With Maintenance of Certification (MOC) in its second decade, many changes are underway. Through conversations between physicians and the American Board of Medical Specialties (ABMS), these changes are intended to make the MOC process, including the Part III examination, more relevant to clinical practice and less burdensome.
In recent years, the AMA’s Council on Medical Education (Council) has developed a constructive working relationship with the ABMS on these issues. Council work has been effective in contributing to moving the Boards to consider alternatives to high-stakes testing and other changes in MOC to make it more relevant for physicians.
An article that describes a conference discussion between the Council and ABMS details the changes that are currently underway and what could be coming in the future through conversations between the two organizations.
“The AMA has been very helpful in bringing the voice of the physicians to the Boards Community,” said Mira Irons, MD, senior vice president for academic affairs at the ABMS, “and to help us understand the greatest concerns that physicians have regarding MOC.”
“The Council has created an opportunity for the Boards Community to maintain a dialogue with relevant groups of the AMA.” Dr. Irons said. “This is a way to learn about what each organization is doing and, more importantly, the context in which these innovations are being created.”
Physicians detail issues with current MOC approach
One challenge to the current approach to MOC examinations is that practice patterns evolve over the years. Examination measurement standards require a thorough and explicit definition of the content of the domain, yet physicians have expressed concern that the material included on the exam is broader than what typically presents in most physician practices.
AMA members have raised a number of important issues about the exam; for example, that it needs to be more personalized to practice and it needs to be more about clinical judgment and patient management skill. And the experience needs to be more convenient and easier to integrate into their busy practices.
As a result, the Boards are piloting a number of changes specifically to address these issues:
- Modularizing the exam to make it more relevant
- Incorporating audio and video to simulate real-life decision-making
- Redesigning questions to move from recall to clinical judgment and decision making
- Incorporating remote proctoring that moves the experience from testing centers to the home or office environment
- Moving to more frequent, low-stakes testing in place of the single high-stakes exam
- Providing more feedback to make the experience more formative and helpful to continuing professional development
Alternatives to the current MOC Part III examination
In response to both physician input and emerging views on how to increase the relevance and benefit of the Part III exam, several ABMS member boards are piloting alternative formats consistent with the Standards for the ABMS Program for MOC. The Standards offer flexibility to individual boards for implementation, and some of the boards have been taking advantage of that flexibility with major innovations in content and delivery.
The ABA’s MOCA Minute®
After analyzing feedback from board-certified anesthesiologists and the availability of information technology, the American Board of Anesthesiology (ABA) explored ways to enhance the Maintenance of Certification Anesthesiology Program® (MOCA®) through a program redesign called MOCA 2.0®. MOCA 2.0 is intended to promote continuous lifelong learning, increase the relevance of MOCA to practices, integrate Parts II, III and IV of MOC and include continuous longitudinal (low-stakes) assessment.
The result of the ABA’s exploration and discussions is the implementation of MOCA Minute®, an online longitudinal assessment tool. Introduced as an expanded pilot in January to replace the cognitive high-stakes exam taken every 10 years, physicians who are enrolled in MOCA 2.0 answer 120 MOCA Minute questions annually.
The questions include core information essential for anesthesiologists as well as topics that are reflective of an anesthesiologist’s areas of subspecialization. Once a physician accesses a question, she or he has one minute to answer. As soon as the question is answered, the physician is shown a feedback page that includes the correct answer, a critique explaining the answer with references and a one-sentence summary of the material. The critiques from previous questions are available at any time to reinforce learning.
Initial analysis of the pilot showed that participation was associated with positive diplomate feedback and improved performance on the MOCA examination. Additional analyses are underway.
Watch AMA Wire® for more examples of how medical boards are changing the MOC process.