Features
TEST
MOC Machinations
CERTIFICATE
A look at the changing landscape of MOC Knowledge Check-Ins and how the American Society of Hematology continues pursuing a pragmatic approach to the MOC process .
The past five years have been turbulent for the American Board of Internal Medicine ( ABIM ), its Maintenance of Certification ( MOC ) program , and the health-care practitioners who participate in its certification activities .
In 1990 , ABIM eliminated its “ board-certified-forlife ” status ( although physicians certified in 1989 or earlier were grandfathered in ). Next , it launched a series of changes to its every-10-year recertification program that ultimately morphed to include mandatory participation in periodic , ongoing MOC activities . Then , in 2014 , ABIM announced that it also would start reporting on the MOC status of those who held lifetime certificates . 1 This decision , which capped off 24 years of changes , enraged many diplomates .
In response to frustrations voiced by the medical community , ABIM and ABIM Foundation President and Chief Executive Officer Richard J . Baron , MD , issued an apology : “ ABIM clearly got it wrong . We launched programs that weren ’ t ready and we didn ’ t deliver an MOC program that physicians found meaningful . We want to change that .” 2
The next phase of ABIM ’ s MOC program was set into motion as the organization recommitted to providing valuable MOC activities and decreasing the burden on physicians ’ time and resources . ABIM began to consider providing alternatives to the every- 10-year , high-stakes secure examination ( known as “ MOC Part 3 ”); like shorter , lower-stakes , but more frequent assessments of knowledge . 2
Open-book tests , shorter examinations , and more user-friendly assessments are welcome changes , but for almost two decades , medical specialty societies like the American Society of Hematology ( ASH ) have questioned the underlying premise of MOC programs , citing a lack of evidence that mandatory summative assessments ( or an assessment used to evaluate learning at the end of a defined period of time ) are practice-changing or beneficial to patients .
“ In general , the concept of ensuring that physicians who care for patients continually educate themselves and learn in a changing world of medicine is a good one ,” said Joseph Mikhael , MD , MEd , chief medical officer of the International Myeloma Foundation and professor at City of Hope Cancer Center in Duarte , California . “ The challenge has been that the models by which this is conducted do not reflect the way in which we learn in medicine ,” said Dr . Mikhael , who also serves as a councillor on ASH ’ s executive committee .
ASH Clinical News recently spoke with representatives from ASH and ABIM to gain insight into the new MOC requirements for hematologists and to determine whether a more user-friendly MOC program will translate to better patient outcomes .
What ’ s Changed
The most substantial change to ABIM ’ s MOC program happened earlier this year : Starting in 2018 , the organization launched its “ Knowledge Check-In ” assessment options . These exams can be taken at home , work , or a testing center ; will last about two to three hours ; will provide results and feedback more quickly than the traditional exams ; and are open book using the UpToDate clinical decision support resource . 3 Knowledge Check-Ins are now available for the specialties of internal medicine and nephrology , and the tentative rollout schedule anticipates expansion to all specialties by 2020 ( see TABLE 1 , page 41 ).
“ The two-year assessments that ABIM is offering are breadth of field , across the whole discipline ,” Dr . Baron explained to ASH Clinical News . “ We want to
40 ASH Clinical News July 2018 Bonus Mid-Year Edition