get enough questions right. It's designed that way, though, if you're not getting enough questions right, or meaning you're not getting enough to meet your 100 points, that actually is targeting the push to go say, maybe you need to go and find a resource, some of the society activities or other things that help you get MOC points in that area that you're finding a knowledge gap. So that's the way it's built is to help you identify knowledge gaps and close knowledge gaps and give you credit for it both in MOC points and in passing an assessment. So that's the design principle why the MOC points work the way they do in LKA. So killing two birds with one stone, yep. Yes. It says, and then maybe really quickly, if I don't use the extra 30 minutes in year one, can I use those 30 minutes in subsequent years? Do they roll over like vacation time? No, each year you have a fresh 30 minute bank, whether you used all of your minutes or none of your minutes. Okay, and then lastly, is the fee for LKA and the 10 year assessment included in the annual fee? The fee for the LKA is included in the annual fee. The fee for the MOC exam is not. Okay, got it. Well, thank you. We are at the top of the hour. We really appreciate all of the attendees for joining us tonight and for ABIM for presenting the LKA to us and allowing us to ask some of these wonderful questions. You guys have been awesome. Let's continue the conversation. Ed Deller is gonna send an email to all of our registrants with additional information, our GI leaf information and our email so that you can submit your questions to us. And then we will forward them to our ABIM partners for clarification and further information. So thank you everyone and have a great evening and look forward to seeing you on the LKA or 10 year exam. Be well. Thanks so much. Good night. Bye.

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