Earlier this month, the American Board of Internal Medicine (ABIM) held an Internal Medicine Summit on Maintenance of Certification (MOC), attended by many specialty society presidents and staff. I gave a brief presentation describing SCAI’s support for changes to MOC that ABIM announced earlier this year, which included meeting SCAI’s demands that ABIM:
- Allow normal CME credits to qualify as MOC points;
- Eliminate the designation of “not certified” on the ABIM website;
- Require only one specialty exam for certification; and
- Change MOC Part IV to make it relevant and give credit for quality improvement work done as part of clinical practice.
During the meeting, ABIM President and CEO Richard Baron, MD admitted that ABIM previously operated on a paternalistic authority-based model. However, after widespread rejection of changes in MOC implemented in 2014, ABIM has converted to an organization that uses input from medical professional societies and other stakeholders in determining how to handle MOC.
Dr. Baron went on to state that ABIM is changing its governance structure, increasing efforts to be transparent and accountable. All of these recent changes came as a result of stakeholder input and Baron stated that “The ABIM program will continue to evolve by recognizing community needs and accepting feedback.”
A major purpose of the ABIM Internal Medicine Summit was to obtain feedback on its “Assessment 2020” (http://assessment2020.abim.org/), its long-range plan to support lifelong learning through a simpler MOC process for practicing physicians. The three major recommendations of the Assessment 2020 report were:
- Replace the 10-year MOC exam with more frequent, less burdensome assessments;
- Expand the recertification focus to include cognitive and technical skills; and
- Recognize specialization/focused practice areas within a discipline so as to assure the necessary knowledge is current within that specific area covered by the single subspecialty exam.
Feedback from specialty society representatives was extensive, including the following:
- General agreement that ABIM should eliminate “high stakes” exams at 10-year intervals.
- Substitute modules that could be completed at shorter intervals (2-5 years). Modules could be either sub-specialty focused or more general, allowing physicians to select their choice of modules to demonstrate both specific expertise and more general knowledge.
- Alternatively, create “amortized” exams spread out over the entire recertification period and delivered via daily/monthly/weekly/quarterly email or online tools.
- Provide immediate feedback so physicians can learn from assessments/exams in real time.
- Allow online resources to be used during exams (e.g., open book exams).
- Allow physicians to take assessments either online or at testing facilities.
- Don’t attempt to assess technical skills. Consensus was almost universal that this was not possible for the ABIM, and should be part of hospital privileging.
- Exams should be “no-fail”, such that if a question is answered incorrectly, feedback is immediate and the physician learns from it. Others argued that a no-fail exam would reduce incentive to prepare, and that the current fail rate (including those who fail multiple attempts) of about 4% is probably appropriate.
A panel of non-physician health advocacy experts talked about the public’s expectations of physician certification. They emphasized that the public assumes the medical profession is regulating itself and if the public learned otherwise, it might seize certification of physicians from the control of organized medicine.
ABIM leadership and staff will consider feedback from this meeting as they draft a new MOC program plan. Another meeting of ABIM stakeholder leadership is scheduled for Spring 2016. SCAI will stay actively engaged to hold ABIM to its promised changes and to make sure these changes are beneficial to practicing interventionalists and their patients. Stay tuned for further updates.