Richard J. Baron, MD
The American Board of Internal Medicine (ABIM) says it is working to incorporate a set of changes to its physician Certification and Maintenance of Certification (MOC) requirements that physicians have complained are out of step with the realities of their work.
Specifically, the Assessment 2020 Task Force, convened by the ABIM in 2013, has recommended the following changes:
Replace the 10-year MOC exam with more meaningful, less burdensome assessments.
Focus assessments on cognitive and technical skills.
Explore the need for certification in specialized areas, without the requirement to maintain underlying certifications, while being transparent about specialization to the public.
The ABIM in its statement announcing the new task force report1
said the findings were in accord with the feedback it has received from numerous physicians who complained that existing and proposed new standards for certification and MOC are neither meaningful nor relevant to them as they strive to keep up to date in their fields.
“These recommendations are meant to be a catalyst for further discussion and can ultimately lead to an improved MOC program for diplomates,” Richard J. Baron, MD, president and CEO of the ABIM, said in a statement. He said a subcommittee of the ABIM has already begun working to integrate the recommendations into a strategy for improving certification and MOC requirements.
Two years ago, the ABIM made continuous assessment a feature of the MOC rather than once-in-10-years requalification. But in response to the uproar that came of that, the ABIM said in February of this year it would suspend elements of the new MOC requirements for at least two years.
Following that, the ABIM has made changes to its certification and MOC programs. Those include:
suspending quality improvement and patient safety requirements in the program until “more meaningful” requirements are defined,
no longer requiring underlying certifications for MOC,
offering a one year grace period for physicians who fail the MOC examination in their discipline,
a reduction of the first-time examination retake fee in MOC, and
a new partnership with the Accreditation Council for Continuing Medical Education (ACCME) to accept more forms of continuing medical education for MOC credit.
In addition, the ABIM said the blueprint for the internal medicine exam was recently updated with physician input, and the score reports diplomates receive with their examination results now provide more specific feedback on performance.
“The task force recommendations will inform ABIM’s ongoing collaboration with the internal medicine community to ensure that ABIM Certification and MOC are relevant and meaningful to physicians and patients,” the ABIM said in its statement.
In recommending the abolition of the 10-year MOC, the task force suggested instead the implementation of at-home or workplace tests that would assess “essential contemporary knowledge.” It suggested that some aspects of the testing be “open book.”
It said the intermittent testing would provide a cumulative look at physician competency and could result in an eventual pass/fail decision regarding certification. Physicians who fail would have to undergo further testing, and the task force emphasized that such an approach would ensure that ongoing learning becomes an integral part of the certification process.
The task force recommended that the “ABIM focus its MOC efforts on assessing cognitive and technical skills relevant to the practice of internal medicine,” but suggested that such skills as communication, teamwork, empathy and quality improvement are more difficult to assess and urged that ABM encourage healthcare institutions to assess and promote these skills locally.
Another chief recommendation was that the ABIM recognize that competency in specializations should be considered a sufficient basis for certification.
“Thus, an underlying certification should no longer be required for maintaining certification in subspecialty areas that currently require them. The subspecialty area would stand on its own for MOC,” according to the task force report.
It suggested that a realistic approach to validation of physician qualifications should follow Miller’s Pyramid of Assessment, a physician competency
graphic representation that has “knowledge” and “competence” or “know-how” on the bottom and “action” and “performance” on the top.2
The American Society of Hematology (ASH) has been highly critical of ABIM’s certification methodology and yesterday the organization said it approved of some of the task force recommendations.
“Other recommendations from the task force will require in-depth discussion with ASH and other stakeholders to ensure potentially adverse consequences are avoided,” said ASH President David A. Williams, MD, of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School.
“Such discussions should specifically address what the appropriate role of a certifying board is with regard to ensuring the quality of health care in the United States. The society encourages ABIM to maintain an open and orderly process for dialog around these issues,” Williams said.
Assessment 2020 Task Force. A vision for certification in internal medicine in 2020. American Board of Internal Medicine. 2015. http://assessment2020.abim.org/wp-content/uploads/2015/09/Assessment-2020-Final-Report.pdf. Accessed September 17, 2015.
Lincoln Memorial University. Lmunet. http://bit.ly/1KjtWOg. Accessed September 17, 2015.