The Changing Landscape of Maintenance of Certification: History, Value and Evidence Base, and Future Impact on Forensic Pathology

Abstract

Maintenance of certification (MOC) is a current hot topic in all disciplines of medicine, and no less so in pathology and forensic pathology, specifically. The extent of physician discontent with MOC has risen to a fevered pitch over the past few years, with reporting on specialty board activities and physicians' reactions reaching the popular media. This invited review authored by several of the members of the National Association of Medical Examiners Education Subcommittee on the Development of Self-Assessment Modules provides an overview of MOC as it relates to forensic pathology. We address the history of MOC and its value as stated by the certifying bodies that created, promote, and administer MOC, including the American Board of Medical Specialties and American Board of Pathology. We further provide an analysis of the existing medical literature proposed as an evidence base for MOC, which is somewhat limited in its scope, particularly nonrobust in pathology, and nonexistent in forensic pathology. We discuss recent changes that medical specialties have made to prescribed MOC programs, potential alternatives to MOC, and the impact that MOC in its current and potential future forms may have on the field of forensic pathology, including effects on the workforce, courts of law, and training pathways.