Cognitive Expertise Research Articles

Professional Formation: Extending Medicineʼs Lineage of Service Into the Next Century

In his 1910 report on medical education, Flexner emphasized the importance of competency in basic sciences. Less widely recognized is that he also emphasized the necessity of liberal education. On the Flexner Report's 100th anniversary, medicine is challenged to realize Flexner's full vision for medical education to ensure that physicians are prepared to lead lives of compassion and service as well as to perform with technical proficiency. To meet the complex medical and social challenges of the next century, medical educators must continue to promote cognitive expertise while concurrently supporting "professional formation"-the moral and professional development of students, their ability to stay true to their personal service values and the core values of the profession, and the integration of their individual maturation with growth in clinical competency. The goal of professional formation is to anchor students to foundational principles while helping them navigate the inevitable moral conflicts in medical practice. The consequences of inadequate support for professional formation are profound, impacting individual learners, patients, the profession, and society at large. Among the many successful professional formation projects nationally, two long-standing programs are described in modest detail to identify common elements that might guide future developments elsewhere. Key elements include experiential and reflective processes, use of personal narratives, integration of self and expertise, and candid discussion within a safe community of learners. Committing to professional formation within medical education will require transformation of formal and informal curricula and will necessitate a rebalancing of attention and financial support within schools of medicine.

Maintenance of Certification in Psychiatry

The American Board of Medical Specialties (ABMS) developed 6 core competencies for physicians of all specialties and a maintenance of certification (MOC) program for board-certified physicians. The MOC program incorporates the 6 competencies into 4 component areas: professional standing, self-assessment and lifelong learning, cognitive expertise, and performance in practice. These 4 components are designed to promote a cycle of lifelong learning, self-assessment and peer review, and incorporation of best practices in order to improve the quality of health care in clinical practice. The American Board of Psychiatry and Neurology is a member board of the ABMS and has adapted the competencies and MOC requirements for psychiatrists and neurologists.

Announcement

ABA MAINTENANCE OF CERTIFICATION “Examination Dates and Qualification Deadlines: 2010” A physician’s ability to demonstrate his or her qualifications through continuous certification is gaining attention among the public, as well as regulatory, licensing, and accrediting organizations. The American Board of Anesthesiology (ABA) recognizes the importance of such an initiative and has developed the Maintenance of Certification in Anesthesiology (MOCA) Program to help physicians demonstrate their commitment to quality clinical outcomes, and patient safety. MOCA offers certified anesthesiologists the opportunity to participate in personal improvement activities to improve their effectiveness, while advancing the standard of specialty medical care. An overview of the MOCA Program follows.MOCA is a four-part program that consists of the following requirements: Part I: periodic assessment of professional standing (medical licensure); Part II: continual participation in lifelong learning and self-assessment activities (continuing medical education); Part III: demonstration of cognitive expertise (via examination); and Part IV: participation in practice performance assessment and improvement activities.The ABA voluntary Anesthesiology Recertification Program is being phased out in 2009. The final application window is now closed, and the last recertification examination will be administered in December 2009. MOCA is now the only recertification option, and is available to all ABA diplomates, whether or not their initial certification is time-limited.Diplomates certified before 2000 hold a non–time limited (NTL) certificate. The ABA will not alter the status of NTL diplomates if they choose not to recertify or complete the MOCA program. However, the ABA strongly encourages NTL diplomates to participate in MOCA because the program promotes lifelong learning with an emphasis on improving the overall quality of care delivered to patients. Maintenance of certification moves beyond the ABA’s former recertification model to formally assess the diplomate’s continuous commitment to lifelong learning and professional development.ABA diplomates certified after 1999 have a time-limited certificate and must complete the 10-year MOCA program in order to maintain their diplomate status. The ABA automatically enrolls them in MOCA when they are awarded initial certification. They can view their MOCA progress report by accessing their portal account through the ABA website (www.theABA.org). The earliest they can qualify for examination is three years before their certification expires (i.e. , 2010 for diplomates with a certificate that expires in 2013).Different forms of the examination are administered annually in January and July or August, by computer, at test centers in the United States and Canada. MOCA and Recertification candidates take the same examination in 2009; only MOCA candidates can qualify for examination in 2010. The test dates and deadlines by which diplomates must qualify for examination during testing windows in 2010 are:

ABA MAINTENANCE OF CERTIFICATION

A physician’s ability to demonstrate his or her qualifications through continuous certification is gaining attention among the public, as well as regulatory, licensing, and accrediting organizations. The American Board of Anesthesiology (ABA) recognizes the importance of such an initiative and has developed the Maintenance of Certification in Anesthesiology (MOCA) Program to help physicians demonstrate their commitment to quality clinical outcomes, and patient safety. MOCA offers certified anesthesiologists the opportunity to participate in personal improvement activities to improve their effectiveness, while advancing the standard of specialty medical care. An overview of the MOCA Program follows.MOCA is a four-part program that consists of the following requirements: Part I: periodic assessment of professional standing (medical licensure); Part II: continual participation in lifelong learning and self-assessment activities (continuing medical education); Part III: demonstration of cognitive expertise (via examination); and Part IV: participation in practice performance assessment and improvement activities.The ABA voluntary Anesthesiology Recertification Program is being phased out in 2009. The final application window is now closed, and the last recertification examination will be administered in December 2009. MOCA is now the only recertification option, and is available to all ABA diplomates, whether or not their initial certification is time-limited.Diplomates certified before 2000 hold a non–time limited (NTL) certificate. The ABA will not alter the status of NTL diplomates if they choose not to recertify or complete the MOCA program. However, the ABA strongly encourages NTL diplomates to participate in MOCA because the program promotes lifelong learning with an emphasis on improving the overall quality of care delivered to patients. Maintenance of certification moves beyond the ABA’s former recertification model to formally assess the diplomate’s continuous commitment to lifelong learning and professional development.ABA diplomates certified after 1999 have a time-limited certificate and must complete the 10-year MOCA program in order to maintain their diplomate status. The ABA automatically enrolls them in MOCA when they are awarded initial certification. They can view their MOCA progress report by accessing their portal account through the ABA website (www.theABA.org). The earliest they can qualify for examination is three years before their certification expires (i.e. , 2010 for diplomates with a certificate that expires in 2013).Different forms of the examination are administered annually in January and July or August, by computer, at test centers in the United States and Canada. MOCA and Recertification candidates take the same examination in 2009; only MOCA candidates can qualify for examination in 2010. The test dates and deadlines by which diplomates must qualify for examination during testing windows in 2010 are:

WE‐C‐211A‐01: Requirements and Opportunities for Maintenance of Certification

The ABR began issuing time‐limited certificates for physicists in 2002. As a result, many physicists are two‐thirds the way through their MOC cycles, and should have reached several milestones by now. This course will discuss the origins of the MOC program, the requirements for physicists, and some of the opportunities available for meeting the requirements. Specific information will be provided to help physicists understand how they can satisfy the requirements for professional standing, through licensure or attestation; life‐long learning and self assessment, through the accumulation of continuing education credits, self‐assessment modules (SAMs) and self‐directed educational projects (SDEPs); cognitive expertise, through participation in a cognitive exam; and assessment of performance in practice, through the conduct of a practice quality improvement (PQI) program. Examples of each aspect will be given. Use of the personal database (PDB) provided by the ABR for each diplomate to facilitate the MOC process will be described, and the opportunities for guidance in accomplishing SDEPs and PQI projects will be presented.Learning Objectives:1. Understand the maintenance of certification program, its history and requirements.2. Learn about opportunities for satisfying the MOC requirements.3. Become familiar with sources of assistance from the ABR, including the personal database.4. Identify opportunities for guidance from sources such as the AAPM.

Six dimensions of expertise: a more comprehensive definition of cognitive expertise for team coordination

Looking at expertise from the vantage point of many knowledge domains allows the observations and resulting definitions to be useful across a broad range of subject areas. A stable set of definitions that work on a higher, more comprehensive level than the current literature offers is needed for an integrated description of expertise. A cohesive cross-domain definition and explanation of expertise can be used to optimise group interactions. Since group performance incorporates additional components of expertise that are not present in individual performance situations, these additional components must be examined in order to see a full picture of the successful utilisation of expertise in a group setting. This expanded expertise definition will allow group dynamics to be better understood and will help break down the expertise components required to have successful group interactions.

The Efficacy of Context and Cognitive Expert Patterns in Academic Vocabulary Learning

AbstractThis research intends to detect which instruction is most advisable for unknown English academic terms in first course students of English Philology. Fot this purpose it evaluates whether or not the context, with a small number of encounters (6) is superior to the visual help (expert cognitive pattern), obtained with the Pathfinder procedure (Schvaneveldt, Durso and Dearholt, 1989; Schvaneveldt, 1990; Thompson, Gomez and Schvaneveldt, 2000), when learning a complex vocabulary set; in this case, academic vocabulary (Coxhead, 1998). Results confirm that both types of instruction are useful when teaching this vocabulary however, context seems to be superior in spite of the small number of encounters used in the instruction. Bearing in mind the ease of getting appropriate contexts of use, this is the type of instruction that our research points to as the most recommendable.

The Assessment of Individual Cognitive Expertise and Clinical Competency: A Research Agenda

There is a large push to utilize evidence-based practices in medical education. At the same time, credentialing bodies are evaluating the use of simulation technologies to assess the competency and safety of its practitioners. At the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," our breakout session critically evaluated several issues important to the use of simulation in emergency physician (EP) assessment. In this article, we discuss five topics felt to be most critical to simulation-based assessment (SBA). We then offer more specific research questions that would help to define and implement a SBA program in emergency medicine (EM).

The Use of Simulation in the Development of Individual Cognitive Expertise in Emergency Medicine

This consensus group from the 2008 Academic Emergency Medicine Consensus Conference, "The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise," held in Washington, DC, May 28, 2008, focused on the use of simulation for the development of individual expertise in emergency medicine (EM). Methodologically sound qualitative and quantitative research will be needed to illuminate, refine, and test hypotheses in this area. The discussion focused around six primary topics: the use of simulation to study the behavior of experts, improving the overall competence of clinicians in the shortest time possible, optimizing teaching strategies within the simulation environment, using simulation to diagnose and remediate performance problems, and transferring learning to the real-world environment. Continued collaboration between academic communities that include medicine, cognitive psychology, and education will be required to answer these questions.

Cognitive Expertise, Emotional Development, and Reflective Capacity: Clinical Skills for Improved Pain Care

The overarching goal of medical training is to nurture the growth of knowledgeable, caring, and insightful clinicians guided by the ideals of medical professionalism. Recent definitions of professional competence identify essential clinical skills, including cognitive expertise, emotional competence, and reflective capacity. This modern framework reflects the increasingly complex nature of the patient-clinician interaction, in which the clinician must exchange diagnostic information while supportively engaging the patient on a deeper, affective level. The affective dimension can be particularly potent when pain is the primary symptom, as it is for the majority of medical visits. Unfortunately, however, current models of professionalism, used as an early guide for medical trainees to develop an understanding of the clinical exchange, largely focus on interactions in the cognitive domain. To emphasize the importance of emotions in professional development, we propose the Cognitive and Emotional Preparedness Model, which describes the clinical encounter occurring on two channels, one cognitive and the other emotional, and stresses the importance of multidimensional development in preparing the clinician to (1) communicate clinical information, (2) provide emotional support, and (3) actively reflect on experiences for continued improvement. Together, acquisition of knowledge, emotional development, and reflective skill will improve the clinical interaction. The proficiency of medical trainees in developing clinical skills profoundly shapes patient satisfaction and treatment outcomes. This article reviews the cognitive, emotional, and reflective development of medical trainees and presents a model illustrating how clinical development impacts pain care. For improved efficacy, pain education should be calibrated to students' developmental needs.

Learning (not) to talk about race: When older children underperform in social categorization.

The present research identifies an anomaly in sociocognitive development, whereby younger children (8 and 9 years) outperform their older counterparts (10 and 11 years) in a basic categorization task in which the acknowledgment of racial difference facilitates performance. Though older children exhibit superior performance on a race-neutral version of the task, their tendency to avoid acknowledging race hinders objective success when race is a relevant category. That these findings emerge in late childhood, in a pattern counter to the normal developmental trajectory of increased cognitive expertise in categorization, suggests that this anomaly indicates the onset of a critical transition in human social development.

Visual attention in adolescents: Facilitating effects of sport expertise and acute physical exercise

Objectives This study investigated visual attention of adolescent orienteers and physically active adolescents non-practising orienteering both at rest and under acute sub-maximal exercise. It was verified whether the practice of orienteering facilitates the development of visual attentional abilities and whether orienteers, who are used to simultaneously handle physiological and cognitive-attentional loads, may better profit than non-orienteers from the beneficial effects of sub-maximal physical load on processing speed. Methods Both the focusing of attention at foveal and parafoveal locations and the orienting of attention at peripheral locations were investigated. In two discriminative reaction time (RT) experiments, a cue of varying size was presented centrally or peripherally and followed by a compound stimulus with local and global target features. The stimulus-onset asynchrony (SOA) varied between a short and a long interval. Results In both experiments, adolescent orienteers and non-practisers showed different patterns of attentional effects. Adolescent orienteers were more similar to young adults in the attentional performance, being better able than non-practisers to perform complex attentional operations involving the intentional zooming of attention in the central visual field and the orienting of the attentional focus in the peripheral visual field. Also, both orienteers and non-orienteers speeded up their performance during exercise, but this facilitation effect was more pronounced for orienteers, who are probably skilled in directing the available resources to task demands. Conclusions Our results suggest that cognitive expertise represents a key factor in sports that accelerates the development of visual attention and enhances the facilitating effects of physical exercise on attentional performance.

The ABPN Maintenance of Certification Program for Psychiatrists: Past History, Current Status, and Future Directions

To describe the American Board of Psychiatry and Neurology (ABPN) Maintenance of Certification Program, its underlying rationale, how it will be implemented now, and what it might look like in the future. The authors describe the philosophical foundation, specific components, and the implementation timeline of the ABPN Maintenance of Certification Program; the development of specific products that might be used by ABPN diplomates to meet its requirements; and several unanswered questions about its current status and future development. The ABPN Maintenance of Certification Program consists of specific requirements pertaining to professional standing, self-assessment and lifelong learning, performance in practice, and cognitive expertise that will be implemented incrementally over the next decade. The ABPN Maintenance of Certification Program has been implemented in a manner that is as consistent as possible with its underlying philosophical beliefs as well as the current and expected public and political concerns, diplomate needs, and the requirements of organizations responsible for licensure, credentialing, privileging, accreditation, professional development, and physician reimbursement.

Should cognitive impairment be included in the diagnostic criteria for schizophrenia?

Neurocognitive impairment is considered a core component of schizophrenia, and is increasingly under investigation as a potential treatment target. On average, cognitive impairment is severe to moderately severe compared to healthy controls, and almost all patients with schizophrenia demonstrate cognitive decrements compared to their expected level if they had not developed the illness. Compared to patients with affective disorders, cognitive impairment in schizophrenia appears earlier, is more severe, and is more independent of clinical symptoms. Although the DSM-IV-TR and ICD-10 descriptions of schizophrenia include several references to cognitive impairment, neither the diagnostic criteria nor the subtypology of schizophrenia include a requirement of cognitive impairment. This paper forwards for consideration a proposal that the diagnostic criteria include a specific criterion of "a level of cognitive functioning suggesting a consistent severe impairment and/or a significant decline from premorbid levels considering the patient's educational, familial, and socioeconomic background". The inclusion of this criterion may increase the "point of rarity" with affective psychoses and may increase clinicians' awareness of cognitive impairment, potentially leading to more accurate prognosis, better treatment outcomes, and a clearer diagnostic signal for genetic and biological studies. Future research will need to address the validity of these possibilities. The reliable determination of cognitive impairment as part of a standard diagnostic evaluation will present challenges to diagnosticians with limited resources or insufficient expertise. Cognitive assessment methods for clinicians, including brief assessments and interview-based assessments, are discussed. Given the current emphasis on the development of cognitive treatments, the evaluation of cognition in schizophrenia is an essential component of mental health education.

Challenges in transdisciplinary technology foresight: cognition and robotics

PurposeThe purpose of this paper is to report on experiences and reflect on challenges in transdisciplinary technology foresight as exemplified by cognition and robotics research.Design/methodology/approachThe study was conducted as a broad transdisciplinary process involving users and producers of robot technology solutions as well as scientists and other experts in cognition and robotics. Transdisciplinarity is understood as the transcendence of disciplinary modes together with the involvement and participation of non‐scientists in problem formulation and knowledge provision. The study focuses on the possibilities for innovation at the crossroads where robotics and cognition meet.FindingsThe paper reflects on the following methodological issues: medium‐ and long‐term research and innovation possibilities and barriers in a transdisciplinary context; the classification and framing of transdisciplinary fields; the facilitation of technology foresight processes; and the trustworthiness of the foresight process and its recommendations.Practical implicationsThe results have been disseminated among relevant advisory and grant‐awarding bodies within research and innovation, relevant knowledge institutions and universities, and companies on both the development and user sides of the technologies.Originality/valueThe paper contributes to European experiences on national‐level foresight exercises. The conceptual findings of the case study are of value to science and innovation policy makers, foresight practitioners and scholars within the field.

The American Board of Radiology perspective on maintenance of certification: Part IV: Practice quality improvement in radiologic physics

Recent initiatives of the American Board of Medical Specialties (ABMS) in the area of maintenance of certification (MOC) have been reflective of the response of the medical community to address public concerns regarding quality of care, medical error reduction, and patient safety. In March 2000, the 24 member boards of the ABMS representing all medical subspecialties in the USA agreed to initiate specialty-specific maintenance of certification (MOC) programs. The American Board of Radiology (ABR) MOC program for diagnostic radiology, radiation oncology, and radiologic physics has been developed, approved by the ABMS, and initiated with full implementation for all three disciplines beginning in 2007. The overriding objective of MOC is to improve the quality of health care through diplomate-initiated learning and quality improvement. The four component parts to the MOC process are: Part I: Professional standing, Part II: Evidence of life long learning and periodic self-assessment, Part III: Cognitive expertise, and Part IV: Evaluation of performance in practice (with the latter being the focus of this paper). The key components of Part IV require a physicist-based response to demonstrate commitment to practice quality improvement (PQI) and progress in continuing individual competence in practice. Diplomates of radiologic physics must select a project to be completed over the ten-year cycle that potentially can improve the quality of the diplomate's individual or systems practice and enhance the quality of care. Five categories have been created from which an individual radiologic physics diplomate can select one required PQI project: (1) Safety for patients, employees, and the public, (2) accuracy of analyses and calculations, (3) report turnaround time and communication issues, (4) practice guidelines and technical standards, and (5) surveys (including peer review of self-assessment reports). Each diplomate may select a project appropriate for an individual, participate in a project within a clinical department, participate in a peer review of a self-assessment report, or choose a qualified national project sponsored by a society. Once a project has been selected, the steps are: (1) Collect baseline data relevant to the chosen project, (2) review and analyze the data, (3) create and implement an improvement plan, (4) remeasure and track, and (5) report participation to the ABR, using the template provided by the ABR. These steps begin in Year 2, following training in Year 1. Specific examples of individual PQI projects for each of the three disciplines of radiologic physics are provided. Now, through the MOC programs, the relationship between the radiologic physicist and the ABR will be continuous through the diplomate's professional career. The ABR is committed to providing an effective infrastructure that will promote and assist the process of continuing professional development including the enhancement of practice quality improvement for radiologic physicists.

Diplomate Verification Update 2007

Since 1970, when the charter class of physicians attained certification by the American Board of Family Practice(ABFM), the Board has acknowledged the accomplishment of all physicians who achieve certification and recertification as a specialist in family medicine, the nation’s twentieth primary medical specialty. For the first 26 years, the Board published an annual Directory of Diplomates as a way of honoring and recognizing certified family physicians. The printed directory was made available to all Diplomates, residency training programs, libraries, and other individuals or entities. Formal recognition beyond certification in family medicine was added in the 1990s for physicians who achieve certification in geriatric medicine and sports medicine and received a Certificate of Added Qualifications (CAQ) in those specialties. When requested, letters are sent to any person, organization, or entity requiring the Board’s assurance that a physician is certified by the ABFM. The ABFM now operates, distributes information, and facilitates interaction with candidates and Diplomates via its Web site at http://www.theabfm.org. The Web site contains a directory devoted to the continued recognition of family physicians who have attained certification, recertification, and a CAQ at any time in their professional career. Obviously, many Diplomates have retired from the practice of medicine, yet the Board continues to recognize the efforts of its past Diplomates in the same way it acknowledges current Diplomates. The online directory has become a refined extension of its predecessor, the Directory of Diplomates. The process of locating certified family physicians online is simple; the user enters a city and state into the online directory and a listing of current board-certified physicians in that geographical area is generated. Alternately, the user enters the first and last name of a physician and all family physicians with identical names are shown with city and state of residence and current and past certification status. Additionally, the online verification process facilitates the ease by which other specialists, hospitals, third-party payers, and health care consumers can verify the certification status of family physicians. By accessing the verification page of our Web site and entering the first name, last name, date of birth, and last 4 digits of the physician’s social security number, the user can search the ABFM’s database to verify a physician’s certification status. The data in the verification system is under the direct and complete control of the ABFM staff and is protected from and cannot be altered by unauthorized individuals. Written verification of a Diplomate’s status continues to be an option for Diplomates and third parties. Diplomates can obtain a verification letter at no charge by entering the Physician Portfolio with their ABFM identification and password and clicking on “Request Verification Letter.” Others seeking written verification of a Diplomate’s status can have a letter generated by ABFM staff for a $25 fee, or they can access the ABFM’s online verification system at no charge. The ABFM grants permission to copy the information provided by the online verification system for the purpose of maintaining physician credentials or for activities related to the evaluation of physician qualifications. The same database is used for written and online inquiries. Just as recertification has evolved into Maintenance of Certification for Family Physicians (MC-FP), the online verification process is evolving in its role as the primary source for finding a family physician’s certification status. A new online verification system will be launched later this year in 2 phases. The first phase, expected to be available in July 2007, will display certification information in a grid format. The second phase, expected to be available by the end of the 2007, will expand verification to include a physician’s standing within MC-FP, a program designed to enhance the clinical excellence of family physicians through continuous measurement of physician competencies. The 4 components of MC-FP—Professionalism, Self-Assessment and Lifelong Learning, Cognitive Expertise, and Performance in Practice—must be successfully completed for renewal of certification. The revised online verification system will display information in 5 categories.

Conceptual vs. perceptual wine spaces: Does expertise matter?

This study explores the differences in wine categorization between wine experts and novice wine consumers using 10 Melon de Bourgogne (MB) and 10 Chardonnay (CH) wines. Participants performed a free sorting task based on odor similarity followed by a CH and a MB typicality rating task and a liking rating. All tasks were performed orthonasally. We observed a clear agreement between experts concerning typicality scores. Moreover, despite a slight overlap we found a clear differentiation between CH and MB for experts’ typicality scores. For novices, no such agreement on typicality scores was observed and we found a complete overlap between both types of wines. These results suggest that experts developed through successive wine tasting separate consensual sensory concepts for CH and MB wines. Multidimensional Scaling analyses of the sorting tasks showed an expertise effect since the expert similarity plot showed a better separation between MB and CH wines than the novices’ one. For experts, significant correlations between both CH and MB typicality scores and the MDS first dimension coordinates suggest that experts’ CH and MB sensory concepts are partially based on perceptual similarities. Additionally, experts’ hedonic scores were significantly correlated with their CH typicality scores as well as with the MDS second dimension. This correlation suggests that liking was involved in the sorting task but was not the main expert’s criteria to sort the wines. Our results suggest that wine expertise may be more of a cognitive expertise rather than a perceptual one.

American Board of Radiology Perspective on Maintenance of Certification: Part IV—Practice Quality Improvement for Diagnostic Radiology

1All authors: The American Board of Radiology, 5441 E Williams Blvd., Tucson, AZ 85711. Address correspondence to J. L. Strife. he American public expects safe, predictable, high-quality care and assumes that physicians work to remain current and competent. The American Board of Radiology (ABR) encourages each board-certified diagnostic radiologist to understand his or her professional responsibilities and to participate in continuous quality improvement and lifelong learning. In the United States health care system, quality of care, medical error reduction, and patient safety represent continuing themes that dominate public concern [1–3]. Maintenance of Certification (MOC), the overarching program of the American Board of Medical Specialties (ABMS) and its member boards, is the response of U.S. physicians to address these concerns [4–8]. Although advances in medical science, technology, and biomedical research continue to accelerate, other barriers prevent rapid dissemination and adoption of evidence-based, recommended care [9]. A RAND Corporation study has estimated that only 50–54% of the care Americans receive is care that has been recommended on the basis of evidence-based medical literature [3]. Much of what radiologists do is not evidence based [10]. Outcomes and costs to diagnose and treat specific diseases vary widely among physicians, hospitals, health care providers, and regions of the country [10]. To address challenges in the medical system and the public’s concerns, the ABMS, composed of 24 member boards representing all medical subspecialties in the United States, mandated in March 2000 that each board initiate specialty-specific MOC programs [4–8]. Diplomates are no longer granted lifetime certification but rather must demonstrate evidence of professionalism, continuing medical education and knowledge, as well as a commitment to practice improvement. The MOC program, including “Part IV: Practice Quality Improvement,” for diagnostic radiology, radiation oncology, and radiologic physics has been developed, approved by the ABMS, and initiated in 2007. The overriding objective of MOC is to improve the quality of health care through diplomate-initiated learning and quality improvement. There are four component parts to the MOC process: “Part I: Professional Standing,” “Part II: Lifelong Learning and Periodic Self-Assessment,” “Part III, Cognitive Expertise,” and “Part IV: Evaluation of Practice Performance” [11–15]. The ABR program for self-evaluation of practice performance is linked to a process of continuing quality improvement and is titled “Practice Quality Improvement” (PQI).

Shaping the Future: Maintenance of Board Certification and Quality Care

This review is a summary of a presentation at the 2005 Intersociety Conference on training for the future of radiology. Certification by all 24 boards of the American Board of Medical Specialties, including the American Board of Radiology (ABR), has changed significantly. All primary and subspecialty certificates issued by the ABR are currently limited to 10 years, and diplomates of the board must maintain their certification by completing the ABR's maintenance of certification (MOC) program. The program consists of 4 components (professional standing, lifelong learning and self-assessment, cognitive expertise, and practice performance) and 6 competencies (medical knowledge, patient care, interpersonal skill, professionalism, practice-based learning and self-improvement, and systems-based practice) that are the key elements to be incorporated within the concepts of continuous quality improvement. The result, over time, is intended to have a major impact in the quality of patient care in terms of outcomes and best practices. How adults learn in the environment of expanding knowledge and the electronic distribution of content is a substantive question requiring research, data, and change. We must seize the opportunity to explore adult learning and the process of MOC. Time-limited certification and MOC can become catalysts for future training requirements, for the design of training pathways, and for certification methodologies. Shaping the future is a noble task requiring leadership, vision, patience throughout change, and creativity.