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Understanding MOC Requirements
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In April of 1966, the American College of Physicians' Board of
Regents (BOR) was presented with a report from its Educational
Activities Committee (EAC). The report indicated that a percentage
of physicians' research of the prevailing medical literature was
both "ineffective and unproductive," and therefore would not lead
toward better patient practices. The EAC findings discussed the
issue of residents with outstanding training backgrounds still
doing poorly on their American Board of Internal Medicine (ABIM)
written examinations. Because the ABIM testing did not offer
results which would demonstrate areas of weakness, candidates who
took the certification examination were confused about those areas
of medical knowledge and training in which they were deficient.
Many ACP members also reported that they could not keep up with the
"flood" of new medical information. Consequently, the EAC advocated
the creation of a continuing medical education program for
internists, arguing that it should become a major focus of the
The Chairman of the EAC, Dr. Hugh R. Butt, suggested that the
major concern of most members was a lack of "guidance" over what a
"practicing physician" should study. Dr. Butt (whose studies of
coagulation a generation earlier showed that Vitamin K could be
highly effective in halting internal bleeding) called for ACP to
establish a system of self-testing, to enable doctors to refresh
their knowledge in private and without having to reveal their test
results. After a series of further discussions and continued
research, the College began work on its first Medical Knowledge
Self-Assessment Program (MKSAP) in late 1966. Dr. Butt selected
"subspecialty chairmen" in nine medical fields: neurology,
cardiovascular disease, gastroenterology, pulmonary disease,
hematology, rheumatology, endocrinology and metabolism, renal
disease, infectious disease and immunology. Each subspecialty
chairman then selected a subcommittee of five with at least one
general internist per group to emphasize "clinical practice."
These MKSAP subcommittees met throughout 1967, discussing the
design of the self-assessment test and the specifics of the type of
questions chosen. Test questions and a prospectus outlining the
program, along with a registration form, were sent out to members
in October 1967. MKSAP 1 was scheduled for a release in January
1968, at a preorder cost of $10 for members, $25 for member orders
after initial publication, and $25 for non-members. By December
1967, 4500 pre-order applications were received by the College, and
through 1971 a total of 12,130 copies of MKSAP 1 were sold.
Follow-up responses from the self-assessment participants were
extremely positive. Most respondents considered the MKSAP as an
outstanding educational tool and defined the experience as
"challenging and humbling."
The College received a great deal of favorable publicity for the
introduction of MKSAP. The self-assessment program was purchased
for residency programs and departments of medicine as an aid in
teaching both medical students and medical school graduates. MKSAP
also served as an inspiration for several peer medical
associations, which informed ACP Headquarters that they would be
creating a similar program for their particular field. Dr. Butt
described the responses from practitioners as demonstrating that
internists were "conscientious" about continuing education and
would "engage in self-appraisal without coercion." As a result of
continuing interest in the program, the BOR voted to repeat and
revise MKSAP every three years.
As new editions have developed MKSAP has changed and grown in a
variety of ways to meet the needs of medical practitioners. The
first 2 editions of MKSAP only contained self-assessment questions,
with accompanying answers and critiques. It was not until MKSAP 3
that a 134 page text-based syllabus was included. Currently the
syllabus is 1,012 pages. While MKSAP 1 contained 720
multiple-choice questions, the current edition has 1094. The first
edition of MKSAP had a total of 12,130 print sales, while the last
edition that completed its sales cycle (MKSAP 14) sold 41,988 print
and electronic packages. Currently in its 15th edition, MKSAP
continues to serve as a highly valued, comprehensive review of
internal medicine and its subspecialties.
-Prepared November 2010 by Eric Greenberg, based on
materials from the Archives of the American College of Physicians
and Rosenow EC Jr. History of the American College of Physicians:
Executive Perspectives, 1959-1977. Philadelphia: American College
of Physicians; 1984.