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Update on Certification Maintenance

Prepared October 6, 2004

The recent Board of Governors meeting in Tucson was marked by genuine enthusiasm regarding substantial progress in ACP-ABIM discussions about maintenance of certification. Over the past six months, intensive discussions between Drs. Steven Weinberger (ACP Senior VP for Medical Knowledge and Education) and F. Daniel Duffy (ABIM Executive VP) have resulted in a welcome and productive atmosphere of collaboration rather than confrontation between the two organizations, also reflected in simultaneous parallel discussions at the level of the CEOs (Dr. John Tooker from ACP and Dr. Christine Cassel from ABIM) and the Board Chairs (Dr. Eric Larson from ACP and Dr. Troyen Brennan from ABIM).

After agreeing upon a set of goals and principles that would form the framework for their discussions, Drs. Weinberger and Duffy developed initial recommendations that were endorsed by the relevant committees and boards of both organizations. These recommendations took into account the evolution of the recertification process into a 4-part Maintenance of Certification (MOC) process, as mandated by the American Board of Medical Specialties (ABMS), the umbrella organization for all medical specialty Boards. The four components of MOC are:

  • Part 1 - Professional Standing (demonstrated by state licensure)
  • Part 2 - Lifelong Learning and Self-Assessment
  • Part 3 - Cognitive Expertise (fulfilled by the secure, closed-book exam)
  • Part 4 - Evaluation of Performance in Practice

Parts 2 and 4 have so far been fulfilled by completion of 5 ABIM SEP (Self-Evaluation Process) modules chosen from several module types, without a specific requirement that one or more of the SEP modules be of a type that meets the Part 4 requirement.

What is new? Based on the 4-part MOC framework, the ABIM has agreed to accept the combination of MKSAP plus an acceptable demonstration of Evaluation of Performance in Practice to fulfill the Part 2 and Part 4 components of MOC, respectively. The MKSAP option for fulfilling the Part 2 requirement will consist of computer-based completion of pre-selected sets of questions from MKSAP 13 (and future editions of MKSAP), delivered in a way that combines self-assessment with education and immediate feedback. Three 60-question MKSAP modules will substitute for 3 SEP modules and will satisfy the entire Part 2 requirement. Part 2 credit will be based on completion of the questions and not on the candidate's score, which is provided to the candidate as a form of feedback about the candidate's level of preparation.

Given the evolving MOC framework and the growing national movement for patient safety and quality improvement in patient care, both ABIM and ACP agreed on the need for a Part 4 component of MOC, but implemented in a way that is efficient, effective, and not redundant. ACP and ABIM have started working together to develop a "wide door" and a variety of options for fulfilling the Part 4 requirement, which would be instituted at the same time the MKSAP option is available to fulfill the Part 2 requirement.

Finally, ACP and ABIM have established a joint, staff-level workgroup to examine options for improving the Part 3 component of MOC (the secure examination for demonstration of cognitive expertise). The goals are to: a) reduce the anxiety provided by a high-stakes examination; b) increase the relevance of an examination to the physician's scope of practice; and c) consider options that might allow the examination to better reflect the way in which physicians have access to informational resources in their clinical practice. The overall intent is to explore options for improving the Part 3 process in a way that would address physician concerns, but would not compromise the integrity, standards, or quality of the process.

ACP and its staff are committed to continued discussions with ABIM and exploration of innovative ways to ease the MOC process and make it as educational and attractive as possible. A collaborative approach to these discussions has been particularly effective and productive, based upon those principles and goals that the two organizations share for the betterment of the profession and for improved patient care.