AMA PRA Credit System

How three boards are changing MOC Part III

Troy Parks , News Writer

The Maintenance of Certification (MOC) Part III examination process is experiencing changes within the American Board of Medical Specialties (ABMS) specialty boards. Though some board-certified physicians are satisfied with their current MOC process, several boards have responded to physician concerns by making meaningful changes to learning and assessment that are transforming the way physicians stay up on the constantly evolving medical landscape.

The American Board of Anesthesiology has recently initiated a pilot—the MOCA Minute™ program—that could ultimately change their MOC examination process. The pilot enables physicians to take the exam over a longer period, one question at a time. Here are three other boards that are also changing that process to best fit their specialists’ needs.

In an effort to emphasize the learning experience, the American Board of Dermatology (ABD) selected a comprehensive item pool representing the expected breadth of knowledge of practicing dermatologists that is delivered as modules.

All examinees take the general dermatology module, which consists of 100 clinical images designed primarily to assess diagnostic skills. Then, each examinee chooses from 50-item subspecialty modules in medical dermatology, dermatopathology, pediatric dermatology or dermatologic surgery.

Six months before the exam, the ABD publishes a list of diagnoses that the general dermatology clinical images will be drawn from, along with a list of questions that are used to generate subspecialty modules.

The ABD’s approach encourages dermatologists to study this material in groups or at dermatologic society meetings. Passing scores are still required for both the general and subspecialty modules—but pass rates generally exceed 90 percent. The ABD has expressed that proof of mastery of this material helps identify dermatologists who are maintaining their competence.

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Not only does the ABD offer subspecialty exam modules, they have also conducted trials employing remote proctoring to monitor exam administration in physicians’ homes or offices. The ABD was able to both ensure the identity of the test taker and monitor the progress of the exam, which allowed test administrators to identify any irregular behavior.

Feedback has shown that dermatologists were pleased to be able to take the exam in a comfortable, familiar environment and not have to travel to a testing center, which can place a financial burden on physicians participating in maintenance of certification. The ultimate goal of the ABD is to launch an open-resource exam that allows access to texts, journals and the Internet, more closely mimicking how dermatologists apply knowledge in practice.

The American Board of Plastic Surgery (ABPS) believes that assessment drives learning through learners’ preparation for and post-assessment review of the exam.

To prepare for the ABPS MOC Part III exam, which is a secure, modular, computer-based test that physicians take once per 10-year cycle, plastic surgeons may use an ABPS produced MOC study guide. The study guide includes more than 2,300 multiple choice questions compiled from the same sources used for the MOC exam and is distributed by ABPS.

Physicians can study the guide in its totality or focus on four specialty-specific practice content areas—reconstructive, cosmetic, hand or craniomaxillofacial surgery. The study guide includes rationales for each question that identify the key learning principles. For each 200-item MOC exam, 25 percent of the items address core principles while 75 percent are sub-specialty-based. So far, the overall pass rate has averaged around 95 percent.

The examinees also receive their performance results to help them focus their future learning on the areas where the exam revealed knowledge gaps. The plastic surgeons have provided positive feedback so far on the exam’s dual emphasis on learning and assessment of knowledge.

The American Board of Pediatrics (ABP) is introducing a new method for its MOC examination Part III that will launch as a pilot in 2017. The new approach would entail shorter and more frequent assessments of physician knowledge.

The Maintenance of Certification Assessment for Pediatrics (MOCA-Peds) is a new testing platform designed as an alternative to the current MOC Part III examination. What is different about MOCA-Peds is that it will provide immediate feedback and references to foster enhanced learning for pediatricians.

The ABP will release a series of questions through mobile devices or a web browser at regular intervals. Twenty multiple-choice questions will be available every three months and may be answered anytime during the quarter, making the examination more convenient for busy pediatricians.

The pilot model will allow for questions to be tailored in regards to the practice profile of the pediatrician and each participant in the pilot will be able to give ABP feedback on individual questions so that the exam can be continuously improved.

The AMA Council on Medical Education continues to work on behalf of physicians to bring the physician voice to the American Board of Medical Specialties (ABMS) member boards to transition MOC toward a more relevant framework of high-quality assessment and learning activities.

resolution to retire the MOC Part III secure, high-stakes recertifying examination was passed by the AMA House of Delegates at the 2016 AMA Annual Meeting. Additional adopted policy calls for the AMA to work with the ABMS to encourage the development by and the sharing between medical specialty boards of alternative ways to assess medical knowledge other than by a high-stakes examination.

Although some physicians have expressed concern about the value and cost of MOC participation, groups such as the American Academy of Family Physicians (AAFP) Congress of Delegates recently did not approve a resolution aimed at eliminating the MOC Part III “high stakes” examination. In a Medscape article last month, the AAFP argued that the Part III examination is a way to distinguish its members from nurse practitioners and other nonphysician clinicians.

Stay tuned to AMA Wire® to learn more about the ABMS Portfolio Program which offers MOC credit for quality improvement activities.