Longtime Chair of CME Courses Relishes Helping Peers
Oct. 19, 2023, David Mitchell — David Weismiller, M.D., Sc.M., FAAFP, wasn’t happy when his octogenarian father told him last year he had an appointment to follow up on the results of a prostate-specific antigen test.
“I said, ‘Why in the world are they doing a PSA on you at 88?’” Weismiller recalled. “‘Cancel the urology appointment. That could harm you. It could kill you.’”
Weismiller’s father canceled the appointment in question, but his family physician son wondered why it had been scheduled in the first place. The U.S. Preventive Services Taskforce and the American Urological Association both recommend against routine screening for prostate cancer in men 70 and older. The USPSTF’s recommendation dates to 2018, while the AUA’s position has been in place for nearly a decade.
The disconnect between clinical recommendations and clinical practice isn’t surprising. Studies have shown that it often takes the U.S. health care system more than a decade to complete the cycle from research findings that are ready for practice and can improve patient outcomes to widespread adoption of new clinical recommendations.
“I am working my darndest to get that needle to move more quickly,” said Weismiller, who has been a professor in the Department of Family and Community Medicine at the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, since 2016.
For nearly three decades, Weismiller has been working to help family physicians pass their board exams and to keep them up to date in their clinics. He spoke at his first AAFP Board Review course in 1996, two weeks before starting his first job as an attending physician. That first presentation was scheduled on the last day of a weeklong course. The day’s agenda began at 7:30 a.m. and ran until 6 p.m.
“I walked into the hotel ballroom that Sunday morning in Raleigh thinking, ‘Nobody’s going to be here,’” he said. “There were 600 people, which started me on my way.”
At that time, the AAFP offered Board Review courses in three different regions each spring. In 2005, the Academy added a fall review course to aid physicians who had not passed the summer board exam and to offer an alternative to residents who had yet to complete their training when the academic year ended in June.
“We developed this shortened course thinking, ‘People can’t leave their practices for a week,’” he said. “As we looked at the content of the weeklong course, it was great CME, but a significant amount of the content was not going to be on the board exam. We said, ‘Let’s develop a new course.’ We shortened it and focused on the content of the exam.”
The result was AAFP Family Medicine Board Review Express. Weismiller has been course chair since its inception.
“Today in the Board Review Express, for example, we do all of maternity care in two 30-minute presentations,” he said. “In the previous big course, we had seven 30-minute presentations on one day.”
Upcoming Board Review Express Courses
The AAFP Family Medicine Board Review Express is offering a live course in Dallas Feb. 21-24, 2024, as well as a livestream option. The course reflects the blueprint of the ABFM exam and focuses on 14 body system categories.
The live and online events are both eligible for 29.25 credits. Participants who register for either version of the event by Feb. 7 save $150.
The need to focus on what’s actually in the exam is critical when a growing number of family physicians are carving out niches within the specialty — sports medicine, geriatrics, etc. — rather than practicing a broad scope.
At the same time, the ABFM’s introduction of a longitudinal option to its one-day exam in 2019 changed how most family physicians approach maintenance of certification. Family physicians are given 25 questions in the longitudinal exam every three months. Participants may use resources but must answer each question within a five-minute window.
“The latest number I saw was that 86% of people taking the exam are using the longitudinal approach,” Weismiller said. “You still have to prepare because it’s an exam. The 25 questions provided to you every three months are not 25 questions on cardiovascular disease and then 25 questions on OB. Each set of 25 questions mirrors the blueprint of what percentage of questions on the exam are pulmonary, cardiovascular, men’s genital/urinary, women’s genital/urinary, etc.”
The Board Review Express faculty, Weismiller said, has assembled high-quality information that informs family physicians about where to focus.
“Most people are just overwhelmed,” he said. “They think, ‘I don’t take care of kids anymore,’ or, ‘I don’t do OB anymore.’ ‘There’s going to be surgery and inpatient questions, but I don’t do hospital anymore.’
“Among the eight or nine faculty in this course, there’s probably 210 years of experience in undergraduate and graduate medical education, and we have very robust practices that include all the dimensions of family medicine, but in clinical practice anymore, a lot of physicians are either doing outpatient or inpatient. They might be doing administrative work. I met a woman family physician who practiced in a pediatric feeding clinic. I thought, ‘OK, you are not thinking about lipid disorders. You’ve got a lot of review to do.’ So, we are putting forth a structured review of what we think is important as you look for a strategy by which, in those five minutes, you can potentially find the right answer to a question.”
As Weismiller says, the AAFP put the original weeklong, in-person review course “to bed” in 2009 and has since focused on the Express version of the course. He plans to stay on until 2025, his 20th year as chair.
He said the course will be due for a major revision at that point.
“We had one format, and then we developed a new format,” he said. “Now it needs an overhaul for another new format. I have loved doing it, but I’m not the person to do the next format.”
Weismiller said he hopes the focus will be on how family physicians can use the content of the review course in practice to improve patient outcomes.
“Today, medical school students get their knowledge on this thing while walking to class,” he said, holding up his cell phone.
Upcoming FM Update Courses
Can’t make it to the Family Medicine Experience this month in the Chicago? The AAFP has other in-person and online events coming up to help family physicians earn board certification and stay up to date.
The AAFP’s Family Medicine Update 2023 course will offer a livestream event Nov. 28 through Dec. 2.
The update course, which offers 32 CME credits, will cover
- the top POEMS (patient-oriented evidence that matters) of the year;
- guidelines on antibiotic treatment for common outpatient infections;
- the annual update of the Global Strategy for Asthma Management and Prevention;
- treatment for opioid use disorder and addiction;
- use of SGLT-2 inhibitors and GLP-1 receptor agonists to reduce incidences of cardiovascular mortality, myocardial infarction and kidney failure; and
- how well risk scores predict cardiovascular events.
The course also will offer optional clinical procedural demonstrations on
- basic and advanced EKG interpretation;
- telemedicine and remote patient monitoring in practice; and
- physician leadership and well-being.
Participants who register by Nov. 18 can save up to $140.
The 2024 Family Medicine Update will offer a livestream course April 30-May 4, 2024. Online registration will open in early December.
“Anytime you tell students in the curriculum that they have to meet face to face, they want to know why because they don’t want to meet face to face. And our data shows that the more they’re in class, the worse they do on Step 1 of the USMLE.”
For a generation of learners who have grown up with the internet and mobile devices, Weismiller said it will be more critical than ever for educational tools to be “nimble” so they can be updated quickly as evidence and recommendations change.
Weismiller already is trying to provide timely information as chair of the AAFP’s Family Medicine Update course, which started in 2010 as a companion course to Board Review Express for people who have passed the board exam but want to stay up to date.
He said 90% of the course content changes every year, including updates regarding USPSTF recommendations and CDC vaccine recommendations.
Although Weismiller, 60, is preparing to wind down his role with Board Review Express, he has yet to make such plans for Family Medicine Update.
“I want to keep doing that for a bit,” said Weismiller, who also teaches self-assessment modules for the ABFM and speaks at other AAFP conferences. “I think I’ve got another 12 to 15 years to practice. My husband thinks I’m crazy that I will practice until I’m 75, but my dad is 89 now, and he and his wife live independently in a 4,000-square-foot house. He still mows the lawn, although he finally bought a riding mower this year. I don’t know what’s going to happen to me, but I love what I do.”
Weismiller sees patients five to six half-days a week and mentors students, residents and fellows.
“One of my undergraduate degrees is in an area of performance,” he said. “Every time you get up there to speak, it’s a type of performance. The performance must then be tied to sound science and data, empathy, and the patient voice. If you think otherwise, your evaluations — well, let me say — will speak for themselves. I’ve figured out a way to meet those two ends of the spectrum, I think, squarely in the middle, and I continue to work at it every day. I have been fortunate.”