Commentary

This Is What Passes As “Continuous Knowledge” at the American Board of Family Medicine

  • By MD and Stanley Goldfarb
  • February 7, 2023

The American Board of Family Medicine (ABFM) offers Self-Assessment and Lifelong Learning in a number of topics that many physicians use to obtain and maintain their family medicine board certification. Individual modules in the “Knowledge Self-Assessment” section also provide continuous medical education (CME) credits to maintain a medical license. One such tool is the Continuous Knowledge Self-Assessment (CKSA). Launched in 2017, the CKSA delivers 25 multiple-choice questions to the ABFM member portal on a quarterly basis throughout the year.       

Do No Harm obtained a copy of a recent practice question on the CKSA:

A 13-year-old who was assigned female at birth has been diagnosed with gender dysphoria. His parents fully support their child and affirm his gender as male. One examination the patient has a sexual maturity rate of Tanner stage 3. Which one of the following steps would be appropriate for optimal support and therapy for this patient?

The appropriate approach is to conduct psychosocial assessments, followed by family counseling. None of the answer choices reflect the course of action that is aligned with a family physician’s duty to minimize the risk of harm to the child, rather than prescribing “gender-affirming” treatments. While incorrect, the most conservative response is “Recommending delaying any gender-affirming treatment until he is at least 18 years old to prevent adverse psychosocial outcomes of puberty suppression.”

Figure 1. Practice question on the ABFM CKSA.

However, the ABFM has a different idea of appropriate care for children, and the answer is appalling. The CKSA shows “recommending GnRH analogue treatment” (puberty blockers) as the correct choice for this question.        

Figure 2. ABFM’s indication of the correct answer to the CKSA practice question.

Why is the ABFM endorsing the use of puberty blockers in children? Even if commonly cited guidelines are accepted by the physician, this is still an erroneous response. The World Professional Association for Transgender Health (WPATH) guidelines, which the CKSA cites, lists the summary criteria for adolescents. The first intervention listed is “a comprehensive biopsychosocial assessment including relevant mental health and medical professionals” (WPATH Standards of Care for the Health of Transgender and Gender Diverse People, version 8, appendix D).

Figure 3. From WPATH Standards of Care, Version 8.

The ABFM’s rationale for this answer says it refers to the WPATH guidelines and asserts there is “consistent evidence” in the treatment of “gender incongruence.” Adolescents who receive puberty blockers, it says, “have improved mental health outcomes,” so family physicians must “recognize the indications for timely treatment or referral.” The explanation goes on to say, “Puberty suppression is reversible,” and prescribing it “allows transgender adolescents, their families, and the care team to determine appropriate gender-affirming care as the patient approaches adulthood.” Plus, the references they use are flawed, as noted by the Society for Evidence Based Gender Medicine (SEGM) in a recently published study.

Figure 4. Rationale for the ABFM’s correct answer.

But it gets worse. The final paragraph of the rationale states:

It is unethical and against recommended guidelines for a physician to attempt to convert a person’s gender identity to the sex assigned at birth.

Figure 5. Rationale for the ABFM’s correct answer.

In other words, the ABFM is compelling family physicians to agree with prescribing so-called “gender affirming care” to minors as the correct answer on its practice exam and self-assessment for members.

Doctors who are taking advantage of the continuing education resources the ABFM is giving them are being coached with incorrect information regarding the safest course of treatment and advocating for preventing harm to their adolescent patients with “gender dysphoria.” The ABFM holds all the power with family physicians who are seeking the credential of board certification. They, and others who are committed to protecting children from potentially catastrophic harm, are the ones who must fight back against this alarming stance by the American Board of Family Medicine.

Is your accrediting or certifying organization pushing gender ideology? Please let us know via our secure portal. You may remain anonymous if you wish.