Maintenance Of Certification Process Research Articles

APA Reports Results of Member Survey on MOC

Back to table of contents Previous article Next article Education & TrainingFull AccessAPA Reports Results of Member Survey on MOCMark MoranMark MoranSearch for more papers by this authorPublished Online:18 May 2021https://doi.org/10.1176/appi.pn.2021.6.16AbstractRespondents who participated in an APA survey on maintenance of certification (MOC) reflected deep dissatisfaction with the process as well as an appreciation of the value of continuing medical education.An APA survey about members’ attitudes toward maintenance of certification (MOC) reflects members’ endorsement of continuing medical education (CME) and lifelong learning—as well as deep dissatisfaction with the time, expense, and perceived irrelevance of other components of MOC required by the American Board of Psychiatry and Neurology (ABPN).For instance, 63% of respondents agreed with the statement, “The Continuing Medical Education (CME) component of the MOC process is relevant to my practice.” Yet only 39% agreed that the “self-assessment component of MOC is relevant to my practice,” and just 16% said that the Part IV Improvement in Medical Practice component is relevant to practice.“Maintenance of certification is a contentious issue for physicians of all disciplines, and many of our members believe aspects of the ABPN program are onerous, expensive, and not relevant to their practice,” said immediate past APA President Jeffrey Geller, M.D., M.P.H. “Our survey of more than 1,400 members who are participating in the MOC process confirms this impression. It also shows that a sizeable number of psychiatrists believe in the importance of ongoing education.“APA has been and will continue to be actively engaged with the ABPN to reform the process of maintenance of certification to make it more meaningful and useful to members, to enhance those aspects of MOC that psychiatrists find valuable, and to alter or eliminate altogether those aspects that don’t work,” Geller said.APA randomly selected 4,999 ABPN-certified members and invited them to complete the survey; 2,153 members responded. The data in the survey report are confined to the 1,446 of the respondents who are currently participating in MOC.“This approach allowed us to be sure we were soliciting the perspective of those most impacted by MOC and at the same time hearing from a representative sample of members,” said Tristan Gorrindo, M.D., director of the APA Division of Education.Of the 1,446 respondents, 48% were women; 30.36% were within 10 years of graduation from medical school, and 60.72% were 10 to 30 years from graduation. Respondents were roughly evenly spread out among the district branches in APA’s seven Areas, with Area 5 having the highest percentage of respondents (26.96%).Beliefs about the value of MOC were mixed. While 41% agreed or strongly agreed with the statement that “MOC helps me keep up to date with current information,” 38% disagreed or strongly disagreed. But just 21% agreed with the statement that MOC “improves patients’ confidence in their physicians”; 56% disagreed or strongly disagreed.The impact of MOC on career and professional status was likewise mixed:46% said that participation in MOC is required for ongoing employment; 54% said it is not.39% said that participation in MOC affects career advancement; 61% disagreed.21% said participation in MOC affects salary or bonuses.36% said that participation in MOC is required by one or more insurance panels.The most widely shared beliefs were about the time and expense of the ABPN process. A total of 76% of respondents participating in MOC said it “takes up too much time,” while 68% strongly disagreed with the statement “The cost of the MOC program is appropriate.”However, the new journal-based alternative to the 10-year knowledge exam is highly popular: 89% of respondents said they favor it over the 10-year exam (Psychiatric News).“Among those participating in MOC, these data show us that it’s not a simple ‘MOC is all good or all bad’ story,” said Gorrindo. “Many psychiatrists are unhappy with MOC, but there are also many who find value in some parts of the MOC process. The impact of MOC on an individual’s employment, ability to participate in MOC, and financial compensation is also highly variable. This underscores APA’s need for a thoughtful and nuanced approach to MOC-related issues.”Ranga Ram, M.D., chair of APA’s Caucus on MOC, highlighted the finding about the link between MOC and ongoing employment. “Forty-six percent said MOC is required for employment, which I see as something APA needs to fight,” Ram said. “In every state, we need model legislation that [prohibits requiring MOC as a condition of employment].”(APA has official policy opposing use of MOC as a condition of licensure.)Earlier this year, the Board of Trustees approved a study on the feasibility of APA’s creating its own certification process, something Ram said the caucus strongly supports (Psychiatric News). ■ ISSUES NewArchived

Board Approves Action Items on Maintenance of Certification

Board Approves Action Items on Maintenance of Certification

How Physicians Prepare for Maintenance of Certification Exams: A Qualitative Study.

Little is known about how board-certified physicians prepare for their periodic maintenance of certification (MOC) examinations. This qualitative study explores how physicians experience MOC exam preparation: how they prepare for the exams and decide what to study and how exam preparation compares with what they normally do to keep their medical knowledge current. Between September 2016 and March 2017, the authors interviewed 80 primary care physicians who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine MOC exam. They analyzed transcripts and notes from these interviews looking for patterns and emergent themes, using the constant comparative method and a social practice theory perspective. Most interviewees studied for their MOC exams by varying from their routines for staying current with medical knowledge, both by engaging with a different scope of information and by adopting different study methods. Physicians described exam preparation as returning to a student/testing mindset, which some welcomed and others experienced negatively or with ambivalence. What physicians choose to study bounds what they can learn from the MOC exam process and, therefore, also bounds potential improvements to their patient care. Knowing how physicians actually prepare, and how these activities compare with what they do when not preparing for an exam, can inform debates over the value of requiring such exams, as well as conversations about how certification boards and other key stakeholders in physicians' continuing professional development could improve the MOC process.

American Board of Thoracic Surgery 10-Year Maintenance of Certification Exam Improves and Validates Knowledge Acquisition

Previous "high-stakes" examinations by the American Board of Thoracic Surgery (ABTS) required remote testing, were noneducational, and were not tailored to individual practices. Given the ABTS mission of public safety and diplomate education, the ABTS Maintenance of Certification (MOC) examination was revised in 2015 to improve the educational experience and validate knowledge acquired. The ABTS-MOC Committee developed a web-based, secure examination tailored to the specialty-specific practice profile (cardiac, general thoracic, cardiothoracic, congenital) of the individual surgeon. After an initial answer to each question, an educational critique was reviewed before returning to the initial question and logging a second (final) response. Intraexam learning was assessed by comparing scores before and after reading the critique. Diplomate feedback was obtained. A total of 988 diplomates completed the 10-year MOC examination between 2015 and 2017. Substantive learning was demonstrated with an 18%, 17%, 20%, and 9% improvement in cardiac, general thoracic, cardiothoracic, and congenital final scores, respectively. This improvement was most notable among diplomates with the lowest initial scores. Fewer diplomates failed the new exam (<1% vs 2.3%). Diplomate postexam survey highlighted marked improvements in clinical relevance (35% vs 78%), convenience (37% vs 78%), and learning (15% vs 45%). Over 80% acknowledged educational value, and 97% preferred the new format. The new MOC process demonstrates increased knowledge acquisition through a convenient, secure, web-based practice-focused examination. This approach provides feedback, identifies baseline knowledge gaps for individual diplomates, and validates new knowledge attained.

Maintenance of Certification: Perceptions and Attitudes of Neurosurgeons.

Assuring clinical competence throughout the career of a neurosurgeon is of paramount importance for patient safety. We present the first comprehensive survey of all neurosurgeons board certified through the American Board of Neurological Surgery (ABNS) to evaluate perceptions of Maintenance of Certification (MOC). We administered a validated, online, confidential survey to 4899 neurosurgeons (2435 ABNS diplomates participating in MOC, 1440 diplomates certified prior to 1999 [time-unlimited certificates], and 1024 retired diplomates). We received 1449 responses overall (30% response rate). Our study found that most respondents believe that neurosurgeons should be required to participate in continuing professional improvement following initial board certification (75%). Most believe that specialty boards, working in conjunction with specialty societies, should require diplomates to participate in programs meant to promote continuous professional development (73%). The majority of respondents (76%) believed that self-assessment tests constituted a meaningful professional development activity, in addition to periodic case log reviews (33%) or quality improvement projects (32.6%). A plurality of respondents (44%) do not feel that the MOC process as currently structured provides them with value. There were no differences between those who were "grandfathered" and those who actively participate in MOC and no differences between those in private practice versus those in academics. The ABNS is cognizant of diplomate concerns and is actively developing new MOC paradigms to ensure that the process achieves both the goals of meeting the public interest and assuring that the quality of American neurosurgery remains exemplary.

Assembly Backs Blocking MOC as a Condition of Licensure

Assembly Backs Blocking MOC as a Condition of Licensure

Attitudes and Experiences of Early and Midcareer Pediatricians With the Maintenance of Certification Process

ObjectiveMaintenance of certification (MOC) value and relevance have been recent topics of controversy and discussion in medicine. Systematically assessing pediatrician's attitudes and experiences to encourage and inform future modifications is important. MethodsWe surveyed 866 pediatricians in 2014 who graduated from residency 10 to 12 years ago and are part of a larger longitudinal study. Cross-sectional quantitative and qualitative data on understanding, attitudes, barriers, and needs specific to MOC part 2 (self-assessment/continued learning activities) and part 4 (quality improvement projects) were analyzed. McNemar tests compared responses on questions specific to part 2 with those specific to part 4. Multivariable logistic regression considered differences in participants who did and did not have positive part 4 attitudes. ResultsA total of 77.8% completed the survey. Comparing part 4 to part 2, there was less understanding of requirements (59.9%, 72.9%, P < .001), more agreement that relevant available activities is a barrier (67.6%, 44.0%, P < .001), stronger agreement that more choices would be helpful (72.8%, 53.8%, P < .001), and less perceived impact on patient care or lifelong learning (12.5%, 47.2%, P < .001). Participants reporting that part 4 improves care were less likely to agree that time to fulfill requirements (adjusted odds ratio = 0.30, 95% confidence interval 0.18–0.51) and relevant available activities (adjusted odds ratio = 0.22, 95% confidence interval 0.13–0.39) were barriers. Qualitative analysis revealed themes including time, cost, and relevance. ConclusionsPediatricians expressed significant frustration with the MOC process, poor understanding of requirements, and barriers with the process, especially for part 4. Increasing diplomate education on the process and increasing available and relevant activities may be important to optimize physician's continuous learning.

MyPOD: an EMR-Based Tool that Facilitates Quality Improvement and Maintenance of Certification.

Maintenance of Certification (MOC) was designed to assess physician competencies including operative case volume and outcomes. This information, if collected consistently and systematically, can be used to facilitate quality improvement. Information automatically extracted from the electronic medical record (EMR) can be used as a prompt to compile these data. We developed an EMR-based program called MyPOD (My Personal Outcomes Data) to track surgical outcomes at our institution. We compared occurrences reported in the first 18months to those captured in the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) over the same time period. During the first 18months of using MyPOD, 691 cases were captured in both MyPOD and NSQIP-P. There were 48 cases with occurrences in NSQIP-P (6.9% occurrence rate). MyPOD captured 33% of the occurrences and 83% of the deaths reported in NSQIP-P. Use of the MyPOD program helped to identify series of complications and facilitated systematic change to improve outcomes. MyPOD provides comparative data that is essential in performance evaluation and facilitates quality improvement in surgery. This program and similar EMR-driven tools are becoming essential components of the MOC process. Our initial review has revealed opportunities for improvement in self-reporting which we can continue to measure by comparison to NSQIP-P. In addition, it has identified systems issues that have led to hospital-wide improvements.

Maintenance of certification: How performance in practice changes improve tobacco cessation in addiction psychiatrists' practice.

In 2000, the American Board of Medical Specialties implemented the Maintenance of Certification (MOC), a structured process to help physicians identify and implement a quality improvement project to improve patient care. This study reports on findings from an MOC Performance in Practice (PIP) module designed and evaluated by addiction psychiatrists who are members of the American Academy of Addiction Psychiatry (AAAP). A 3-phase process was utilized to recruit AAAP members to participate in the study. The current study utilized data from 154 self-selected AAAP members who evaluated the effectiveness of the MOC Tobacco Cessation PIP. Of the physicians participating, 76% (n = 120) completed the Tobacco PIP. A paired t-test analysis revealed that reported changes in clinical measure documentation were significant across all six measures. Targeted improvement efforts focused on a single clinical measure. Results found that simple change projects designed to improve clinical practice led to substantial changes in self-reported chart documentation for the selected measure. The current findings suggest that addiction psychiatrists can leverage the MOC process to improve clinical care. The study demonstrates that a quality improvement collaborative can support an MOC process to help addiction psychiatrists eliminate barriers to access to tobacco cessation treatment. (Am J Addict 2017;26:34-41).

MO-G-204-02: Assessing Cognitive Expertise of Medical Physics Diplomates

Learning Objectives: 1. The participants will understand how to comply with the revised ABR MOC requirements 2. The participants be able to utilize the new Participatory PQI into their MOC program 3. The participants will be able to comply with the ABR MOC simplified attestation requirements 4. The participants will be able to meet the requirements for the annual ABR MOC lookback This presentation will update medical physicists about the American Board of Radiology Maintenance of Certification (MOC) process. The MOC process has recently undergone a number of significant changes and this presentation will review these for the attendees. The entire process has been simplified by going to a process whereby most items can be attested to. The ABR has also adopted a process whereby the status of the diplomate is reviewed on an annual basis (lookback). This process makes the MOC process continuous basis rather than the episodic basis that existed in the past. The Process Quality Improvement (Part 4) has many new opportunities so that many medical physicists can meet the Part 4 requirement based on their routine clinical activities.

MO-G-204-01: Current MOC Requirements with An Emphasis On Recent Changes

Learning Objectives: 1.The participants will understand how to comply with the revised ABR MOC requirements 2.The participants be able to utilize the new Participatory PQI into their MOC program 3.The participants will be able to comply with the ABR MOC simplified attestation requirements 4.The participants will be able to meet the requirements for the annual ABR MOC lookback This presentation will update medical physicists about the American Board of Radiology Maintenance of Certification (MOC) process. The MOC process has recently undergone a number of significant changes and this presentation will review these for the attendees. The entire process has been simplified by going to a process whereby most items can be attested to. The ABR has also adopted a process whereby the status of the diplomate is reviewed on an annual basis (lookback). This process makes the MOC process continuous basis rather than the episodic basis that existed in the past. The Process Quality Improvement (Part 4) has many new opportunities so that many medical physicists can meet the Part 4 requirement based on their routine clinical activities.

MO-G-204-00: The American Board of Radiology Maintenance of Certification Process

Learning Objectives: 1.The participants will understand how to comply with the revised ABR MOC requirements 2.The participants be able to utilize the new Participatory PQI into their MOC program 3.The participants will be able to comply with the ABR MOC simplified attestation requirements 4.The participants will be able to meet the requirements for the annual ABR MOC lookback This presentation will update medical physicists about the American Board of Radiology Maintenance of Certification (MOC) process. The MOC process has recently undergone a number of significant changes and this presentation will review these for the attendees. The entire process has been simplified by going to a process whereby most items can be attested to. The ABR has also adopted a process whereby the status of the diplomate is reviewed on an annual basis (lookback). This process makes the MOC process continuous basis rather than the episodic basis that existed in the past. The Process Quality Improvement (Part 4) has many new opportunities so that many medical physicists can meet the Part 4 requirement based on their routine clinical activities.

ABPN Expands Options for Meeting Improvement in Practice Requirement

Back to table of contents Previous article Next article Education and TrainingFull AccessABPN Expands Options for Meeting Improvement in Practice RequirementMark MoranMark MoranSearch for more papers by this authorPublished Online:11 Mar 2016https://doi.org/10.1176/appi.pn.2016.3b10AbstractThe change allows diplomates to use a feedback module whereby clinicians seeking to meet Part IV of the MOC Improvement in Medical Practice requirement obtain feedback from patients, peers, residents, and supervisors.The American Board of Psychiatry and Neurology (ABPN) has expanded the options that diplomates may use to meet the Improvement in Medical Practice (also referred to as Performance in Practice, or PIP) requirement for Part IV of Maintenance of Certification (MOC).Specifically, diplomates may now use a “Clinical Module” or a “Feedback Module” to meet the PIP requirement. Prior to the change, instituted in February, diplomates did not have the option of using a feedback module to meet their Part IV requirement. (The PIP Unit is a quality improvement exercise designed to identify and implement areas for clinical improvement.)According to the ABPN website, preapproval is not needed for using a feedback module if the questionnaire or survey meets general competencies. The six general competencies to be reviewed on the feedback forms are medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, patient care, and system-based practices.The module can consist of any one of the following feedback methods: patient feedback from five patients, peer feedback from five peers, resident evaluations from five respondents, “360 degree evaluations” from five respondents, institutional peer reviews from five respondents, and a supervisor evaluation from one supervisor. Qualified feedback modules, as well as clinical modules, are listed on the ABPN website.Effective immediately, this development now gives diplomates more flexibility with the Part IV requirement for MOC, said ABPN President and CEO Larry Faulkner, M.D.“As a result of the flexibility provided in the 2015 MOC standards, the ABPN has been able to make a number of changes in its MOC requirements that have made it easier for our diplomates to document their current involvement in ongoing quality improvement activities (MOC Part IV),” Faulkner wrote in comments to Psychiatric News. “Our belief is that many, if not most, of our diplomates are already involved in quality improvement activities, and we see our role as helping them to document that fact.“There are many different activities that can contribute to quality improvement, and patient feedback and various types of peer feedback are important options that we want to recognize for diplomates who choose to use them. Constructive feedback from patients or peers can contribute valuable input to diplomates as they strive to improve the quality of care they provide.”APA President Renée Binder, M.D., said, “I applaud the efforts of the ABPN to increase the flexibility of meeting requirements for MOC. This is a very important step in that direction. We will continue to work collaboratively with the ABPN to recommend further improvements in the MOC process.”APA Director of Education Tristan Gorrindo, M.D., said APA has been closely following changes being made to the MOC program. “APA has been advocating for the real-world experiences of our members to be counted by the ABPN as activities that meet MOC requirements,” he told Psychiatric News. “The ABPN’s increased flexibility in meeting these requirements is consistent with our advocacy efforts.” ■Information about options for meeting the PIP requirement and about MOC generally is posted on the ABPN’s website. Comprehensive information about MOC is posted on APA’s website. ISSUES NewArchived

THE NATIONAL GRADUATE SURVEY FOR FAMILY MEDICINE.

The Association of Family Medicine Residency Directors (AFMRD) is excited to announce the rollout of a standardized national graduate survey. Beginning in 2016, the survey will be conducted through the American Board of Family Medicine (ABFM) Maintenance of Certification process. Understanding the

ABMS President Defends MOC Part 4, Calls for Physician Engagement in Quality

ABMS President Defends MOC Part 4, Calls for Physician Engagement in Quality

Study Modules Fuel Quality Gains in Diabetes Care

Study Modules Fuel Quality Gains in Diabetes Care

Quality Improvement in Childhood Obesity Management through the Maintenance of Certification Process

To assess the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a web-based clinician education program that promotes appropriate screening, prevention, and management of weight among youth by pediatric practitioners, based on the 2007 Expert Committee recommendations. The project currently provides Maintenance of Certification (MOC) Part 4 credit through the American Board of Pediatrics. Participants identified themselves to the HOPE MOC Part 4 program. Enrollees were required to complete all continuing medical education modules (10.5 hours). Knowledge acquisition and self-reported confidence levels related to screening, prevention, and management practices of pediatric obesity were measured using preknowledge and postknowledge questionnaires. Participants were also required to perform a quality improvement project and submit practice performance data from repeated medical chart reviews over time. Knowledge acquisition, self-efficacy, and practice performance data were analyzed using repeated-measures analyses. The 51 participants demonstrated significant improvements in knowledge acquisition and self-efficacy scores after viewing individual modules. In addition, participants demonstrated significant improvements in measured clinical compliance with recommended practices over time. Participation in the HOPE MOC Part 4 program appeared to improve knowledge acquisition, self-efficacy, and physician compliance with recommended practice recommendations for the screening, prevention, and management of pediatric obesity. Further data are required to determine whether such practice-based improvements translate into actual reduction in patient weight and/or reduction in health-related costs related to overweight and obesity in youth.

MO‐D‐137‐01: ABR Update

This session will present a review of the ABR requirements and policies for the initial certification of medical physicists. Changes in the program that have occurred in the last several years will be discussed. The requirements for certification for 2014 and beyond will be reviewed. Changes in the oral exam and the board eligibility policy will be presented he MOC program will also be reviewed. The changes that occurred in 2013 will be emphasized. These include the change to continuous MOC, easy public access to certification status and the new ABR My ABR website. There will be adequate time for questions and group discussion.Learning Objectives:1. The participant will understand the role of the ABR in the certification of medical physicists.2. The participant will understand the ABR requirements for Medical Physics Certification.3. he participant will understand the requirements for participation the ABR's Maintenance of Certification process.

Maintenance of certification: part 2—continuous certification

In the first article of this series, we explored the historical development of medical specialty societies, and how this process ultimately resulted in the formation of the American Board of...

Engagement of Groups in Family Medicine Board Maintenance of Certification

The American Board of Medical Specialties' Performance in Practice ("Part IV") portion of Maintenance of Certification (MOC) requirement provides an opportunity for practicing physicians to demonstrate quality improvement (QI) competence. However, specialty boards' certification of one physician at a time does not tap into the potential of collective effort. This article shares learning from a project to help family physicians work in groups to meet their Part IV MOC requirement. A year-long implementation and evaluation project was conducted. Initially, 348 members of a regional family physician organization were invited to participate. A second path was established through 3 health care systems and a county-wide learning collaborative. Participants were offered (1) a basic introduction to QI methods, (2) the option of an alternative Part IV MOC module using a patient experience survey to guide QI efforts, (3) practice-level improvement coaching, (4) support for collaboration and co-learning, and (5) provision of QI resources. More physicians participated through group (66) than individual (12) recruitment, for a total of 78 physicians in 20 practices. Participation occurred at 3 levels: individual, intrapractice, and interpractice. Within the 1-year time frame, intrapractice collaboration occurred most frequently. Interpractice and system-level collaboration has begun and continues to evolve. Physicians felt that they benefited from access to a practice coach and group process. Practice-level collaboration, access to a practice coach, flexibility in choosing and focusing improvement projects, tailored support, and involvement with professional affiliations can enhance the Part IV MOC process. Specialty boards are likely to discover productive opportunities from working with practices, professional organizations, and health care systems to support intra- and interpractice collaborative QI work that uses Part IV MOC requirements to motivate practice improvement.